SUBMITTED TO: SUBMITTED BY:

Dr.C.M. MARYA SHWETA SHARMA

(HOD OF PUBLIC HEALTH DENTISTRY) 3RD YEAR
ROLL NO. 86
 CONTENTS:

• Importance of infection control.

• Cross infection.

• General principles of infection control.

• Universal precautions.

• Needle stick injury.

• Waste disposal in health care setting.

• Infectious diseases of concern in dentistry.

WHY IS INFECTION CONTROL IMPORTANT IN DENTISTRY?

Both patients and dental health care personnel (DHCP) can be exposed to pathogens.

Contact with blood , oral and respiratory secretions, and contaminated equipment occurs.
Proper procedures can prevent transmission of infections among patients and DHCP.

INFECTION
Infection is the depositon of organisms in the tissues and their growth resulting in a host
reaction.
The no. of organisms required to cause infection is termed the infective dose.the infective dose
is dependant on

1. Virulence of the organism and

2. Suspectibility of the host

INFECTION CONTROL

It involves two basic factors.

1.prevention of spread of microorganisms from their host(patient and clinicians)

2.killing or removal of microorganisms from object and surfaces.

CROSS INFECTION

It is defined as transmission of infectious agents among patients and staff within a clinical
environment.

Transmission of infection from practitioner to practitioner

Pathways of cross infection.

There are six common pathways:-

1. Patient to practioner
2. Practitioner to patient

3. Patient to patient

4. Clinic to community

5. Clinic to practitioners family

6. Community to patient

Transmission of infection from practitioner to patient

ROUTES OF TRANSMISSION

1. Direct contact with blood or body fluids.

2. Indirect contact with a contaminated instruments, equipment or environmental surfaces.

3.Contact of mucosa of the eyes, nose or mouth with droplets or spatter.

4.Inhalation of airborne microorganisms.

5.Direct inoculation into cuts and abrasions of unprotected skin or mucosa via contaminated
sharps or instruments.

UNIVERSAL PRECAUTIONS
They apply to all patients. Integrate and expand universal precautions to include organisms
spread by blood and also body fluids, secretions, and excretions except sweat, whether or not
they contain blood, non-intact skin and mucous membranes.

Universal precautions for dental teams, entail

(1)Employment of various personal protective barrier techniques, such as gowns, face mask,
protective eyewear, gloves etc., which reduce the risk of exposure to potentially infectious
material. In addition precautions should be taken against injury from sharp instruments.

(2)Immunisation: The CDC recommends all members of dental team who are exposed to blood
or blood contaminated articles should vaccinated against hepatitis-B with a boosted dose after 3
years and

(3) routine handwashing.

HANDWASHING AND CARE OF HANDS

In a clinical setup hands must be washed

(1) At the beginning of each session

(2) Between patient contacts.

(3) Before putting on sterile gloves.

(4) Immediately after skin contact with blood and other body fluids.

(5) After touching eyes, nose, face or mouth.

(7) Before leaving the clinic.

(8) Before, eating, drinking, smoking, or inserting contact lens.

(9) After any break in the routine or chain of asepsis such as answering the telephone or

retrieving an instrument.
HAND WASH TECHNIQUES
(1)Remove all jewelleries (watch ,ring, bracelet)
(2)Clean finger nails with a plastic or wodden stick.
(3) Scrub hands,nails and forearm with a liquid germicidal agent.
(4)Rinse hands thoroughly with running water.
(5) Dry hands with towel.
A combination of liquid soap and an anti-bacterial agent is more effective than bar soap
alone
HAND CARE
• Gloving is an important aspect of hand care.
• Torn,cut or punched gloves must be removed immediately.
• Any obvious sores,abrasions and cuts must be covered with a protective adhesive
waterproof dressings prior to donning gloves.
• Handcream must be used at the end of the session, to prevent drying and cracking
of skin.
• Finger nail should be short,trim and clean.

PERSONAL PROTECTION :PROTECTIVE ATTIRE BARRIER

TECHNIQUE

The use of barrier technique is very important which includes clinic attire,face
masks,protective eyewear and gloves.

CLINIC ATTIRE
High necked, long cuffed, sleeved cover gowns while performing surgery. The ADA
guidelines recommended changing garments atleast daily and more frequently and when
visibly soiled or contaminated.
 Use of protective clinic attire.
FACE MASKS
They should be changed when sneezing,occurs,when damp,and in between patients.the
maximum time for wearing masks should be not more than one hour.
A chin length plastic face shields must be worn in addition to face masks.

HEAD CAPS
Hair should be properly tied. Long hair (which extends below collar level) must be either
covered or restrained from face. All personnel involved in direct patient care must wear
freshly laundered uniform .

PROTECTIVE EYEWEAR
Eyewear with solid side shields or chin length face shields must be used when splashing
and splattering of blood,saliva or pus is expected.
GLOVING
It is an effective barrier to reduce risk of transmission of disease. Gloving is mandatory
for all types of patient care. All staff must wear gloves during patient contact. There is
evidence to indicate that dental staff who do not wear gloves contract herpes simplex
infections. Sterile gloves are required during surgical procedures. For procedures non
sterile gloves should be worn. The efficacy of gloves as a barrier /protection is greatly
diminished if they are perforated. Quality of gloves should be ascertained prior to their
purchase. It is advisable to change gloves at least hourly for long procedures. The ADA
has condemned the reuse of gloves.
The dental practitioner should be aware of some drawbacks related to the usage of gloves
(1) Difficulties in handling small instruments such as endodontic instruments
(2) Loss of fine sense of touch
(3) Inflammability and hence the danger of working close to open flames.
(4) Possible effect on setting time of some impression materials.
Wear a new pair of gloves for each patient.

Do not wash gloves for reuse.

PREVENT ENVIRONMENTAL CONTAMINATION
Uncovered jewellery should not be worn during dental procedures. A wrist watch worn
under the cuff of the cover gown, and thus is protected by it, is acceptable.
Pens/pencils should be cleaned and disinfected if contamination has occurred. Food and
beverages must not be kept in patient care, laboratory and sterilization areas. All
procedures and manipulations of potentially infected materials should be performed
carefully to minimize droplets, splatters and aerosols, whenever possible. Use of rubber
dam and high volume evacuation is recommended.

SPILLS OF BLOOD AND BODY FLUIDS

Gross-inorganic materials should be removed with an absorbent material, using a glove,
followed by disinfection. In case, there is a blood contamination on the floor, a
disposable impervious shoe covering should be used. Spraying solution directly on to a
spill should be avoided in order to decrease the risk of splatter exposure.

ENVIRONMENTAL CLEANING AND DISINFECTION

At the end of treatment session of each patient and at the completion of each session of
daily work, dental unit surfaces and countertops should be cleaned. These surfaces should
be disinfected with a suitable chemical germicide.

LOW LEVEL DISINFECTANTS

A “hospital disinfectants” which is not labelled as for tuberculocidal activity(e.g.
quaternary ammonium compounds) are appropriate foe general cleaning purposes such as
floors, walls, and other surfaces. Intermediate and low level disinfectants are not
recommended for reprocessing critical and semicritical dental instruments.
All environmental surfaces should be disinfected between and at the beginning and end
of the day. Use of 70 per cent alcohol, quaternary ammonium compounds or antiseptic
agents for surface disinfection within the clinical and surgical area are considered to be
inadequate.
Disposable blood/saliva impermeable barriers, such as plastic wrap or aluminium foil
must be used to cover the surfaces from direct or indirect contact, whenever possible.
Areas difficult to clean and disinfectant include: light handles, light controls, chair
switches, evacuation control, three-way syringe, saliva ejector etc.
Floor should be cleaned daily.
Protective barriers must be worm during cleaning, should be employed to clean and
disinfect a “high tough areas”, is as follows:
1) Spray the surfaces and/or equipment with cleaner/disinfectant.
2) Dry the surface with paper towel and discard.
3) Spray the surface and equipment with cleaner/disinfectant and leave in contact for 10
minutes.
4) Set up for next clinical procedure.
5) Clean the chair with soap and water.
This technique is performed in three stages. The first “spray” stage is a cleaning
stage. In the second stage the surfaces are “wiped” cleaned. The third stage is
to“spray” the areas again and leave them in contact for 10 minutes

Fig. shows iodine disinfectant and floor disinfectant respectively

Bulletin boards used for displaying posters, schedules and other information, etc.
should be located outside of splatter zone. Patient’s charts and radiographs should
not be handled in the operating areas to avoid contamination. Chart entries can be
made after gloves are removed and hand washed to prevent contamination with
blood/saliva.

USE OF SHARP INSTRUMENTS AND NEEDLES

Sharp items such as needles ,blades and wires, contaminated with patients blood or
saliva should be considered potentially infective and handled with care to prevent
injuries. All sharp items should be disposed of in designated puncture resistant
containers. orthodontic wires and bands are also considered sharps, and disposed off
accordingly. Unsheathed needles should not remain on the instrument tray or in the
operating field.

Fig.1 depicts needle and syringe hub cutter.

Fig.2 depicts storage of sharps for disposal.
DISPOSAL OF WASTE / INFECTED MATERIALS

Waste materials can be

(1) Biohazardous and
(2) Non biohazardous
BIOHAZARDOUS MATERIAL
Includes
 (1) Waste items soaked with blood or other body secretions
(2)Waste capable of causing infectious disease
(3) Waste that is capable of having a poisonous effect
(4) Human tissue removed during surgery
(5) Teeth and incidental tissue
(6) Blood
(7) Bloody gloves.

Biohazardous waste disposal bags.

NON BIOHAZARDOUS MATERIAL

Includes

(1) Matrix band

(2) Masks ,caps, gloves ,patients napkins
(3) Impression materials, x rays packets ,surface covers.

The following procedure is adopted for disposal of medical waste :The bags used for
collection and disposal of different waste are colour coded for ease of identification.In a
clinical set up ,the medical waste is collected in a small bag.After completion of the
procedure the bag is closed and sealed.The waste bag is disposed in yellow plastic trash
bags.All other waste such as gloves,masks,paper towels and paper barriers should be placed
in blue plastic bags.

HANDLING BIOPSY SPECIMENS

Specimens incorrectly collected and transported substitute a danger to members

of staff and laboratory personnel. Hence, should be put in sturdy containers with a secure lid
to prevent leaking during transportation. It is absolutely essential to label the specimens
clearly and accurately. Avoid contaminating the exterior of the container. In case,
 contamination occurs, use another container. Use appropriate transport media and
refrigeration if necessary. Avoid delay in dispatching to laboratory . Hemolytic streptococci
on a dry swab may survive only for as short-time as 30 minutes; while gonococci survive
only for seconds.

PROSTHODONTICS

The following factors must be considered

(1) Impression trays :clean the trays immediately after separating impression from cast
(2) Instruments, articulators and custom trays ,etc.
(3) Custom impression trays, base plates and occlusion rims and all prosthesis must be
disinfected.
(4) Alginate impression (a)The patient must rinse mouth with an antiseptic rinse prior to
making an impression (b)Rinse the impression under running tap water to remove saliva
and other debris (c)Immerse the impression in an approved disinfectant solution (1;10
chlorine) for 30 seconds and rinse again under tap water (d)immerse again in the
approved disinfectant for 10 minutes,wrap in a towel soaked in disinfectant and place in a
bag.(5)final impression : follow the procedure mentioned for alginate impression

Use of gloves is mandatory while taking impression.

The dentist or dental assistant prepares a potentially infectious impression for transport by
rinsing the impression and placing it in a biohazard-labelled plastic bag without
contaminating the bags outer surface.

DENTAL RADIOGRAPHY

The staff working in radiology department is no t aware of the medical history of the patients
referred for radiography hence it essential to take certain precautions the major concern arises
from saliva contamination of working areas and equipment the x-ray tube head , exposure
selector and timer button are likely to get contaminated with saliva

INTRAORAL TECHNIQUES

1,Put on gloves

2. Place all film holders and film packets required for patients in a special tray

3.Carry out the requested radiographic examination

4. Place the contaminated film packet and film folder the special tray

After completion of the radiographic examination

1. The film holding devices may be rinsed under running water to remove the saliva
2. Film packets are wiped with gauze to remove excess saliva and place in the special tray
 3. Wipe the x-ray tube head , exposure selector, timer button and film packets with
detergent chloros .
4. Transfer the tray with film packet to the dark room .
5. The films are processed . The film packets are collected in the tray to be discarded into
yellow bag.

RUBBER DAM ISOLATION

The advantages are first it reduces aerosols and droplets that may be contaminated with
infectious microorganisms and it eliminates splatter.

MINIMIZING DENTAL AEROSOLS AND SPALATTER

The advantages are first it reduces aerosols and droplets that may be contaminated with
infectious microorganisms and it eliminates splatter.

NEEDLE STICK INJURY

Don’t keep gloved fingers near the cutting edges of surgical blades.

Needle stick injury.

 Correct method for disposal of needle.

MEAURES FOR PREVENTION

This can be prevented by

1. Ensuring that the needles and surgical blades are sheathed when not in use.
2. Keeping full control of sharp instruments and retaining full concentration while handling
such instruments .
3. Keeping gloved figure behind the cutting edges of surgical blades and elevators for the
points of probes or needles .
4. Adequate retraction of tissues with appropriate instruments.
5. Placing needles in sharp safe box .
6. Taking care when clearing away the surgical sharps , wire. etc.
7. Over gloving using double gloves .

POST ACCIDENTAL MANAGEMENT -CHEMOPROPHYLAXIS

The measures which are to be undertaken are as follows .

1. Remove the gloves

2. Wash the side of injury under running water with soap and water .
3. Avoid the scrubbing and encourage bleeding and then protect .
4. Inform the patient about the incident .
5. Usually, it is necessary to take bloods specimens of both the patients and the injured
person and tested for HBV and HIV
HIV INFECTION CONTROL

It can be describe under two headings

1. Measures at the time of surgery and

2. Measures for health care workers .(HCW)

MEASURES AT THE TIME OF SURGERY

The protocol to be followed in operation theater is as follows

Special precautions when dealing with HIV positive or high risk patient special precautions are
to be taken which are as follows

1. OPERATION THEATER the following factors may be consider . 1. The patient should be
posted at the end of operation list to allow for sufficient time for adequate cleaning of the
theater following surgery . 2. It is advisable to cover the operating table with water proof sheet
3. The patient should be allowed to recover fully in operating room
2. PERSONNEL .1 Members of staff with laceration or abrasions on their hands are excluded
from theater .2. Non essential personnel should not be allowed inside the theater. 3. All
member of staff not actually involved in surgery should have following attire
3. (a). Disposable foot covers( b) Disposable cap and face mask (c) Disposable plastics gowns
and gloves (d). Protective eye wears. In case the mask or cap of any of the member of
operating team is splattered with blood it should be immediately change

3. SURGERY TECHNIQUES . 1 A no touch technique is employed . 2. Scissors or cutting

diathermy must be used in preference to blade . 3. Sharp instruments should not to be handed
over to surgeon and vice versa .

4. AT THE END OF SURGERY .1. Patient should be allowed to recover from anaesthesia in
operation theater . 2.In case of spillage of blood or body fluids the area should be mopped up by
a person using gloves and old linen/ paper towels or newspapers and sent for incineration in
plastic bag. The area should then be covered with one person sodium hypochlorite for thirty
minutes the solution is cleanup with absorbent material and placed in the contaminated waste
container the floor should then be wiped with soap and water followed by one percent sodium
hypochlorite.3. The member of operating team should remove their shoe cover and gowns before
removing gloves.

5.OPERATION THEATER WASTE DISPOSABLE

(1)All disposable sharps should should be put in a rigid puncture proof plastic container.(2)All
non sharp waste (like gauze pieces ,iv bottles, tubings etc.)should be put in a large plastic bag,
labelled and sent for incineration.

6.REUSABLE INSTRUMENTS (1)The instruments which can be autoclaved should be

autoclaved before washing.(2)The non autoclavable instruments are immersed in 2 percent
glutaraldehyde solution for 1 hour.(3)The suction bottles should contain 30 ml of 2 percent
glutaraldehyde for 1 hour.the solution is discarded.(3)The suction bottles should contain 30 ml
of 2 percent glutaraldehyde or 60 ml of 1 percent sodium hypochlorite solution.(4)The ventilator
tubes should be rinsed with running tap water for 5 minutes.

7.LABORATORY SPECIMENS (1)They should be put in 10 percent formalin filled jars with a
tight leakproof cork and then put in a plastic bag which is tightly closed and sealed, properly
labelled and transported to the laboratory

8.OPERATION THEATER The operating room need not be closed down or fumigated after
performing surgery in a seropositive patient.

9.EQUIPMENTS AND SURFACES The equipment and surfaces which are difficult to disinfect
and may get contaminated should be covered by aluminium foils or by disposable plastic covers.

MEASURES FOR HEALTHCARE WORKERS

Needlestick injury is the commonest cause of contracting HIV infection in HCWS.The risk of
acquiring HIV through needle stick injury is 0.4 percent and through mucous membrane is 0.04
percent.

NEED FOR HIV INFECTION CONTROL

The majority of people infected with HIV look and feel healthy for a no. of years .The disease
has a long latent period(5 to 10) years in the development of full blown disease or with clear cut
clinical manifestations hence these patients patients are asymptomatic.Secondly,during the early
phase known as” window period”, antibodies are not demonstrared despite presence of high
degree of viremia .This period may last from 4 to 12 weeks after exposure to virus. During this
period the patient is highly infectious, however ,he will be taken as a normal individual, as
antibodies are not demonstrated .in view of these facts, it is advisable for the HCWS ,to consider
all patients as potentially infected with HIV and take ”universal precautions”. These precautions
include: Hand washing ,careful handling of sharp objects, proper sterilization, disinfection or
disposal of instruments after use ,appropriate use of gloves, masks and gowns etc.

HIV POST EXPOSURE PROPHYLAXIS (PEP)/CHEMOPROPHYLAXIS FOR

HEALTH WORKERS

STERILISATION AND DISINFECTION OF PATIENT CARE ITEMS

Critical instruments

They penetrate mucous membranes or contact bone, the bloodstream,or other normally sterile
tissues of the mouth .examples include surgical instruments,scalpel blades,periodontal
scalers,and surgical dental burs.
 scalpel blades

Semicritical instruments

They contact mucous membranes but donot penetrate soft tissue. examples include dental mouth
mirrors ,amalgam condensers and dental handpieces.

Hand piece Mouth Mirror

Non critical instruments

They contact skin .examples include X ray heads,facebows,pulse oximeter,blood pressure cuff.
 Facebow

HEAT BASED STERILISATION

It includes steam under pressure (autoclaving),gravity displacement ,pre vacuum,dry heat and
unsaturated chemical vapour.

Steam pressure sterilizer(autoclave)

LIQUID CHEMICAL STERILANT / DISINFECTANTS

It suitable only for heat sensitive critical and semicritical devices. Powerful,toxic chemicals raise
safety concerns.

DISINFECTION OF DENTAL EQUIPMENT

1.Handpieces :Rationale for sterilization of handpieces

The internal surfaces of handpieces become contaminated with blood and debris etc.the
handpieces which are not autoclaved should be subjected to a disinfection regimen.the handpiece
is wrapped in gauze soaked with a recommended disinfectant and kept in a sealed plastic bag for
a recommended time.prior to use the residual chemical residue may be removed by rinsing with
sterile water or wiped with gauze soaked in alcohol.

Cleaning of handpiece

2. Dental unit water systems (DUWS)

The dental unit water systems (the tubes that connect the high speed handpiece,air ?water syringe
and ultraviolet scaler to the water supply)harbor a wide range of microorganisms including
bacteria,fungi,and protozoas.these organisms gain an entry along with water.when the system is
switched off a negative pressure is created ,resulting in retraction of water.these microorganisms
colonise and replicate on the inner surfaces of the water line tubings ,resulting in microbial
accumulations termed “biofilms”.these biofilms serve as a reserviour for amplying free floating
microorganisms in the water exiting the waterlines.these microbial accumulation can contribute
to occasional odors and visible particles of biofilm material material exiting the system.
 Dental chair with water setup
Therozone

Water quality improvement

The ADA council on scientific affairs recommends to improve the design of dental equipment so
that water delivered to patients during non surgical dental procedures contains no more than 200
colony forming units /ml of bacteria at any point of time in the unfiltered output of dental unit.

WASTE DISPOSAL IN A HEALTH CARE SETTING

CLASSIFICATION

WHO classification of waste is as follows :

1.General hazardous

2.Sharps

3.Chemical and pharmaceutical

4. Infectious and other hazardous medical wastes

AIMS OF WASTE TREATMENT

The aims include :

1.Disinfection

2.Reduction in the bulk volume

3.Making surgical waste unrecognisable

4.Rendition of the dangerous recyclable items unusable

SEGREGATION

Segregation is the key to management of hospital waste.it allows sorting out of different
categories or bags.the advantages are:

1.Reduction in total treatment cost

2.General waste does not become infectious

3.Reduction in the chances of infecting HCWS.

4. Segregation of different wastes on the basis of classification. And as per the guidelines.the
bags should be labelled;bearing the international biohazard symbol.all the waste, after
segegation must be stored in colour coded containers.

Collection of biohazardous wastes from institutions and sending it to common community

incinerator.
 Segregation of waste material.

The following table represents the colour coding to be employed in waste disposal

DISPOSAL OF HOSPITAL WASTE

HOUSEHOLD NON INFECTIVE WASTE :It is to be collected in thick polythene bags or

plastic cans and discarded like household waste.

SHARP INFECTED HOSPITAL WASTE: It is to be collected separately in puncture resistant

or plastic containers containing 1 percent sodium hypochlorite which can be closed or
sealed.needles and syringes should be disinfected and destroyed mechanically before disposa
INFECTED HOSPITAL WASTE: The infected waste from the wards ,operating theater.OPD
and laboratories should be collected in metallic containers decontaminated by autoclaving and
then disposed off at garbage disposal sites on daily basis.The metal containers should be
thoroughly cleaned and disinfected after emptying the waste.

DISPOSAL OF INFECTED WASTE.

It is done by the following methods1.Incineration:It is sophisticated method of burning the

waste.2.Deep burial with bleaching powder or lime.

The following table shows the type of waste and the methods of disposal

INFECTIOUS DISEASES OF CONCERN IN DENTISTRY

BACTERIAL INFECTION

1.TUBERCULOSIS.
It is caused by M.tuberculae.It is transmitted by inhalation, inoculation and ingestion. The two
main infections seen are in the form of tuberculous cervical lymphadenitis and pulmonary
infection.

This picture represents transmission of TB

Prevention: Immunization with BCG vaccine adequately covers dental staff .

Wearing gloves and masks can also be beneficial.

2. LEGIONELLOSIS

It is caused by gram negative bacteria, which usually reside in warm and stagnant water
reservoirs. There is a possibility that legionellosis may spread via water in the dental unit water
systems .It multiply in dental unit water systems. It causes pneumonias in elderly.

Prevention: The dental unit water systems should be flushed with fresh water before and after
use and particularly prior to the treatment of the first patient in the morning to eradicate any
contaminants. Dental staff Should be informed of the long term risk of legionellosis.

VIRAL INFECTIONS

1.HERPES VIRUS INFECTION

There are at least six herpes viruses: herpes simplex (types 1and 2), varicella zoster (VZV),
Epstein barr virus(EBV), Cytomegalovirus(CMV), Human herpes virus 6(HHV6)

HERPES SIMPLEX VIRUS.

It is the most common herpes virus transmitted to dental clinical staff. The major signs of
primary herpes infection are acute illness with fever and malaise, lymphadenopathy and
ulcerative gingivostomatitis.90 percent of orolabial herpes simplex lesion are caused with either
a herpetic lesion or infected saliva by type 1 (HSV1)And 10 percent by (HSV2),herpes virus
infections of the fingers (herpetic whitlow).Transmission occurs by direct contact of abraded
skin or intact mucosa with infected lesions or secretions.

This picture shows herpes simplex infection.

Prevention : Wearing of gloves provide adequate protection .

VARICELLA ZOSTER VIRUS

It is the causative agent of both chickenpox and shingles. Chickenpox is highly contagious and
spreads via airborne route.

Prevention: Masks and gloves offer some protection.

CYTOMEGALOVIRUS(CMV)

This causes latent infections. the foetus, preterm neonates and immunocompromised patients are
at a risk of this.

Prevention : Routine use of gloves and masks is a good protective measure..

HEPATITIS B VIRUS (HBV)

This is a DNA Virus which causes acute hepatitis. It has a long incubation period (45 to
180days)during the acute infection and in carriers of HBV, viral particles released from the
liver are present in circulation. Hepatitis B surface antigen (Hbs ag) is identified by serological
tests as the main indicator of active infection. A second antigen, Hbe ag, which is derived from
core particles of the virus present in the liver.

Prevention.: Dental team should be vaccinated against hepatitis B.

This kit is an ELISA for the qualitative determination of e antibody to human hepatitis B
virus in serum or plasma. It is used for screening blood donors and diagnosing patients
related to infection with hepatitis B.

HEPATITIS C VIRUS

It is a RNA. virus. Acute phase is asymptomatic

This picture shows how hepatitis C is transmitted in injecting drug users.

HUMAN IMMUNODEFICIENCY VIRUS(HIV)

It is a RNA retrovirus. This infects the major cellular component of immune system and the
CNS, especially the T helper cells. The major cellular component for HIV is the CD4 antigen
which is present on helper The mode of transmission is through sexual contact,blood or blood
products and from mother to child. Infection with HIV has oral manifestations.

T H

The left one shows positive HIV test

Revised classification of HIV associated oral lesions 1990

Group 1.lesions strongly associated with HIV infections.

1.Candidiasis:erythematous,hyperplastic and pseudomembranous.

2.Hairy leukoplakia(EBV)

3.HIV gingivitis

4.Necrotising ulcerative gingivitis

5.HIV periodontitis
6. Kaposi’s sarcoma

7.Non hodgkins lymphoma

Group 2.lesions less commonly associated with HIV infection

1.A typical ulceration(oropharyngeal)

2.Idiopathic thrombocytopenic purpura.

3.salivary gland diseases (a) dry mouth due to decreased salivary flow rate( b)unilateral or
bilateral swelling of major salivary glands.

GROUP 3.lesions possibly associated with HIV infection

1.Bacteria infections excluding gingivitis / periodontitis (a)actinomycosis (b)enterobacter

cloacae(c)E.coli.(d)M.avium(e)klebsiella pneumonia

2. Cat scratch disease.

3.Exacerbation of apical periodontitis

4.fungal infection other than candiadiasis

NON HODGKIN’S LYMPHOMA

 HAIRY CELL LEUKOPLAKIA.

HERPETIC WHITLOW.

RECURRENT APTHOUS ULCERS

SIGNS AND SYMPTOMS OF HIV INFECTION

The WHO report on AIDS describes the various the various signs and symptoms of AIDS are:

EARLIER SIGNS OF HIV INFECTION

1.Unexplained weight loss of more than 10 percent of body weight

2.Unexplained fever lasting more than one month.

3Unexplained chronic diarrhea

4.Shingles(caused by herpes zoster virus)

5.Oral thrush(infection by a fungus ,Calbicans)

6.Oral hairy leukoplakia

7.Persistent generalized lymphadenopathy(PGL)

LATE SIGNS OF HIV INFECTION(AIDS)

AIDS is responsible for 2 main categories of disease

1.Opportunistic infections

2.Certain tumours

OPPURTUNISTIC INFECTIONS :The main signs of opportunistic infections are

a) LUNGS : cough, shortness of breath and chest pain

b) GASTROINTESTINAL TRACT :Difficulty in swallowing, nausea, vomiting, abdominal

pain, severe weight loss.

c) BRAIN- (1) Headache, impairment function, fits, peripheral and central paralysis, in
coordination and coma (2) Visual defects.

d) SKIN-(1) Perioral and oral ulceration (2) Genital and perianal ulceration.
CERTAIN TUMOURS:

A) Kaposis sarcoma
B) Lymphomas.

KAPOSIS SARCOMA
REFERENCES:

1.Text book of “oral and maxillofacial surgery” by NEELIMA ANIL MALIK

2.Sturdevant’s ART AND SCIENCS OF OPERATIVE DENTISTRY.

3.www.dentistry.co.uk

4.www.dentistrytoday.com

5. Textbook of community and Preventive dentistry by SOBEN PETER.