HIV Testing — at the Dentist's Office?
WHY YOU SHOULD CARE
Because dental checkups that include an HIV test could help stop the virus from spreading.
By Melissa Pandika
Your dentist might begin scoping out more than cavities, plaque and gum disease. She could one day test for HIV, too.
So say some public health researchers, for whom dental providers represent a vastly untapped resource in the fight against AIDS. Not only are they located throughout the community, but many also have ongoing relationships with patients. They also know how to recognize diseases that have oral health symptoms, like the sores and white patches that line the inside of some AIDS patients’ mouths. It also appears that people at high risk of HIV are more likely to see their dentist regularly than their primary-care physician.
More than one million people aged 13 and older in the U.S. are HIV-positive, but 15.8 percent don’t even know they are. Advocates hope getting HIV screening services in more places will result in more people getting tested, curbing the spread of the virus. Research shows that most HIV-positive people refrain from sexual behaviors that might transmit HIV — like unprotected sex — once they learn their status.
Dentists in South Korea have already begun regularly offering HIV tests, and so have a few in Canada, Mexico and the U.S. The idea is to “make HIV testing considered as normal as any other chronic disease screening,” says Anthony Santella, a public health scientist at the University of Sydney. “For HIV testing to be fully integrated into the health system, we’re trying to think outside the box of the primary-care doctor or sexual health clinics.”
It could be just the first of many health checks you could knock off your list when you get your teeth cleaned.
HIV testing could be a routine health check to knock off your list during a teeth cleaning. Dental providers could go the route of pharmacies, which now offer tests for vision, cholesterol and more, says Harold Pollack, a faculty chair of the University of Chicago Center for Health Administration Studies. First, Pollack thinks, dentists need to offer “services that are more intimately connected to oral health” — like smoking cessation — “for HIV tests to be normalized.” Dental providers could also offer oral-based diagnostics for diabetes and hypertension.
It’s still too early to tell whether existing dental provider-based programs have reduced HIV transmission, or whether the idea makes economic sense — i.e., whether HIV testing costs as little at the dentist’s office as it does at the doctor’s. And most people don’t see a dentist on a regular basis, because dental insurance is pricey. Only 50 percent of companies in the U.S cover it. Obamacare doesn’t, except for children.
It’s estimated that more than 70 percent of high-risk people in the U.S. who haven’t been tested visit their dentist regularly.
There are other obstacles. Less than a third of dentists in a 2012 nationwide survey had even heard of rapid HIV testing. Even fewer have been trained in pre- and post-test counseling. But, says Pollack, patients also need to be “trained” to expect a dental professional asking whether they want an HIV test. One strategy: savvy public health messaging — think the Truth anti-tobacco campaign.
Still, high-risk people do visit their dentists — often. A 2010 study Pollack led estimated that more than 70 percent of high-risk people in the U.S. who haven’t been tested visit their dentist regularly. In comparison, most people see their doctors only when they feel sick. “We don’t need anything from our primary-care physicians,” Pollack says. “We want nice-looking white teeth with no cavities.”
Most dental patients are open to receiving an HIV test. Santella’s survey of 500 dental patients in Sydney, presented at the Sydney University HIV Testing Symposium last month, revealed that 82 percent would welcome the option. Results from surveys in Missouri and New York were similar. “I’m gonna be laid back getting my teeth done,” said one dental patient interviewed as part of an NYU College of Dentistry study. “I might as well — two birds with one stone.”
Dental offices are likely to use oral HIV tests that detect proteins called antibodies…
But study participants also found it important for the tests to be offered universally and free of charge. “For people like myself who can’t afford insurance, aren’t in a stable position, [they can’t] go somewhere else and get it done,” said one patient. Also crucial: that dental professionals are trained in communicating test results. “I think how you receive the news is very important…. I wouldn’t want to hear it from a dental student.”
Rather than a traditional blood test, dental offices would likely use oral HIV tests that detect proteins called antibodies that the immune system releases to attack HIV. One device, the OraQuick Advance, is a paper strip coated with harmless amounts of HIV antigens. It’s used to swab the cheeks and gums. A health provider then dips the strip in a vial filled with an enzyme solution that reacts to HIV antibodies in oral fluids, producing a solid line on the strip to indicate a positive result. No antibodies, no line. The test takes around 20 minutes.
Santella thinks dental hygienists could administer the test, most likely at the start of an appointment. Patients could get their results at the end. Since a positive result doesn’t necessarily indicate HIV status, the hygienist would then refer positive-testing patients to a primary-care doctor for further testing. Santella and his group propose testing an HIV test kit at three dental hygiene clinics in New York City.
“We need to have a mentality that really grasps that oral health is part of health,” Pollack says. “In the U.S., we’ve done a bad job of carving oral health out, having separate insurance plans… . [The mouth] is the gateway to the human body” — and possibly to halting the spread of HIV.
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