Dental health care workers (DHCWs) can provide important diagnostic, treatment, and referral services for patients with AIDS and at risk for AIDS. They also have a responsibility to protect all patients in their practices, and themselves, from infectious disease transmission through the use of infection control. However, as health care workers, dental students and dentists, we must be knowledgeable of the disease process, its oral manifestations and their management, modes of transmission, preventive strategies, and most importantly the instructions to the team and education to the public.To determine the extent to which dental health care workers are prepared to assume these responsibilities, a randomized survey of California DHCWs was conducted.
Responses were obtained from 297 dentists, 128 hygienists, and 177 dental assistants. DHCWs who expressed a greater willingness to treat people with AIDS or HIV infection also practiced more thorough infection control. Response in all groups who perceived a greater percent of their patients to be at risk for AIDS were more likely to use infection control procedures (Patient less than .0001). They also were more willing to treat such patients (Patient less than .004) and were more likely to assess patients for AIDS by taking a thorough medical history (Patient less than .02) and sexual history (Patient less than .04).
Since attitudes toward AIDS and perception of the percent of patients at risk in one’s practice affect patient assessment and infection control procedures used by dental health care workers, educational programs designed to enhance dental health workers response to the HIV epidemic should alert them to the extent of the problem and help them cope with their concerns.
There are many major authorities dealing with the ethical and legal issues related to HIV and AIDS. They are the American Dental Association (ADA) and the centers of disease control (CDC) in USA and similarly General Dental Council (GDC) and the British Dental Association (BDA) in UK.
In UK, there are two guidelines to be followed in HIV discrimination, the GDC & the BDA. The GDC guidelines states that “It would be unethical for a dentist to refuse to treat a patient solely on the grounds that the person was HIV Positive”.
Regarding the patient confidentiality, according to BDA, “Any information obtained in the course of consultation and treatment is confidential, including personal health information. Practitioners should ensure that their staff are aware of the absolute duty of confidentiality and behave accordingly”.
It is also advisable to seek the permission from the HIV infected patient for each release of their HIV related information. There are three possible transmission routes for HIV in a dental practice.
(1) From a Dentist deliberately to a patient,
(2) From the Dentist to patient by accident, and
(3) From an infected patient to another patient.
As we all know, protection from any disease is mainly through immunization, but unfortunately an AIDS vaccine is still at large. Preventive Strategies in a Clinic should be carried out by means of universal precautions, through cleaning and disposal of blood, saliva or tissues from all patients. Accidental needle stick injuries are relatively common in practice. So all the members of Dental team should be trained to avoid such injuries, though the chances of contracting HIV from a needle stick is very slim (less than 1%).