Oral manifestations of HIV infection : implications for delivery of oral health care service

Abstract

The prevalence and determinants of oral lesions related to Human Immunodeficiency Virus (HIV) infection were examined in the context of the delivery of oral health care services. This was complemented by an examination of the perceptions and experiences of oral health workers and HIV infected patients with regard to oral health care services. Method: A cross sectional study was carried out on 239 patients who attended a HIV outpatient clinic. participants' dental history and perceptions were determined through structured interviews, whilst clinical and medical details were obtained from physical examinations and clinical records. A qualitative study of oral health care workers was carried out to assess their perceptions and experiences with regard to service provision. A costing exercise was done to determine the average cost of care per visit. Results: Oral HIV lesions presented in 68.6% of the sample. Significant determinants of oral lesions presence included, CD4 cell counts <2OO (OR 2.07), smoking (OR 2.74, presence of calculus (OR 4.27) and poor access to oral care (OR 6.36). The majority of the patients sought dental care from the public sector services (670lo) and the prime reason was for emergency care (/0olo). The main barriers to care from the patient perspective were cost (337"), fear of pain (21%) and rejection (16%). The majority (87%) of the oral health care workers were in favour of providing comprehensive care at primary level. The main concerns of the oral health care providers were the management of needle-siick injuries and their skills deficiency in managing complex @ses. The average cost of care per visit was R130.73. Conclusion: Oral Iesions presented in more than two thirds of the sample. Barriers to care, lowered immune status, smoking and high calculus deposits were significantly associated with the presence of lesions. The most commonly reported barriers to seeking care were cost and fear of pain. Patients' perception of oral health and their health seeking behaviour were influenced by oral symptoms. The rising cost of treating oral lesions will impact on the delivery of health care services. Oral morbidity related to HIV infection can be reduced with the application of simple preventative, health promotive measures such as promoting smoking cessation and good oral hygiene, removal of local tooth deposits and improved acess to health services.