Dental Health Care: What it means to PLHIV

PDA dentist examines mouth of HIV patient

“Ayoko maghandle ng mga katulad niyo kasi mamaya yung mga equipment na gagamitin ko, mahawa yung ibang mga pasyente ko.”

Jake recalled his “traumatic experience” and the spiteful words his dentist told him the last time he decided to get checked due to the discomfort he felt from his swelling teeth.

Jake, his alias, has been diagnosed with the human immunodeficiency virus (HIV) in 2012.

In his five years of living with HIV, he has learned to tolerate various forms of discrimination directed to him. However, it was his first time to be declined of dental services because of being HIV-positive.

Known as one of the most stigmatized infectious disease, HIV continues to be on the rise. The World Health Organization (WHO) recorded that 36.7 million individuals globally are living with the disease as of 2015.

In the Philippines, the Joint United Nations Program on HIV/AIDS (UNAIDS) estimated over 1,000 victims of acquired immunodeficiency syndrome (AIDS)-related deaths and 6,400 new cases of HIV infection in 2015 alone.

From January to May 2017, the HIV/AIDS Core Team (HACT) of the Research Institute for Tropical Medicine (RITM) served 9,801 patients with HIV. Meanwhile, according to the Department of Health (DOH), the daily average number of new HIV cases is 30.

One concern that is commonly left unnoticed for PLHIV is dental health. There is barely a discussion about dental health care services and strategies specifically intended for PLHIV in the country.

Dilemma between PLHIV and dental care

“Parang ayoko na pumunta ng dentista. Hindi naman sa dinadamay ko lahat ng mga doktor and dentista. Baka kasi mangyare na naman ‘yun. Baka hindi na ‘ko makapagsalita (I no longer feel like going to the dentist. It’s not that I’m generalizing all doctors and dentists. I’m just scared it might happen again. I may not be able to help myself),” Jake said.

After the incident, Jake was traumatized. He had decided to take matters into his own hands and eventually resorted to drinking mefenamic acid whenever he would experience toothaches or swelling.

According to RITM HIV clinic doctors, a significant number of patients who went for consultations raised their concerns about the lack of services they receive for their dental and oral health needs.

RITM HIV Primary Care Physician Dr. Natasha Julienne Delgado shared that most of the concerns were about dentists who are trying to require patients to disclose their status.

Dr. Delgado also noted that PLHIV, who already disclosed their status to their dentists, were requested to present their CD4 count results and other laboratory test results to their dentists prior to the dental service but would eventually be refused.

Dr. Anna Maureen Dungca, RITM HIV Primary Care Physician, also confirmed that there are PLHIV who are being denied of service by their dentists. Even simple procedures such as the adjustment of braces are being turned down, for the reason that the dentists do not know how to handle PLHIV in particular.

“All surgical procedures should observe standard precaution and treat all of their patients as if they were infectious,” said Dr. Dungca.

RITM Physicians would usually work this out by giving endorsement or referral letters to address their concerns.

“Kaya sila nadidiscriminate, kasi there is a knowledge gap on handling PLHIV and their dental concerns (The reason why they are discriminated is because there is a knowledge gap on handling PLHIV and their dental concerns),” said Dr. Delgado.

On the other hand, RITM Infectious Disease Consultant Dr. Mark Kristoffer Pasayan shed light on one of the possible reasons why some dentists would opt not to offer their services to HIV positive individuals.

Dr. Pasayan mentioned that dentists are hesitant in providing their services due to the fear of possible HIV transmission. However, he clarified that if the dentists indeed practice standard precautions “there is negligible risk of [HIV] transmission.”

Discrimination and PLHIV

It was March this year when Jake consulted his dentist. Before the procedure of pulling his tooth out, Jake wanted to discuss his condition with his dentist. He jokingly mentioned that he is HIV-positive, however Jake did not expect such an offensive reaction from his dentist.

True enough, discrimination continues to be the one of pressing concerns revolving around PLHIV and their demand for dental care.

For many times, Jake mentioned his yearning for the day when he and his HIV-positive friends can enjoy such services without being discriminated.

“Yun lang ang gusto ko. Sana meron kaming doctor na puwede kami pumunta, maintindihan kami (That’s all I want. I hope we can have a doctor we can visit, and who would understand us),” he said.

RITM Dental Health Bus

Addressing the need of PLHIV, RITM recently signed a memorandum of agreement with the Philippine Dental Association (PDA) Muntinlupa Chapter to provide quality dental and oral health services for these patients. A Dental Health Bus was donated by DOH to serve as the RITM dental clinic.

The dental health bus donated by the Department of Health

The provisions are still being ironed out but the good thing about the bus is it does not only provide dental services that cater especially to PLHIV, but is also free-of-charge. From oral prophylaxis to tooth extraction, the dental bus has it covered.

Volunteer dentists from PDA will be in charge of the dental clinic patients at RITM. RITM-HACT already conducted a training course on the basics of HIV/AIDS, including topics on disease transmission and infection prevention and control for the dental practitioners as a preparatory step for this program.

Aside from accommodating PLHIV, RITM-HACT Assistant Chair Dr. Jemelyn Garcia said that the Dental Health Bus will be also made available to RITM employees. However, dental services will be provided on appointment basis.

Given the mobility of the dental clinic, RITM permits PDA to use it to offer free dental services for their outreach programs within the National Capital Region (NCR). The RITM-PDA dental clinic started its operation this August 2017 and operates every 1st and 3rd Thursday of the month.

Jake expressed his optimism about the Institute’s endeavor, “I’m happy. Yung maghahandle sana sa’min kaparehas lang ng mga doctor namin na hindi nandidiri humawak o ano. Sana pantay pantay lang yung tingin nila sa’min (I’m happy. I hope that these dentists would treat us the same way other doctors treat us — with respect. I hope they would treat us equally).”

The partnership between RITM and PDA will run until 2022.

by Chicco Emmanuel Carmona, Contributor