Treating an HIV positive patient

[DDS2BE]

I was just reading a post about some hygienist posted, claming that his friend, a hygienist, got himself /herself stuck with a sharp instrument after treating an HIV positive patient. This made me question myself how would I treat a patient knowing the fact that a person sitting in my dental chair is an HIV carrier. It would, of course, freak me out , but with a proper patient/doctor barrier the accident risk factor should be taken down to a minimum . So, as a doctor, does one actually have a right to refuse providing dental care to an HIV positive patient? Or would a client be obligated to disclose the fact that he/she is an HIV carrier? How would you approach this? And if similar dental cases being taught at dental schools?

Thanks for the input.

---

Members don't see this ad.

 

[Blue Tooth]

Exposures happen. I had one on a HIV patient. It's just an occupational hazard. You can't refuse treatment for a patient with any communicable disease (except maybe TB). Just act like the adult and professional you are.

 

[JavadiCavity]

I'm friends with one of the nation's leading HIV/AIDS doctors. She just got back from a conference where she talked with dentists about what steps to take when working with HIV positive patients. I'll try to get the text of her talk if I can.

One of things she warned dentists (and physicians, of course) is that patients with HIV are typically very embarrassed to disclose that information. Even though it's required by law for the patient to tell healthcare providers, many don't--which puts dentists and physicians at risk. She said Dentists are at a much higher risk since they work with sharper instruments/needles and blood more often than many physicians.

Her outlook was bleak. Since there is no way to determine if someone is carrying the virus by looking at them, the only way to treat patients is to act as if all patients are positive. There are a list of precautions to take. I'll see what I can get from her.

I'd also like to know if Dentists can refuse to treat someone with HIV or other infectious diesease. So, I'll have another sit down with my friend and see what I can learn.

 

[kato999]

Basically, standard infection control is that you should treat every single patient as though they had HIV. There shouldn't be any different treatment like double gloving or anything like that.

 

[Dr. Pedo]

I'm friends with one of the nation's leading HIV/AIDS doctors. She just got back from a conference where she talked with dentists about what steps to take when working with HIV positive patients. I'll try to get the text of her talk if I can.

One of things she warned dentists (and physicians, of course) is that patients with HIV are typically very embarrassed to disclose that information. Even though it's required by law for the patient to tell healthcare providers, many don't--which puts dentists and physicians at risk. She said Dentists are at a much higher risk since they work with sharper instruments/needles and blood more often than many physicians.

Her outlook was bleak. Since there is no way to determine if someone is carrying the virus by looking at them, the only way to treat patients is to act as if all patients are positive. There are a list of precautions to take. I'll see what I can get from her.

I'd also like to know if Dentists can refuse to treat someone with HIV or other infectious diesease. So, I'll have another sit down with my friend and see what I can learn.

Can't refuse pt. based on disease--- Exception I believe is active TB. This is a very sticky situation if you try to refer based solely on the pt's disease. Discrimination is the keyword here. Now you could find a dental condition that the pt. presents with that perhaps is out of the scope of your practice and could be better served by another/specialist DDS. But this condition would have to be consistently referred out on other patients as well. If the pt was very compromised systemically you may be able to refer to a hospital-based dentist who could manage their care more efficiently. Bottom-line is to my knowledge there as never been an incident of HIV being transfered from patient to dentist-----and every patient in your chair should be treated as if they had a serious disease because we have no idea what they did the night before. Simply use universal precautions, have good technique (fulcrums etc...) and everything will be just fine.

 

[captaintripps]

www.virusmyth.net

 

[ISU_Steve]

They do have sharps resistant exam gloves. I would recommend them on any patient you strongly suspect of having a communicable disease.

Now, if you did know a patient has HIV, you could just refer them off to another dentist (most patients would not know that you are turfing them off to someone else), preferrably someone you don't like. *NOTE: That was said as a joke.

I could never refuse to treat a patient who needed it. It's just unethical and goes against every reason I am in the health care field.

 

[TaliaTN]

You can't refuse treatment. If I remember, I'm pretty sure you can't insist that the person tell you about their disease. First of all, some won't even know it. I also think HIV is classified as a "disability" by whatever group decides these things, and that is why you can't descriminate against them. I think, that by law, you don't have to disclose a "disability" to anyone UNLESS you actually want to. Our office has one up front and honest HIV patient (from a blood transfusion long ago) and probably countless others who didn't even know themselves.

I've had 2 HIV tests in the 3 yrs I've worked. Most people who have an exposure actually know that the patient has HIV. The nervousness alone makes you more likely to get a stick. The ones who you don't suspect aren't the ones you get all nervous about!

 

[toofache32]

It is illegal to deny treatment to HIV patients based on their HIV, but they can still be referred for the same reasons you might refer any other patient.

I don't worry about HIV nearly as much as Hep C. HIV is very treatable these days whereas there is no fix for Hep C. Also, if you get stuck by an HIV needle, you are much less likely to seroconvert than if you are stuck by a needle with Hep C. I'll take HIV any day over Hep C.

 

[KatieJune]

Its interesting, though, that one of the regional exams will not allow HIV positive patients to be treated during the exam.....I'm suprised no one has sued them over this....yet.



Also, even if you get a needle stick from someone with HIV, its still 1:1000 chance you'll get the virus and if you get a splash its even lower. Still good idea to be careful though....

 

[cgt3477]

Individuals with HIV/AIDS are protected under the Americans Disability Act. You can be sued for refusing to treat a patient with HIV/AIDS. Also patients are not required to tell you their status (even if they know they are positive). Of course we as professionals will have to inform patients if we have HIV/AIDS or if we are carriers for Hep. But the chances of getting HIV from a needle prick is minimal...if anything I would be more worried about Hep (there is a greater risk of getting Hep from a needle prick-there is no vaccine for C but there is a vaccine for A and B).

 

[JavadiCavity]

Far from being insensitive, but doesn't it seem wrong that a person who knows they are infected with HIV (or any infectious diesease) doesn't have to disclose that to an individual who by providing healthcare exposes themselves to the risk of contracting HIV from that patient?

Honestly, it seems people are more worried about privacy than they are about health. If a pedophile moves in down the street, I'd like to know before I let my kids walk by his house. I'm not saying that pedophilia is the same as HIV, but I'd still like to be aware of what dangers or risks I might be exposing my staff, myself, or others too.

I have no problem with treating HIV patients, but I'm setting up camp on the side of the fence that says it would be better to know that the patient is HIV compromised before I go wandering around in their mouth.

 

[KatieJune]

Far from being insensitive, but doesn't it seem wrong that a person who knows they are infected with HIV (or any infectious diesease) doesn't have to disclose that to an individual who by providing healthcare exposes themselves to the risk of contracting HIV from that patient?

Honestly, it seems people are more worried about privacy than they are about health. If a pedophile moves in down the street, I'd like to know before I let my kids walk by his house. I'm not saying that pedophilia is the same as HIV, but I'd still like to be aware of what dangers or risks I might be exposing my staff, myself, or others too.

I have no problem with treating HIV patients, but I'm setting up camp on the side of the fence that says it would be better to know that the patient is HIV compromised before I go wandering around in their mouth.

the problem with that is that the majority of those with HIV don't know they have it....its best to just treat everyone the same (as if they are infected and take proper precautions....)

 

[Dr.BadVibes]

Far from being insensitive, but doesn't it seem wrong that a person who knows they are infected with HIV (or any infectious diesease) doesn't have to disclose that to an individual who by providing healthcare exposes themselves to the risk of contracting HIV from that patient?

Honestly, it seems people are more worried about privacy than they are about health. If a pedophile moves in down the street, I'd like to know before I let my kids walk by his house. I'm not saying that pedophilia is the same as HIV, but I'd still like to be aware of what dangers or risks I might be exposing my staff, myself, or others too.

I have no problem with treating HIV patients, but I'm setting up camp on the side of the fence that says it would be better to know that the patient is HIV compromised before I go wandering around in their mouth.

I agree with you, but I can understand how HIV patients feel reluctant to tell people....when they do, people will act differently towards them....

Today I was working with kids with sickle cell amenia, and when I asked them what is one thing that they wanted everyone else to know, u know what their answer was??

"We want people to treat us as everyone us....we dont want people's pity and to look at us differently"

When you hear something like this right from kid's mouths, it really makes you think. Im sure HIV patients would be the same.

 

[ItsGavinC]

Basically, standard infection control is that you should treat every single patient as though they had HIV. There shouldn't be any different treatment like double gloving or anything like that.

Although I don't think you shouldn't double-glove if you feel you ought to. It takes only seconds to slap on another pair, and if it provides the provider with another level of comfort, then I'm all for it. I wouldn't do it in front of the patient (do it discreetly) however.

 

[ItsGavinC]

When you hear something like this right from kid's mouths, it really makes you think. Im sure HIV patients would be the same.

I understand the underlying message, but sickle-cell isn't transferrable. That adds another dimension (and an important one at that).

 

[ItsGavinC]

Its interesting, though, that one of the regional exams will not allow HIV positive patients to be treated during the exam.....I'm suprised no one has sued them over this....yet.

That's the least of their worries when it comes to lawsuits. I'm surprised the regional exams haven't been sued for allowing students to determine their level of competency on LIVE patients. Think about it. That's insane and we are the only profession to do that.

 

[ItsGavinC]

www.virusmyth.net

That's the biggest bunch of crap I've ever read. Good for some laughs, that's for sure.

 

[captaintripps]

I doubt you've read it.

 

[1-16-17-32]

There has never been a case reported where a patient transmitted HIV to a dentist through an occupational exposure. Thats right - NEVER.

 

[DDS2BE]

First off, thanks for all of your input... there are some very interesting opinions here

Someone mentioned earlier that an HIV patient is obligated to tell about his/her condition. Now, here is a hypothetical situation: an HIV patient lies about having HIV on that form that patients supposed to fill out during their initial visit. Then his/her dentist finds out the patient is an HIV carrier. Can the doctor refuse treatment to that patient or even go after the patient, from a legal stand point, solely based on the fact that the patient simply lied about having HIV and exposed the office staff including doctors to the danger which they were not aware of?

 

[tx oms]

Exposures happen. I had one on a HIV patient. It's just an occupational hazard. You can't refuse treatment for a patient with any communicable disease (except maybe TB). Just act like the adult and professional you are.

Absolutely. You will get a sharps stick during your career, probably several. Don't be a doctor if you don't want to deal with the smelly people (disease carriers, lower class, etc).

Hep C is easier to acquire from patients than is HIV. Count on this: everyday you will treat at least one person who has a blood-bourne disease that doesn't tell you or doesn't know. Use precautions and be prepared for your needle stick. It's coming.

 

[ItsGavinC]

I doubt you've read it.

You're right. I found it too difficult to click on the link.

For the record, are you saying that 1) the cause of AIDS is unknown 2) HIV is harmless 3) AIDS is not sexually transmitted and 4) people actually die as a result of toxic poisoning from the antiviral drugs they take?

Please tell me how that isn't a load of crap?

 

[captaintripps]

You're right. I found it too difficult to click on the link.

For the record, are you saying that 1) the cause of AIDS is unknown 2) HIV is harmless 3) AIDS is not sexually transmitted and 4) people actually die as a result of toxic poisoning from the antiviral drugs they take?

Please tell me how that isn't a load of crap?

Yes. Not everything in medicine and biology is so perfectly understood as presented in school and the media. This topic requires more critical analysis rather than big pharma spreading fear.

 

[rrc]

If you are concerned about the treatment of patients with a communicable disease, then you are in the wrong line of work. Trying to find ways to avoid treating certain patients is intolerable and insulting to the health care profession.

 

[tx oms]

That virusmyth website sounds like a book I read in college, "Inventing the AIDS virus". The book was long and written by a PhD of somesort all about how HIV had not been proven to cause AIDS. Much of his book was interesting and critiqued the development of the HIV causes AIDS theory. I haven't read enough HIV journal articles to critque any of it.

The problem with all the people who claim HIV and AIDS are not related is that AIDS does exist, no matter where it comes from, and it is a problem. It won't go away by arguing that there is no absolute irrefutable proof that HIV causes AIDS. Most of those arguements are essoteric critiques of someone's scientific method rather than the conclusions they draw.

 

[DcS]

Although I don't think you shouldn't double-glove if you feel you ought to. It takes only seconds to slap on another pair, and if it provides the provider with another level of comfort, then I'm all for it. I wouldn't do it in front of the patient (do it discreetly) however.

Unless you double-glove for every single patient, doing so for an HIV patient is illegal and if sued you would lose in a nanosecond. Crazy huh.

 

[captaintripps]

That virusmyth website sounds like a book I read in college, "Inventing the AIDS virus". The book was long and written by a PhD of somesort all about how HIV had not been proven to cause AIDS. Much of his book was interesting and critiqued the development of the HIV causes AIDS theory. I haven't read enough HIV journal articles to critque any of it.

The problem with all the people who claim HIV and AIDS are not related is that AIDS does exist, no matter where it comes from, and it is a problem. It won't go away by arguing that there is no absolute irrefutable proof that HIV causes AIDS. Most of those arguements are essoteric critiques of someone's scientific method rather than the conclusions they draw.

The 'PhD of some sort' is a tenured professor at UCB and a member of the national academy of sciences - Peter Duesberg. Critique of an investigators method is essential to determining the significance of the results and conclusion.

 

[ItsGavinC]

Unless you double-glove for every single patient, doing so for an HIV patient is illegal and if sued you would lose in a nanosecond. Crazy huh.

Is it illegal because you are modifying standard treatments for somebody with a disability?

It certainly doesn't change the *quality* of care or treatment. What would the terms of the lawsuit be? There wouldn't be any harm to the patient nor any neglect or practicing below the standard of care.

 

[nothen2do]

The 'PhD of some sort' is a tenured professor at UCB and a member of the national academy of sciences - Peter Duesberg. Critique of an investigators method is essential to determining the significance of the results and conclusion.

Just because he has a PhD from anywhere, doesn't mean his views are not bullheaded and crap. Sounds like you believe HIV is a myth, and so I'm happy that I will never recieve any treatment from you in the future.

 

[captaintripps]

Just because he has a PhD from anywhere, doesn't mean his views are not bullheaded and crap. Sounds like you believe HIV is a myth, and so I'm happy that I will never recieve any treatment from you in the future.

Whatever.

 

[Biogirl361]

do most dentists have a yearly screening for themselves and staff for HIV, Hep C, TB, etc?

 

[DcS]

Is it illegal because you are modifying standard treatments for somebody with a disability?

It certainly doesn't change the *quality* of care or treatment. What would the terms of the lawsuit be? There wouldn't be any harm to the patient nor any neglect or practicing below the standard of care.

The question has nothing to do with standard of care, putting on 2 sets of gloves for only HIV patients is discrimination. I'm not saying I agree, but we were told that in lecture and there have been lawsuits in some fashion that have been won because of it. I am not a lawyer so am not sure how the lawsuit would be framed.

 

[DcS]

Well from everything I can read online it appears as if double gloving is not illegal. I guess whoever mentioned it in lecture a few years ago was wrong.

 

[JavadiCavity]

I think the question is why would it be illegal to double up on gloves when you know you are working on a patient with an infectious diesease while on non-infected patients a provider would only use a single glove.

Playing the discrimination card is ridiculous. The provider is taking safety measures against a KNOWN risk. This isn't about skin color, sexual preferences, or country of origin. HIV, Hep C, and other dieseases are actually harmful.

 

[onetoothleft]

I can tell from some of the posts and responses that some people have never known/worked with a person with HIV. There is a reason why there are so many lawsuits and so much sensitivity with this issue. I personally do not know about double gloving or not, but altering your method of treatment for a person with HIV is discrimination. It has been determined that the "universal precautions" taken by practitioners are enough protection from transmission of the virus (as it was said before, HIV is not very contagious this way and there has never been an incidence of such).

So when you do go beyond that solely because you know the person has HIV, that is like a slap in the face to that patient. Think of how that person must feel walking into an office where everyone treats him like a leper. Many HIV patients see this discrimination in the dental field especially. A few years ago, an HIV positive friend of mine related that about 50% of dentists would not treat her. 50%!!!

Seeing this was one of the reasons I wanted to be a dentist. There is so much good that we can do for communities such as this that face difficulties that we can only imagine. I can't imagine refusing to treat anyone. That just seems immoral to me.

 

[Dr.BadVibes]

If double gloving for an HIV patient is considered discrimination, then that is just pathetic and the legal system is going to hell. Has there been a discrimination case like that????? I hope to God not, because that is just bull.

Like Gavin said, its not like the quality of treatment diminishes.....that is the most important factor to be considered.

 

[Biogirl361]

I think it's quite selfish on the part of the patient if he/she purposely does not reveal their disease or sues a dentist for protecting their health or even life from a known risk factor. i mean which is more important, the patient having their feelings hurt or putting the health care workers at higher risk of a life threatening disease. I am not saying it's okay for the dentist not to treat an hiv patient or to treat them badly, and of course you should be careful with all patients, but it's rediculous if dentists and staff can't take extra precautions in the event of a confirmed disease. just put the gloves on in another room and the patient will never even know you're taking extra precautions, it is not like you have to take them out of the box and put them on under his nose.

 

[ItsGavinC]

So when you do go beyond that solely because you know the person has HIV, that is like a slap in the face to that patient. Think of how that person must feel walking into an office where everyone treats him like a leper. Many HIV patients see this discrimination in the dental field especially. A few years ago, an HIV positive friend of mine related that about 50% of dentists would not treat her. 50%!!!

I'm not talking about not treating anybody. I'm talking about slapping on another pair of gloves if it makes me happy. That's not treating anybody like a leper.

Change the scenario to a Hep patient since Hep is way more likely to be transmitted than HIV. Why wouldn't I double-glove for that patient? It wouldn't change my treatment, my quality of care, or my attitude or communication with the patient. In fact, they'd never know.

 

[ItsGavinC]

Whatever.

You can't respond with "whatever". That's a cop-out.

 

[ItsGavinC]

just put the gloves on in another room and the patient will never even know you're taking extra precautions, it is not like you have to take them out of the box and put them on under his nose.

Those are my sentiments. I'd NEVER go out of my way to make the patient aware of this. I'd just do it and proceed onward.

 

[toofache32]

Huh? I don't get it. How does double-gloving discriminate against anything (other than maybe the virus itself)? The patient is still having the same procedure done. Is wearing a condom discrimination also? Because gloves are just condoms for the hand.

I guess a single pair of gloves is discriminating against people infected with candida and Strep mutans (everybody).

 

[ItsGavinC]

I guess a single pair of gloves is discriminating against people infected with candida and Strep mutans (everybody).

My wife and I were discussing this issue and came up with the same point, although I couldn't figure out a good way to word it. Gloves are discrimination period.

 

[Midoc]

My wife and I were discussing this issue and came up with the same point, although I couldn't figure out a good way to word it. Gloves are discrimination period.

Discrimination is seeing a difference between two or more sets of people/things/whatever. To wear gloves with everyone is not discrimination since you are treating everyone the same way. Universal precautions are universal for a reason - they're designed to protect against all diseases. In my opinion double gloving is very little added protection with a high risk of pissing off the patient who has multiple avenues of venting his anger (lawsuit, bad-mouthing you to the community, etc.)

For the record I have treated patients with HIV, HepB/C and I did not feel uncomfortable treating them in the same manner I have treated other patients.

 

[tx oms]

The 'PhD of some sort' is a tenured professor at UCB and a member of the national academy of sciences - Peter Duesberg. Critique of an investigators method is essential to determining the significance of the results and conclusion.

Exactly, he is a PhD of some sort and you don't even seem to know of what.

I treat known HIV infected people regularly. We get referrals from medicine and infectious disease to see the patients. I don't do anything differently. I wear one pair of gloves and sometimes a mask with face shield, depending on what I'm doing. I know it's difficult to contract HIV and rest comfortably in the fact that my single gloves will be fine. If somehow they got pierced I'd wash my hand for a while.

As for HIV infected individuals feeling they are shunned, I don't care. I treat them the same and don't get worked-up about it. Some people do. Look, if you engage in risky behaviour things happen, one of which is HIV and the stigma it comes with. It's the way people are. You don't want the risk of HIV and it's stigma? Keep you wee-wee away from your buddy's bung hole, don't shoot up, and don't sleep around. Otherwise, be prepared to roll the dice.

 

[typeB-md]

i am not a dentist but a medical student. we are allowed to deny treatment based on the fact that someone has HIV/Hep, etc. you guys should get your ADA lobbyists in action up there at the capitol.

 

[dentheartthrob]

The efficacy of wearing two gloves is as the same as wearing one since that (lets face it) being punctured by a sharp hand instrument (curettes, scalers, explorers etc...etc...) contaminated with blood will pierce through both layers and will have the same likely hood of transmitting a communicable disease. That alone makes it discrimination but not as the same degree as being put at the back of the bus or having a separate bathroom. I think knowing the patient's CD4 count will perhaps give a slight inclination toward the dentist in declining the patient infected with HIV (because dental treatment could be a contraindication). But what I want to know is why HIV is under "disability"? I still don’t think all that jazz about Universal Infection Control would make it so that HIV would be under “disability”

 

[captaintripps]

Exactly, he is a PhD of some sort and you don't even seem to know of what.

www.duesberg.com
Here you go, dipsh/t.

 

[ItsGavinC]

The efficacy of wearing two gloves is as the same as wearing one since that (lets face it) being punctured by a sharp hand instrument (curettes, scalers, explorers etc...etc...) contaminated with blood will pierce through both layers and will have the same likely hood of transmitting a communicable disease.

True, but a puncture is different from a stick, which might penetrate only an outer layer. Also, gloves leak, but doubling gloves would provide a futher layer of protection against normal glove leakage in theory.

 

[dentheartthrob]

Also, gloves leak, but doubling gloves would provide a futher layer of protection against normal glove leakage in theory.

protection from what? getting rashes or a wrinkly skin. hehehe