May 6, 2010
Should HIV Testing Be a Routine Part of Dental Care?
by Kate Ferguson
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.
Watch the video interview below.
Search: Oral care, HIV testing, Dr. Catrise Austin, dentists
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