May 17, 2010

Should HIV Testing Be a Routine Part of Dental Care?

Some physicians say yes—because many people who don’t know their HIV status do regularly visit the dentist.

A staggering 3.6 million Americans say they’re at risk of HIV but haven’t been tested, according to a 2005 survey. Researchers are hoping to change this imbalance by introducing HIV tests to an unexpected setting: the dentist office.

The proposal makes a surprising amount of common sense. First off, Americans routinely seek dental care, so if dentists include HIV tests as part of their standard care, potentially millions of people could become aware of their status.

Then there’s the fact that dentists, in many cases, are the first health care professionals to come across visible signs that a person is HIV positive. This is because oral problems are often the first symptom of HIV infection and may signal clinical progression of the disease.

Common oral symptoms of HIV fall into several categories: fungal, viral and bacterial infections, and neoplasms (such as the oral lesions of Kaposi’s sarcoma and large, ulcerated masses on the palate or gums that typifies non-Hodgkin’s lymphoma). Nonspecific presentations also show up, such as salivary gland diseases, dry mouth (xerostomia) and small, round ulcers called canker sores (or apthous ulcers).

If a dentist notices these symptoms, it’s even more vital that the patient be tested for HIV. Nowadays, that’s easier than ever. HIV can be screened with rapid noninvasive saliva, blood or plasma tests, such as the OraQuick Advance Rapid HIV-1/2 Antibody Test. With these simple tests, it’s easier than ever for dentists to screen people for HIV and connect them to care, should they test positive.

“As dental providers, we see our clients at least twice a year, so we’re able to check for cavities, gum disease and other oral diseases,” says Catrise Austin, DDS, a cosmetic and general dentist in New York City. “When I learned that OraSure HIV Rapid testing involved just swabbing the mouth and putting the swab into a developing solution and you get the results in 20 minutes, I thought that it only made sense that dentists start offering this service.”

But a study about routine HIV testing by dentists, published in the Journal of Dental Education, suggests that there is more to it than just a quick swab of the mouth. Physicians must resolve important ethical and legal issues before testing can be successful in dental offices.

Some of these issues revolve around the dentists’ responsibilities in terms of patient consent, HIV education, counseling and notification. Then there’s the issue of paying for the testing costs to both dentist and patient.

The study also discussed other challenges to successful HIV testing in dental offices. In addition to learning the intricate science behind HIV/AIDS, dentists must have the appropriate oral HIV test training. They must know their states’ HIV-specific privacy and confidentiality requirements. And they must be able to connect patients to care.

The good news is that some dentists, like Austin, have had no trouble getting prepared. She took a certification and training course and offers HIV testing as a free service in her office.

“I contacted the New York State Department of Health,” Austin says. “It was very easy, and it only took, maybe, a month to a month and a half to get the credentials to do [testing], and the program is going very well.”

The bad news is that not many dentists offer HIV testing as part of their routine dental care. In addition, there is a disconnect between some state laws and the latest Centers for Disease Control and Prevention (CDC) guidelines, which recommends that doctors eliminate formal pretest counseling and specific written informed consent for HIV testing.

“Patients could be offered the test and then can accept or refuse,” researchers say. “But patients must be informed explicitly that the dentist will test for HIV infection unless they refuse.”

This procedure is called routine opt-out screening. The CDC believes that it would result in more people being tested for the virus, reduce the potential of HIV transmission and zoom patients into early treatment.

But if dentists in certain states try to follow the CDC’s recommended guidelines, they may face legal problems. Which is why researchers recommend that dentists press state legislators to reform their laws to comply with the new national guidelines.

As professionals on the cutting edge of comprehensive health care, dentists are in a unique position to minister to people’s needs.

Today, the health and wellness industry is undergoing rapid change prompted by health care reform. Dentists and other health care professionals are increasingly moving toward a more medically holistic approach to health. This means that doctors act more like a team working together to get and keep their patients healthy.

“HIV testing is something that’s new to our industry,” Austin says. “One of my goals is to talk about it with groups of dentists. This would be something that’s good for dentists to offer as part of their routine care.”

All it would take in a busy dental practice, researchers stress, is for dentists to present the preliminary test result and then refer patients to their physicians.

In Austin’s office this is the way she offers the test, smoothly offering HIV testing as a new service that’s “quick and painless” with the clincher that patients will have the results in 20 minutes.

“Many patients find that it’s very convenient to not have to go to a medical doctor to get the testing done,” Austin says. “Some of them have even commented that their medical doctor never even offered the test.”

But the most important thing, Austin says, is that she stresses to her patients that they need to know their HIV status.

Search: Dental care, HIV testing, Catrise Austin, DDS, OraQuick Advance Rapid HIV-1/2 Antibody Test

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Previous Comments:

JB, Georgia, 2010-06-27 22:08:48
I think universal precautions should be used in any healthcare/dental facility in regards to blood and body fluids. However, I disagree with those that think the dentist office is the appropriate place that should require HIV testing. It's hard enough going to the grocery store in my town and seeing staff from my infectious disease doctors office now I have to see the dental assistant too. Great let's add to my depression

Grace, usa, 2010-06-18 19:47:08
As much as I want to see more people tested, I believe in informed consent, not opt-out testing, which might allow rights to be trampled. Also, dentists need to be trained to deal with the social and emotional impact of finding out, as well as stigma training. Otherwise, it would be awful to find out at your dentist's, and then just be shuffled off to an ASO. How someone handles that initial informing of one's status, can set the course for whether that person connects to care, or not.

BAM, , 2010-06-07 23:51:42
Testing at your dentist? I don't think it would work. I rencently went to a new dentist in Hollywood and they seemed somewhat distressed by my disclosure. This has been my general experience with most dentists and I live in LA, I can only imagine what it would be like in a small town. I say sell OraQuick tests at the drug store and you will have a lot more people testing.

Jules Rivera, New York, 2010-06-02 14:49:40
Really if you think about it....what population really goes to the dentist???? who will be tested? I think this is great. I believe this should be the standard for all medical fields, not just dentist offices.

poz atlanta, atlanta, 2010-06-02 08:48:25
i think hiv dentist need to stop risking their patients health! and they should be subject to ethics board and oversight committee, dentist stop putting patients health at risk because you think you are above the laws. and manage your clinics better so patients can be seen when they have a health threatening situation that included dental health that affects physical well-being.

JA, , 2010-05-28 03:15:41
No way!! Are you in dreamland peoples?? Dan from Florida - you are right. Zwollywood from the Netherlands - this is exactly what can and does happen when dental professionals become aware of your status.I am a dentist and know only too well the hidden attitudes of many of my colleagues towards HIV. Your dentist doesn't need to know your status - EVER. But you as an individual should know and this should be done in the appropriate place by the appropriate professionals!

CE, Florida, 2010-05-25 15:39:13
Well after the story and the comments I am going to say WOW! I have been POZ for over 20 yrs. Probably longer. The reason I did not get tested is it was not readily available as well as The stigma connected with it! I feel that the CDC should change what they need too. As well it is bad when it comes to culture and what your friends and family think of you. Then when some one see you coming or going from a know HIV/AIDS place. We the people need to stop thinking the way we do! GOOD LUCK on That

Elizabeth P. Robinson, Riviera Beach, 2010-05-25 15:23:31
Cases of HIV continue to rise in spite of our efforts to educate our community. More funding and attention must be paid to PREVENTION! Relax HIV counseling and testing requirements. Go back to anonymous testing to save the people or continue the way we are going and watch them DIE too early!

MIke, Tampa, 2010-05-25 12:57:24
Its naive to think so many go to the dentist. Most I know don't have any coverage, and can't afford even 1 check up a yr, or flat out don't go until they have a tooth problem. The demographic of young & those at risk are amongst the groups that can not afford dental which is every bit as expensive as any medical. I just got a crown that was $1,750,.without coverage I would have waited to have the tooth pulled, its that simple. No to this anyway, it will be used against the person.

Dave, Nashville, 2010-05-25 12:16:26
It's an idea whose time has come. It will help de-stigmatize HIV and make it more mainstream to be tested. There are many ways to get HIV, MSM does Not have the sole proprietorship over contracting HIV. We are discussing it here in Nashville in hopes of bringing this forward to the 21st Century.

keegan, Philadelphia, 2010-05-23 13:51:09
This is a loaded debate and will never be something everyone can agree on. But I think it should be mandatory for HIV testing for every citizen. Private and confidential but mandatory. It is the responsibility to yourself and fellow citizen to be tested to prevent the continued spread of this virus. Ignorance is not an excuse for not being tested. Just do it!

luis, , 2010-05-22 18:49:57
I think its a good idea to make testing as convenient as possible. On the same note,I remember my opthamologist asking me how my immune system was doing 2 years before i was diagnosed. Although I thought it was a strange question the connection never occured to me. I had no idea or reason to believe i had been exposed at at the time and only after do i look back and wish I had questioned why he was asking.

Dan, Florida, 2010-05-22 09:19:59
NEVER! I still remember the day this profession banned those with HIV from there office or wore excessive protective gear. Now you want them to test and counsel?

Peter, Detroit, 2010-05-21 13:27:43
This is an interesting idea that deserves more attention. My immediate concern is would the dentist or other staff person be able to counsel a patient with a preliminary positive result, and then refer for the confirmatory test? But this is just testing, not true prevention. How many dentists feel comfortable discussing sex, sexuality, and needle sharing with their patients - such as initiating a discussion on how long to wait after an extraction before engaging in oral sex?

Zwollywood, Netherlands, 2010-05-21 05:24:42
I was diagnosed after a visit to the mouth hygienist. She recognised hiv-lesions in my mouth. If it had not been for her I would of not known, and could be dead by now. However, since my dental practice has been aware of status I now am only allowed appointments at the end of the day, a practice I hear is common. I was being honest and fair to my dentist now feel slighty discriminated against. Are all patients honest to their dentist in informing them of health conditions????