Do People with HIV Get the Dental Care They Need?

[Dan J.]

Key findings:
 
Many patients who receive regular medical care for HIV do not get the dental care they need.

Many of those reporting unmet need for dental care — including Medicaid recipients whose state Medicaid program does not provide dental coverage — lack dental insurance.

HIV-infected patients are more likely to get dental care when it’s provided by the clinic where they get their medical care.

"Because of its effects on the immune system, HIV is a disease that affects every aspect of health. One of the earliest findings in the 20-year history of the HIV epidemic is that oral health was a frequent problem among HIV-infected individuals. In fact, opportunistic oral lesions and infections were often one of the first manifestations of HIV. Dental researchers have identified some 16 conditions that can occur in HIV-positive persons, some of them potentially life threatening. Thus, health experts agree that HIV-positive individuals (as well as those at increased risk for the disease) should see a dentist regularly. Yet anecdotes abound regarding dentists who refuse to treat people who are HIV-positive and HIV-positive individuals who avoid seeing a dentist out of fear of having to reveal their HIV status."

http://www.rand.org/pubs/research_briefs/RB9067/index1.html

[raroy273]

Wow.  Intresting.  My Dr's gave me the name and number of a Dentist who is a friend of the practice and also specilaizies in HIV dentistry.  I see him on the 30th, and this is the first time in 4 years that I have seen one so am a little anxious.  I do admit that I see dentists when I have the coverage.  This is the first time I have had coverage in 4 years, but am having to see an out-of-network dentist.  I guess that's the pirce we have to pay.  I am finding that since being diagnosied that I prefer to see out providers that specialize in HIV, this is probably due to the shame/fear of having to disclose, but also wanting to get the best care. 

[RapidRod]

Dan, those on medicaid in Ohio,  get dental care and vision care. I've used both.

[Matty the Damned]

In a word, Danno - no.

Oral/dental health is (as your OP notes) a big issue for HIVers. Obviously I'm not familiar with the complexities of how this works in the States, but if I've learned anything about the States it's that your health system is, well, complex.

As for us Down Here, dental health is a big issue. Unlike most other aspects of healthcare dentistry is not provided for under our national health insurance, essentially if you can't afford to pay for a dentist you're gonna end up with rotten teeth.

For people receiving welfare (be it the dole or a disability pension or whatever) the state governments provide varying degrees of free coverage, but the waiting lists are very very long. People often go without much needed dental care for years at a time.

A few years back I had a whole lot of dental work done, up to and including the removal of my intransigent wisdom teeth. Because I've got AIDS I was given priority in the NSW public dental system and got pretty timely and competent treatment at the United Dental Hospital in Sydney. It meant I had to travel three hours each way to have a filling done on occasion, but it was free and that seemed a small price to pay.

UDH was excellent. All the dentists, nurses and students there were completely up to date about HIV issues. Before any major procedure, they made sure they new my current CD4/VL results and had the requried antibiotics or whatever on hand. Not only that but they would check regularly for things like OHL or CMV lesions and the like.

But my experience is not a common one. I know that many Aussie HIVers are crying out (often literally) for basic dental care and to no avail.

MtD

[Dragonette]

No, and more than just dental care, I certainly don't get the gum care that I need. My doc told me my gums are fine when anyone could see with their own eyes that the roots of my bottom teeth are exposed due to extreme gingivitis. I had to haggle to get him to refer me to a dental hygenist, and when I finally had my appointment with her, she said it was so bad she can only do the top and I had to make a new appointment, in several month's time, for the bottom jaw.
My dentist knows I have HIV and has more poz patients. He doesn't care though. The reason is the system here. In the last days I have been crying over the whims of the Dutch health system. I could not post it here though, because almost no one could have related and it would take ages to explain. But in a nutshell: Great facilities, good equipment, good training, and I pay 124 Euro a month for insurance, but something is missing... the human factor. Too many people in healthcare just don't give a s***.

[Dan J.]

My HIV meds make my mouth dry. I brush & floss after every meal but still have a serious plaque problem. Smoking ciggarettes may be part of the problem, but I started Chantix today & hope to be smoke free soon. Maybe that will improve things for me.

Does anyone know what the 16 conditions that affect oral health care in HIV+ people  are?

Danny

[Miss Philicia]

I receive free dental care from an HIV-oriented program at the Univ. of Pennsylvania's Dental School.  I even had a crown replaced earlier this year.  The care is excellent, and the only students I encounter are ones observing.  My actual dentist is a faculty member.

NYC's ADAP also had dental services, though it took me 2 years to discover this as nobody really informs you.  I would encourage anyone on ADAP to investigate your available state resources.

Previous to ADAP I paid for all of my dental care out of pocket, as my office did not offer coverage.

[Dan J.]

My dental care is paid for with Ryan White $ through my local ASO. That is the only Ryan White services I recieve. They did offer vison services but that funding was cut a few years ago.

[SoSadTooBad]

I have private insurance, and an understanding dentist.  He thinks it is better to see me 3x per year than the normal 2x per year that he recommends to his (non poz) patients.  So, I go a little more often, and he gives me a checkup that is a little more thorough.  He and the hygenist always ask about my counts, and any changes - I feel very blessed.  If anyone needs the name of an excellent dentist in NYC, PM me.

[ademas]

I definitely don't get the preventative dental care I need.
My last full cleaning was about 18 months ago.
In 2002, 2004, and 2005 I travelled to Thailand--twice on cheap airfares and once on frequent flier miles--with the express purpose of having fairly extensive dental work done.
Amazing that I could fly r/t to Bangkok, stay in decent hotels, take sidetrips, and have all my dental work done--all cheaper than I could have the same work done at any dentist in the Seattle area.
Thailand won't be an option again for awhile (plus the dollar ain't stacking up against the Thai baht so good these days) so I'm sure hoping nothing happens.

[Oceanbeach]

Hey Dan,

California took a big hit in decreased RWCA funding in the Ryan White Modernization Act.  It was assumed at the beginning of last years Funding Allocation Working Group that MAI funds could be used for dental care of Hispanic men, women and children (the second highest group of new infection) in our county.  The use of MAI funds requires tracking of medical information, not normally used in the three dental clinics available.  This would require hiring extra staff in the dental clinics and driving up costs for services.

As our $1.6 million RWCA budget of last year became $728,000 budget for this year, we (FAWG members), allocated the total MAI Budget to medical care, RWCA funding to dental care, which resulted in deeper cuts for other care and services to the 500 + or - persons living with HIV in Sonoma County.  Food for Thought, Sonoma Counties AIDS Food Bank and Face-to-Face, our nonprofit based ASO took huge cuts in funding sources also.

General dentistry is pretty much available to anyone with Medi-Cal or RWCA support but Oral Surgery is not available to anyone who do not have private insurance or can pay in full at time of service.  There is no Oral Surgeon in Sonoma County who will accept Medi-Cal or RWCA funding for payment.  A person living with HIV in Sonoma County who needs oral surgery will have to be treated in San Francisco and provide their own transportation because volunteers are not available to transport medical/dental patients, outside of the county.

There is a minor exception to this rule which is never spoken in any health clinic or any care organization in Sonoma County.  Kaiser Permanente has a hospital in Santa Rosa and they accept Medi-Cal from their members.  Twenty years ago, Sonoma County closed their hospital and became "open enrollment".  If a person living with HIV in Sonoma County should need Emergency Services and go to the nearest ER, that should be at Kaiser Permanente (who does accept Medi-Cal insurance).  This ER visit puts that person on the KP books as a patient and in "open enrollment" they can transfer their care from any other HIV clinic to Kaiser Permanente and get that oral surgery at no cost.  I learned this from a Medi-Cal biller who used to work at County Hospital and then was hired at Kaiser Permanente at closing.  He is HIV + and has been at KP (employee and patient) for 20 years.

Last year, I had such an ER visit for an XRAY.  Cut my finger with an ax... With HIV funding being cut in every area, I chose Sutter ER because my ID doc also works at Sutter and if the Center for HIV Prevention and Care should find themselves to not be able to provide services, I can change clinics and retain my current ID doc at Sutter.  If there should be another ER visit, that will be at Kaiser Permanente so there will be choices.  Have the best day
Michael   

[sdcabincrew74]

I go three times a year.  That is what my insurance pays for, so I use it. 

[allopathicholistic]

Many of those reporting unmet need for dental care — including Medicaid recipients whose state Medicaid program does not provide dental coverage — lack dental insurance.

Oh I never knew Medicaid was different in each state. I do know NY Medicaid provides dental care but with rules e.g. visits are rationed. If you've used up all your visits you can ask about reduced fees and many dentists will say okay because they know Medicaid = "not rolling in dough"

[Miss Philicia]

allopathicholistic:  Do you know that ADAP covers dental services in NY if you go somewhere like the dental department of Callen-Lorde?  They're actually quite good there, and at the time I went I had a rather delicious looking dentist from Ukraine.  Plus, of course, it's 100% HIV savy.

[cjc]

Hello, I receive regular dental care but only because I am poor, my son and myself receive Medicade. We have a checkup on the 19th. I have a private dentist that knows I am HIV + and she is the nicest dentist I have ever meet. Medicade will cover cleaning, and checkups here in NC. I also had oral Surgery and Medicade covered that. But I didn't have regular dental care before I had HIV, I think the HIV was part of the reason I qualify.  Cristy

[rick21007]

I have noticed that since I contracted hiv my dental health has been on the decline. I am religious about flossing, brushing and rinsing.  They do recommend having your teeth cleaned 4X a year.

I am fortunate that my dad, a retired dentist still does my primary dental work.  He did send me out to an endodontist (who was hiv friendly) for two root canals in the past year.  My brother is a periodontist and I need to make the trip to San Diego to get treatment from him.  For years he was one of only two periodontitists in CA who took hiv patients.

Infected teeth/gums are a serious health issue.  I had a nasty tooth infection prior to getting in to see the endodontist last spring.

Rick

[Moffie65]

OK time for the Ryan White guru to speak......

It is my understanding from my membership on the Allocations Committee, for the Southeastern Arizona HIV/AIDS Care Consortium, SEAHACC, there were six line items this year that were required to be funded for each state, by Health and Human Services, HHS.  Dental Care statewide was one of those six.  By that, I mean to say that each of the 50 states where Ryan White Mondernization Act is in effect, Dental Care must be provided.  Now, if you don't qualify for RW, there is every possibility that you will be covered for dental care if your private insurance doesn't cover it.  Beyond that, if you can get coverage from your private insurance, and paying for it places you in a financial bind; then some states will either help pay the premium upgrade, or pay it outright.  It is cheaper for RW to pay your premiums, than for you to be getting services from RWMA.

If your state doesn't have dental coverage under RW, then you need to check out why.  Start at the state health department and start asking questions.  If that doesn't work, then find out who in HHS is in charge for your state and find out if they are funding dental for your state, if they aren't, then you need to find out why.  Somewhere along the way, you will find an answer and then you might be the one that initiates full coverage for your state.

I do hope this doesn't sound like gobbley-gook, because it is really hard to write about this stuff and do it briefly.  (See sonoma post above.)

Love,

[dixieman]

Well I've been going to the same dentist for over 25 years... plus I have insurance... a dentist should not be scared about hiv... but, I can understand dealing with anyone who has hepatitus b, c  it remains contagious up to 72 hours after drying in the desert... hiv basically dies within minutes of being exposed to air...

[allopathicholistic]

allopathicholistic:  Do you know that ADAP covers dental services in NY if you go somewhere like the dental department of Callen-Lorde? 

now i do! thanks

They're actually quite good there, and at the time I went I had a rather delicious looking dentist from Ukraine.   

mm!

[DCGUY2007]

wow very interesting. Never knew hiv could cause so many problems with the teeth and gums

[rick21007]

a dentist should not be scared about hiv... but, I can understand dealing with anyone who has hepatitus b, c  it remains contagious up to 72 hours after drying in the desert..

And where did you hear this?    I will have to let my father and my brother know--both dentists and the latter who has chronic hep B as I do.

Rick

[indyguy]

I start root scaling next month. Even with insurance its expensive. I am so close to drowning its not even funny. Barely keeping my head above water.

[Moffie65]

Indy Guy; did you read my post above.  Seems like you are privately insured, and if you are having difficulty keeping your head above water, are you receiving benifits from Ryan White, and if not why not?

Love,

[indyguy]

I will check with my ASO. Last time when I asked if they could help me with some of the co-pays they said no. I want to become a ASO myself so I can show some empathy for people with HIV/AIDs. The ones here are neg and I dont think they have a good understanding of what we all go through on a daily basis. I will check again. Thanks