September 8, 2009

Mouth Full of Problems: A Crisis in HIV Dental Care

Too few people with HIV get the routine oral health care they need to stay healthy. The teetering economy, experts say, might make the situation a whole lot worse.

Not accessing dental care can be deadly. In early 2007, a 12-year-old boy named Deamonte Driver from suburban Washington, DC, died of an infection that had spread from an abscess in his mouth to his brain. His family’s Medicaid had lapsed because of a technicality, so he didn’t get care until his mother took the by then very ill boy into an emergency room. Experts say an $80 tooth extraction, if done early enough, could have saved his life.

Though Driver’s HIV-status was never reported, and there hasn’t been wide press coverage of a similar story involving an openly HIV-positive person, David Reznick, DDS, head of the HIV Dental Alliance in Atlanta, says that all the necessary ingredients to create such a tragedy are already in place—and could be getting worse.

People with HIV are simultaneously more likely than their HIV-negative counterparts to have more frequent and more serious oral health issues, while being less likely to have the funds and insurance to cover necessary procedures. The public support that is available for providing clinical oral health care to people with HIV, Reznick says, is drying up as various states confront catastrophic budget crises. “We’re just not seeing enough [funding] increases to take care of the people we already serve,” Reznick laments, “So it’s an overwhelming need and no resources to pay for it.”

Open Wide

People rarely think—at least until their face is horribly swollen and they’re immobilized with pain—that oral health care can have much of an impact on their overall well-being. According to Reznick, however, a neglected mouth can lead to more than localized tooth pain: Tooth and gum infections can spread to other parts of the body, and mouth pain can cause people to go without necessary nutrition—and even cause them to forgo their HIV medications.

“If you’re in an extraordinary amount of pain, you’re not going to be able to take your medications,” he explains. “If you don’t have any teeth to chew with, how are you going to get the nutrition you need to stay healthy?”

Reznick also has concerns about chronic inflammation from untreated periodontal disease. A growing number of studies are illuminating the role of inflammation in a variety of non-AIDS-related health problems such as cardiovascular disease. The link between gum and heart disease has been proposed in HIV-negative people, and some evidence suggests it to be true.

For all of these reasons, preventive dental care can have a tremendous influence on a person’s overall well-being.

Unfortunately, many people with HIV don’t know or understand the importance of regular preventive dental care. According to the Health Resources and Services Administration (HRSA), people with HIV who are uninsured are three times as likely to have untreated dental needs as people with HIV who have insurance. HRSA also states, “Moreover, oral infections, mouth ulcers and other severe dental conditions associated with HIV infections go untreated more than twice as often as other health problems related to the disease.”

Roadblocks to Care

Reznick says that HIV stigma and cultural habits against seeking dental care are two big reasons that people fail to go to the dentist regularly even when they have coverage or access to a dentist through public or private benefits. But even among people who want to go to a dentist as often as is recommended—at least once every six months for a thorough cleaning and checkup—lack of insurance or comprehensive public benefits can mean going without. Given the severe budget woes of most states right now, publicly funded dental care is not expanding sufficiently to meet the growing epidemic. In fact, in many areas it is shrinking.

In most cities and towns, the only options for people without dental insurance are oral care programs covered by the Ryan White CARE Act or Medicaid. Ryan White, however, has been essentially flat-funded for several years, and Medicaid dental coverage, already stingy in many states, is beginning to disappear. “Without the Ryan White dollars, there’s minimal access,” Reznick says. “With states that had adult benefits through Medicaid who have lost them, it’s caused a gigantic crunch.”

“We’re struggling to keep up with the need,” Reznick explains, “because people are living longer, and more people are getting tested and entering into the system of care. So we’re literally booked through until November, and I have eight dental chairs and over three full-time dentists and three hygienists, and we’re having a very difficult time meeting the need.”

Reznick hopes that policymakers and people living with HIV understand the consequences of too-little access to good oral health care. Aside from the pain and illness it will almost certainly cause, Reznick contends, it will also end up costing more money in the long run. He is hoping for increases, rather than additional cuts, to services. When people don’t get preventive care, Reznick says, “they end up in the emergency department, and that’s going to cost the public a whole lot more than if they would have kept the benefits in place.”

Search: oral health, dental, teeth, mouth, gum, periodontal disease, David Reznick, HIV Dental Alliance, Grady, Deamonte Driver, inflammation

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Previous Comments:

Garry Singletary, Elizabeth City,NC, 2010-06-22 16:56:09
I am missing a front tooth, most of my teeth in the back of my mouth are dead and broken off. There is no Ryan White funding here. There are NO clinics here, and Dentists don't take payments. I have taken care of my teeth flossing and brushing after each meal, but still I have these problems. What am I supposed to do? For that matter waht are WE supposed to do?

Robert T. J., Chicago, 2010-03-02 03:32:29
Fortunately for me, I live in one of major U.S. metropolitan areas where good dental care for positive persons is readily available and accessible. There are several teaching hospitals with dental clinics specifically for positive people, as well as dental clinics at not-for-profit community health centers that effectively treat positive clients. I have been positive for 9 years and have not suffered any dental problems or opportunistic infections. Major metro areas have health benefits

TakinCare, , 2010-01-28 11:48:14
I have noticed that whereas before, when I was not HIV +, the dentists were always finding work and things that needed to be done, now that I report my status they seldom spend more than four minutes looking in my mouth and they say no problems...even when I can feel cavities.I'd be happy if I didn't have tooth problems, but I think I'm not the only one with issues here. It gets kind of frustrating to be treated this way when with medication I don't pose much risk.

pete, auburndale,FL, 2010-01-27 19:26:21
Best move to Canada, pay your own way (at sharply discounted prices for HIV meds) for 2 years, then you can apply for HealthCanada. Or, stick it out in this frikken country and focus all your efforts on making yourself rich, and just remember-The end justifies the means-i.e.Capitalism! Yay!

Pierce, West Hollywood, CA, 2010-01-27 06:39:11
Even, in isolated cases, when you DO take care of your teeth by brushing & flossing religiously & getting in to see the dentist regularly, a cavity can sneak in, slowly, through the backside, & underneath an old, worn crown--undetected by x-rays OR the dentist (as in my case)--inevitably creating havoc by leading to an abcess & severe complication, in SPITE of finally undergoing a root canal! So this does NOT just happen to the negligent! The dental-DILIGENT can be at risk here also.

Terry, San Francisco, 2010-01-19 01:39:58
I tested poz in 1986. I've had a few O.I.s I have less than 100 t-cells and periodontal disease. I paid for a cleaning and a check up, the estimate for dental work came back as $22,000. That was a year ago. I'm SSI 20K is slightly more than I make a year. I cannot find a low cost dental clinic, and the possibility of getting good care seems impossible. I hate being hopeless, but I am. I'm worried that I've lived this long and my fking teeth are going to kill me.

rino, Indian Rocks Beach, FL, 2009-10-28 22:21:36
I am writing at the end of October 2009. I guess I should feel lucky that I got an appointment to see a Ryan White dental care provider in June 2010. In the meantime, I hope that my old cavity whose filling came out last month, won't get the idea of getting infected or anything like that. Thank god I take excellent care of my oral health ... I don't know if to laugh or cry from the absurdity of it all.

bobby, tacoma, 2009-10-25 04:19:32
I brush and floss but i recently had a filling fall out. I went to the only dentist in my area that will work with the ryan white fund. I have to wait another 4 months to go back and have it filled, by then it will probably need a root canall. Boy what good use of the funds. I found several dentist that will work if i pay them up front and none of them will take payments. I am also diabetic and been told teeth health is extra inportant. extremly furstrated

jboy, New York, NY, 2009-10-21 16:29:11
People!! Remember to brush and floss twice a day. EVERY DAY. I am hiv positive 5yrs, I actually take care of myself, and Ive never had any dental problems.

LLOYD69, Lakeland, 2009-10-12 04:26:31
Yes I agree dental care is not really accesssible for HIV folks I personal keep getting infections in my teeth and gums. And going to or finding a dentist that is willing to help me was really hard because of being positive and the fact that I am always honest about my status and tell them up front. So I finally found a surgeon in another county to just remove them all at my expense and now I live with out the pain and infection all the time but also have to do with out any teeth right now..

Edache Anejo, Abuja Nigeria, 2009-10-06 17:19:14
I am grateful to you for publishing such helpful informations online. However, mine is to make an inquiry. Often,i experience those mouth ulcers when I have malaria. Why is it so

Marc, vallejo, CA, 2009-10-06 13:19:26
where can I go in the SF Bay area for Ryan White funded Dental Care... I haven't been to a dentist in over 2 years... and I'm over due

achona, bronx, new york, 2009-09-27 07:27:29
I have one big problem currently. I have full denture on the top and on the bottom I had partial, however I had to have other teeth removed on the bottom thus leaving me with no bottom denture. Currently I've been having pain in the tooth on the back however my insurance coverage told me I'm not eligible for denture until five years, thus leaving me without any bottom denture, what can I do, I've notice the back tooth is really painful, yet I can't get dentues for the bottom until 2012

J. Combs, Gaithersburg, 2009-09-22 14:25:35
Does anyone find it ironic that there are so many Dentists who proclaim the need to keep up one's dental health, but, seeing them is so expensive, or, they "can't" see you because they are so busy. Jane & I can only see a Dentist if a tooth is hurting. Other than that, anything else is out of our budget, and she is in dire need of Dental care.

pozbronie, , 2009-09-21 10:50:53
Please take care of your teeth. Oral health is important for over all health. I love my dentist!! Tragic that a childs like was lost as a result of poor health care and technicalities. Times like these make me cry for mankind and applaud the efforts of those making an effort for change. ;-)