Dear Dr. Reznik, how important is it for my dentist to know about my HIV status? I have no oral infections or pathologies, my blood work results are very good and I am not on any medication. I need to see my dentist for some minor repair work on one tooth and a possible extraction of another. I understand that universal precautions are mandatory at every dental surgery but was advised by my HIV doctor that I should disclose my status anyway 'out of courtesy'. I also understand that my oral health should be monitored closely but I do not have any problems with it right now and would not really want to disclose just yet. How does it work: universal precautions and courtesy of patients? Please let me know how you view this issue and whether you would like your patients disclose their HIV status at your office? I have my next appointment on 8 May. I would really appreciate your insight. -A.

Dear A.:

You ask a most important question! It is my belief that oral health is an integral part of primary care, therefore any changes in your medical history, including HIV status, should be made known to your dental care provider. As you mentioned in this question, your oral health should be monitored closely as early signs of disease progression can first present in the mouth. The same can be said for a person living with many other conditions including diabetes and cancer. Changes to the soft tissues including oral hairy leukoplakia and candidiasis can be diagnostic of increased viral load and signal a need to begin antiretroviral therapy. I believe these points are a much better reason to inform your dentist than the message you received to inform out of courtesy. Not all dental health care workers realize the importance of these signs and symptoms, but if made aware of your status, they may pay more attention to soft tissue exams.

Now for the reality check:

Whereas attitudes toward treating HIV-infected people in the dental setting have improved, there are still providers who would rather not. Even though the American's with Disabilities Act includes access to places of public accommodation, such as dental offices, many choose not to pursue legal action when denied care. Many do not want to risk rejection in the first place, thus the reluctance to disclose HIV status.

My question to you: would you want someone taking care of your present dental needs who would not if they knew your HIV status?

I hope this helps…..

Sincerely,

DR