HIV/AIDS and the Role of the Dentist

The good news is that transmission of HIV from a dentist to patient is very unlikely (Jaffe et al., 1994). In fact, patient-to-patient infection didn’t seem to occur in one dentist’s practice in spite of the fact that the dentist didn’t follow proper infection control practices – dental tools were not autoclaved after use and were treated with a disinfectant not recommended for disinfecting dental instruments. Also, dental lines were not flushed between patients, which can result in one patient’s tissue being expelled in the next patient’s mouth. Transmission from dentist-to-patient is known to have only occurred once - a Florida dentist infecting 6 patients. Patient-to-patient transmission is known to have occurred only once too.

Almost all AIDS patients will develop oral manifestations of the disease (Weinert et al., 1996), so the dentist definitely has a role in the management of HIV/AIDS patients. The frequency and type of oral lesion depends on the stage of the disease and degree of immunosuppression of the patient. During late stage infection more than 20% of patients experience at least one of the following oral conditions: aphthous ulcers, oral thrush, Kaposi’s sarcoma, oral hairy leukoplakia and linear gingival erythema. Left untreated these conditions can lead to the patient having difficulty talking, chewing and swallowing. Periodontal disease is also common.

HIV is infrequently transmitted orally because there are low numbers of CD4 cell targets and the presence of anti-HIV antibodies and anti-viral factors in the saliva as well as there being thick epithelial wall in the oral cavity (Shugars and Wahl, 1998). HIV recovery from the saliva is very poor.

Dental infection protocols are designed to reduce transmission of infection from any body fluid. In other words treat all patients as if all their body fluids are infectious. Dentists need to be able to recognise the oral features of HIV infection, manage their oral symptoms and understand the systemic effects of HIV, including their mental health and behaviour (Mulligan et al., 2006).

HIV/AIDS patients are likely to not disclose their HIV status to the dentist. One of the reasons for not disclosing is the attitude of the dentist. Some dentists stigmatise HIV/AIDS patients (Seacat et al, 2009). This means that dentists should always use Universal precautions and to display an empathetic attitude towards all patients. 46% of AIDS patients admit to not telling the dentist of their status at least once. Yet over 80% of HIV/AIDS patients would prefer their dentist did know their status (Charbonneau, 1999). The situation where it is most important to know a patient’s HIV status is perhaps after the dentist sustains a needle stick injury and the decision of whether to take antiviral prophylaxis needs to be made based on that patient’s HIV status.

Charbonneau A, Maheux B, Beland F (1999). Do people with HIV/AIDS disclose their HIV-positivity to dentists? AIDS Care. Abingdon vol 11, Iss. 1; pg. 61, 10 pgs

Jaffe HW, McCurdy JM, Kalish ML, Liberti T, Metellus G, Bowman BH, Richards SB, Neasman AR, Witte JJ (1994). Lack of HIV Transmission in the Practice of a Dentist with AIDS. Annals of Internal Medicine 855-859.

Mulligan R, Seirawan H, Galligan J, Lemme S (2006). The Effect of an HIV/AIDS Educational Program on the Knowledge, Attitudes, and Behaviors of Dental Professionals. Journal of Dental Education 70: 857 - 868.

Seacat JD, Litt MD, Daniels AS (2009). Dental Students Treating Patients Living with HIV/AIDS: The Influence of Attitudes and HIV Knowledge. Journal of Dental Education 73: 437 - 444.

Shugars DC, Wahl SM (1998). The Role of the Oral Environment in HIV-1 Transmission. Journal of the American Dental Association 129: 851 - 858.

Weinert M, Grimes RM, Lynch DP (1996).Oral Manifestations of HIV Infection. Annals of Internal Medicine 485-496.