HPV oral and oropharyngeal cancers are more difficult to detect than tobacco-related cancers because the symptoms are not always obvious to an individual, and health professionals may lack the education and background to diagnose HPV-related lesions. Although there are many adjunctive oral cancer screening devices and tests, none of them can currently detect early-stage HPV-positive oral and oropharyngeal cancers. My rule of thumb: Any lesion that persists for 2 weeks should be referred to an oral medicine specialist or oral surgeon to evaluate and biopsy, if indicated.
While enrolled in graduate school at the Rutgers University School of Nursing, I continued to work as registered nurse on a labor and delivery unit at an increasingly busy community hospital in central New Jersey. Though my unit boasts delivery rates exceeding 2,000 births per year, most of our patients are middle-class, low-risk women in their 30's giving birth to planned pregnancies carried to term. Though not a new nurse, at the time I was new to the labor unit, and happened to be on my final days of orientation when I received report on a primigravida in her early 20's in active labor.
Nurses are on the front-lines of increasing access to health care and, as a nurse, my first priority is always the patient. A recent case demonstrates the importance of the role of nursing in providing needed services for patients. In this case, a young person was a victim of sexual assault resulting in HIV exposure. The MidAtlantic AETC had conducted training on post-exposure prophylaxis (PEP) and one of our participants in that training was responsible for making sure that the patient received nPEP.
What is a dental emergency?
I often get this question from non-dental personnel including case managers, physician assistants, nurses, and nurse practitioners. The following is a short list of questions you can ask patients to guide dental referrals for emergency care:
In September 2017, the U.S. Centers for Disease Control and Prevention (CDC) officially recognized that suppressing HIV through antiretroviral therapy (ART) prevents sexual transmission of HIV. In a "Dear Colleague" letter, CDC officials said, "people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner."
A recent study that was conducted among 1200 HIV patient of whom 600 each belonged to with ART and without ART and the occurrence of oral candidiasis and oral hairy leukoplakia. This study shows that oral candidiasis and leukoplakia was less among patients on ART as well as a decrease in the number of opportunistic infections. This is important as oral manifestations might serve as an important marker for monitoring restoration of immune function and ART failure.
The question I most commonly get asked by oral health providers is...
Do I pre-medicate patients based on a high viral load and low CD4 count?
It is estimated that 1.1 million people in the United States are living with HIV. Of those, 1 in 7 do not know they are infected. The number of new HIV diagnoses fell 19% from 2005 to 2014. Because HIV testing rates have remained stable or increased in recent years, this decrease in diagnoses suggests a true decline in new infections. The statistics in the Southern United States are not as promising.
The U.S. Department of Health and Human Services currently recommends that every person living with HIV begin antiretroviral therapy (ART) as soon as possible after diagnosis.