Knowledge, attitudes, behaviour and prevalence of TB infection among dentists in the western Cape

Tuberculosis (TB) remains the most important communicable disease in the world and in South Africa it accounts for 80% of all notifiable diseases. The impact of HIV on the TB epidemic is potentially catastrophic. HIV increases the susceptibility of the HIV-positive person to TB. The resurgence of TB as a public health problem has rekindled interest in this disease among oral health workers. The major concern is the risk of transmission in the dental setting. The aim of this study was to determine the prevalence of TB among dental practitioners and to assess their knowledge, attitudes and practices pertaining to TB. A cross-sectional survey was carried out. A structured questionnaire was used to obtain information on demography, infection control, TB status, behaviour, knowledge and perceived risk. In addition, Mantoux and multipuncture tests were performed to assess prevalence. The response rate was 78%. The sample consisted of 78 dentists, 80% male, with a mean age of 40 years. Ninety-two per cent reported always using gloves, 78% masks (68% surgical masks and 18% paper masks) and 50% glasses when treating patients. Two-thirds reported that they sterilise suction and three-in-one tips. Only 11% reported use of a rubber dam. No practitioner reported the use of high-volume externally vented aspirators or ultraviolet germicidal irradiation. Five per cent reported ever being diagnosed with TB, all after having qualified as a dentist. Half of the sample reported having being vaccinated against TB. The prevalence of those who developed a positive reaction was 33%. Thirty-one per cent reported having referred a patient suspected of having TB for further diagnosis and management. Dentists have a duty to take appropriate precautions to protect themselves, their staff and their patients from the risk of cross-infection. The implementation of infection control policies is critical to the provision of such protection. In addition, a dental health facility provides the opportunity for TB screening which has not as yet been tapped into to its fullest extent in a developing country setting where TB is endemic. Referral and integration of TB screening in high HIV and TB prevalence areas will provide early diagnosis, treatment of TB and possibly prevention and reduced risk of nosocomial infection.