PERSONAL PERSPECTIVE : To Ward Against AIDS, Is This the Beginning of Brave New Dentistry?

I have asked myself what the future holds for dentistry, my profession. Will I be waddling into my gaseous, disinfected operatory in full latex body armor, equipped with Terminator 2000 gloves that have built-in laser drills and injectable, genetically programmed, cavity-filling, enamel-forming bacteria? Will the patient have completed filling out the 1,000-question health history and informed-consent form I gave him or her before the procedure? Will I have completed filling out the 500-question investigative form the patient required of me? And how will the patient be brought into the operatory? On a conveyor belt, encased in a protective body cast, with only the oral cavity exposed?

Well, so much for the doctor-patient relationship!

Fear of contracting or even coming into contact with the AIDS virus is creating such hysteria in this country that laws are being proposed without thinking through their consequences. They pose more questions and problems than answers or solutions.

There is no panacea for the AIDS issue. Nobody wants to be an AIDS statistic and, though I support some form of testing for “personal” care practitioners, I believe we must examine this issue carefully before we start passing laws that may be of no help and wind up costing taxpayers needless millions of dollars.

As Sgt. Joe Friday of “Dragnet” would say, “Let’s have the facts, ma’am. Just the facts.” Here is some information from the July, 1991, special supplement issue of the Journal of the American Dental Assn.:

--In the United States, an estimated one million people are infected with the human immunodeficiency virus (HIV), more commonly called the AIDS virus.

--The Centers for Disease Control reports that, as of December, 1990, at least 40 health-care workers in this country have occupationally acquired HIV infection, but there may be additional cases that have escaped reporting.

--Risk of a patient transmitting HIV infection to a health-care provider is about 0.3%; the reverse is far smaller.

--The recent case of possible HIV transmission from a dentist to patient has raised uncertainty about the risk of transmission from health-care provider to patient. Until this is resolved, the ADA recommends HIV-infected dentists refrain from invasive procedures or disclose their seropositive status. The American Medical Assn. has a similar policy.

These basic facts raise several questions about mandatory AIDS testing.

First, who should be tested? Are health-care workers--physicians, dentists, nurses, paramedics--the only people capable of transmitting the disease? What about acupuncturists, optometrists, manicurists, boxers, hockey players, football players--any occupation or profession where blood exchange might take place?

Let’s not forget the patient. I would like the same knowledge about people I am treating as they are requesting of me. So patients should be tested also.

If recommended infection-control procedures are followed, HIV-positive patients can be safely treated in private dental offices. Dentists can face professional liability problems if they refuse to treat patients of record who report they have become HIV positive. In addition, if a dentist will not see a new patient who is HIV-infected, that dentist may face charges of handicap discrimination.

But if a dentist were to disclose he or she was HIV-positive, would you want him or her working on you? Even though I know the risk is minimal and the odds maybe a million-to-one in my favor that nothing would happen, I would still probably opt to seek care elsewhere. I’d much rather win the lottery than AIDS!

Second, how often should people be tested--every six months, every month, every two weeks? I don’t relish the idea of becoming a human pin cushion or of requiring periodic transfusions from the bloodletting that might occur if the AIDS hysteria gets totally out of control. And who pays for the testing, the health-care workers, the patients or the government?

Maybe a better question would be who has the most to gain from AIDS testing--insurance companies, pharmaceutical companies, testing facilities, patients, health-care workers? What is the possibility that the testing facility may end up transmitting the disease through careless sterilization techniques. And who will police the testing--the AMA, the ADA, a private agency or the CDC?

And what if there is a mistake with the test? Who will assume responsibility or liability? If a health-care worker transmits HIV to a patient, you can be sure lawyers will have a field day. How does it work when the tables are turned? Money and rhetoric that will go into this issue would be better put to use discovering a vaccine or cure, or educating the public about AIDS, or monitoring and improving infection-control procedures of health-care providers.

I do not oppose AIDS testing because patients have the right to know if the individual treating them is HIV-positive. It is nothing short of the informed-consent forms used in most offices and hospitals, which advise patients of the risk factors for the procedure about to be done.

On the same note, I feel the health-care provider has the same right to know if the patient is HIV positive--since the health-care provider is probably more at risk than the patient. The problems and questions surrounding mandatory AIDS testing have yet to be resolved.