I have been seeing my dentist for the last 6-7 years. I am HIV poz and have developed major oral problems with gums and teeth during this time. As my condition escalated I began seeing my dentist more frequently while I had short term dental insurance from my employer while I am on disability. This dental insurance ran out within the first 18 months and I've not had any coverage since then. I've barely managed to keep up with the costs then and in the last two years have not been able to afford dental visits except in emergency cases.

It has been said to me that HIV kills the roots that feed the teeth their blood flow and subsequently causes them to crack or chip and eventually disintegrate. This is my current situation along with manifestations of constant gum infections and soreness which prevents me from eating as I had before.

My dentist has been networking within his field and has found cases that were similar to mine which were filed and paid under major medical insurance as a side effect condition to HIV elsewhere in the US. We had filed with my major medical insurance but have been denied saying it is covered under dental insurance and not major medical.

I am appealing their denial but am having a difficult time locating any documentation to support the hiv/oral relationship and cases.

Without major medical to pick up the costs for the now extensive work I need, I am left to either malnutrition, pain, and no teeth.

Can you direct me to pertinent published studies/research that substantiate this HIV related side effects?

Also is there anyone who can assist with HIV insurance claims that can help with my preparing an appeal to these claims being denied?

Thanks

rmarquis

Dear Marquis:

The problem you are having to deal with is why it is so important for people who are living with HIV/AIDS to be able to access dental care when your dental insurance runs out or if you are on disability or receiving care at a Ryan White CARE Act funded program.. Access to dental care still remains a serious problem for people living with HIV/AIDS. There are dental programs available for people who no longer have their dental insurance or who do not have funds available for care via the Ryan White CARE Act which I will refer to later in this response.

Although there has been much written and said about the relationship between antiretroviral therapy and rapidly advancing dental decay, the exact cause of this problem is still not known, nor does it manifest in everyone on HAART. There are a few theories as to why this occurs, the most commonly accepted is the relationship between severe dry mouth (xerostomia) and dental decay. HIV does not "kill the roots that feed the teeth". I would assume that the cause of your dental problems is related to dry mouth since you mentioned both antiretrovirals and antidepressants in the title of this posting. A note for others out there who are having similar dental problems, please have your dental or medical provider prescribe you fluoride therapies which will help prevent rapidly advancing dental decay. Also inquire about receiving in office fluoride therapies when you have your teeth cleaned.

I have not heard of any successful attempts to have dental care covered by medical insurance based on the cause of the problems with your oral health being related to consequences of HAART or HIV disease. I believe you will have a very difficult time trying to convince a medical insurance company to cover the costs of your dental care, even though I would love to see this happen for you and others. My advice would be to see if you can access dental care at a Ryan White CARE Act funded program or via a dental education facility such as a dental school. There are federal dollars available for dental care, it is just a matter of locating a provider or program who receives said funds. I would suggest you contact your state's Department of Human Resources to locate programs which receive Ryan White CARE Act funds or access the Referral Section of the HIVdent project which is located in our Resource Section to locate a participating dentist in your community.

I wish I could be of more assistance here, but even if even you were to search the Oral Manifestations Section of HIVdent for abstracts or articles that show an increased incidence of dental decay and periodontal problems in people living with HIV/AIDS, the process you are initiating would be a very long and difficult one. Please send me your email address through another question, which I will not post, so we can discuss these options further.

Hang in there!

DR