Say 'Ah!': Dental offices providing HIV testing

A routine dental cleaning now may come with an unexpected option: an HIV test.

Some dental locations, especially in New York City, are offering HIV screenings to patients through a fast and inexpensive oral test.

Dental clinics have screened hundreds of patients with the OraQuick Advance HIV test, a technique that uses a swab of fluid around the gum. Results can be available 20 minutes later, during the same cleaning appointment. No blood-work, no two-week wait for the lab report.

Health care professionals who support dental HIV testing note that more than 1 million Americans are living with HIV, but about one-fifth of them do not know they are infected. And many Americans at risk for HIV visit a dentist more often than they do a physician.

"The dental setting is a very natural setting for this to be done,'' says Dr. Stephen Abel, an associate dean at Florida's Nova Southeastern University College of Dental Medicine. "Young people are using the dental office more regularly than a doctor's office.''

Still, dental HIV testing ''is still in its infancy,'' and its prevalence is unknown, adds Abel, who co-wrote an article on the topic in January's American Journal of Public Health.

Co-author Lisa Metsch, of the Miller School of Medicine at the University of Miami, points out that an oral test's detection of HIV can help a person connect to medical care earlier and reduce transmission of the virus.

A test kit costs in the $12 to $20 range, dentists say, but at Metropolitan Hospital Center in New York, it's a freebie to patients, with a city program covering the cost.

"When the technique came onto the market, we felt it was a natural fit,'' says Dr. Joseph Morales, chief of the Department of Dental Medicine at the hospital. The hospital's dental clinic performs 60 to 80 tests per month.

"There has been very little negative response,'' Morales says. He explains the natural fit of dentistry and the oral HIV test: "We are in the mouth already.'' The clinic trains young dentists fresh out of school in the technique, and many will bring it to their private practices, Morales adds.

The dental clinic provides counseling both before and after the screening. A positive OraQuick screening must be followed up by a confirming blood test.

While the dental screening is not widespread, the Centers for Disease Control and Prevention says the agency is committed to expanding access to HIV testing and is investigating alternative testing venues, including testing in dental offices.

Dr. Catrise Austin introduced dental HIV testing in her New York private practice last year. Since July, she has tested more than 300 patients, and says she had her first positive in late December. The city of New York funds the test, but Austin says that medical insurance should cover the costs.

"Most dentists think it is a good idea,'' she says.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, says dental HIV testing represents good primary health care. The test is ''pretty easy to do,'' he notes.

But he points out several barriers to wider use of the technique. They include dentists not knowing about the test, a lack of strong financial incentives to perform it, and the fact that some dentists may feel it's outside their scope of practice.

"You're going to have to guarantee privacy, but dentists do that already,'' Caplan says. ''It requires a certain ability to counsel -- that's an additional burden for dentists.''

But given the shortage of primary care providers in the U.S., Caplan says, "the moral case is very strong to promote this.''
For some people, especially young adults, a dentist ''will be the only primary care person they will see for a while.''
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