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TREATMENT OF THE HIV-INFECTED PATIENT
LEITTERS
OADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, doublespaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. TREATMENT OF THE HIVINFECTED PATIENT
Thank you for the excellent articles in the June and July issues of JADA that were concerned with treatment of the HIV-infected patient and patients' rights vs. provider rights (Dentistry and the Law columns). They covered the topics in a thorough and fair manner. Prior to my retirement one year ago, I was in the practice of general dentistry for 38 years. Thirty-two of those years were spent in private practice. My last six years in practice were spent employed full-time as a dentist in a federally financed program sponsored by Catholic Charities of the Diocese of Rockville Centre, N.Y. This program provided dental treatment exclusively for people with HIV/AIDS. It was a pioneering program at the time, as it was the only program providing dental care to people with HIV/AIDS in a free-standing clinic on Long Island. I recently received a Distinguished Service Award from the New York State Department of Health AIDS Institute for my work with HIV/AIDS patients. 1350 JADA, Vol. 128, October 1997
Having spent all those years as a private practitioner and then in the program providing treatment for people with HIY/AIDS, I feel that I am uniquely qualified to comment on the articles in JADA. I sincerely sympathize with my colleagues who face many difficulties in the practice
of dentistry caused by laws and regulations, some of which are of very limited use, and many that are extremely difficult to implement in the dental office. After treating hundreds of patients with HIV/AIDS and hearing the experiences that many had in seeking treatment in private dental offices, I must say, however, that we in the dental profession brought on some of the difficulties we are now encountering, or will encounter, with reference to treating these patients. In the early days of the AIDS epidemic, many dentists behaved in a manner that brought no honor to our profession. They refused to treat patients with HIV/AIDS for reasons that involved ignorance, unreasonable fear, homophobia and fear of financial loss. Some dentists cruelly excluded HIV-infected patients from their offices as soon as they discovered the patients were HIV positive. Some used excuses that were actually silly. Many patients were told, for example, that special sterilization procedures were required to treat them and that these could not be offered in the private dental office. This is, of course, nonsense. Later on, when dentists began to realize that they could have big problems by turning away patients solely because they were HIV-positive, I began to hear more sophisticated excuses that were given to patients, who then came to my
program seeking treatment. One young woman who came to me from another dentist was on the verge of suicide. Her dentist's refusal to treat her was the final rejection in a long series of
rejections, expressions of fear, judgments and hatred that she had experienced. She was not fooled by the high-sounding but untrue excuse given by her dentist. She was in despair. In my practice, routine universal infection control procedures, which must be observed in every dental office, were strictly followed and were excellent protection for both the patient and the practitioner. Yes, there is the almost negligible chance that one could become infected from a contaminated sharp instrument, although this has never happened to a dental practitioner. The chance of becoming infected even from a stick from an HIV-contaminated needle is 0.4 percent. That means that in 99.6 percent of cases, HIV infection will not result even from this extreme accident. We are all treating HIV-positive patients; some of us just do not know it. Many HIV-infected patients came to me for treatment after receiving dental treatment elsewhere for years while HIV infected. Many did not even know of their HIV-positive status at the start of dental treatment. Many knew, but decided not to tell their dentist that they were HIV positive. Finally, not wanting to continue treatment under those circumstances, they left their dentist and came to my program. With the advent of combination drug therapy using the protease inhibitors, more and more HIV-infected people are going to live longer, high-quality lives.
LETTERS Many will be asymptomatic. Many will be seeking dental treatment at your office and may or may not tell you of their HIV status. The bottom line is that if one is unwilling to treat HIV-infected patients, it might be advisable either to try another profession or to seek a branch of dentistry that does not require patient contact. I do not say this lightly. I say this because it is the reality that one must face today in the practice of dentistry. Anthony M. Giambalvo, D.M.D. Commack, N.Y. NITROUS OXIDE
In the August issue of JADA, Dr. Kenneth Johnsen (in response to my letter in June JADA) made several comments that need to be addressed.
I did not disparage a study that concluded the safe level of exposure to nitrous oxide was in the range of 25 to 50 parts per million, or ppm. I quoted and cited two letters from the authors of the study retracting the study because of flaws. I also quoted the only three papers that give us guidance as to what are safe levels. I did not come up with 400 ppm off the top of my head. One of the problems of professional literature is that once a study has been published, it can never be removed from the literature and retraction letters are easily missed. Even letters like Dr. Johnson's, which compared being exposed to 400 ppm of nitrous oxide with smoking and nicotine, neither of which is true, can be referenced by future authors, adding more confusion to the issue.
I have reviewed more than 400 papers on the subject of nitrous oxide exposure; these papers came from OSHA and MEDLINE computer searches. There has never been a study that showed a problem at levels below 1,000 ppm except for the retracted paper. If anyone knows of a paper that shows a problem with exposures below 1,000 ppm, I would appreciate a copy.
Yes, I would face the female employee (or her attorney). It is very sad that she miscarried, but if levels of nitrous oxide were below 1,000 ppm, nitrous oxide was not the culprit. It may have been the noise from the high-speed drill, the soap used in the restroom, the stress in the office or it may have been no one's fault; about 25 percent of known pregnancies end spontaneously with a miscarriage.
SPECIALIZE IN DENTAL EXCELLENCE. Today's Air Force offers a challenging specialty practice...without the pain of office administration and overhead. Be the specialist you've always wanted to be. Take flight as an Air Force officer with: * great pay & benefits * well-equipped facilities * support of skilled technicians *30 days vacation with pay per year Learn how to qualify for our worldwide dental service. You may qualify for our $30,000 sign-on bonus. Call
1-800-423-USAF Visit us at www.airforce.com AIM HIGH
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HEALT PROFE HEALTH PROFESSIONS
-
OADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, doublespaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. TREATMENT OF THE HIVINFECTED PATIENT
Thank you for the excellent articles in the June and July issues of JADA that were concerned with treatment of the HIV-infected patient and patients' rights vs. provider rights (Dentistry and the Law columns). They covered the topics in a thorough and fair manner. Prior to my retirement one year ago, I was in the practice of general dentistry for 38 years. Thirty-two of those years were spent in private practice. My last six years in practice were spent employed full-time as a dentist in a federally financed program sponsored by Catholic Charities of the Diocese of Rockville Centre, N.Y. This program provided dental treatment exclusively for people with HIV/AIDS. It was a pioneering program at the time, as it was the only program providing dental care to people with HIV/AIDS in a free-standing clinic on Long Island. I recently received a Distinguished Service Award from the New York State Department of Health AIDS Institute for my work with HIV/AIDS patients. 1350 JADA, Vol. 128, October 1997
Having spent all those years as a private practitioner and then in the program providing treatment for people with HIY/AIDS, I feel that I am uniquely qualified to comment on the articles in JADA. I sincerely sympathize with my colleagues who face many difficulties in the practice
of dentistry caused by laws and regulations, some of which are of very limited use, and many that are extremely difficult to implement in the dental office. After treating hundreds of patients with HIV/AIDS and hearing the experiences that many had in seeking treatment in private dental offices, I must say, however, that we in the dental profession brought on some of the difficulties we are now encountering, or will encounter, with reference to treating these patients. In the early days of the AIDS epidemic, many dentists behaved in a manner that brought no honor to our profession. They refused to treat patients with HIV/AIDS for reasons that involved ignorance, unreasonable fear, homophobia and fear of financial loss. Some dentists cruelly excluded HIV-infected patients from their offices as soon as they discovered the patients were HIV positive. Some used excuses that were actually silly. Many patients were told, for example, that special sterilization procedures were required to treat them and that these could not be offered in the private dental office. This is, of course, nonsense. Later on, when dentists began to realize that they could have big problems by turning away patients solely because they were HIV-positive, I began to hear more sophisticated excuses that were given to patients, who then came to my
program seeking treatment. One young woman who came to me from another dentist was on the verge of suicide. Her dentist's refusal to treat her was the final rejection in a long series of
rejections, expressions of fear, judgments and hatred that she had experienced. She was not fooled by the high-sounding but untrue excuse given by her dentist. She was in despair. In my practice, routine universal infection control procedures, which must be observed in every dental office, were strictly followed and were excellent protection for both the patient and the practitioner. Yes, there is the almost negligible chance that one could become infected from a contaminated sharp instrument, although this has never happened to a dental practitioner. The chance of becoming infected even from a stick from an HIV-contaminated needle is 0.4 percent. That means that in 99.6 percent of cases, HIV infection will not result even from this extreme accident. We are all treating HIV-positive patients; some of us just do not know it. Many HIV-infected patients came to me for treatment after receiving dental treatment elsewhere for years while HIV infected. Many did not even know of their HIV-positive status at the start of dental treatment. Many knew, but decided not to tell their dentist that they were HIV positive. Finally, not wanting to continue treatment under those circumstances, they left their dentist and came to my program. With the advent of combination drug therapy using the protease inhibitors, more and more HIV-infected people are going to live longer, high-quality lives.
LETTERS Many will be asymptomatic. Many will be seeking dental treatment at your office and may or may not tell you of their HIV status. The bottom line is that if one is unwilling to treat HIV-infected patients, it might be advisable either to try another profession or to seek a branch of dentistry that does not require patient contact. I do not say this lightly. I say this because it is the reality that one must face today in the practice of dentistry. Anthony M. Giambalvo, D.M.D. Commack, N.Y. NITROUS OXIDE
In the August issue of JADA, Dr. Kenneth Johnsen (in response to my letter in June JADA) made several comments that need to be addressed.
I did not disparage a study that concluded the safe level of exposure to nitrous oxide was in the range of 25 to 50 parts per million, or ppm. I quoted and cited two letters from the authors of the study retracting the study because of flaws. I also quoted the only three papers that give us guidance as to what are safe levels. I did not come up with 400 ppm off the top of my head. One of the problems of professional literature is that once a study has been published, it can never be removed from the literature and retraction letters are easily missed. Even letters like Dr. Johnson's, which compared being exposed to 400 ppm of nitrous oxide with smoking and nicotine, neither of which is true, can be referenced by future authors, adding more confusion to the issue.
I have reviewed more than 400 papers on the subject of nitrous oxide exposure; these papers came from OSHA and MEDLINE computer searches. There has never been a study that showed a problem at levels below 1,000 ppm except for the retracted paper. If anyone knows of a paper that shows a problem with exposures below 1,000 ppm, I would appreciate a copy.
Yes, I would face the female employee (or her attorney). It is very sad that she miscarried, but if levels of nitrous oxide were below 1,000 ppm, nitrous oxide was not the culprit. It may have been the noise from the high-speed drill, the soap used in the restroom, the stress in the office or it may have been no one's fault; about 25 percent of known pregnancies end spontaneously with a miscarriage.
SPECIALIZE IN DENTAL EXCELLENCE. Today's Air Force offers a challenging specialty practice...without the pain of office administration and overhead. Be the specialist you've always wanted to be. Take flight as an Air Force officer with: * great pay & benefits * well-equipped facilities * support of skilled technicians *30 days vacation with pay per year Learn how to qualify for our worldwide dental service. You may qualify for our $30,000 sign-on bonus. Call
1-800-423-USAF Visit us at www.airforce.com AIM HIGH
mMIRW PI
HEALT PROFE HEALTH PROFESSIONS
-