DISCUSSION
The optimal oral health condition is essential for the general wellbeing of the HIV patient. It is important that physicians who primarily care for these patients be able to recognize important oral lesions in their patients both for diagnostic and prognostic reasons. In a country like Nigeria with poor dental visiting habit, these clinicians may be the first persons that HIV positive patients come in contact with. This study reveals an inadequate knowledge of oral lesions seen in HIV infection among the respondents. Only 16 (20.5%) of them could name three pertinent oral lesions seen in HIV infection. This may be an indication that they may not be able to identify these lesions. The EC clearing house on oral problems related to HIV infection 9 classified oral lesions associated with HIV into four groups with about eight lesions classed as lesions strongly associated with HIV. Of these lesions, the doctors in this study appear to be more familiar with pseudomembranuous candidosis mostly with oral hairy leukoplakia coming a very distant second and Kaposi?s sarcoma third. None of the other lesions strongly associated with HIV was mentioned by the doctors.
Oral ulcerations, herpes simplex infection and hyper pigmentation, which were listed by the doctors are classified as lesions commonly associated with HIV infection. Also while some of the doctors claimed they could identify some oral lesions, there was no way of objectively assessing this claim. There is a need for adequate training of physicians caring for HIV patients in Nigeria in recognition of these oral lesions. While the mouth can be easily examined by clinicians and some oral lesions such as pseudomembranous candidosis may be simply identified as shown in this study, other lesions may be misdiagnosed by the inexperienced eye. In a study of primary care physicians, only 26% were able to diagnose oral Kaposi sarcoma and 22% hairy leucoplakia 10. Another study revealed a sensitivity of 45.2% in the accuracy of recognition of oral lesions by medical clinicians after undergoing a 1-day- refresher course; however they were less able to describe such lesions accurately 11.
In terms of attitude, while 66 (84.65%) of the respondents agreed that routine dental checkups is desirable as part of management of HIV, only 18(23.1%) of them had ever referred a patient for dental treatment. Also a considerable number-12 (15.4%) felt that regular dental checkup was unnecessary for HIV patients. This shows poor attitude in these doctors whose opinion may be a source of barrier to accessing oral health care for their patients. It is essential that both the patient and the health care provider be better informed of the importance of good oral health as it has an impact on their overall quality of life. Attending physicians in Nigeria needs to be educated so that they see the management of HIV patients in a more holistic way.
CONCLUSION AND RECOMMENDATIONS
In conclusion, an appreciation of the role of oral health care workers in diagnosis and treatment of HIV patients and indeed the adoption of a team approach involving physicians, dental surgeons, nursing staff and community care workers is very important in ensuring the best management of HIV patients. A formal training of attending physicians in Nigeria in the recognition and management of oral lesions in HIV is desirable. These doctors should be educated and encouraged to include regular dental checkups in their routine management of HIV positive patient. They should consciously refer their patients for regular screening and prophylaxis as part of their preventive management of HIV patients.
We also recommend that patients with HIV in Nigeria be referred to a dentist for routine checkups two times a year.