The perception of surrogate teaching patients with HIV disease of dental providers' fear and comfort.

We conducted a focus group with eight surrogate teaching patients who participate in an HIV/AIDS training program for dentists and auxiliaries. With one exception, these surrogate patients were HIV-seropositive, had taken part in eight training sessions over six months, and had been examined by about forty groups of trainees. Researchers inquired about how surrogate patients could tell if the trainees were afraid or comfortable, what negative experiences with trainees occurred or stood out, and what positive experiences were recalled or stood out. Theme analysis was used to interpret the results of the focus group. The main signifiers of clinician discomfort were related to physical distance, avoidance of physical contact, verbal interaction, and what we call "dentist interaction." The results suggest that training of dentists and other dental personnel to interact with patients with HIV/AIDS should attend to reduction of patients' psychological distress as well as management of any physical discomfort. The feedback from surrogate patients with HIV disease who have experienced a large number of dental examinations is a valuable tool for providing feedback to, and insight into, the factors that cause psychological discomfort to patients with HIV disease.

Cancer curricula in U.S. dental schools.

The current cancer curricula of 52 U.S. dental schools were assessed using a survey similar to that conducted in 1981 by the American Association for Cancer Education. Data demonstrate significant declines in both cancer education representation on the curriculum committee and the existence of a cancer education committee. The percentage of schools with university general budget funding and NCI funding has also declined significantly. Despite recommendations from the 1981 AACE committee, deficits in oral oncology education at present include: 1) an active cancer education committee; 2) practical clinical oncology experience in diagnosis, the decision-making process, referral procedures, management of oral sequelae of cancer therapy, and maxillofacial rehabilitation; 3) psychosocial training in oncology; 4) community cancer activities; and 5) sustaining funds for oncology education programs.

Oral cancer education in dental schools: survey of Texas dental students.

BACKGROUND: Senior dental students at the three Texas dental schools were surveyed about their attitudes and perceptions of their knowledge and skills in areas related to prevention, detection, and diagnosis of oral cancer, and the management of oral sequelae of cancer therapy methods. A 16-item survey was distributed to a total of 251 fourth-year dental students. A total of 198 completed surveys were returned, for a response rate of 79%. RESULTS: Just over half of the students had observed a biopsy of oral tissue or read a biopsy report, but only about one fourth had actually performed the procedure. Respondents who had observed or performed a biopsy or who had read a biopsy report were significantly more likely to report that they were comfortable with their competence in performing a biopsy. Although only about half (57%) reported that tobacco-use cessation programs had been discussed in their training and only 14% had received actual training, a much larger percentage intended to provide cessation materials or training in their practices. Likewise, only a fourth had been instructed in prescribing nicotine replacement therapy, but almost two-thirds planned to do so in their practices. Most respondents felt they were comfortable with their skills in counseling patients about oral cancer risk factors, and most felt they would be able to recognize a malignant lesion. Almost all had been taught full head and neck examination technique, and most (84%) were comfortable with their skills in performing such an examination. Smaller percentages reported instruction in the management of the oral sequelae of chemotherapy and radiation therapy. CONCLUSIONS: Future practitioners are more comfortable with skills that have been practiced in training. These data suggest that an increased emphasis on certain aspects of cancer education within the dental curriculum would result in a more confident, competent practitioner.

Reported latex sensitivity in pediatric dental patients from hospital- and dental school-based populations.

A number of intraoperative anaphylactic reactions to latex occur in pediatric patients. To determine the frequency and characteristics of latex reactions in pediatric dental patients, a 32-item survey was completed by consenting parental interview at three pediatric dental clinics. Two were hospital-based, specializing in dental care for chronically ill or disabled children. The other was a dental school clinic. A total of 290 surveys were completed, in approximately equal numbers from each of the three clinics. Of the total, 2.7% reported a history of adverse reactions to latex contact. All adverse reactions were reported from the two hospital-based clinics. The rate from the hospital-based clinic specializing in the care of orthopedic and neurologically compromised children (Texas Scottish Rite Hospital, Dallas, TX) was 5.7%. The rate reported from the hospital-based clinic for chronically ill children (Children's Medical Center, Dallas, TX) was 2.0%. A history of eczema, a familial history of allergies, and a history of multiple surgical procedures were significantly more common (P < 0.05) in the population reporting adverse reactions to latex. No adverse latex reactions were reported in the one-third of the pediatric population described as normal, healthy children. Adverse reactions were more common in medically compromised children, particularly those with histories of spina bifida and/or multiple surgical procedures.

Latex reactions in an adult dental population.

A review of the medical histories of 300 adult patients presenting for emergency dental care at a dental college revealed no individuals who identified themselves as allergic to latex. A 32-item survey was distributed to adult dental patients receiving care at the dental school. 323 patients volunteered to complete the questionnaire. 3.7% of the patients reported adverse reactions associated with wearing latex gloves. However only 8.8% of the patient population reported work-related latex glove use. The reported incidence of sensitivity to latex products such as rubber dam material and condoms was equal to that associated with gloves, and slightly lower in the case of enema tips (2.8%) and balloons (2.5%). Sensitivity to rectal and/or vaginal examination with latex gloves was reported by 5.5% of the population. Predisposing factors to reported latex sensitivity found to be significant (P < .01) included a history of eczema and a familial history of allergies. No significant differences were found with regard to age or gender. Only two individuals reported severe systemic symptoms related to latex exposure. Data suggest that careful questioning of patients regarding a history of sensitivity to multiple latex-based products can facilitate the identification of possibly latex sensitive individuals, thus preventing latex-related allergic reactions in the dental operatory.

Latex glove reactions found in a dental school.

When a survey was distributed to students, faculty and staff of a dental school to determine the incidence of latex glove reactions, 15 percent reported adverse reactions to glove use. The most frequently reported symptom was dermatitis, followed by urticaria, sweating, conjunctivitis and rhinitis.

Attitudes of dental practitioners and dental students towards AIDS patients and infection control.

Members of a large urban dental society and students of three Texas dental schools were surveyed concerning their attitude and actions regarding infectious disease (AIDS and hepatitis) and infection control measures. In general, the responses of clinicians in practice less than 10 years more nearly paralleled that of students. Although the majority of both groups felt they were well informed regarding appropriate infection control, the percentage was significantly greater for the practitioners. While infection control is imposed in all clinical situations in the dental schools, compliance for practitioners was not consistent with their reported level of awareness. A majority of both groups reported decreased apprehension because of their knowledge of infection control techniques in the treatment of HIV positive individuals. A significantly higher percentage of students had received hepatitis B vaccine. Similar percentages of both groups reported they would willingly treat HIV positive patients, although a higher percentage of students were undecided. Practitioners reported having treated a significantly higher percentage of HIV positive individuals than did students in their clinical years. The percentage of clinical students who felt it was their professional obligation to treat HIV+ patients was significantly higher than in practitioners. There was an increase in student perception of their knowledge across years in school and a significant reduction in fear associated with education. Education appeared to have no effect on opinions as to whether the HIV positive patient could be safely treated using appropriate infection control measures.

Mucous membrane pemphigoid. Treatment experience at two institutions.

The initial oral findings and treatment in 50 cases of mucous membrane pemphigoid are presented. Histologic and immunologic studies were undertaken in each case to confirm the clinical diagnosis. The treatments prescribed are summarized and illustrate that topical steroids are effective, but in some cases systemic steroid therapy with or without other immunologically active drugs is required. A significant number of patients had extraoral manifestations of the disorder.

Oral presentation of pemphigus vulgaris and its response to systemic steroid therapy.

This article reviews our experience during a 20-year period with patients with oral lesions of pemphigus vulgaris. Of the 30 patients, 20 were women and 10 were men, with an age range of 24 to 68 years. The soft palate was involved in 80% of cases at initial presentation. Direct immunofluorescence studies were positive for IgG in the intercellular region in all cases where lesional tissue was histologically studied. Systemic steroid therapy alone controlled the disease in 24 patients, one patient was given no treatment, and the remaining five required additional treatment with either azathioprine, cyclophosphamide, or gold. Steroid therapy was continued in the long-term at a reduced dose, but side effects such as diabetes mellitus, hypertension, and duodenal ulcers were observed. Long-term steroid therapy is therefore the treatment of choice for the oral lesions of pemphigus vulgaris, but in some cases alternative treatment options may be required.

Factors that affect patient attitudes toward infection control measures.

This study examined how differences in infection control procedures and patients' perceived knowledge of infection control, and how AIDS and hepatitis might affect attitudes toward the use of such measures. Patients receiving treatment at two sites where the methods of infection control and the frequency of their use differed (dental school and private dental practices) were surveyed concerning their approval/acceptance of infection control measures and self-report of knowledge concerning infectious disease and possible transmission of infectious disease during dental treatment. Data were collected from 379 patients, 272 from the dental school and 107 from five private practices. A high percentage (95 percent) of both dental school and private patients felt they were adequately protected, while fewer than 2 percent expressed anxiety about infection control procedures being used in either setting. Factors such as gender, age, and years of formal education did not significantly affect attitudes toward infection control measures, but age and education were correlated with perceived knowledge of infectious diseases. Patients' reported knowledge of infectious disease had a significant effect on their decision to leave a practice if the dentist was HIV positive. A significantly higher percentage of dental school patients felt that barrier infection control techniques should be used routinely. Patients treated where such techniques were not routinely used nevertheless expressed satisfaction with that level of protection, implying that patients tend to accept the level of infection control being practiced where they receive treatment.

Microcomputer use in an oral biopsy service.

The need for rapid and accurate retrieval of the data generated by an oral biopsy service and the adjacent medical center was met with the purchase and programming of a microcomputer and hard disk drive. The planning phase involved an assessment of the needs of the department, creation of an ideal form to be displayed on the video screen that can be easily used to enter the information, selection of coding systems, and selection of compatible hardware and software. Customized in-house programming using a commercially available database management system has created an entry form and menu-driven information retrieval system tailored to the needs of the department.

Epidemiological and diagnostic aspects of oral squamous cell carcinoma.

Available data in United States on morbidity, mortality and survival is reviewed and trends discussed. Oral squamous cell carcinoma is a small problem in numerical terms, but is a highly lethal disease. The diagnosis is not difficult for the competent pathologist but problems arise in the diagnosis and prognosis of potentially malignant conditions. Our understanding of the behavior of dysplastic lesions is limited and any attempts to determine individuals "at risk" should be encouraged.

Traumatic granuloma of the tongue.

The traumatic granuloma is a rare, reactive lesion that occurs primarily in the tongue of males. It can mimic other diseases, including malignancy, both clinically and histologically. It is, therefore, a lesion with which clinicians and pathologist should be familiar.