Few Dentists Willing to Treat AIDS Patients : West Hollywood Clinic Set Up to Handle Cases Rejected by Private Practice

He is an AIDS patient. And like many with acquired immune deficiency syndrome, he was shunned by friends and family members. But Edward at least found acceptance from health practitioners treating him for the deadliest disease of our time.

Until he broke the crown of a tooth.

Then, suddenly, Edward (a pseudonym) faced a form of health-care discrimination common to AIDS sufferers around the country. His dentist of long standing refused to work on him because of his disease.

“It was a difficult time for me emotionally,” Edward recalled recently, adding that through his physician he finally located a dentist who would do the job.

Anger Still Lingers

But a trace of anger still lingered in his voice when he remembered the initial rejection: “I was surprised at the swiftness with which I was escorted out of that office. I just stood on the corner in Beverly Hills and said, ‘What am I going to do now?’ ”

Such corners are becoming increasingly crowded as more and more dentists refuse to deal with AIDS patients. The dentists are concerned that the AIDS virus (HTLV-III) has been isolated in both blood and saliva (though no cases of AIDS transmission by saliva have been recorded). The practitioners point out they sometimes get both blood and saliva sprayed in their eyes or nick themselves with sharp instruments while they’re working.

According to representatives of AIDS resource centers in New York, San Francisco, Los Angeles and other cities with sizable populations of AIDS carriers, it is far more difficult for AIDS patients in those cities to find dental care than to find medical care. And this is occurring despite the fact that dental schools and associations claim that treatment of AIDS can be low-risk if certain precautions are observed. (Typical guidelines, such as those recently issued by the Los Angeles City-County AIDS Task Force, include wearing gloves, masks and goggles as well as using heat sterilization on all instruments.)

Even so, the shortage of dentists in private practice available to work on Los Angeles area AIDS patients is so acute that the county Department of Health recently had to set up a separate dental clinic exclusively for people with AIDS. It is located in a trailer in West Hollywood, the address of which is given only to those referred for treatment. Created in conjunction with the AIDS Project/L.A., a private support organization funded by both public and private contributions, the West Hollywood dental clinic is believed to be the first of its kind.

“People with AIDS don’t necessarily have worse dental problems than other people, but they are extremely vulnerable to infection,” said Bill Mizenheimer, executive director of the AIDS Project/L.A. “It’s important for them to have good dental treatment.”

Mizenheimer noted that he’s spoken with gay dentists in the Los Angeles area who are unwilling to work on AIDS patients and that the AIDS Project had a difficult time finding any dentists willing to have their names listed in a local resource manual.

Though 10 volunteer dentists now work at the West Hollywood dental clinic on a rotating basis, none would agree to be interviewed by The Times, even anonymously. They indicated they feared that their private practices would suffer if their patients learned they were treating people with AIDS.

Such fears exist despite studies from the federal Centers for Disease Control (CDC) revealing that no health professionals have contracted AIDS--unless they were already in one of the disease’s high-risk groups (chiefly homosexuals, bisexuals, intravenous drug users and hemophiliacs).

In High-Risk Groups

As of April 11, according to CDC dental officer Dr. Margaret Scarlett, 10 dentists and five dental assistants were reported to have contracted AIDS, but all are members of high-risk groups associated with the disease.

In addition, Scarlett emphasized, CDC has been closely following the cases of 502 health-care professionals--including one dentist and three dental assistants--who have had accidental exposure to AIDS (by inadvertently puncturing themselves with a needle used on a patient, for example). As of March 31, Scarlett said, none of these individuals had shown any symptoms or indications of having been infected with the disease.

But such studies have apparently done little to assuage the fears rampant in dental offices across the country.

“All but about four or five of the dentists (in private practice) in New York City won’t treat AIDS patients,” according to Dr. Jack Rosenberg, president and founder of the Manhattan Dental Guild, a 6-year-old association of gay dentists.

‘Fear Based on Ignorance’

Rosenberg calculated that about half his clients have AIDS and said he suspects that “fear based on ignorance” is responsible for the behavior of colleagues who refuse to serve those with the disease.

“It stinks,” he added. “It really does. They should remember that they’re health-care providers and what that means. If AIDS patients are turned down by their dentists, it makes them feel even more like lepers. I’ve had guys sitting in my chair crying. It takes them a while to find me and by the time they finally get here they’re so glad somebody treats them normally. They tell me how many dental offices they’ve been thrown out of.”

Bea Roman, director of development for San Francisco’s Shanti Project, an AIDS resource center, estimated that only 12 to 17 dentists in the Bay Area are willing to take referrals of AIDS patients. “Dentists are much harder to come by than medical doctors. It’s pretty universal around the country,” she said.

In Boston, Dr. Myron Alleukian, director of community dental programs for the Department of Health and Hospitals, has supervised AIDS dental education programs for 20 neighborhood healthcare centers. But it is still difficult for AIDS sufferers to find dental help in private offices there. In fact, Alleukian feels that the refusals of some private dentists to treat AIDS patients may be creating a more serious problem for dentists: patients who know they have AIDS but don’t say so and display no readily observed symptoms.

Alleukian, who is also the president of the American Assn. of Public Health Dentistry, pointed to the case of an AIDS patient in the Boston area who was turned down by nine private dentists. The man finally showed up at the Harvard School of Dental Medicine but did not disclose he had AIDS.

The Harvard dental student treating him, however, observed symptoms of AIDS and confronted the patient with the findings before treating him. According to Dr. Richard Valachovic, director of (dental) patient care at Harvard, there have already been four cases at the dental school in which individuals with AIDS denied such history.

Emergency Situations

Many dental schools throughout the country do work on those with AIDS. But that care is sometimes restricted to people who are in emergency situations, who have severe medical problems or who require oral surgery. The Los Angeles County-USC Medical Center’s dental/oral surgery department, for instance, has treated a number of AIDS patients. But it is not set up to handle many general dentistry cases. Routine dental care is offered on a “space availability basis,” explained Dr. Joseph Anselmo, a clinical assistant professor in oral medicine and oral surgery.

“We’re not going to turn away somebody with AIDS. We’ll do what we can,” he said, observing that AIDS carriers often automatically fall into the category of patients with severe medical complications. “We would encourage other AIDS people to seek general dental work at the county’s West Hollywood dental clinic for AIDS patients.”

Some dental schools do not treat anyone with AIDS at this time. At Temple University, for example, microbiologist Norm Willett said that dental patients with AIDS are routinely turned down and referred to a hospital in Philadelphia.

The reason?

“Fear, for one thing,” said Willett, who is also the co-founder of the Society for the Control of Infection in Dentistry. “It’s a case of almost mass hysteria. The dental profession is scared out of its wits when it comes to AIDS because it has a very high fatality rate. . . . We’re still trying to develop a policy of what to do here. In the interim, we send them to a hospital in Philadelphia that does treat AIDS patients.”

Assorted Fears

Fear of being infected with or spreading AIDS are only two of the problems with which dentists are dealing. There is also considerable fear among some dentists that other patients may not return if they learn that their dentist is treating people with AIDS.

But despite all the assorted fears, Willett and others have noticed at least a few indirect benefits coming to the dental profession since the outbreak of AIDS.

“More and more dentists are starting to wear gloves,” Willett said, noting that he and many others lecturing on control of infectious diseases believe dentists should wear gloves when working on every patient.

This is because, in many cases, nobody knows who has been infected with AIDS. Symptoms are often slow to appear and the CDC has estimated that incubation periods for the disease can be as long as five years.

‘It Bothers Me’

“There are still a lot of dentists who say, ‘I don’t think wearing gloves is necessary. It bothers my patients. It bothers me.’ They’ll say they lose their sense of tactility. Yet the answer to that is that heart surgeons don’t have any trouble wearing gloves. A lot of dentists who wear gloves and masks feel they’re more removed from their patients,” Willett said. “In general, you’ll still find more dentists who don’t wear gloves than those who do, but this is changing.”

So, apparently, is the dental profession’s desire to learn more about how to recognize and treat AIDS.

“Four or five years ago if I lectured once a month on this subject (infectious diseases in the dental office) it was a busy year,” said Dr. Robert Runnels, an assistant professor at the University of Utah School of Medicine’s division of dental education. “Now I average three lectures a week throughout the country and the reason is not because of me, it’s because of the need for knowledge by dentistry about how to cope with the various new kinds of diseases. I find that a plus for dentistry. Dentists are seeking a better way to treat patients and to protect themselves, too, but mainly to treat patients.”

Increasingly, that treatment includes being the first to discover AIDS or pre-AIDS symptoms in a patient. Several of the early symptoms of AIDS and AIDS-related conditions--signs such as pain in swallowing or a persistent white coating or patches on the tongue--manifest in the mouth and neck. Thus dentists are finding themselves in the position of breaking this news to their patients and referring them to medical personnel for further testing.

“I wouldn’t say we get a case every week, but at least once a month we get a case of somebody who doesn’t know they have AIDS and we have to tell them,” said Dr. Sol Silverman Jr., chairman of the oral medicine at UC San Francisco’s School of Dentistry and chairman of the Council on Dental Research for the American Dental Assn.

Oral Symptoms

“Several of the preliminary studies on AIDS show that about half the patients are identified first because of oral symptoms,” Runnels said. “Potentially, half of the AIDS patients will wind up in dental offices first. Dentistry is in an important position as far as diagnosing AIDS is concerned.”

At the moment, however, Runnels suspects that much of the profession’s refusal to work on people with AIDS is simply a matter of a lack of education. “It’s difficult because the majority of dentists so far don’t know what the symptoms for AIDS are,” he said. “But the preliminary screening for AIDS is a rather easy one.”

Despite the fact that Runnels spends most of his time lecturing, he has treated AIDS patients and is among those practitioners who do not fear any adverse consequences. “The HTLV-III virus has been shown to be very easy to kill (on instruments and other surfaces),” he said. “At this point in time it may be the easiest of the viruses to kill. I’m not frightened by AIDS because I think it will be shown to be difficult to transmit in dentistry.”

Similar declarations of safety and fearlessness come from dentists in health maintenance organizations, in hospitals and in private offices where some individuals with AIDS are, in fact, finding treatment.

But not all of the dentists providing care have managed to banish their fears completely. Some of those who observe all the recommended procedures for control of infection and help to set such standards are willing to admit they’re still worried.

As Dr. Frank Lucatorto, director of oral medicine/oral diagnosis at the UCLA School of Dentistry and director of the dental emergency clinic, put it: “I have fear. But I’m still working (on AIDS patients). Somebody has to help them. Somebody has to take them out of their pain.”