Hi Dr. Reznick. Glad to see that there is finally a forum dedicated to oral health and HIV! I have a question for you - if a person is HIV+, asymptomatic, and receives regular medical care from an infectious disease specialist, why is it necessary for said person to inform a dentist of their serostatus? Considering the biases of many dentists regarding treatment of those with HIV, I do not understand why a dentist would or should have the need to know a person's serostatus unless that person requires oral surgery, some type of special care due to disease progression itself, and/or that person develops an adverse oral reaction to HIV medications. In other words, as long as a person is exclusively in need of preventative dental care, is sure their dentist is practicing the appropriate universal precautions, and would consult their doctor for an appropriate referral if oral problems presented, why should they have to divulge their serostatus to their regular dentist? Is there any legal requirement that a dentist must know this information? What are the ethical considerations if one should decide not to inform their dentist? Thank you very much for your time and assistance.

I apologize for taking so long to address the important question, but I felt it necessary to carefully think this through before offering an opinion.

The first topic I would like to address is why some people with HIV are hesitant revealing their HIV status to their dentist. You are very correct in your observation that there are dentists who for one reason or another do show a negative bias towards HIV+ individuals. In my opinion there are a few reasons for this: fear of contracting the virus (although there are not any documented cases of dental health care workers getting HIV disease in the dental setting), fear of the unknown (not understanding HIV disease or being familiar with the medications or opportunistic infections involved) and prejudice. To help tackle some of these issues we put together the HIVdent Internet project to address concerns on infection control, dental treatment considerations for HIV+ individuals, oral manifestations, medical issues, commonly used medications, drug interactions, etc. The idea is that through education we can alleviate some of these unfounded concerns. There is not much we can do to address the issues surrounding prejudice, except to continue to press forward with our efforts to educate.

Another important point to bring up is that people living with HIV/AIDS are covered under the Americans with Disabilities Act, there fore they should be allowed access to places of public accommodation, including dental offices. This Act was recently upheld at the level of the Supreme Court in the case of Abbott vs. Bragdon.

Now, why is it important to let your dentist know of your status. My first argument for filling out your medical history accurately would be that dentistry is an integral part of primary care. Many of the initial signs and symptoms of disease progression are evident in the oral cavity. So even though you may be scheduled for a dental cleaning, the dentist should come in and do a complete examination of both the hard (teeth) and soft tissues of the mouth and check for any signs of change. Whereas this should happen for all dental patients, no matter if their serostatus is known or not, there are certain signs and symptoms that dental personnel should be able to recognize that would prove beneficial to your overall well-being. It is very important that dental health care workers have all information available in order to provide the optimum care. Another issue would be drug interactions. If you do not list medications that you are on (which would be the case if you did not divulge your medical status) , the dentist may write a prescription for a medication that will have serious interactions with certain medications used to fight off HIV such as protease inhibitors. You asked about potential legal ramifications. Whereas I do not even pretend to have any expertise in this area, if a person visited the dental office and had a serious reaction to a medication used or any medical consequence to a procedure performed, they probably would not have much of a chance in the legal setting because they did not accurately fill out the medical history.

I would like to end my response by stating the following: In the mid 1980s, when I originally started to put the program I direct together, access to dental care for people living with HIV disease was shamefully difficult. Following the Acer case, it only became worse. Through the efforts of the American Association of Dental Schools (via participation in the Ryan White Dental Reimbursement program, the AIDS Education and Training Centers, the American Dental Association, consumers, and educational tools such as HIVdent, we are making serious progress in changing the attitudes of dental health care workers. We also realize that there still is a great deal of work which needs to be done.

Regards,

DR