Safety at the doctor's appointment

vladimirpolenichkin
YULIA SHUKHOROV

MD, doctor of the highest category, head physician of GBUZ "Samara Regional Clinical Dental Clinic"

Experience in the implementation of rapid diagnostic methods for HIV and hepatitis C in dental practice
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GBUZ Samara Regional Clinical Dental Clinic became the first Russian dental clinic to introduce mandatory testing for HIV and hepatitis C for patients. Today, medical technologies can save patients time without compromising the quality of diagnostics in detecting such formidable diseases as HIV infection and HCV. The most frequently visited specialist is a dentist, and the rapid tests that have appeared for the diagnosis of antibodies to HIV infection and hepatitis C are undoubtedly relevant for both doctors and patients.
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The problem of the spread of HIV infection for more than 25 years continues to be relevant for the world community and has been repeatedly considered at the highest world level, including the UN General Assembly, the G8 Summits, the SCO, the CIS and the Eurasian Economic Community. The scale of the spread of the human immunodeficiency virus has become global and poses a real threat to the socio-economic development of most countries of the world.

Currently, the HIV epidemic in the Russian Federation remains tense, the spread of human immunodeficiency virus among the population and the increase in the cumulative number of infected and sick people continue.
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According to the results of 2011, the Samara Region was included in the top ten regions of Russia with the highest HIV prevalence rate. According to the Office of Rospotrebnadzor in the Samara region, our region occupies a leading place among the 10 most affected by this disease (living with HIV per 100 thousand people), industrialized regions with higher incomes along with Irkutsk, Leningrad, Sverdlovsk, Orenburg , Tyumen, Chelyabinsk, Ulyanovsk regions, the city of St. Petersburg and the Khanty-Mansi Autonomous Area.

The total number of residents in whose blood antibodies to HIV were detected as of January 1, 2012 amounted to 46,410 people, of which almost 4 thousand were registered last year. Also in the Samara region is an urgent problem of viral hepatitis. Viral hepatitis infects hundreds of millions of people each year; more than 1 million people die from these diseases every year.
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Hepatitis C is an inflammatory liver disease caused by the hepatitis C virus. There are 11 varieties of hepatitis C virus in Europe, and much more in Southeast Asia. Hepatitis C can occur both in acute and in chronic form. Due to the nature of the virus, "hiding" from the immune system, acute hepatitis becomes chronic in 80–85% of patients. 20–30% of patients with chronic hepatitis C develop liver cirrhosis, and 3–8% of liver cancer.
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Infection with viral hepatitis and HIV infection can occur during transfusion of donated blood, dental treatment, surgical interventions and the use of poorly sterilized instruments, through sexual contact, and it is also possible that a child is infected from a sick mother during pregnancy and childbirth.
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The contact pathway of infection with viral hepatitis is not excluded, since the virus can be excreted in urine, saliva, sex secrets and penetrate a healthy person through damaged skin and mucous membranes.

Test systems for HIV -1/2 antibodies OraQuick Advance and HCV antibodies OraQuick HCV Rapid Antibody Test for saliva is a disposable device designed for the qualitative determination of antibodies to human immunodeficiency virus types 1 and 2; and antibodies to hepatitis C virus in samples of periosticular fluid (saliva), whole blood, serum and plasma. The test is packaged in a sterile bag and consists of a testing device and a tube with a developing solution. Testing is carried out manually, the result is ready in 20 minutes.
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Rapid testing with OraQuick Advance is a very simple procedure that does not require blood sampling and in only 20 minutes provides reliable results about the presence or absence of HIV infection without the use of laboratory equipment. The simplicity and convenience of the system make it possible to use it in almost any environment, including outside a medical facility. Built-in control minimizes the likelihood of application errors or incorrect reading of the result. Technical and medical tests of the rapid test showed its sensitivity and specificity, not inferior to the ELISA method.

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Barack Obama publicly conducted rapid HIV testing with OraQuick at the second annual AIDS Summit.

Patients aged twenty years and older visit the dentist more often than the general practitioner, which provides dentists with great opportunities for diagnosing HIV and HCV. However, do not forget about important ethical, legal and organizational issues related to diagnostic strategies for these diseases. Dentists should be prepared for the fact that any testing for HIV and HCV is accompanied by counseling, which should be carried out with extreme caution. Before testing, the Samara Regional Clinical Dental Clinic at the Samara Regional Clinical Dental Clinic tells the patient in detail about the indications for the study and the interpretation options for the data obtained as a result of the analysis.

A positive test result can stun a person. Therefore, if the test is positive, the patient is told in detail about the identified disease, its etiology, clinic, methods of prevention and treatment. The doctor then recommends that the patient contact the regional center for the prevention, research and fight against HIV and hepatitis C for additional testing. The specialists of the centers interact with the clinic staff to prevent the spread of parenteral infections, prepare methodological materials, conduct lectures on the basis of the clinic on the methods of prevention, diagnosis, clinic and treatment of HIV infection and hepatitis C.
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The instructions attached to the tests describe in detail the algorithm of the testing. Therefore, the introduction of analysis in the Samara Regional Clinic did not require additional staff training. Using OraQuick tests does not require special education of medical personnel and quality control tests. Thus, in a dental office, gingival fluid analysis may be part of a routine examination.
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Despite the fact that testing entrusts additional functions to doctors, the staff of the Samara clinic took the innovation positively, and there were no difficulties in using the tests and the research procedure. Since the analysis is carried out with the consent of the patient, the clinic also did not encounter legal difficulties. The cost of testing is included in the cost of the initial appointment of the patient on a self-supporting basis.

Specialists of the Samara Regional Clinical Dental Polyclinic GBUZ conduct testing of patients during initial treatment and before surgical dental interventions. Carrying out test data, the clinic guarantees its patients that in the process of treatment and diagnostic procedures all sanitary and epidemiological regimes will be observed. On the other hand, these express systems allow you to immediately identify infected patients and, in case of injuries to employees during treatment and diagnostic measures, immediately begin treatment and preventive procedures.
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According to the sanitary and epidemiological rules, all medical institutions must be provided or, if necessary, have access to rapid HIV tests and antiretroviral drugs in case of emergency. The rules also prescribe the implementation of HIV prevention programs in the workplace. OraQuick tests provide an opportunity to protect against viruses and patients and clinic staff.