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A frequent problem experienced by many HIV/AIDS patients is the lack of access to reliable dental care services.
Each year, December 1st is internationally recognized as World AIDS Day. The day is hallmarked by efforts to support the millions of people worldwide living with HIV/AIDS, to remember those who have died, and to unite people globally in efforts to combat the disease.
The virus was first identified in 1984, and since then more than 35 million people have died from it. Currently, there are an estimated 34 million people living with HIV all over the world. The United States Centers for Disease Control and Prevention (CDC) estimates that, in 2015, 39,513 new people were diagnosed with HIV in the United States. However, the numbers of people infected have fallen in recent years, thanks in part to educational efforts targeting at-risk populations and increased access to more reliable diagnostic testing methods.
You might have treated patients diagnosed with HIV already. With the other physiological problems caused by the virus, it’s easy for these patients to overlook their dental care in favor of more pressing issues. As a dentist, it’s your responsibility to assist HIV/AIDS patients in dealing with their oral health problems before they spiral out of control.
A Common Barrier to Receiving Dental Care
A frequent problem experienced by many HIV/AIDS patients is the lack of access to reliable dental care services. Many of the common oral health problems associated with HIV are easily treatable, but patients still report discrimination and fear from dental providers when they seek out help. A study published by the Williams Institute in 2011 focused on discrimination against HIV/AIDS patients living in Los Angeles County, CA. It was found that 5% of dental practices in the county refused to see a patient on the sole basis of their HIV diagnosis.
Discrimination against a person because they have been diagnosed with HIV is illegal. In fact, the Americans with Disabilities Act (ADA) grants federal civil rights protections to patients who have been diagnosed with the disease, and they can make complaints on the basis of disability discrimination to the federal government. Violators of the disability law can be summoned for mediation with the complainant, or, in some cases, be sued in federal court.
Oral Health Problems Resulting from HIV/AIDS
After infection with HIV, the mouth might be the first area of the body in which symptoms of the disease appear. Some oral infections, like candidiasis (thrush), are opportunistic and will flourish when the body’s immune system is not working as it should. The virus makes patients more susceptible to many types of oral health problems, including:
· Dry mouth
· Oral warts
· Fever blisters
· Canker sores
· Dental caries
· Tooth decay
Dentists know that many of these problems, if left untreated, can lead to much more serious problems later on, including oral cancer. Infections in the mouth can also cause serious systemic infections, which place more stress on the body’s immune system. The number of CD4 cells, a type of white blood cell that identifies infectious pathogens within the body and “flags” them for elimination by the rest of the immune system, is reduced. In turn, this causes an increase in the HIV viral load, or the amount of the virus that is present in the patient’s blood.
Dental Management of HIV/AIDS
Today, HIV/AIDS is managed as a chronic disease across the dental and medical fields. It is critically important that HIV patients maintain a regular treatment schedule with their dentists. Since the goal of treatment is to decrease viral load as much as possible, dentists are in a unique, front-line position to help these patients stay as healthy as they can for as long as they can.
First, it is important to have conversations with your patients regarding their HIV status. Realizing that you cannot discriminate against a patient on the basis of their diagnosis, you can begin a dialogue, using tools like a health history form, that explores the patient’s medical history and any chronic health conditions. Having this conversation during an initial consolation with every new patient could help to ease fears of discrimination and allow you to treat your patients at your most informed, in as safe a way as possible.
Since oral health problems are some of the first indicators of disease, dentists are in prime position to recognize some of the more common initial clinical manifestations of HIV. Additionally, there have been significant advances in the ability to quickly and accurately diagnose HIV in patients at the initial point of care. Since individuals are more likely to see dentists more frequently than other healthcare providers, your dental practice is a unique setting in which to perform a rapid HIV test. The OraQuick HIV Test involves the collection of oral fluids on a swab, with results available in 20 minutes. If results are positive, it is well within a dentist’s scope of practice to refer the patient for further medical testing and confirmation of the diagnosis.
Disease management in your dental practice also involves keeping your HIV patients as comfortable as possible so they can eat. Many treatment drugs must be taken with food, but oral lesions are a common problem experienced by this patient population. Treating these painful lesions allows the patient to eat more comfortably and better adhere to their treatment plan. It is also appropriate to consider products that increase saliva production or otherwise help in the management of dry mouth. Referrals to specialists for problems like hairy leukoplakia or other periodontal conditions is also appropriate and sometimes necessary.
Managing the HIV virus in your dental patients is a long-haul effort that will require extra work and communication. As a dentist, you can help HIV patients achieve the maximum quality of life possible. Dentists are vital components of the treatment team for these patients, and your work can help make the difference in the longevity and comfort of this particular patient population.