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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 9  |  Page : 1259-1265

Assessment of knowledge level about acquired immune deficiency syndrome and patient approaches of dental students


1 Department of Oral Diagnosis and Maxillofacial Radiology, Marmara University, Faculty of Dentistry, İstanbul, Turkey
2 Dentistry Student, Marmara University, Faculty of Dentistry, İstanbul, Turkey

Date of Acceptance27-May-2019
Date of Web Publication6-Sep-2019

Correspondence Address:
Dr. G Keser
Department of Oral Diagnosis and Radiology, Marmara University, Faculty of Dentistry, Başıbüyük Sağlık Yerleşkesi Başıbüyük Yolu 9/3 34854, Maltepe, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_116_19

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   Abstract 


Background: The aim of this study was to evaluate the level of knowledge about HIV, and intraoral signs that can be seen in HIV positive patients and the interpretation of attitudes toward HIV positive patients of fourth- and fifth-grade students at Marmara University Faculty of Dentistry, İstanbul, Turkey. Material and Methods: In our study, a questionnaire consisting of 23 questions was applied to 100 fourth- and 100 fifth-grade students totalling 200 dental students who are educated in Marmara University Faculty of Dentistry. Besides the knowledge level of the students, their attitudes were evaluated using the survey conducted. Chi-square (or Fisher's exact test at appropriate locations) was used to examine the relationship between categorical variables. Statistical significance level was determined as P < 0.05. Results: Of the 200 participants, 46 (23.0%) were males and 154 (77.0%) were females. One hundred people (50%) are fourth grade, 100 people (50%) are fifth grade. The rate of fifth grade agreements for the question “Treatment of HIV positive patient increases the risk of transmission of HIV infection to dentist” was statistically higher than that of fourth-grade students (Fisher's exact P < 0,05). Fifth-grade knowledge of oral symptoms of HIV/AIDS was statistically higher than fourth grades (Fisher's exact P < 0.05). Conclusion: As the grade level increases, the knowledge about HIV/AIDS raises portraying a relevant approach to patients with AIDS. Comprehensive training and motivation for improving dentistry students' awareness against HIV-positive patients will also improve knowledge and attitudes of the students that enable them to take better care of HIV-positive patients.

Keywords: Acquired immune deficiency syndrome, awareness, human immunodeficiency virus,, oral findings


How to cite this article:
Keser G, Göcüncü N, Pekiner F N. Assessment of knowledge level about acquired immune deficiency syndrome and patient approaches of dental students. Niger J Clin Pract 2019;22:1259-65

How to cite this URL:
Keser G, Göcüncü N, Pekiner F N. Assessment of knowledge level about acquired immune deficiency syndrome and patient approaches of dental students. Niger J Clin Pract [serial online] 2019 [cited 2019 Nov 20];22:1259-65. Available from: http://www.njcponline.com/text.asp?2019/22/9/1259/266151




   Introduction Top


The most severe state of the clinical spectrum that results from infection with human immunodeficiency virus (HIV) is called Acquired Immunodeficiency Syndrome (AIDS). It was first described in the United States in 1981 as a viral infection that could affect all systems of the body, without effective treatment and could result in death.[1],[2],[3],[4] According to the World Health Organization (WHO), 40 million HIV cases have been reported worldwide and 40% of these infected cases are women and more than half are under the age of 25 years.[4]

The most important feature of HIV infection is the progressive decrease in the number of CD4 + T cells. In addition, HIV causes defect in many stages of the immune system, both by direct cell infection and indirectly by its effect on cell functions. The number of CD4 cells (T-cells) in the body are reduced due to HIV, resulting in predispositon to infections or infection-related cancers, if left untreated.[2],[3],[4],[5] Taking advantage of a collapsed immune system, these opportunistic infections or cancers reveal that the person has the last state of HIV infection, Acquired Immune Deficiency Dyndrome (AIDS).[5],[6],[7],[8] Dental treatment procedures usually involve blood and saliva, which may contain a variety of blood transported pathogens, such as HIV.[9],[10],[11] Oral symptoms of HIV infection are the first signs of the syndrome and these can be used as diagnostic criteria in the detection of AIDS in approximately 60%–70% of HIV-positive individuals.[8],[11],[12] The dental students (dentists of the future) play a vital role in treatment of individuals with HIV/AIDS.[13]

Dental students should have a comprehensive knowledge about standard precautions and should know that every single patient is considered to be infected with a bloodborne pathogen.[9] Since HIV can be easily spread by direct contact with blood, the risk of being infected is very high in dental practice.[9],[10],[14] Dental students may be involved in situations in which infections, including AIDS, from patient's body fluids may be present. Yet, refusement of a dental care of HIV/AIDS patient is definitely not ethical for a dental practioner and all dentists must provide dental care to these patients.[9],[14],[15]

Students' willingness to treat these patients are influenced by knowledge about the disease course, its oral manifestation, and way of transmission.[14],[16] Published studies showed that dental students lack knowledge about diagnosis, the treatment, and dental care of HIV/AIDS patients.[7],[17],[18]

Grover et al.[19] declared that only 28% of students have excellent knowledge regarding HIV/AIDS, and certain misunderstandings were prevalent regarding mode of transmission. Hamid Albujeer et al.[20] in their study among Iraqi dental students' knowledge about HIV/AIDS awareness reported that the knowledge of about half of the medical students (54%) was at an intermediate level and of 27.1% students was at a good level; more than half of the dental students (68.2%) had an intermediate level, and 10.5% had a good level of knowledge.

Oberoi et al.[9] conducted a study to assess the knowledge and attitude of Indian clinical dental students toward the treatment of patients with HIV/AIDS and attitude regarding HIV. There was no correlation between the knowledge and attitude score, portraying a gap between knowledge and attitude among dental students relating to treatment of HIV-infected patients.

The aim of this study was to evaluate the level of knowledge about HIV, and intraoral signs that can be seen in HIV-positive patients and the interpretation of attitudes toward HIV-positive patients of fourth- and fifth-grade students at Marmara University Faculty of Dentistry, İstanbul, Turkey.


   Materials and Methods Top


The study protocol of the study was approved by the Research Ethics Committee on 04/05/2018 with protocol number 09.2018.375. A survey of 23 questions was conducted to assess the HIV-related knowledge and attitude among 200 clinical dental students studying in fourth (100) and fifth (100) (final) years at Marmara University Faculty of Dentistry, İstanbul, Turkey.[9],[21]

Statistical analysis

Descriptive statistics were used to define continuous variables (mean, standard deviation, minimum, median, maximum). Chi-square (or Fisher's exact test where appropriate) was used to examine the relationship between categorical variables. The analyses were performed using the MedCalc Statistical Software version 12.7.7 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2013). The P value was significant when <0.05.


   Results Top


Most of the respondents (n = 181; 90.5%) considered treating HIV-positive patients to be the moral and ethical responsibility of the dentist. Among the study population, willingness to treat patients with HIV was 29.5%, with students in the fourth year (n = 37; 37.0%) showing a significantly (P < 0.05) higher willingness to treat such patients compared with students in the fifth year (n = 22; 22.0%) [Table 1].
Table 1: Evaluation of individuals' level of knowledge about AIDS and their approach to patients according to year of study

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The accurate response to the question “Is HBV more infectious than HIV?” was given by 117 (58.5%) respondents. A significantly (P < 0.05) higher proportion of the fourth-year male students (71.4%) also agreed [Figure 1]. In the study population, 170 (85.0%) respondents agreed that treating an HIV-positive patient can be an unsafe behavior and might result in the transmission of HIV infection to the treating dentist [Table 1]. A significantly (P < 0.05) higher proportion of the fifth-year students (93.0%) also agreed in our study.
Figure 1: According to you, is HBV more infectious than HIV? (Male students)

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The statement “Infection-control practices for HBV are adequate for protection against HIV?” was agreed upon by 86 (43.0%) respondents, A significantly (P < 0.05) higher proportion of the fourth-year students (43. 0%) also agreed.

A large number (n = 179; 89.5%) of the respondents agreed that the occupational exposureto saliva/blood in the dental setting can readily transmit HIV to the dentist, with a significantly (P < 0.05) higher number of fifth-year students (n = 95; 95.0%) agreeing with this statement [Table 1].

When asked about the statement “A combination of transcriptase inhibitors (NNRTIs and NRTIs) and protease inhibitors (PIs) is taken under standard antiretroviral therapy (ART) for the treatment of HIV/AIDS?” higher proportion (47.0%) of the fifth-year students agreed in our study (Fisher's exact, P < 0.05) [Table 1].

The majority of the students correctly identified the oral lesions that can be associated with HIV/AIDS, such as oral candidiasis (n = 161; 80.50%), oral hairy leukoplakia (n = 172; 86.0%), Kaposi's sarcoma (n = 157; 78.50%) and salivary gland diseases (n = 89; 44.50%). The knowledge regarding the oral lesions was significantly (P < 0.05) higher among the fifth -year dental students. In fourth grades, a significantly higher propotion of male students agreed on Kaposi's sarcoma being an oral lesion (Fisher's exact P < 0.05) [Figure 2]. The rate of oral hairy leukoplakia being an oral lesion agreed among women in fifth grades was found to be higher (Fisher's exact, P < 0.05) [Figure 3].
Figure 2: Is Kaposi's sarcoma an intraoral finding of HIV/AIDS? (Male students)

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Figure 3: Whether an oral disease is associated with AIDS/HIV (Female students)

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   Discussion Top


The most severe state of the clinical spectrum that results from infection with HIV is called AIDS.[1],[2],[3],[4],[5],[6],[7],[8],[9],[22] According to the reports, 13,181 people are diagnosed with HIV positive in Turkey in 2016.[23],[24]

Dental practitioners should increase their knowledge about the disease since there is an increased need for dental care of people with HIV.[23],[24],[25],[26] Willingness to treat HIV-positive patients was 29,5% in our study population, with students in the fourth year (37.0%) showing a significantly (P < 0.05) higher willingness to treat such patients compared with students in the fifth year. In a study conducted by Çapar et al.[14] in Yeditepe University Faculty of Dentistry, out of 250 students almost half of the students reported that they could safely treat HIV/AIDS patients. Oberoi et al.[9] did not find a statistically significant difference in the study. The willingness of the students to treat HIV patients in their study agreed with the findings of other studies.[10],[27]

In our study, the majority of the respondents (90.5%) considered treating HIV-positive patients to be the moral and ethical responsibility of the dentist. Another study conducted by Oberoi et al.[9] reported that the majority of the respondents (74.20%) considered treating HIV-positive patients to be the moral and ethical responsibility of the dentist, with significantly (P < 0.05) more final-year students (86.50%) agreeing. Oberoi et al.[9] did not show a statistically significant difference (P: 0.19; P > 0.05) among the study groups as seen similar with our study (P: 0.76; P > 0.05).

The statement “Treatment of an HIV (+) patient increases the risk of transmission of the HIV infection to the dentist” did not show a statistically significant difference (P: 0.346; P > 0.05) between study groups in Oberoi et al.'s [9] study. However, in our study, a significant difference was found between the fourth (77%) and fifth (93%) grades (P: 0.002; P < 0.05).

The statement “A combination of transcriptase inhibitors (NNRTIs and NRTIs) and protease inhibitors (PIs) is taken under standard antiretroviral therapy (ART) for the treatment of HIV/AIDS?” did not show a statistically significant difference (P: 0.346; P > 0.05) between study groups in Oberoi et al's study.[9] On the other hand, a statistically significant difference was found in our study and 47% of fifth year students agreed (P: 0.001; P < 0.05).

Oral lesions may be the first sign of HIV infection in most patients.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[13],[14],[15],[16],[17],[22] Candidiasis may be the first sign of disease in early AIDS cases. Possible oral changes in patients with AIDS occur as infection or neoplasm due to increased immune defense suppression. In a Brazilian study,[28] the most common oral lesion was candidiasis (26.6%). This was followed by hairy leukoplakia (9.3%), periodontal diseases (4.4%), Kaposi's sarcoma (2.5%), oral ulceration (2.5%), Herpes Simplex (1.2%), and papilloma (0.6%).

The greater number of the students correctly identified the oral lesions that can be related with HIV/AIDS, such as oral candidiasis (n = 348; 81.50%), oral hairy leukoplakia (n = 339; 79.40%), oral Kaposi's sarcoma (n = 303; 71.00%), and salivary gland enlargement (n = 260; 60.90%). The knowledge of oral lesions was significantly (P < 0.05) better among the final-year dental students in the study by Oberoi et al.[9] Most of the students in the study conducted by Singh et al.[29] were aware of the major oral manifestations of AIDS: Kaposi's sarcoma (90,5%), oral candidiasis (99,3%), and hairy leukoplakia (89,1%), three of the most common oral lesion in HIV positive, which is also similar to our study and a previous study.[30]

In the study conducted by Çapar et al.;[14] majority of the students answer correctly the HIV-associated oral lesions such as oral candidiasis (86.9%), major aphthous ulcers (60.4%), and herpes simplex (56.4%), whereas condyloma (35.2%) and xerostomia (34%) were less known. The majority of the students correctly diagnosed the oral lesions that can be related with HIV/AIDS, such as oral candidiasis (n = 161; 80.50%), oral hairy leukoplakia (n = 172; 86.0%), Kaposi's sarcoma (n = 157; 78.50%), and salivary gland diseases (n = 89; 44.50%) in our study. The knowledge of oral lesions was significantly (P < 0.05) higher among the fifth-year dental students. Studies had shown that as the knowledge increases the willingness to treat HIV/AIDS patients increase.[11],[18]

The study by Ali et al.[31] also concluded that as the students grow older, their knowledge of disease increases: 10.74 ± 3.53 for the older student group (aged 24- to 25-year old) and 9.55 ± 4.784 for the younger group (aged 22- to 23-year old), with a P value of 0.007. This can be reasoned by the fact that the older group has gained more experience over the years and has been exposed to a larger number of patients as compared with the younger group. Another study findings revealed that among 600 dental students, 274 (46%) had inadequate knowledge, 191 (32%) had moderately adequate knowledge, and 135 (23%) had adequate knowledge.[19]


   Conclusion Top


Dental students need to be aware of the significance of HIV/AIDS and the effect of the disease on the oral cavity to carry out effective clinical management. Knowledge of the disease process, recognition of oral manifestations, and understanding the forms of transmission are associated with the willingness to treat patients with HIV/AIDS. An adequate knowledge about the lesions related to HIV/AIDS, such as Kaposi's sarcoma and hairy leukoplakia is necessary for the recognition of the disease. The findings on oral cavity should alert dental educators about the importance of educating their students comprehensively about infection-control procedures. There are limited studies in our country on attitudes toward HIV-positive patients of dentistry students. Future studies are needed to asses the understanding of the students' knowledge and attitudes toward HIV/AIDS.

Acknowledgements

This study was presented as on oral presentation in 24th TDB International Dental Congress that was held on September 27-30th in Ankara, Turkey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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