Knowledge of Infection Prevention and Attitudes Towards HIV/AIDS Among Chinese Dental Bachelor Interns: An Appeal for Educational Intervention

PURPOSE

The present study aimed to assess the current situation of Chinese dental bachelor interns on HIV/AIDS-related knowledge and their attitudes towards HIV/AIDS patients.

MATERIALS AND METHODS

A cross-sectional, paper-based survey involving 147 dental students from three Chinese dental schools was conducted. Students were recruited to complete the questionnaire regarding their knowledge, awareness and attitudes concerning HIV/AIDS anonymously and voluntarily.

RESULTS

A total of 144 students responded to the study, generating a response rate of 98.0%. Although 97.0% of the dental students believed dentists were at high risk of HIV infection, 97.2% of students expressed no prejudice towards HIV/AIDS patients and stated their willingness to provide oral healthcare service for such patients. No statistically significant differences in the responses on attitudes and some basic knowledge were found between students who had received the relevant education about infection control and the students who had not. However, regarding most questions about oral manifestations in adult and paediatric patients living with AIDS, the students who received relevant education showed more knowledge than the students who did not (p <0.05). The cognitive level about respecting HIV/AIDS patients' autonomy and privacy was generally low in all the students.

CONCLUSIONS

Most of the dental students in this survey held positive attitudes towards HIV/AIDS patients and good grasp of some basic knowledge about HIV/AIDS. On the other hand, the questionnaire results reflected gaps in education, such as respecting HIV/AIDS patients' privacy.

Dentists' knowledge and behavior toward managing hypertensive patients

OBJECTIVES

Dental office is an ideal screening place to identify undiagnosed/uncontrolled patients with hypertension. The aim of this study was to assess the knowledge and behavior of dentists toward performing proper management of hypertensive patients in Saudi Arabia.

MATERIALS AND METHODS

A close-ended e-questionnaire was created and sent to dentists of all levels (n = 710) in Saudi Arabia. The questionnaire included questions that assessed attitudes and behavior toward using a sphygmomanometer in dental clinics and assessed dentists' knowledge and behavior toward proper management of patients with hypertension.

RESULTS

About 62.4% of dentists had a sphygmomanometer in their clinic. Around 79.5% believe that working on patients with high blood pressure (BP) is associated with a risk of complications. However, only 13.3% of them measure the BP of all patients prior to treatment, and 63.3% would do so only if the patient noted a problem. About 54.3% of the respondents prefer using local anesthetics without epinephrine, and they would prefer to refer those patients to dental consultants for treatment. If a patient's BP was 180/100 mmHg, 78.1% of dentists would urgently refer that patient to his or her physician and would not perform a routine elective dental treatment.

CONCLUSION

There is a lack of knowledge and behavior toward proper management of patients with hypertension in our dental sociality. Broadening the breath of dentists' responsibilities to include screening and working together with physicians will help improve the community dental and general health of visiting patients and should be the goal of all dentists.

Oral tranexamic acid associated with platelet transfusion to prevent hemorrhage in a patient with Glanzmann thrombasthenia

Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.

Multidisciplinary dentistry for transitional care patients

A growing patient population is adolescents and young adults who have had one or more serious medical problems and are aging into adulthood. This group of patients has unique medical needs, which has resulted in the development of a specialized area of medicine: transitional care medicine. The case reviews of two of these patients are described. Patient 1 was a 23-year-old man with hereditary pancreatitis. His genetic condition resulted in the need for pancreatic splenectomy and removal of part of his small bowel, resulting in insulin-dependent diabetes and malnutrition. These complex clinical issues and the challenges of chronic pain were further complicated by severe anxiety disorder and substance abuse. He presented to the University of Rochester Medical Center's Complex Care Center (CCC), an interdisciplinary clinic that provides care for adults with pediatric onset conditions, staffed with both dentists and physicians, with acute pain from a grossly decayed premolar tooth. His blood glucose measured > 500 mg/dL and he was experiencing an acute episode of anxiety. With the expertise and experience of center staff his care needs could be met. Patient 2 was a 32-year-old woman with chronic juvenile rheumatoid arthritis, drug-associated lupus, and mental health problems including depression. This condition requires her to be managed with broad spectrum immunosuppression to prevent joint inflammation that results in significant joint destruction and bone loss. She presented to the CCC with an abscessed molar tooth, which prevented her from receiving her required immunotherapy, IV tocilizamab. While monitored by on-site physicians, a center dentist could safely proceed with the extraction. These cases illustrate that, as the population of transitional care patients grows, general dentists can learn to work on-site with physicians and allied health per-sonnel to meet the need.

Dementia-Friendly Dentistry: Why Dementia Guidelines?

FGDP(UK) recently launched its dementia-friendly dentistry: good practice guidelines publication, which members will have received free-of-charge. Vice Dean and editor of the guidelines, Paul Batchelor, explains why the publication is necessary and why all practitioners should make the effort to incorporate these recommendations into their practice.

Dental management of patients with inherited bleeding disorders: a multidisciplinary approach

Bleeding disorders can be inherited or acquired and demonstrate different levels of severity. Dentists may be called on to treat patients who have bleeding disorders such as hemophilia A and von Willebrand disease (vWD). Dental extraction in any patient with clotting factor defects can result in a delayed bleeding episode. Local hemostatic measures provide effective results in a majority of cases but are insufficient in patients with severe hemophilia A and vWD. Therefore, consultation with the patient's hematologist is required to ensure preoperative prophylactic coverage. Dental care providers have to be aware of any signs of bleeding disorders and refer patients for further medical investigations. This article aims to provide dental care providers with the knowledge to manage patients with inherited bleeding disorders, especially hemophilia A and vWD.

Patients with Psychiatric Disorders: What the General Dental Practitioner Needs to Know

Psychiatric illness is extremely common and the general dental practitioner (GDP) will inevitably encounter patients with such an illness. This article outlines common psychiatric conditions that the GDP should be familiar with alongside its impact on oral health. It also gives a systematic approach to dealing with a patient who presents to practice with an undiagnosed psychiatric illness, whereby the illness interferes with delivery of suitable dental care.

Oral Radiographic Evidence of Secondary Hyperparathyroidism in an End-Stage Renal Failure Patient: A Case Report

BACKGROUND

The authors report a case of a 42-year-old woman with End Stage Renal Disease (ESRD) undergoing dialysis therapy with the relative loss of tooth root lamina dura and several mandibular radiolucencies. Secondary hyperparathyroidism related to End Stage Renal Disease may result in the loss of bone density and radiolucent lesions, which has been previously described as Brown tumor. Findings significant for hyperparathyroidism may befound on routine dental imaging.

RESULTS

The patient was evaluated, and treatment was initiated for her dental conditions. She is at present still on the kidney transplant waiting list.

CONCLUSION

Patients with End Stage Renal Disease and hyperparathyroidism require communication and cooperation between dentists and physicians.

PRACTICAL IMPLICATIONS

It is important for dentists to consider Brown tumor as a possible diagnosis of radiolucent jaw lesions.

Dental issues in lacrimo-auriculo-dento-digital syndrome: An autosomal dominant condition with clinical and genetic variability

BACKGROUND AND OVERVIEW

Lacrimo-auriculo-dento-digital (LADD) syndrome is an autosomal dominant disorder with variable lacrimal and salivary gland hypoplasia and aplasia, auricular anomalies and hearing loss, dental defects and caries, and digital anomalies.

CASE DESCRIPTION

The authors present the cases of 2 unrelated children with enamel defects and history of dry mouth leading to recurrent dental caries. The referring diagnoses were Sjögren disease and hypohidrotic ectodermal dysplasia, respectively. The geneticist suspected LADD syndrome, which was confirmed by means of molecular studies showing mutations of 2 genes: fibroblast growth factor receptor 2 and fibroblast growth factor 10, respectively. Similarly affected relatives indicated an autosomal dominant inheritance. These relatives needed multiple dental rehabilitations during childhood and dentures in adulthood.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Dry mouth, multiple caries, enamel defects, and abnormal tooth morphology were the reasons for seeking care from dentists. However, clinical evaluation and diagnostic imaging studies helped identify anomalies of the lacrimal and salivary glands, ears, and digits, indicating involvement of different areas of the body, compatible with LADD syndrome. Accordingly, dentists should consider genetic disorders in patients with multiple anomalies. For instance, oculodentodigital syndrome, oral-facial-digital syndrome, and LADD syndrome (among others) may have dental issues as the major clinical manifestation. Accurate identification of a particular syndrome is now commonplace with the use of genetic testing. When a patient has multiple anomalies suggestive of a syndromic condition, appropriate genetic testing can help verify the clinical diagnosis. Keeping genetics in mind helps earlier identification of other affected family members with diagnostic genetic testing and appropriate treatment; the economic advantage is to shorten the diagnostic odyssey and possibly preserve dentition.

Hereditary Blood Coagulation Disorders: Management and Dental Treatment

Patients with hereditary hemostatic disorders, characterized by a tendency to bleeding or thrombosis, constitute a serious challenge in the dental practice. Advances in the medical diagnosis of hemostatic disorders have exposed dental professionals to new patients not amenable to the application of the management protocols associated with other, more well-known, disorders. It is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients with hereditary hemostatic disorders. An extensive review has been made (PubMed, Science Direct, Web of Knowledge, etc.) of literature pertaining to hereditary disorders affecting blood coagulation factors and how they affect the practice of dentistry. Several aspects relating to the care of such patients must be recognized and taken into consideration when dental treatment is planned. Replacement of deficient coagulation factors ensures that safe dental treatment will be carried out. However, the half-life of such coagulation factors requires that dental treatment be specifically planned and adapted to the type of pathology involved.

(A1) Identification of Oral Health Care Needs in Children and Adults, Management of Oral Diseases

The workshop considered five questions reviewing the identification of international oral health care needs of children and adults, and the management of oral diseases in resource-poor countries: (1) What is the role of the dental profession in the management of the HIV-infected individual? (2) Identifying health care needs-What are the epidemiology and disparities of HIV-associated oral lesions in children from different continents? (3) How effective is HIV treatment in controlling oral diseases? (4) Could we develop basic inexpensive oral and dental care protocols for economically deprived HIV-infected patients? and (5) What is the best method of arranging resources to meet the oral health care needs of people with HIV disease? The consensus of the workshop participants was that there is a need to re-target research efforts to non-established market economy countries and prioritize research in these regions to children with HIV disease. It will be important to assess commonalities and variations in oral health needs across geographical and cultural boundaries, and research efforts should be centralized in resource-poor countries to support multi-center longitudinal standardized studies. It is essential that oral health research be integrated into other health care research programs, to make these research priorities and public health initiatives feasible.

Oral and Physical Manifestations of Anorexia and Bulimia Nervosa

Food avoidance and disordered eating behavior are hallmarks of the psychopathologic disorders known as anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by severe restriction of food intake, which leads to weight loss and the medical consequences of starvation. Bulimia nervosa is characterized by attempts to curtail food intake, interspersed with binge eating, followed by self- induced vomiting to rid the body of food. Tooth erosion and heightened sensitivity, caused by tooth contact with gastric acid during vomiting, are among several intraoral signs and symptoms of anorexia nervosa and bulimia nervosa. Self-induced vomiting in bulimic patients may cause trauma to intraoral soft tissues in the form of epithelial ulceration. Dentists and dental hygienists are often the first health care providers to examine patients with anorexia nervosa and bulimia nervosa, and are in a good position to recognize the physical and oral effects of eating disorders. Unfortunately, too few oral health practitioners consistently assess patients for oral manifestations of eating disorders, and equally few patients suffering with eating disorders regard their oral health practitioners as an important source of information about eating disorders. Lack of knowledge about the intra- and extraoral effects of eating disorders creates barriers that prevent patients from speaking frankly with oral health practitioners about their issues. It is incumbent upon oral health practitioners to recognize and diagnose the effects of these disorders and render appropriate treatment.

Autonomic Nervous System Trial: Control and Resolve for Sleep-Breathing Disorders

Conventional approaches to sleep dentistry concentrate on apneas/ hypopneas that cause periodic desaturations and fragmentations, a strategy that may be leading healthcare professionals to overlook many patients in dental practices with breathing-disturbed sleep. Recent studies have explored a new chronic "stress" paradigm rather than the apnea/hypopnea model to explain damage from sleep-breathing disorders and the progressive nature of this problem. This article will discuss the shortcomings of traditional approaches for dealing with obstructive sleep apnea and other sleep-breathing conditions and provide a protocol, which involved the autonomic nervous system trial, for improving control and management with mandibular advancement appliances. Most importantly, an algorithm for interdisciplinary resolution strategies is presented.

The Impending Oral Health Crisis

Last May, the New York State Dental Association and the New York State Dental Foundation convened the first "Oral Health Stakeholders' Summit on the Future of Special Needs Dentistry, Hospital Dentistry and Dental Education." The summit was chaired by David J. Miller, then NYSDA President Elect, and Carl H. Tegtmeier, then chair of the NYSDA Council on Dental Health Planning and Hospital Dentistry. It brought together experts, called to frame the issues and provide information necessary for a reasoned response. And it sought input from attendees to develop recommendations to ensure that patients with intellectual and developmental disabilities, as well as an aging population with Alzheimer's disease and dementia, have access to appropriate oral health care in the years ahead. Over 100 participants, representing dentistry, hospital training programs, third-party payers, state government offices and related patient support associations, attended the two-day event in Albany. They focused on the impact of reductions in funding, the transition of Medicaid services into a managed care model, a loss of service providers and the need for expanded training programs. They heard from speakers epresenting a broad spectrum of those involved in he oral health care of patients with intellectual and evelopmental disabilities, the Alzheimer's Association, dental educators and researchers, hospital dentistry and the benefits industry, whose presentations focused on a looming oral health crisis threatening access to dental care for patients with disabilities.

Impact of Referral Protocols on the Dental Management of Patients Undergoing Treatment for Head and Neck Oncology in Northern Ireland

Management of head and neck oncology necessitates an extensive multidisciplinary approach. Throughout Northern Ireland all oral care for Head and Neck Oncology patients is overseen within the Centre for Dentistry, Queens University Belfast via referral from the Head and Neck Multidisciplinary Team. The aim of this study was to develop and introduce a referral pro-forma to improve communication between members of the multidisciplinary team and ultimately expedite provision of oral care prior to patients undergoing treatment for Head and Neck Oncology. The study period ran from June 2013 until November 2014. All patients undergoing treatment for Head and Neck Oncology in Northern Ireland were included in the study. A referral pro-forma was introduced in June 2014 in an attempt to streamline the referral process. Data was gathered on patient waiting times, extraction protocols with comparisons made between the period before and after introduction of the pro-forma. In total 137 patients were included in the study: 96 patients were referred to the service using referral letters, confidential emails and via telephone; 41 patients were referred using the pro-forma. The introduction of the referral pro-forma resulted in a significant decrease in the mean number of days from referral to assessment (12 to 7 days) (p < 0.05) and significantly increased mean interval time between extractions and patients beginning radiotherapy (13 to 17 days) (p < 0.05). Significant improvements have been made with the introduction of the referral pro-forma where patients are waiting significantly less time for dental assessment and having extractions completed in a more timely manner therefore expediting the commencement of their oncology treatment.

Electrosurgery and ultrasonics on patients with implantable cardiac devices: Evidence of side effects in the dental practice

OBJECTIVE

Implantable cardiac pacemakers and cardiac defibrillators (ICDs) have been introduced in the care of patients with cardiac dysrhythmias. Most dental practitioners demonstrate extreme caution when treating patients with ICDs. This paper presents a review of the available literature on these devices and how they interact with dental electrosurgery and ultrasonic device use.

RESULTS

Based on the analysis of the literature, this view is not corroborated by the current clinical data, and appears to be misguided. While further in-vivo studies are needed to truly determine the true level of risk, the evidence suggests that there is no contraindication for electrosurgery or ultrasonics use in patients with ICDs.

CONCLUSION

Using the precautions stated in this analysis, the risk of any deleterious effect on ICD function is minimal.

Dental Treatment Considerations for Children with Complex Medical Histories: A Case of Townes-Brock Syndrome

It is common for oral health and dental care to be considered a lesser priority for children with complex medical histories than other aspects of their health care. Often, these patients are at a high risk for caries and infection due to poor oral health practices at home, special or restricted diets, and no early establishment of a dental home for routine dental care. Unfortunately, many of these patients present to their first dental visits with caries and require aggressive treatment, such as extractions instead of pulp therapy, or crowns instead of fillings, due to their high caries risk and the difficulty in safely managing them medically during treatment. A unique example of this occurred at the Children's Hospital of Michigan, where a patient with Townes-Brock syndrome (TBS) presented to the dental clinic with advanced caries. TBS is a rare autosomal dominant disorder characterized by major findings such as anomalies of the external ear, imperforate anus, renal malformations, and malformations of the hand. Like many medically complex cases, dental anomalies are not a direct consequence of TBS; however, due to the necessity of high calorie and high sugar feeding supplementation, many of these patients are at high risk for advanced dental caries. Due to this high caries risk, a more aggressive treatment plan is necessary to minimize the risk of recurrent decay and infection. It is critical to stress that even if the disease, syndrome, etc., of a patient does not have inherent dental consequences, it is imperative for regular dental care to be part of the comprehensive treatment plan for these patients. This includes the establishment of a dental home at a young age and proper oral health education of the patient's caregivers and their physicians. In the case of the patient with TBS, recommendations for daily brushing, especially after high sugar feedings was stressed, as well as the reduction of any other sweets within the diet.

Sleep-related breathing disorders and dentistry: What is the relationship?

Non-restorative sleep has considerable consequences for daily life. A sleep disorder is recognized by symptoms such as daytime fatigue and performance or concentration disorders. Furthermore, it increases the risk of developing cardiovascular, metabolic, and neurologic diseases. The diagnosis and therapy of sleep disorders is not only in the sleep medicine doctor's hands. A multidisciplinary approach reflects the affected patients' choice. Dentists can make an important contribution, especially to the therapy of sleep-related breathing disorder.

Apple Tree Dental: An Innovative Oral Health Solution

The Surgeon General's Report on Oral Health called attention to the "silent epidemic" of dental disease. Older adults and other vulnerable people continue to suffer disproportionately from dental disease and inadequate access to care. As a society and as dental professionals, we face multiple challenges to care for our aging patients, parents and grandparents. Apple Tree Dental's community collaborative practice model illustrates a sustainable, patient-centered approach to overcoming barriers to care across the lifespan.

Methadone Maintenance Therapy and the Dental Patient

Methadone is a Schedule II drug best known for its use in the treatment of opioid dependence. Dental providers should be aware of the oral and systemic effects of methadone. In patients undergoing methadone maintenance therapy, there is a higher incidence of rampant caries, xerostomia, bruxism and poor oral hygiene. A review of the pharmacology, systemic effects, drug interactions and oral manifestations is presented, as well as possible modifications to treatment and specific considerations in dental therapies.

Dental implants in the patient with multiple myeloma: Literature review and case report

Multiple myeloma is a blood dyscrasia involving plasma cells in the bone marrow. Much new information and many management strategies exist for these disorders. For dental care, there are a number of issues for the clinician to consider. This review discusses current management of this disease and a case report.

Dentists' knowledge and opinions of oral-systemic disease relationships: relevance to patient care and education

Population studies consistently support associations between poor oral (periodontal) health and systemic diseases such as cardiovascular disease (CVD) and diabetes. The aim of this study was to assess the knowledge of dentists and document their opinions regarding the evidence on oral-systemic disease relationships. A survey consisting of 39 items was developed and mailed to 1,350 licensed dentists in North Carolina. After three mailings, 667 dentists (49%) meeting inclusion criteria responded. The respondents were predominantly male (76.3%), in solo practice (59.5%), and in non-rural settings (74%). More than 75% of these dentists correctly identified risk factors like diet, genetics, smoking, obesity, and physical inactivity for CVD and diabetes. The majority rated the evidence linking periodontal disease with CVD and diabetes as strong (71% and 67%, respectively). These dentists were most comfortable inquiring about patients' tobacco habits (93%), treating patients with diabetes (89%) or CVD (84%) and concurrent periodontal disease, and discussing diabetes-periodontal disease risks with patients (88%). Fewer respondents were comfortable asking patients about alcohol consumption (54%) or providing alcohol counseling (49%). Most agreed that dentists should be trained to identify risk factors (96%) or actively manage systemically diseased patients (74%). Over 90% agreed that medical and dental professionals should be taught to practice more collaboratively. These data indicate that these dentists were knowledgeable about oral-systemic health associations, had mixed comfort levels translating the evidence into clinical practice, but expressed support for interprofessional education to improve their readiness to actively participate in their patients' overall health management.

Periodontal management of a patient with severe psoriasis: A case report

Psoriasis is a common, disfiguring and stigmatizing skin disease associated with impaired quality of life. In patients with severe psoriasis unresponsive to other treatments, cyclosporine can induce a rapid remission. Although drug-induced gingival overgrowth (GO) is a frequent side effect, in the guidelines for the use of cyclosporine for psoriasis regular dental examinations were not mentioned as an essential part of monitoring of these patients.

CASE REPORT

A 59-year-old man with GO involving almost all the interdental papillae (Seymour's grading score 1-5) reported difficulties in mastication and gingival swelling. The medical history revealed severe recalcitrant psoriasis treated by oral cyclosporine. The periodontal treatment consisted of strict oral hygiene instructions, scaling, root surface instrumentation, and a 2-month interval periodontal supportive treatment. At 12 months an almost complete regression of GO was observed. A careful nonsurgical periodontal treatment combined with meticulous self-performed oral hygiene may avoid the need for surgical intervention, even in advanced cases.

Psychoactive Substance Dependence: A Dentist's Challenge

Given the number of individuals who are dependent on alcohol and/or drugs, it is inevitable that they will present for dental treatment. They are at an increased risk of dental disease for multiple reasons. This paper aims to provide an overview for general dental practitioners (GDPs) of the challenges that can arise in treating such patients, alongside some suggestions for meeting these challenges. General issues are taken into consideration first, then a focus is made on each of the most common substances, together with their implications in dentistry.

A Case Report for a Complex Denture Case on a Special Care Patient with Osteogenesis Imperfecta

This case report presents a patient with Dentogenesis Imperfecta (DI) associated with Osteogenesis Imperfecta (OI) and its subsequent dental manifestations. The patient in this report (see Figure 1) has spent his life living with his disability type III OI (also known as brittle bone disease) and its degenerative affects. The patient is independent and enjoys his social life but felt his existing dentures were having an adverse effect on the quality of his life. The patient attended Dorset County Hospitals Special Care Dentistry and on clinical examination it was noted the patient was partially dentate with a class III malocclusion and brownish discoloration of the remaining teeth caused by enamel hypoplasia. Treatment for this patient would entail making a maxillary complete denture and a mandibular partial chrome denture, normally quite simple tasks but due to the DI and its dental manifestations, the treatment would be complicated. This case demonstrates how a complex case treated by a collaborative dental team using their different skills and knowledge can lead to a successful and rewarding treatment for both patient and team.

Are Dental Implants the Answer to Tooth Loss in Patients with Parkinson's Disease?

Individuals with Parkinson's disease present a challenge to dental clinicians as this degenerative disease leads to problems accessing care and maintaining an adequate level of oral health. This article provides an overview of the implications of Parkinson's disease on oral health and explores the role of dental implants in the management of such patients.

Hepatitis C virus and dental health workers: an update

Hepatitis C virus (HCV) infection is a worldwide health problem, affecting over 130 million individuals. The virus is transmitted parenterally, making health care professionals a risk group for infection. For this reason it is important that dental health-care workers recognise the symptoms of the infection, which can be present in the oral cavities of hepatitis C-infected individuals. Moreover, dental health-care workers should know how to manage hepatitis C-infected individuals during dental treatment and the measures to prevent nosocomial spread of HCV. Thus, the purpose of this study was to perform a review of HCV epidemiology, natural history, transmission, diagnosis, treatment and prevention focusing on oral manifestations in and dental management strategies for HCV-infected individuals.

An Analysis of the hemophilia of the royal families of Europe, its startling implication and dentistry's role in treating the hemophiliac patient

Hemophilia is an inherited x-linked recessive disorder. It is known popularly as "The Royal Disease," as it has affected many of the royal families of Europe by virtue of Queen Victoria being a carrier for the gene and, subsequently, passing it on to her offspring. They, in turn, married and had children with other royal families of Europe. Hemophilia is certainly not limited to royalty. There are many hemophiliacs living in our communities, and they must receive both proper dental home-care education and dental treatment in order to prevent possibly life-threatening emergency dental episodes. Individuals with hemophilia pose different management issues to the dental professional. The various precautions and modifications that must be taken in order to ensure the safe delivery of dental care to hemophiliac dental patients are discussed.

Women of valor: post-traumatic stress disorder in the dental practice

Dental professionals can intervene in head, neck and facial pain found in female patients who suffer from post-traumatic stress disorder (PTSD). There are three theories for why women are predisposed to pain: hormonal differences, nervous system rewiring and sympathetic issues. This article includes case studies of three patients who are representative of these theories. A rapid, nonintrusive intervention will also be described.

Orthodontic and orthognathic management of a patient with osteogenesis imperfecta and dentinogenesis imperfecta: a case report

This case report describes a patient's severe Class III malocclusion, managed with a combination of orthodontic and orthognathic treatment. The medical history was complicated by osteogenesis imperfecta and dentinogenesis imperfecta. In addition the patient was a Jehovah's Witness. Patients with osteogenesis imperfecta carry an increased risk of perioperative haemorrhage, and this led to bimaxillary surgery being carried out as two discrete surgical episodes for the patient described. In addition, the risk of enamel fracture led to orthodontic bands being cemented on all teeth. In spite of the increased risks a successful outcome was achieved.

Knowledge, attitudes and practices of oral health care workers in Lesotho regarding the management of patients with oral manifestations of HIV/AIDS

Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) have presented with oral manifestation of HIV as the first sign of the disease. Oral health workers regularly encounter patients presenting with oral lesions associated with HIV disease and therefore need to have adequate knowledge of these conditions for diagnosis and management. The aim of the present study was to determine the knowledge, attitudes and practices of oral health care workers (OHCW) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCW in 26 public and private care facilities in all ten districts of Lesotho. A self-administered questionnaire was used to gather information. The response rate was 100%. Nearly all (94.7%) agreed that oral lesions are common in people living with HIV and/or AIDS. The majority (91.3%) named oral candidiasis (OC) as the most common lesion found in PLWHA while Kaposi's Sarcoma (KS) (34.7%) and Oral Hairy Leukoplakia (OHL) (32.6%) were mentioned as the least common oral lesions of HIV. Most correctly identified the images of oral candidiasis (97.8%), angular cheilitis (86.9%) and herpes zoster (80.4%). Only 16.7% felt they had comprehensive knowledge of oral HIV lesions, although 84.8% reported having previously received training. Almost three quarters (71%) reported that there was no need to treat HIV positive patients differently from HIV negative patients. OHCW in Lesotho demonstrated high confidence levels in their competence in managing dental patients with oral lesions associated with HIV, however, they lacked an in-depth knowledge in this regard. Amongst this group there is a need for comprehensive training with regards to diagnosis and management of oral lesions of HIV including the training of other cadres of health care workers together with nurses and community health workers.

The management of dental patients taking new generation oral anticoagulants

Recently, new oral anticoagulants have been introduced as alternatives to warfarin. While national guidelines for treatment of dental patients taking warfarin as an anticoagulant are well-established, no such information is available for these novel therapeutic agents. At present, the local guidance available is contradictory between different health boards/health planning units, and liaison with the medical practitioner managing the individual patient's anticoagulation is imperative if any invasive procedure is proposed. This paper examines the available evidence regarding these drugs and sets out proposals for clinical guidance of dental practitioners treating these patients in primary dental care.

[Malignant hyperthermia - problem in dental surgery. An introductory report]

Malignant hyperthermia is a genetic defect of uncontrolled hypermetabolic skeletal muscle response to anesthetic triggering drugs. Some congenital myopathies are regarded as risk increasing factors. The use of volatile anaesthetics or suxamethonium (succinylcholine) in patients who are predisposed to malignant hyperthermia leads to an increase in Ca2+ release from sarcoplasmic reticulum, which in turn causes a set of biochemical and clinical symptoms, which can be a cause of death, if dantrolene is not administered adequately. The aim of the study was to draw attention to the problem of malignant hyperthermia, which is hardly ever described in Polish literature, and requires the necessity of intensifying the cooperation between the dentist and specialists from other medical fields. The origin of the article was a case of congenital myopathy with recognized malignant hyperthermia in an 18-year-old patient, in whom surgical extraction of teeth was indicated. The course of diagnostics and treatment showed once more that contemporary medicine is in need of holistic approach, and in consequence, promising and effective cooperation of many specialists.

Prosthodontic rehabilitation for a patient with acromegaly

Acromegaly is a condition which results from an excess of growth hormone produced by the pituitary gland after epiphyseal plate closure at puberty. The most common cause of acromegaly is a benign pituitary adenoma. Acromegaly is characterised by enlargement of the hands, feet, nose and ears; expansion of the skull and pronounced brow protrusion. From an oral standpoint, the most relevant symptoms are mandibular protrusion, spacing of the lower teeth and macroglossia. A 46 year-old patient was referred to University Dental School and Hospital by her General Dental Practitioner. The patient had been diagnosed with acromegaly and was receiving medical care from a consultant endocrinologist. The patient was partially dentate with only her lower anterior dentition remaining. She was wearing a complete upper denture but was unable to function effectively due to a lack of occlusal support. Treatment comprised non-surgical periodontal management, construction of upper and lower removable prostheses in a class III relationship and composite restorations on the remaining lower teeth.