Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report.

In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.

Determinants of Oral Diseases in the African and Middle East Region.

Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual and community. Interventions in health promotion programs in the AMER need more research on the epidemiology of oral diseases and the role played by the social determinants of oral diseases, especially with regard to poverty. The high levels of poverty and low gross domestic product in most countries in the African region make it difficult to fund high-quality, affordable, accessible oral health services.

Knowledge, attitudes and practices of oral health professionals with regard to the hepatitis B virus in their workplace, Harare.

Objective: To assess the knowledge, attitudes and practices of Harare oral health professionals regarding Hepatitis B Virus (HBV) in the workplace. Design: A cross sectional study was conducted using a structured 36 item interviewer administered questionnaire to collect data from consenting participants. Setting: The study was conducted at private and public dental practices in Harare. Participants: Oral health professionals comprising dentists, dental therapists and technicians were purposively sampled and interviewed. Results: Eighty nine study participants were interviewed. Seventy four (83%) and 69 participants (77.5%) knew about the potential transmission through contact with blood and saliva respectively. Forty seven (52.8%) participants knew that HBV infection is incurable. Thirty five participants (39.3%) were unaware of the ability of HBV to remain infective in dried blood. Although 22 participants (25%) stated that there was potential for transmission of HBV to patients at their workplace, 81participants (92%) felt they were at risk of contracting HBV infection at work. Sixty one participants (69%) reported being vaccinated, but on verifying the vaccine doses the participants received, 35 (39.3%) received three doses, 15(17%) two doses and 11 (12.4%) one dose. Forty six per cent of the fully vaccinated participants (16 of 35) had a post-HBV vaccination test. Seventy nine (87%) and 83(93.3%) professionals stated consistent use of face masks and gloves during procedures respectively. Conclusion: Although the oral health professionals in Harare appreciated the risk of HBV transmission in dental settings, they had incomplete knowledge of HBV infection and there was poor uptake of HBV vaccination among these professionals.

Osteosarcoma of the jaws: a 23 year retrospective review.

OBJECTIVE: To review 31 cases of osteosarcoma of the jaws in Zimbabwe, and to retrospectively study the age, gender, site distribution, clinical features and treatment outcome ofjaw osteosarcoma in Zimbabwe. DESIGN: Descriptive. SETTING: Oral and Maxillofacial surgical clinics at two specialist referral hospitals, Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. SUBJECTS: 31 cases ofosteosarcoma of the jaws. METHOD: Clinical records of patients who presented with osteosarcoma of the jaws during the period January 1981 to December 2003 were reviewed for age, gender, site of lesion, radiology, histopathology, treatment outcome and follow up. RESULTS: There were 31 cases of jaw osteosarcoma during the 23 year period: 45.2% (n=14) males and 54.8% (n=17) females, mean age 27 years. Of the cases 83.9% occurred in the mandible and 16.1% in the maxilla. Surgery was the treatment of choice. The majority of patients were lost to follow up within 12 months. CONCLUSION: Jaw osteosarcoma is most common in the mandible with an equal male and female affliction in a relatively young age group.

Acinic cell carcinoma of the submandibular salivary gland presenting as a large cyst.

Acinic cell carcinomas are rare tumours of salivary gland origin, most commonly seen in middle-aged women and predominantly in the parotid gland. The case of a long-standing, predominantly cystic, acinic cell carcinoma located in the submandibular gland of a child is presented here. The tumour was successfully removed and there has been no recurrence.

Sarcomas of the oral and maxillofacial region: a review of 88 cases in Zimbabwe.

We reviewed the case notes of 88 patients who were treated for sarcomas of the oral and maxillofacial region over a period of 24 years. There were 51 men (mean age 23 years) and 37 women (mean age 29). Forty-six tumours were in the mandible. Osteosarcoma accounted for 31 cases, and rhabdomyosarcoma 21 (usually under the age of 10 years).

Congenital double lower lip: report of a case.

A case of the management of a congenital double lower lip in a 2-week-old female child: is described. The mother stated that the child was having difficulties when suckling and was also worried about the unsightly appearance. The redundant lower lip was excised under general anaesthesia. The child made an uneventful recovery.

Oral malignant neoplasia: a survey of 428 cases in two Zimbabwean hospitals.

A review of oral malignant neoplasms biopsies accessioned in the pathology services of Harare Central Hospital and Parirenyatwa Hospital, Harare, Zimbabwe, during the 10year period January 1982 to December 1991 was carried out. Clinical records of 428 patients with histologically diagnosed oral malignant neoplasms by ICD-O type and site (COO.O-CO6.9) were retrieved and analyzed for gender, age, history of tobacco and alcohol usage, neoplastic type and histologic differentiation of squamous cell carcinoma (8000/3). Oral malignant neoplasms constituted 24.8% (n = 428) of the 1723 biopsies accessioned in the department during this period. There was a male to female ratio of 1.9:1, with lesions being most common in the 41-60 year age group. Squamous cell carcinoma, (8070/3) 73.1%, was the predominant oral malignancy most common in the 61-70 year age group with 21.1% on the mandibular gingivae (CO3.1), 20.5% on the tongue (CO1.9-CO2.9), 18.5% on the floor of the mouth (CO4.9) and 10.5% each on the maxillary gingivae (CO3.O) and buccal mucosa (CO6.O). The hard palate (CO5.9) had 9% of the lesions. Lip malignancy (COO-COO.9 and C44.0), inclusive of mucosa of lip, vermilion and skin, constituted 3.3% and minor salivary gland (CO6.9) malignancy (M-8940/3) 4.9%. The remaining oral malignancies, 11%, included Burkitt's lymphoma (M-9687/3) 4.7%; Kaposi's sarcoma (M-9140/3) 3.7%; osteosarcoma (M-9180/3) 2.6% and malignant melanoma (M-8720/3) 1.9%. Fourty five percent of the patients admitted tobacco and alcohol consumption, of whom 95% were males. Oral malignant neoplasms were more common in males than females and occurred in a relatively young age group. Well-differentiated squamous cell carcinoma (M-8070/31) was the most common oral malignant neoplasm and was most frequently found on the mandibular gingivae (CO3.1), tongue (CO1.9-CO2.9) and floor of the mouth (CO4.9). The lip (COO-COO.9) was least affected with a high palatal (CO5.9) involvement.

Mandibular fracture in a neonate: report of a case.

Neonatal mandibular fractures are rare and are mostly due to traumatic delivery. Attempted infanticide has also been reported as a cause. A case of a fractured mandible in a neonate assaulted by its mother suffering from postpartum psychosis is presented.

Lip cancer in Zimbabwe. Report of 14 cases.

Lip cancer, relatively common among fair-skinned males, is uncommon among Black-skinned males. In a 10-year review period of 358 Black African patients with orofacial squamous cell carcinoma, 3.9% (n = 14) were found on the lip with a male to female ratio of 2.5:1. Fifty percent (n = 7) of the patients were albinos and two were children with xeroderma pigmentosum. The lower lip was most commonly affected (78.6%). The well-differentiated and moderately differentiated histopathologic types each comprised 42.9% of the lesions. Alcohol consumption and tobacco usage was admitted to in 42.9% (n = 6) of the patients.

Ranula: another HIV/AIDS associated oral lesion in Zimbabwe?

AIM: To show that sublingual ranula is associated with HIV/AIDS and as such should be considered an HIV/AIDS associated oral lesion in Zimbabwe. OBJECTIVES: To retrospectively study the prevalence, age and gender distribution, the HIV serostatus of ranula patients and the trend in prevalence of ranula and Kaposi's sarcoma (KS) in patients at the two largest referral Oral and Maxillofacial Surgery specialist centres in Harare, Zimbabwe. To use this information to infer an association between ranula and HIV/AIDS in Zimbabwe. DESIGN: Descriptive study with a retrospective and prospective component. SETTING: Oral and Maxillofacial Surgical clinics at specialist referral hospitals, Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. SUBJECTS: Eighty-three cases of ranula were studied: 45 cases retrospectively and 38 consecutively. A total of 231 cases of KS were studied retrospectively. METHODS: Histopathologic records of patients who presented with ranula and KS during the period January 1981 to September 2003 were studied. Gender and age were recorded for each case. Thirty-eight ranula patients studied consecutively during the period June 1999 to September 2003 were consented for HIV testing. RESULTS: There were 83 cases of ranula; 43.4% male and 56.6% female. There were 231 cases of KS, 61.2% male and 38.8% female. Male to female ratio was 1:1.3 for ranula and for KS was 1:0.6. Ranula was predominant in the 0-10 year age group (73.5%) while KS was most common in the 21-40 year age group (76.4%). Ranula and KS both had a marked rise in prevalence from 1992 to 2003. A total of 88.5% of the ranula cases tested HIV positive with 95% in the 0-10 year age group. CONCLUSION: There was a rising prevalence of ranula which mirrors that of KS (an HIV/AIDS associated oral lesion) and that 88.5% of ranula patients were HIV positive with 95% of them in the 0-10 year age group. Sublingual ranula should thus be considered another HIV/AIDS associated lesion in Zimbabwe, especially in children.

HIV/AIDS orofacial lesions in 156 Zimbabwean patients at referral oral and maxillofacial surgical clinics.

OBJECTIVE: To document the prevalence, age and gender distribution and clinical features of HIV/AIDS orofacial lesions in patients referred to the two largest Oral and Maxillofacial specialist centers in Harare, Zimbabwe, and compare the findings with those from other parts of the world. DESIGN: Descriptive study. SETTING: Oral and Maxillofacial Surgical Clinics at specialist referral hospitals; Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. SUBJECTS: A total of 7800 consecutive patients referred for various orofacial conditions were examined. From this group, 156 patients with orofacial lesions of or suggestive of HIV/AIDS were further interviewed and examined by the oral and maxillofacial surgeon in charge of the clinics. METHODS: Head, neck and oral examinations were carried out. Oral examination was carried out using mouth mirror and dental light in a dental chair. HIV/AIDS orofacial lesions were recorded and diagnosed using the EC Clearing House Criteria on Oral Problems related to HIV Infection (1993). RESULTS: There were 79 males and 77 females. Male:female ratio 1:1; age range 1-56 years; candidiasis (55.1%) was the most common lesion with the pseudomembranous type (55.8%) predominating. High prevalences of Kaposi's sarcoma (18.6%), salivary gland disease (12.2%) and cancrum oris (3.8%) were noted. Heterosexual contact and mother to child transmissions appear to be the mode of transmission. CONCLUSION: The spectrum of orofacial lesions is similar to that in other countries. This study shows a high prevalence of candidiasis, Kaposi's sarcoma, salivary gland disease, non-Hodgkin's lymphoma, cancrum oris and rampant caries.

Supernumerary teeth: literature review.

A review of the literature on supernumerary teeth in general and supernumerary molars in particular was carried out on prevalence, aetiology, complications and the treatment of supernumerary teeth. Additional teeth are relatively common and are usually of simple conical shape (supernumerary teeth) but may resemble teeth of the normal size and shape. The aim of this review is to provide reference material for dental practitioners in Zimbabwe.

Temporomandibular joint ankylosis: review of thirty-two cases.

I have reviewed aetiology, sex, age at time of treatment, clinical features, radiographic findings, anaesthetic techniques, surgical treatment, complications, and results in 32 patients with ankylosis of the temporomandibular joint. Trauma and infection were the commonest causes of ankylosis: 50% and 41%, (n = 13), respectively. The 21-30 year age group had the most trauma cases. Twenty (63%) of the patients presented with bilateral ankylosis. Failing to do jaw-opening exercises was the main cause of relapse.

Human bites of the face. A review of 22 cases.

OBJECTIVE: To compare experience with human bites of the face in a unit in Harare, Zimbabwe, with other similar studies in respect of reasons for the assaults, age and sex of the patients, timespan between injury and treatment, surgical management and incidence of infection. DESIGN: Prospective study. SETTING: Department of Oral and Maxillofacial Surgery Outpatients Clinic, Harare Central Hospital, Harare, Zimbabwe. PATIENTS: Twenty-two consecutive patients with human bites of the face. MAIN OUTCOME MEASURES: The black female is the predominant victim and assailant, with the lower lip most commonly involved. RESULTS: Of the patients 81.8% were female. The mean age was 32.5 years. Interpersonal violence was the commonest cause of the injury, with the lower lip involved in 90.9% of cases. Early presentation reduces the risk of infection. CONCLUSION: The results indicate that the black female predominates both as victim and assailant. Early presentation with thorough surgical debridement under antibiotic cover produces satisfactory results.

Oral manifestations in 100 Zimbabwean HIV/AIDS patients referred to a specialist centre.

OBJECTIVE: To document the prevalence, age, sex ratio and clinical features of oral lesions associated with HIV/AIDS among patients referred to the two largest specialist centres in Zimbabwe. DESIGN: Prospective study. SETTING: University Hospital. SUBJECTS: 100 consecutive patients with oral manifestations of HIV/AIDS were interviewed and examined by Dental Surgeons and Physicians. METHODS: Inspection and palpation of head and neck was done in all cases. Examination of the oral cavity and oropharynx with torchlight and wooden spatula was performed and lesions recorded according to WHO recording form for oral lesions possibly related to HIV infection. RESULTS: The median age was 35 years (range 19 to 66 years). The male to female ratio was 4:1. General symptoms and signs found were: weight loss in 52, diarrhoea in 34, lymphadenopathy in 21 and Herpes zoster in 12 patients. Ninety two patients had oral lesions of some sort. These consisted of: oral ulcerations in 26, candidiasis in 22, osteomyelitis in three, necrotizing gingivitis in two and herpetic gingivostomatitis in one patient. Neoplasms recorded were: Kaposi's sarcoma in 72 patients, squamous cell carcinoma in two patients. Four other tumours not associated with HIV/AIDS were found. No hairy leukoplakia was found in this study. CONCLUSIONS: The peak prevalence was in the age group 31 to 40 years with a male dominance of 4:1. The most frequent lesion was Kaposi's sarcoma, M:F ratio 3:1, followed by oral ulcers and candidiasis.