INTRODUCTION
The oral cavity is an important and frequently undervalued source of diagnostic and prognostic information in patients with HIV disease1. A variety of conditions have been described affecting oral tissues in HIV infection 2. These oral lesions may indicate HIV infection in previously undiagnosed cases thus making the dentist the first health care worker to detect the disease; they may be predictive of disease progression and may also be used in staging and classification of the disease.
Studies indicate that 70-90% of HIV patients will have at least one oral manifestation at some point during the course of the disease 3,4 hence many HIV positive patients may require dental treatment at different times during the course of the disease. Oral lesions in HIV patients though often debilitating can be managed effectively with proper oral health care. Also the state of oral health can complicate the treatment of HIV positive patients by causing feeding discomfort and thus exacerbating nutritional problems. Oral health has been found to be significantly associated with both physical and mental health in a study measuring quality of life in HIV patients5.
The periodontal tissues in the mouth provide a potentially weak barrier through which bacteria and their factors can enter the connective tissues and systemic circulation. Therefore, maintaining a low microbial load within the mouth should be seen as an essential component of preventive treatment regimen in HIV positive patients 1. This can be achieved through regular dental checkups and prophylaxis. A study of the impact of intensified dental care on outcomes in HIV infection concluded that "access to dental screening, prophylaxis and repair will significantly improve oral health, functioning and quality of life in persons with AIDS" 6. Therefore prophylactic oral health care is important even in the absence of oral lesions. Hence it is vitally important that HIV positive patients have easy access to oral health care.
Access to oral health care may be influenced by many factors including a lack of perception of the importance of oral health and an ignorance of existing services. While the authors have no knowledge of any study of the utilization of dental services by HIV positive patients in Nigeria, a previous Nigerian study reported a low level of utilization of oral health services amongst Nigerian households 7. Also most Nigerians are reported to attend the dental clinic mainly because of pain rather than for preventive practices 8
In an unpublished study on HIV patients in Nigeria, about 54% of them claimed they would complain to their attending physician in the haematology clinic of the teaching hospital where they attend regularly for antiretroviral therapy if they have any oral problem. This indicates that these physicians and others who consult in other medical outpatient and paediatric clinics may be the first port of call for the Nigerian HIV patient with oral lesions and thus have an important role to play in the ability of these patients to access oral health care, which may contribute to their total quality of life. These clinicians though working in tertiary hospitals may be regarded as primary care physicians for these patients because they see to the basic health needs of these patients in the Nigerian health care setting. They are therefore in a good position to advice their patients on regular dental care and indeed help the patient to easily access such care by referring them for regular dental checkups.
The objective of this study is to assess the knowledge of attending physicians on oral manifestations of HIV, their attitude towards referral of HIV positive patients for oral care and their present pattern of referral with a view to recommending ways of achieving better access to oral health care for HIV positive patients in Nigeria.
METHOD
The study was carried out by means of a self-administered questionnaire distributed to physicians and paediatricians who attend to HIV positive patients in various outpatient clinics at the Lagos University teaching hospital (LUTH), and also to doctors and heamatologists in HIV dedicated clinics of LUTH, Lagos State University teaching hospital (LASUTH) and the National hospital, Abuja, Federal capital territory. The questionnaire contained questions, both close- ended and open- ended addressing the demography of the doctors, their knowledge of oral lesions in HIV infection, the practices of doctors towards oral health complaint by their patients and their attitude towards dental referral for these patients.