Bite - In

This month's opinion brings to fore the very scary topic of AIDS and the extensive fear instilled in minds of dentists and patient alike about the possible spread of AIDS during or after dental treatement. Dr Ajay Kakar debates the possibilites and explodes a few myths about AIDS in the dental clinic.

Debunking AIDS in Dentistry

AIDS, over the last two decades has certainly loomed large and has been one of the largest killer diseases of mankind in current history. The problem with AIDS has been the inability to find a cure for the problem and the rapid rise in the percentage of population suffering from it.

Nevertheless, it is only fair to mention that the AIDS paranoia has been highly overplayed by the media, may it be the idiot box or may it be the press. There have been numerous talk shows and umpteen number of sensational headlines lilterally proclaiming the start of the end of mankind due to the disease. As time has gone by, most of these dramatic proclamations have come to naught.

The initial steep growth curve of increase in the percentage of population suffering from AIDS has plateaued off. In the U.S alone, huge sums of money has been sanctioned for research into AIDS, as also in evaluation the incidence and spread of AIDS. Over the last few years, the very general AIDS paranoia in U.S and Europe has definitely decreased with none of the doomsday predictions about AIDS coming true.

Scientific study has quite unequivocally proved today that AIDS is caused primarily via homosexual intercourse followed by Intra-Venous Drug Abuse, heterosexual intercourse, contaminated blood transfusion and lastly transmission via infected mothers to newborn infants. AIDS is essentially a blood borne disease and is transmitted only if sufficient quantities of infected blood is introduced into the recipient's circulatory system.

The fourth estate always was waiting for a celebrity to get AIDS and a big production was made out of it, as if every person in the same circumstances would get AIDS. Very convenient omissions are usually made about the countless non-celebrities who undergo blood transfusion and do not get infected, but one celebrity and the entire media goes into a song and dance.

Now, where does dentistry come into the picture? Almost 80% of routine dentistry is non surgical dentistry. Almost 90% of routine dentistry does not involve injecting either medication or any other substance into the patient's circulatory system and 100% of dentistry does not involve transmission of blood from the dentist to the patient or for that matter having any kind of sexual contact with the patient.

The incidence of blood interaction with the patient is almost thousands of time more in surgical medicine than in dentistry, but about 6-7 years ago, the media created a hoopla about the unfourtunate patient who contracted AIDS from his dentist who was HIV positive. The case was of one Dr. David Acer, who was a dentist in the US Air Force before entering into private practice. A review of his medical records showed homosexual activity and 100 to 150 partners over a 10 year period. It was confirmed that one HIV positive patient had a sexual relationship with Dr. Acer. These are the totally ascertained facts garnered out of written medical records. No one documents complete details about multiple bisexual partners and nor does one carry around HIV blood reports of every sexual partner. The media found it very convenient to never mention that the dentist as well as the patient were both homosexuals with multiple sexual partners. The author is in no position to check finer details but the fact of both, the dentist and the patient being homosexuals is very pertinent. There was some kind of civil law suit filed with large sums of monies being involved.

No definite hypothesis or proof of any sorts was ever mentioned about how the patient could have contracted AIDS from the dentist during dental treatment. The author cannot imagine any which way whereby a sufficient quantity of infected blood from the dentist entered the blood stream of the patient due to dental treatment.

It is only fair to educate the common man patient that AIDS is not a air or water borne disease, nor is it transmitted by physical contact. One just does not leave behind HIV viruses for the picking on dental towels, dental instruments, dental chairs, handpieces etc.

A similar alarm ran through opthalmologists in the U.S when someone suggested that HIV could be transmitted through tears. This fear was put to rest with a report in JAMA, March 1988 which ruled out such a possibility. Similarly, saliva has never been shown to contain enough virus to cause infection. In fact, the May 1988 issue of JADA carried an article by Philip C. Fox et al that Saliva actually inhibits HIV infectivity. The study reported that "the ability of HIV to infect human peripheral blood lymphocytes (WBC, the usual abode of HIV) can be completely inhibited by incubation of the virus in unstimulated whole saliva in the test tube at body temperature for one hour. In 1990, Fumio Shimizu at the University of Tokyo found that human saliva could kill HIV. Must be quite difficult setting up home in the oral cavity for dear old HIV.

JADA, January 1993 carried an paper by Barbara Gooch et al which found that the dental handpieces and prophy jets did not transmit HIV in the sensationalised Acer case.

The author would like to quote from a very rational and objecvtive book on AIDS written by Michael Fumento "AIDS is not just another disease. It is the most intensely reported-on, most metaphorical, most exploited disease in history. It is the ultimate triumph of politics over science. Indeed, it is the triumph of politics over reality, with what is "right" or "correct" determined not by what is scientifically right or correct, but by whatever happens to fit a specific agenda and whatever is socially acceptable".

Unending newspaper headlines, public announcements and books predicted about the AIDS epidemic, that one out of every 10 Americans would die of AIDS by the early 1990's. The year 2000 is round the corner but the AIDS epidemic does not seem to be getting anywhere nor does it seem that the dentist is contributing at all in this mythical epidemic.

Let us, as dentists, first be very clear in our minds about HIV transmission and then try to allay the fears in the minds of our patients.

AIDS - Acronym for Acquired Immune Deficiency Syndrome, caused by the HIV virus. AIDS is a disease brought about by a deficiency in the body's immune system, which fights infections in the body.

HIV - The virus responsible for AIDS. HIV is a lentivirus i.e. a virus with an extremely long incubation period. HIV was originally known as HTLV-III in the U.S and LAV overseas. Recently, a second strain of HIV has been found and the two strains are known as HIV-I and HIV-II. HIV can have a latency period as short as a few weeks to as long as almost 15 years. Once activated an explosion of replication activity takes place which directly kills of immobilizes the T lymphocyte leaving the human host vulnerable to almost all kinds of infections which in turn usually prove to be fatal.