Oral health is important, but often overlooked

14.3% of HIV patients have unmet dental needs

Providers sometimes neglect to examine HIV patients thoroughly for oral infections, mouth ulcers, and other severe dental problems that are associated with HIV infections, according to a new study published in the winter 2001 issue of the Journal of Public Health Dentistry. The study was part of the HIV Cost and Services Utilization Study, conducted by a consortium led by RAND Health under a cooperative agreement with the U.S. Agency for Healthcare Quality and Research in Rockville, MD.

Primary care providers and HIV specialists may assume that patients are receiving regular dental treatment, when this often is not the case, says Kevin C. Heslin, chief investigator for the study, who also is a PhD candidate and a research associate in the department of health services at the University of California - Los Angeles.

"Poor people really have a lot of problems with their teeth because they don’t have good access to dental care," Heslin says. "And with HIV disease there are 15-20 dental health problems that show up, such as oral thrush and bleeding gums."

Oral candidiasis often is a first sign that a patient’s immune system is having problems, so it’s important to catch this disease early so an antiretroviral regimen can be initiated or changed, Heslin says. In addition, HIV patients’ oral health might suffer from medication side effects, which result in problems of dry mouth and sour throats.

The UCLA study randomly selected 4,042 people in January 1996, and 2,864 of these HIV-infected individuals completed an interview that asked them questions about their unmet needs for dental and medical care.1 The study is a nationally representative sample obtained by using probability sampling techniques, Heslin says.

Those patients who were most likely to report unmet dental and medical needs typically were under age 50, had low income, were unemployed, and lived in the South. Patients who had incomes of $10,000 or below had about twice the rate of unmet dental needs of those with incomes above $25,000. Women reported significantly more unmet dental need than did men, and people who had less than a high school education also had a greater rate of unmet dental need. "We can generalize this to all HIV patients in the United States, and it’s the first study of its kind," Heslin says.

Each participant was interviewed in a face-to-face survey lasting about an hour and a half. Patients were asked to measure their unmet needs through straightforward questions, such as "Was there a time in the last six months when you needed dental care but could not get it?"

The study found that 14.3% of HIV patients reported having unmet dental needs. This compares with 6.2% who reported having unmet medical needs. Heslin says the chief problem is that many HIV patients lack dental health insurance coverage, and some states do not even provide dental coverage for Medicaid recipients. Therefore, oral health screenings are left to primary care physicians, who have not had extensive training in this area. "I don’t think physicians take it so seriously because dental practice is not so complicated, and that’s detracted from it getting more attention, unfortunately," Heslin says.

However, HIV patients who have untreated oral health problems, such as periodontal disease, can suffer from life-threatening infections. Other oral problems could make it painful for patients to chew or swallow, which could in turn lead to weight loss and poor adherence to antiretroviral regimens. The study suggests that HIV providers could create systems to coordinate and monitor their patients’ medical and dental care, using case management as a strategy to ensure they receive both types of services.

Reference

1. Heslin KC, Cunningham WE, Coulter MM, et al. A comparison of unmet needs for dental and medical care among persons with HIV infection receiving care in the United States. J Public Health Dent 2001; 61:14-21.