Faced with attitudes such as these in both
patients and practitioners, not to mention the general shortage of dentists
willing to provide NHS care, one option is to contact your local Community
Dental Service: clinics in which dentists who are receiving an NHS salary
provide first-line service.
In Lothian, for instance, Dr Chris
Cunningham, co-author of the BHIVA study,12 works for the Salaried
Primary Care Dental Service (the equivalent of a Community Dental Service).
“We do still have a specialist care team
for people with HIV. Edinburgh
has always been different in that we’ve had quite a large population of people
with HIV and also injecting drug users.
“Only a small minority of our patients have
had problems getting a dentist specifically because they have HIV. A larger
number can’t find an NHS dentist for the same reasons as anyone else – there
aren’t enough of them. A proportion of patients want to disclose their HIV
status to us and not to a high street dentist. And, finally, some think we will
offer a better service.
“For a while we have only been accepting
new referrals for people with CD4 counts less than 200 or with specific oral
problems but as a result of our study we are reconsidering whether we should
accept asymptomatic HIV-positive individuals. We’ll offer a course of
treatment, get you dentally fit, and our advice is then to go and find a
regular NHS dentist. If you get refused because of HIV you can take them to the
General Dental Council.”
Dr Steve adds: “If they reject you because
of HIV, or if the dentist insists on
conditions such as double-gloving (such rubbish!) or your having to have the
last appointment of the day, you have the winning hand, not the losing one: the
General Dental Council Good Practice Standards are quite explicit and they
could face a charge of professional misconduct. I hope, armed with this
knowledge, HIV-positive dental patients who are feeling a little intimidated
about going to the dentist may feel just that little bit more empowered.”
In other parts of the UK, however these services are
seeing fewer patients with HIV as their reason for referral. A spokesman for
the Lambeth, Southwark and Lewisham Community Dental Service, for instance,
told HTU that “in contrast to the
early 1990s, when I saw lots of people with HIV at the PCT dental clinic, now
to get referred you’d need to have additional needs other than HIV: maybe a low
CD4 count, complex dental problems, or issues such as mental health [problems].
Having said that, our criteria also include “people who may not otherwise seek
or receive dental care”.
One option if you have difficulty in
getting a dentist is not to disclose your HIV, of course. There is no legal
obligation to do so, you’re unlikely to have HIV-specific complications with a
reasonable CD4 count, and relatively few drugs used in dentistry have interactions
with HIV medications (ones that do include sedatives for patients who have
dental phobia and some antibiotics). However drug interactions do exist and
you’re withholding medical information that might help your dentist make a
diagnosis.
Another answer is to go private, but even
Dr Steve (who only does private work) recommends that if you haven’t had dental
care for a long time, it may be a good idea to seek out an NHS dentist first. If
you’ve not been able to find a dentist in your immediate local area you could
search for one at the NHS website at www.nhs.uk or contact NHS
Direct on 0845 4647. Working with an NHS dentist should restore you to basic
dental health and save you money. In Scotland, basic check-ups are free.
Unless you are on certain benefits such as Income Support, in which case you
get free treatment, NHS dentists in England
and Wales
will charge you one of three fees:
-
£16.50 for a basic checkup, X-rays and
cleaning
-
£45.60 for drilling and anything up to 20
fillings
-
£198.00 for crowns, inlays or anything
outsourced such as dental lab work.
If you go private you may get a quicker
service, or one that is closer to where you live, but it is likely to cost you
a lot of money. Steve gives as typical private charges for an out-of-London
clinic – London
practices may cost a lot more:
-
£80 for an initial consultation
-
£150 for a complete check-up and
comprehensive clean
-
At least £460 for a crown
Another reason for going private or
contacting your Community Dental Service might be dental phobia.
Even if you don’t have an extreme fear of
people putting sharp metal objects in your mouth, Steve says, “It’s very
important to establish a rapport. It’s a very intimate procedure. You might
simply not like the dentists. Well, if you don’t, move on.”