Dentist questions

[Falkore]

Hey guys, I have a question. 

The family dentist that I visited when I was growing up is my uncle.  I used to always go with my family to visit my uncle Tom for my annual cleaning and checkup.  Back in 1998 I moved to another city to go to college and was over 3 hours drive away from my Uncle's office.  Because of that I have not been back except once about 4 years ago or so.  I really need to go back for another cleaning and checkup, but here is my dilemma.

Should I tell him that I am positive?  I know that it is the best thing to do since there is a large chance that my gums will bleed and all that.  I know that if I do tell him my status, he is legally bound to keep it confidential, however I do not like the idea of placing such a burden on my Uncle.  I have yet to tell anyone in my family of my status.  I plan on telling them soon, but not yet.  I spoke with a representative from my Dr's office and she said it's best to tell him or to go to a dentist who focuses on HIV + people. 

What do you guys think?  Should I tell him and request that he keep it confidential, should I not tell him and hope that the universal precautions hold, or should I just go to another dentist? 

Also, I have noticed my last four blood results have shown my CD4 count slowly drop from 595 to the current 531.  Should I be concerned?  I know that for the most part, over 500 is good, but it's slipping.  Any concerns?
Thanks!

[Ann]

Hi Falkore,

It is always best to let your dentist know that you're positive.

How close are you to your uncle? If you have a good relationship with him, he may be a very good source of support for when you do tell your family. If you're not close, or have had a rocky relationship with him, then maybe it would be best to see another dentist. Which ever you choose, it is always best to let your dentist know. This is so they can be on the lookout for oral problems we positive people are prone to having.

Ann

[David_CA]

I'd probably get a local dentist.  That's what I did when I moved away from home years ago for college.  It was a lot easier than making a trip of 5 hours r/t.  If it's easier, I know I'm more likely to go to the dentist.  If part of the reason you haven't been to the dentist is due to the drive, and part is not wanting to tell your uncle your HIV status, the decision seems to be a bit easier to make: get a local dentist and tell him / her.  If you've moved back closer to your uncle, it may be a bit more difficult to switch dentist, though. 

David

[Miss Philicia]

Indeed.  Why be so averse to going to a local dentist if you are not ready to disclose to a family member?  Seems like a simple solution to me.

Also, we are advised to disclose to a dentist specifically not for HIS benefit, but OURS.  There are special needs we HIVers have when visiting the dentist, and mine even routinely ask for current lab results for their files once a year.  I guess if your cd4's are in a lower range it is something that the dentist wishes to know.

[dixieman]

Well since your dentist is your uncle and youve not disclosed to your family... to make it simple find a local dentist who deals with hiv... just to make it easier and less complicated... and when you disclose to your family... and you would like to use your Uncles services... then thats the appropriate time to let him know... Why put him in a situation between knowing your status... and not being able to share information with you other family members... People talk... especially Family Members between themselves... so if you want your status not known.. Find another dentist! period.

[megasept]

... to make it simple find a local dentist who deals with hiv... just to make it easier and less complicated... so if you want your status not known.. Find another dentist! period.

Dixieman: We don't need to find HIV Dentists! I refuse to live in an HIV ghetto! Everyone deserves GOOD DENTISTS.

I disclose where it asks on the intake form (once), and we go from there. (US Federal) HIPPA law guarantees you medical privacy. I can tell that my HIV status is announced to this or that hygienist, or dental tech, but always discretely. Once, this lead to an enjoyable discussion of my HIV and HIV treatment. It made me feel respected and that the dental practice was on board with me and my total health. A similar event happened in an ER once.

I wouldn't go to my Uncle for medical or dental care, because I like my privacy, so I am not discussing the original issue of family relationships, privacy, disclosure, etc. If I found a dentist who wouldn't treat me or follow HIPPA, I'd report them! Demand professionalism, and you're more likely to receive it.


  -megasept

[emeraldize]

Hi Falkore

This is an important decision as a dentist is the ideal lookout for all changes in your mouth and especially those related to HIV. I like Ann's advice regarding the relationship aspect.

The one thing you did not touch upon is whether you're considering your Uncle because you need dental care and because cost is a factor. If it's a factor, then you need to weigh the figurative cost of disclosing to him as I'm assuming he would treat you at no cost or very little cost.

However, if cost is not an issue ( and obviously you've got a three-hour drive/six-hour round trip X $? / gal/mil car you're using) then go local. It's easier for starters and if you need more treatments over a longer period, you're going to be relieved you've got someone nearby. You can disclose more easily and develop a relationship.

I empathize. I changed for a similar reason. My former, wonderful dentist was a high school chum. His wife, VERY chatty. As it turns out, she became his office manager. I would not have been ready for that at that time. Now, I'm out in certain groups so it's not as big an issue, but at that particular time, I needed the wagons circled.

When faced with decisions such as these a pro's/con's list helps you work it out quantitatively---just for one more option.

Em

[whizzer]

If you are concerned that you may offend your uncle by seeking more convenient dental care, why not call him explain that distance has precluded you from getting regular dental care, and could he recommend someone close to you that you could see.  That way, you're not going behind his back, he's still participating in your care (by steering you to a good provider), you don't feel guilty about for changing dentists, and you don't have to disclose to your uncle. 

Just make sure and tell the new dentist that your family does not know of your HIV status.  After all, he and your uncle may be buds from dental school or something and you don't want him mentioning something in passing that you don't want mentioned.  HIPAA covers a lot of issues concerning PMI, but it does not preclude two individuals of the same profession from discussing a patient's history in whom they have a common interest, especially if one of the doctors has referred a patient to the other one.