AIDS and Dental Treatment

[mellowt]

I was just simply wondering what one would do if a patient told them they were HIV positive and needed an extraction or root canal where transmission is possible.
I am taking an AIDS course right now and learned that a dentist in Maine did not want to treat the HIV positive patient and referred her to a hospital about 10 or so miles away. To the best of my memory, I believe she sued and won initially with a vote of 5 to 4 and an appeals court upheld. So what would you do?

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[scalpel2008]

I was just simply wondering what one would do if a patient told them they were HIV positive and needed an extraction or root canal where transmission is possible.
I am taking an AIDS course right now and learned that a dentist in Maine did not want to treat the HIV positive patient and referred her to a hospital about 10 or so miles away. To the best of my memory, I believe she sued and won initially with a vote of 5 to 4 but the appeals court later turned it over. So what would you do?

treat them

 

[phremius]

I was just simply wondering what one would do if a patient told them they were HIV positive and needed an extraction or root canal where transmission is possible.
I am taking an AIDS course right now and learned that a dentist in Maine did not want to treat the HIV positive patient and referred her to a hospital about 10 or so miles away. To the best of my memory, I believe she sued and won initially with a vote of 5 to 4 but the appeals court later turned it over. So what would you do?

this is even a question?? You treat them, we have gloves and stuff for a reason!

HIV is a ***** virus when it comes to transmission. Don't be a rookie about it.

 

[mellowt]

Yeah I would treat since theres not much for debate and it is safe to treat HIV positive patients. I just thought it weird that the dentist refused treatment and this was in the mid 1990's.

 

[crazy_sherm]

You treat every patient as if they had HIV, HBV, HCV, etc because you never know. They might not even know. The only time I would refuse to treat someone with HIV is if they had full blown AIDS and whatever treatment I was going to give had the possibilty of doing more harm than good.

 

[Trookie]

Agreed. Universal precautions.

 

[aphistis]

You treat every patient as if they had HIV, HBV, HCV, etc because you never know. They might not even know. The only time I would refuse to treat someone with HIV is if they had full blown AIDS and whatever treatment I was going to give had the possibilty of doing more harm than good.

Absolutely. They're not called "universal precautions" because it's such a cool name, they're called that because you're supposed to apply them to everyone.

 

[ColumbiaDoc]

Absolutely. They're not called "universal precautions" because it's such a cool name, they're called that because you're supposed to apply them to everyone.

just being the devil's advocate though; how come if a dentist has HIV he cannot treat patients but we HAVE to treat a HIV patient?

 

[MD2b20004]

just being the devil's advocate though; how come if a dentist has HIV he cannot treat patients but we HAVE to treat a HIV patient?

Who said that, I think there was a story on a physician who is HIV and was a surgeon in fact and treated patients. We learned in sometime back in my medical ethics class or Medical Philosophy, one of those undergrad classes.

 

[LSR1979]

just being the devil's advocate though; how come if a dentist has HIV he cannot treat patients but we HAVE to treat a HIV patient?

No I think Columbia Doc is right. Of course I don't have any objective literature or anything to back me up on this, but I'm fairly sure that if you are HIV+ you cannot treat patients. Anybody else care to credit/discredit this?

 

[kilani]

No I think Columbia Doc is right. Of course I don't have any objective literature or anything to back me up on this, but I'm fairly sure that if you are HIV+ you cannot treat patients. Anybody else care to credit/discredit this?

If you are HIV+ and decide to not disclose no body will know about it, your physician (by law) can't disclose this to your employer or to any other entity unless you consent to this, so technically yes you can go on treating patients as you have nothing, but common sense says you should refrain from invasive risky procedures, that may increase the risk of transmitting the disease.....

 

[CorneliusFudge]

I was just simply wondering what one would do if a patient told them they were HIV positive and needed an extraction or root canal where transmission is possible.
I am taking an AIDS course right now and learned that a dentist in Maine did not want to treat the HIV positive patient and referred her to a hospital about 10 or so miles away. To the best of my memory, I believe she sued and won initially with a vote of 5 to 4 and an appeals court upheld. So what would you do?

HIV infection is covered under the ADA (americans with disabilities act). You can refuse to treat but you better have a rationale that ISN'T related to AIDS or you may be subject to legal repercussions. I don't really agree with that, but that is the way things stand.

 

[Biogirl361]

I don't believe it is illegal to treat patients if you have aids, i think it is more of an ethical thing where you "shouldn't" treat patients (i don't agree with this personally though). if it was actually illegal i feel like they would require us to get tested before starting dental school.

You can refer aids patients away as long as it is for the same type of procedures you would send a normal patient or if it is legitimately for their own health, for example if you honestly believe their risk of infection etc is too high to make performing the procedure as usual worth the risk.

What I don't understand is why we are absolutely not allowed to double glove, special glove or take any other needlestick precautions for known aids patients, yet we are told to avoid using the cavitron on known aids patients because of aeresolization...

 

[aphistis]

What I don't understand is why we are absolutely not allowed to double glove, special glove or take any other needlestick precautions for known aids patients, yet we are told to avoid using the cavitron on known aids patients because of aeresolization...

It's because, strange as it sounds, taking "extra" precautions for infectious disease patients makes you *more* likely to get yourself in trouble, not less. Once you start seeing patients, you'll get into your own little customized infection control routine, and you'll get pretty good at in pretty fast, since you're doing it on every single patient you see. What happens when you start treating ID patients differently is that you're suddenly out of the routine you know works, and you're a lot more likely to make a dumb mistake the first time you do something than you are the 500th.

 

[toofache32]

What I don't understand is why we are absolutely not allowed to double glove, special glove or take any other needlestick precautions for known aids patients, yet we are told to avoid using the cavitron on known aids patients because of aeresolization...

Is this a school policy? I've never heard of not being allowed to double-glove. I do it every day.

 

[DrTacoElf]

What I don't understand is why we are absolutely not allowed to double glove, special glove or take any other needlestick precautions for known aids patients, yet we are told to avoid using the cavitron on known aids patients because of aeresolization...

You are allowed to double glove provided that you do that for EVERY single patient.

 

[LSR1979]

I don't believe it is illegal to treat patients if you have aids, i think it is more of an ethical thing where you "shouldn't" treat patients

So why is it ~unethical~ to send away a patient that is HIV+ for fear of disease contraction but it is ~ethically~ the right thing to not treat patients if I have HIV? Seems liks a huge double standard.

The world expects us to be put in harm's way, albeit a very small risk percentage wise, of contracting diseases. However, if somebody has an infectous disease and is a HCW, they should not treat patients? Hypocrisy at its finest.

 

[3rdMolarRoller]

HIV patients do not scare me. Its the Hep C and TB coughing up a storm that worries the $hit out of me.

Follow infection control and you will have no issues.

 

[Biogirl361]

I don't believe it is illegal to treat patients if you have aids, i think it is more of an ethical thing where you "shouldn't" treat patients

So why is it ~unethical~ to send away a patient that is HIV+ for fear of disease contraction but it is ~ethically~ the right thing to not treat patients if I have HIV? Seems liks a huge double standard.

The world expects us to be put in harm's way, albeit a very small risk percentage wise, of contracting diseases. However, if somebody has an infectous disease and is a HCW, they should not treat patients? Hypocrisy at its finest.

yup, you'll find out fast that as unfair as it is, dentists (and other doctors) are held to a lot higher standard than the rest of society in almost every way.

and yes i realize you're allowed to 2x glove if you do it for everyone, I guess my point was you can't change your personal protection routine when it comes to needlesticks but you are encouraged to change your actual treatment approach as far as the cavitron for protection. seems like a huge contradiction to me. aphistis' explanation is a good start, but i'm not totally convinced i would be more likely to poke myself because i was being more careful. if someone has any other explanations for the gloving/cavitron contradiction please tell me, i have honestly been turning this one over in my mind for a while and haven't come up with a good excuse for why one is encouraged but the other is discrimination. the only thing i can think of is maybe the gloving thing is mostly to spare the patient's feelings, but i still think that's an awful reason because if there is a choice between the patient's feelings and my safety i'll take my safety every time. I guess that goes back to how dentists are always expected to put the patient first no matter how unfair it is.

 

[galangvu]

So why is it ~unethical~ to send away a patient that is HIV+ for fear of disease contraction but it is ~ethically~ the right thing to not treat patients if I have HIV? Seems liks a huge double standard.

if you look at it as a ratios thing... it kinda makes since that a HIV+ doctor shouldnt treat patients. one doctor could treat hundreds of patients, but how many patients actually come in contact with hundreds of doctors in a medical setting? the risk of transmittance is much higher if the doctor was the carrier of the virus (HIV, hep. B, hep. C, etc.)

 

[toofache32]

It gets even stickier sometimes. I know an oral surgeon who became jaundiced and found out he had Hep C. His hospital told him he couldn't work there anymore so he turned to his disability insurance carrier to start collecting disability. They told him they wouldn't pay him because he hadn't lost his "ability" to work.

 

[Biogirl361]

if you look at it as a ratios thing... it kinda makes since that a HIV+ doctor shouldnt treat patients. one doctor could treat hundreds of patients, but how many patients actually come in contact with hundreds of doctors in a medical setting? the risk of transmittance is much higher if the doctor was the carrier of the virus (HIV, hep. B, hep. C, etc.)

but at the same time, for each appointment, the risk of a patient transmitting something to a doctor is also a lot higher than a dentist transmitting something to a patient. it is the patient who gets the shot, gets the burs in their teeth, scalpel in their gums or whatever. it is their blood and saliva that is everywhere, on all the sharp instruments, aeresolized by the burs and cavi etc.

 

[letsgfuad]

arent there drugs (that inhibit reverse transcriptase) (maybe others) that are given to health care professonals who may have stuck themselves? I know there is a wash and im pretty sure there are some anti-viral drugs as well that durasticaly decrease the chance of developing an infection. Am i wrong?

 

[scalpel2008]

arent there drugs (that inhibit reverse transcriptase) (maybe others) that are given to health care professonals who may have stuck themselves? I know there is a wash and im pretty sure there are some anti-viral drugs as well that durasticaly decrease the chance of developing an infection. Am i wrong?

only proven to be effective if you start taking them w/i 24 hours or so. i know residents who have stuck themselves and not many finish the course because it makes you puke your guts out.

 

[AhhPuller]

I don't know what's more depressing, this post or all the ones by Lesley about poor dental incomes.