|Year : 2018 | Volume
| Issue : 4 | Page : 63-67
Knowledge, attitude, and practice of dentists toward patients with human immunodeficiency virus and hepatitis B virus infections in Bhubaneswar, Odisha, India
Rajeev Ranjan1, Rudra Joshi2, Saurabh Pramanik3, Chhaya Jha4, Anirban Kundu5, Diplina Barman6
1 Dental Surgeon, Community Health Center, Bero, Ranchi, Jharkhand, India
2 Intern, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
3 Post Graduate Trainee, Department of Pedodontics, Saraswati Dental College, Lucknow, Uttar Pradesh, India
4 Post Graduate Trainee, Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
5 Resident Medical Officer, Department of General Medicine, ILS Hospital, Salt Lake DD-6, Salt Lake City, Kolkata, West Bengal, India
6 Post Graduate Trainee, Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
|Date of Web Publication||29-May-2019|
Dr. Diplina Barman
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, Campus 5, KIIT University, Patia, Bhubaneswar - 751 024, Odisha
Source of Support: None, Conflict of Interest: None
Background: During routine dental work, dentists and dental students can be exposed to human immunodeficiency virus (HIV) and hepatitis B virus (HBV). The aim of the present study was to assess the knowledge, attitude, and practice of the dentists toward HIV- and HBV-infected patients in Bhubaneswar, Odisha, India.
Materials and Methods: A cross-sectional study was conducted among dentists practicing in Bhubaneswar, Odisha, India, from December 2016 to April 2017. A total of 200 practitioners (89 males and 111 females) participated in the study. A pretested validated questionnaire related to the knowledge, attitude, and practices (knowledge – 17, attitude – 13, and practice – 17) of the dentists toward HIV- and HBV-infected patients was distributed among dental practitioners.
Results: Almost 80% of the dental practitioners had existing fear and concern of the infection transmission from HIV and HBV patients, and this was the primary cause of refusal to treat these infected patients.
Conclusion: The dentists did not have proper knowledge in the field of transmission of HIV and HBV infections. Fear and concern of being infected make them to refuse treating these patients. Therefore, training dentists to improve their attitudes toward the treatment of these patients is necessary.
Keywords: Attitude, dental practitioners, hepatitis B virus, human immunodeficiency virus, knowledge
|How to cite this article:|
Ranjan R, Joshi R, Pramanik S, Jha C, Kundu A, Barman D. Knowledge, attitude, and practice of dentists toward patients with human immunodeficiency virus and hepatitis B virus infections in Bhubaneswar, Odisha, India. Int J Prev Clin Dent Res 2018;5:63-7
|How to cite this URL:|
Ranjan R, Joshi R, Pramanik S, Jha C, Kundu A, Barman D. Knowledge, attitude, and practice of dentists toward patients with human immunodeficiency virus and hepatitis B virus infections in Bhubaneswar, Odisha, India. Int J Prev Clin Dent Res [serial online] 2018 [cited 2019 Dec 6];5:63-7. Available from: http://www.ijpcdr.org/text.asp?2018/5/4/63/259263
| Introduction|| |
Among the major global health concerns, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infections are known to be the most prominent of all occupational hazards. It is the most common health hazards in developing countries such as India. Global reports estimate about 40 million victims to the HIV virus, whereas the World Health Organization (WHO) documents over 500 million cases of HBV virus. India has the third-highest number of people living with HIV in the world with 2.1 million Indians accounting for about four out of 10 people infected with the deadly virus in the Asia-Pacific region, according to a UN report. India ranks second and homes over 40 million hepatitis B-infected patients constituting about 15% of the entire pool of hepatitis B in the world. The HIV is a lentivirus  which is a subgroup of retrovirus. It causes HIV infection and later on acquired immunodeficiency syndrome (AIDS)., HBV is a DNA virus that has caused epidemics in some parts of Asia and Africa. Dental treatment often revolves around direct contact with patients' blood and saliva, which makes them more prone to these transmittable infections. Fear of transmission is one of the major reasons why patients with HIV or HBV infection face refusal for dental treatment by various practicing dental personnel. Multiple cases have been reported in the UK,, North America, and Italy, in which the dentists have denied treatment to HIV and HBV patients due to the lack of knowledge about these types of infections along with a fear of contamination. There are various recommendations by the government as well as international governing organization WHO regarding the safety measures while handling HIV- or HBV-infected patients, despite which the dentists fail to practice safely, resulting in spreading these infections., This study aims to assess the knowledge, attitude, and practice of dentists in Bhubaneswar, Odisha, India, toward patients with HIV and HBV infection to provide them with no refusal dental treatment.
| Materials and Methods|| |
A cross-sectional, descriptive, questionnaire-based survey method was taken up to assess the knowledge, attitude, and practice level regarding HIV and HBV infections among all the dentists belonging to the age group of 27–45 years and practicing in Bhubaneswar, Odisha, India. All the doctors who had institutional attachment as well as who were solely on private practice were recruited as the study population. The ethical approval to conduct this study was obtained from the Research and Ethics Committee, KIIT University, Bhubaneswar, Odisha, India. A pilot study was conducted with n = 40 before the commencement of the study for determining the feasibility of the study. The confidence level was attained to be 95%, and the absolute precision was found to be 5%. The total sample size was derived to be 200 using the G*Power (Erdfelder, Faul and Buchner, 1996). The participants of the pilot study were excluded from the main study. All the dentists who were practicing in the Bhubaneswar and willing to take part in the study were included in the study. The study was conducted over a period of 3 months from December 2016 to February 2017. A written informed consent was obtained from the participants before the distribution of the questionnaire. Dentists not giving consent and not willing to participate were excluded from the study. A pretested validated questionnaire was distributed among the eligible participants,,, in the workplaces and collected within the same session. The reliability of the questionnaire (Cronbach's α value = 0.789) was moderate. Data were collected through a pretested questionnaire to ensure its clarity and comprehensiveness. The questionnaire was divided into various sections of sociodemographic data and the knowledge, attitude, and practice toward HIV and HBV infections with a total of 47 questions. Each questionnaire was assigned an identification number which was referred during data entry. The study was conducted in accordance with the Helsinki guidelines (1975). The questionnaire included demographic details as follows: knowledge questions (vertical transmission of HIV, transmission through water, through social contact, through saliva, through antiretroviral therapy, donating blood, and developing AIDS); attitude questions (treated HIV patients, opportunity to treat HIV patients, treating HIV patients in clinics, anxious dentist, patients to dentist, and dentist to patients); and practice questions (use of gloves, changing gloves, changing face mask, use of face mask, washing hands after each patient, recapping of syringe needle, and use of patient gown). The data were entered into MS Excel 2016, and the obtained result was evaluated statistically using the SPSS software package version 19. Quantitative analysis based on the knowledge-, attitude-, and practice-related data was performed, and the individual percentage mean was calculated. The statistical significance was fixed at P < 0.001.
| Results|| |
The distribution of gender is shown in [Table 1]. The mean age of the participants was 31.77 years. The vertical transmission of HIV from mother to child was known to 56% of the participating individuals, whereas 50% of them stated that HIV could as well be transmitted as a water-borne disease. It was seen that 60% of them stated that HIV spread through social contacts, whereas 22% of them disagreed to this fact. A total of 96% of the participating population agreed to the transmission of HIV through the saliva. It was found that 88% of them had no knowledge about antiretroviral therapy and that 82% of them did not agree on the fact that the patients infected with HIV can donate blood. Almost 50% of the individuals believed that postneedle stick injury could be an entity to get infected by HIV or HBV, whereas 90% of them did not agree on HIV developing to AIDS. It was seen that 55% believed that HIV is a sexually-transmitted disease, whereas only 45% of them agreed that blood splashing could spread HIV. HIV is treatable in hospitals was acknowledged by 62% of the clinicians. More than 60% of the population acknowledged that vaccination prevents HIV, whereas 20% of them were unknown to the HIV vaccinations. There were 65% who agreed treating the infected patients, whereas 18% of them denied treatment of those patients., Some of the dental professionals (75%) reported to have had an opportunity to treat the infected patients. Treatment of HIV in specialized clinic was disagreed by 88% of the doctors. Few of the dentists (70%) had the fear of cross infections, and 60% of them were quite anxious in treating the patients with HIV or HBV. Few of the individuals (45%) believed that the spread of infection was from the patients to dentists and that 42% believed that it could be vice versa as well. Approximately 52% of them agreed to the fact that the transmission of HIV and HBV could also be from patient to patient. [Figure 1] shows the inference of the regular practice of the practicing dental personnel.
|Figure 1: Practice of the dental practitioners toward human immunodeficiency virus and hepatitis B virus patients|
Click here to view
| Discussion|| |
The knowledge, attitude, and practice of the dental practitioners are important as it is directly proportional to the quality of service they provide, thus having an impact on the society's health status. The community health workers should take up initiatives for both the dental health professionals and the patients infected with HIV and HBV viruses to improve the level of concern toward the infectivity of these diseases and the level of precaution that has to be taken during the treatment. Analyzing the data collected in this study, it has been seen that the prominent drawback is the psychological fear of the professionals handling those infected patients. They fail to attain the exact precaution required for encountering HIV- and HBV-infected patients, thereby resulting in denying treatment to the needful. There was lack of knowledge among the participating dental practitioners on the modes of transmission of the HIV and HBV disease as compared to other studies conducted worldwide. A national survey on the Indian dentists revealed that the lower level of knowledge with regard to saliva as a mode of transmitting HIV infections was one of the major reasons of drawback in providing valued oral health care to the individuals. The impact of an educational program was seen to be 65% among few dental professionals providing treatment after attending the health program. The clinicians should be provided with proper health education on the precautions that are to be taken while treating the patients infected with HIV or HBV viruses. They should be well aware of the WHO recommendations and the use of disposable mouth masks, double-layered gloves, and head caps on a regular basis while treating any patient with such a medical history. The above-conducted study showed a good amount of dentists practicing the use of gloves and regularly changing them along with washing hands before and after patient handling. In some studies conducted in Iran and Mexico,, it was observed that a majority of dental practitioners were using gloves and face masks while treating the patients, a finding which was in agreement with our present results. In comparison to the above-conducted study, Al-Sandook et al. reported that only 2.38% of the dentists used three main protection tools (gloves, glasses, and face masks), which were seen to be lower than the reports from other developing countries. Although handwashing is documented as one of the important basic principles of the infection control, compliance by some dentists is lower than ideal. In the above-conducted study, 85% of the dental practitioners reported washing their hands before treatment and 95% of them after treating the patients. In a study in Italy and United States,, this ratio was seen to be 79% and 59%, respectively. The face mask is considered to be a potential source of contamination; it is advised to change the mask during the work every 20 min of usage as it becomes saturated with innumerable microorganisms. Therefore, the risk of cross infection increases for dentists who use a face mask all day as compared to the dentists who do not use. In this study, less than half of the clinicians participating reported that they changed their face masks between patients. As mentioned above, wearing gloves and face masks are more important than other infection control measures because these are more prominently visible and well acceptable by the patients. In the conducted study, no significant correlation between dentist's practice and demographic information was found. However, in the study of Savabi et al., dentist's practice was better in private and government clinics than dental offices. This study might be subjected to a potential of selection bias; further studies with randomization while selection of samples is recommended. The study can be extrapolated among other practicing dentist after conducting large-scale survey to ensure the correlation between the knowledge, attitude, and practice regarding the treatment of HIV and HBV patients.
| Conclusion|| |
This study clearly provides an insight into the various levels of knowledge, attitudes, and practices prevalent among the practitioners of Bhubaneswar, Odisha, India. It clearly shows the need for a broadened aspect of health education for the practicing figurines about the precautionary measures pertaining to the treatment of HIV- and HBV-infected patients. The scope of improving the quality of treatment or services the dental surgeon provides would simultaneously be improved based on the improved depth of knowledge and the precaution-based practices. This study increases the scope of further studies aiming to improve the knowledge, attitude, and practice among dental practitioners.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ryalat ST, Sawair FA, Shayyab MH, Amin WM. The knowledge and attitude about HIV/AIDS among Jordanian dental students: (Clinical versus pre clinical students) at the university of Jordan. BMC Res Notes 2011;4:191.
Kabir A, Tabatabaei SV, Khaleghi S, Agah S, Faghihi Kashani AH, Moghimi M, et al
. Knowledge, attitudes and practice of Iranian medical specialists regarding hepatitis B and C. Hepat Mon 2010;10:176-82.
Weiss RA. How does HIV cause AIDS? Science 1993;260:1273-9.
Douek DC, Roederer M, Koup RA. Emerging concepts in the immunopathogenesis of AIDS. Annual review of medicine. 2009;60:471-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18947296
. [Last accessed on 2016 Dec 02].
Crossley ML. A qualitative exploration of dental practitioners' knowledge, attitudes and practices towards HIV+and patients with other 'high risk' groups. Br Dent J 2004;197:21-6.
McCarthy GM, Koval JJ, MacDonald JK. Factors associated with refusal to treat HIV-infected patients: The results of a national survey of dentists in Canada. Am J Public Health 1999;89:541-5.
Angelillo IF, Villari P, D'Errico MM, Grasso GM, Ricciardi G, Pavia M. Dentists and AIDS: A survey of knowledge, attitudes, and behavior in Italy. J Public Health Dent 1994;54:145-52.
Carpenter CC, Fischl MA, Hammer SM, Hirsch MS, Jacobsen DM, Katzenstein DA, et al
. Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the international AIDS Society-USA panel. JAMA 1997;277:1962-9.
Kadeh H, Saravani S, Golzari P. Knowledge, attitude and practice of dentists towards patients with HIV, hepatitis B and hepatitis C infections. Avicenna J Dent Res 2014;6:1-6.
Askarian M, Mirzaei K, McLaws ML. Attitudes, beliefs, and infection control practices of Iranian dentists associated with HIV-positive patients. Am J Infect Control 2006;34:530-3.
Brailo V, Pelivan I, Škaricić J, Vuletić M, Dulcić N, Cerjan-Letica G. Treating patients with HIV and hepatitis B and C infections: Croatian dental students' knowledge, attitudes, and risk perceptions. J Dent Educ 2011;75:1115-26.
Al-Sandook T, Al-Naimi R, Younis M. An investigation of dentists knowledge, attitude and practices towards HIV+ and patients with other blood borne viruses in Mosul city. Al Rafidain Dent J 2013;10:298-308.
Bodhade A, Dive A, Khandekar S, Dhoble A, Moharil R, Gayakwad R, et al
. Factors associated with refusal to treat HIV infected patients: National survey of dentists in India. Sci J Public Health 2013;1:51-5.
Mulligan R, Seirawan H, Galligan J, Lemme S. The effect of an HIV/AIDS educational program on the knowledge, attitudes, and behaviors of dental professionals. J Dent Educ 2006;70:857-68.
Askarian M, Mirzaei K, Cookson B. Knowledge, attitudes, and practice of Iranian dentists with regard to HIV-related disease. Infect Control Hosp Epidemiol 2007;28:83-7.
Maupomé G, Acosta-Gío E, Borges-Yáñez SA, Díez-de-Bonilla FJ. Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico city. Am J Infect Control 2000;28:21-4.
Gershon RR, Karkashian C, Vlahov D, Grimes M, Spannhake E. Correlates of infection control practices in dentistry. Am J Infect Control 1998;26:29-34.
McCarthy GM, Koval JJ, MacDonald JK. Compliance with recommended infection control procedures among Canadian dentists: Results of a national survey. Am J Infect Control 1999;27:377-84.
Savabi O, Hasankhani A, Mohamadikhah Z. The attitude and practice of dentists in relation with HIV and HBV infected patients in Isfahan Province. Iran J Med Educ 2011;10:868-76.