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Allow HIV dentists to practise, government told

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A leading indemnity provider for dentists is demanding the Department of Health withdraw the current rule that stops HIV positive members of the dental team treating patients.
 
The rule exists in spite of evidence that there is no risk of transmission.

A spokesperson for Dental Protection, the UK indemnity providers, says: ‘It is 20 years since the draconian rules were introduced preventing dentists (and other healthcare professionals) from providing treatment to patients.
 
‘Initially introduced as a precautionary measure soon after the mysterious case of Dr Acer, a dentist in the USA who was thought to have infected six patients with the AIDS virus, there has never been any other recorded transmission of the disease in a dental setting.'

Meanwhile many UK dentists – along with dental hygienists and therapists – have lost their livelihood because they have been forced to stop working in their chosen profession.
 
Dental Protection continues: ‘On being given their own diagnosis they were told to “clear their desk” with immediate effect.'

Anti-retroviral medication can now effectively control HIV, so that patients with HIV display levels of the infective particle in their blood which are too low even to measure.
 
This, combined with the high levels of infection control that are demanded of the profession, means that much of Europe along with countries like Australia and America have removed this outdated restriction for dentistry.

The Beijing Declaration from the 6th World Workshop on Oral Health and Disease in AIDS in April 2009 highlighted the outdated stance currently adopted by the Department of Health.
 
Failure to revise its guidance in the light of the latest consensus of evidence-based opinion leaves the Department open to accusations of discrimination.

In calling for greater fairness and a more consistent application of the evidence, Kevin Lewis, director of Dental Protection, says: ‘Dental Protection has championed the cause of HIV-infected dental health professionals for more than a decade in several parts of the world and will continue to take action against this kind of unfair and discriminatory treatment of its members.

‘The international evidence base is overwhelming and the Beijing Declaration unequivocal in confirming that HIV infected dentists can continue to practise safely with no risk to patients, subject only to some very clear and manageable criteria being met. 
 
‘In every other area of professional activity, dental health professionals are directed to follow the evidence base, but HIV has for too long remained a singular exception – during which time careers have been destroyed, lives have been devastated and patients have been deprived access to safe dentists.'

He continues: ‘The time has come to acknowledge the evidence and stop running scared of ill-informed public perception and media scaremongering.  It seems to be forgotten that infected dental health professionals are also patients themselves and they should they be treated no less fairly than other patients. The sound of foot-dragging has been deafening and some immediate action needs to be taken to bring the UK guidance out of the previous century.'

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It just takes one HIV positive Dentist with courage (Has to go public) to take the case to the Courts (and if not winning the caes to the European Court of Justice) to challange this stupid rule. Obviously a case like this should have the financial and moral support of the entire profession.

Posted by Frasse 21/10/10 at 22:58

There are always potential risks with infected and potentially contagious practitioners: http://www.heraldsun.com.au/news/breaking-news/police-raid-late-term-abortion-clinic/story-e6frf7jx-1225942582719

Posted by Philip Robertson 23/10/10 at 06:20

In response to Philip Robertson's use of the Melbourne anaesthetist Hepatitis C case to illustrate the "potential risks with infected and potentially contagious practitioners": by the same token does he therefore think that every GP practising in the UK who carries morphine in his/her surgery is a potential Harold Shipman risk? The Melbourne case is being investigated as a case of deliberate, intentional harm carried out by this particular doctor to his patients, his motives for doing so are not yet known (although in common with the Harold Shipman case, both doctors were previously disciplined for self prescribing of pethidine for their own intravenous use). Here, the doctor used his own Hep C positive blood to inflict harm to patients whereas Shipman used morphine instead, is there really that much of a difference? What this simply cannot be said to suggest is that this example is a reason to justify why an HIV positive healthcare worker should be barred from performing invasive procedures.

Just like in the Dr Acer dentist case, where it has always been suspected that he deliberately infected 6 of his patients with his own blood, and which was instrumental in instigating the current Dept. of Health ruling barring HIV positive dentists from practising here in the UK, this current case illustrates its potential for facilitating unnecessary discrimination, stigma and fear of HIV positive practitioners who put patient safety as their top priority and who would do everything within their abilities to prevent cross infection to their patients, either from their own pathogens or that from other patients by employing proper infection control protocols and methods.

What about the case of dentists/doctors who deliberately employ inadequate cross infection control methods who are not themselves carriers of blood-borne viruses and risk the transference of patient to patient pathogens? This Melbourne doctor happened to use his own blood but if he hadn't have been positive for Hep C, he could just as easily have deliberately inoculated his patients with blood containing Hep C that he had drawn from a suitable patient, either way if he was intent on carrying out harm to his patients, he would have had many means at his disposal to do it....his own Hep C was his method of choice but that certainly cannot be used to suggest that ALL HIV positive practitioners, whether they perform invasive procedures or not, are a potential risk of deliberately harming their patients in this manner.

Over 90% of dentists in the UK carry the herpes virus, many carry Epstein Barr Virus and herpes zoster along with being colonised with MRSA and pneumococcus. Many of these pathogens have the potential to be transferred to a patient and to cause significant harm to them but we do not routinely stop a dentist infected with these from practising. Instead we use the proper infection control and assume that we are all caring, non-psychopathic and non-patient harming professional people, unlike this Melbourne fella as it would seem! It should be no different with HIV.

All the world-wide gathered epidemiological evidence shows that practitioner to patient transfer of HIV, just as with all the many other blood-borne pathogens potentially carried by dentists, is totally preventable when proper infection control methods are used. Additionally, the use of highly active anti-retroviral therapy which takes HIV positive peoples' level of viraemia down to below undetectable levels and which all the evidence points to such a state meaning that they are 100% uninfectious to others means that HIV positive dentists can practice safely without risk to patients.

It is high time for the UK dental profession to come together, as a group that values equality, fairness and diversity headed by the General Dental Council to put a stop to the current Department of Health rule that prevents caring and professional HIV positive dentists from providing treatment to their patients and which results in them being left personally and professionally ruined, estranged and set apart from the rest of their colleagues because of the outdated, non-evidential and scientifically-challenged current regulations-our continued credibility as a caring and fair profession requires that we do this without delay.

--This post was last edited on 24/10/10 at 12:04--

Posted by allan.reid9@btopenworld.com 23/10/10 at 07:48

Phillip Robertson There are always potential risks with everything in life! And Allan thank you very much for an excellent analysis. The silly thing about this current DOH reule is that the GDC is required to ask for this eveidence only (once) on the time of registration. As with the CRB checks, it is in theory valid only for a very very short time i.e potentially on the day the CRB check was done or blood test was taken. There is no logic behind it. It is much easier to come up with draconian, stupid regulations to "reassure" the public that to educate them.

Posted by Frasse 23/10/10 at 12:51

This is very true, Frasse. The Department of Health guidance say that after this initial HIV test required either before dental school training or before the taking up of a post that requires the performance of invasive procedures, that they then rely on the self-disclosure of any practitioner who receives a positive HIV result to Occupational Health (OH). Similarly, even if a dentist suspects that they may have been exposed to HIV then they should seek OH advice and get tested.

However, do they really expect any dentist to get tested when a positive result means the end of their career and livelihood? Especially now when there is so much evidence available to show that the risk of a positive practitioner transmitting the virus to a patient provided that the appropriate cross-infection methods of Universal Precautions are used, is negligible and that HIV+ dentists are allowed to practice in most of Europe, the USA, Israel and Australia? Let's get real for a minute...who in their right mind, when armed with this information, is going to put themselves up for testing when, if found positive, they stand to lose their job and income, suffer having virtually the entire dental profession turn their back on them, be pretty much largely unemployable in any other field unless they retrain to something completely different (which costs money and takes time), lose their home, potentially become bankrupt etc etc etc...and that's just the start of it! What about the potential for the affected dentist's personal and family relationships to get destroyed along with the local community where the dentist lives finding out? It's almost impossible to keep the identity of an newly diagnosed dentist confidential by the manner in which they are suddenly "withdrawn from service". And all this happens in the UK because a team of experts (UKAP and the EAGA) who advise the government say that it is the most appropriate thing to do in this country!

One really serious effect of these rules is that dentists with HIV will go underground (it is the case already in the UK, believe me). The ones who continue to practise will have to work under immense personal pressure with their HIV status kept secret and risk being blackmailed or exposed and identified in the tabloid press by unscrupulous people who find out about their status. For those who avoid finding out their HIV status altogether, they risk seriously damaging their health by denying themselves the treatment that can give them a normal life expectancy and could lead to (potentially) higher risk to patients through possible iatrogenic transmission (not to forget their sexual partners also) because of the potential of their viral loads to rocket to sky-high levels because they go unchecked.

Another possible serious effect of the current rules is that it has the real potential to deter dentists and other healthcare workers from coming forward and reporting needlestick injuries sustained in practice and getting access to post-exposure prophylaxis treatment where required to prevent seroconversion. Significant when one considers that the risk of patient to practitioner HIV transference, although extremely small, is of many orders of magnitude more than the other way round.

With this in mind, surely its better and far more acceptable to allow HIV+ dentists to practice with their viral loads monitored and their adherence to any anti-viral treatment kept in regular check by their attending physician in communication with Occupational Health (similar to the situation for HIV positive surgeons in France for instance). That way, it's a win-win situation for everyone: patient safety can be assured and HIV+ dentists can practice and stay healthy and they can also effectively manage their HIV around their personal life and avoid passing HIV on to their sexual partners. The way it is currently, with these rules causing more and more positive, potentially positive and at-risk of becoming positive healthcare workers to hide underground, has the real potential to cause much more harm than good and policy makers, dentists and the public need to realise this and fast and do something about it!


One might think that if a dentist is found to be hiding an HIV+ status and continues to practise then he would be erased from the register? I can point out the GDC have stated in their live policy report from Nov 2009 that, and I quote:

"With the Beijing Declaration in place, the GDC may well find considerable difficulty, if not embarrassment, in reaching a finding of impairment against a dentist who continues to practice whilst being aware that they are HIV positive (and thus contravening current Department of Health guidance)".

Furthermore, in a recent professional conduct case against a dentist who did not disclose and continued to perform invasive procedures, which was held in private to protect the dentist's identity in July 2009, the GDC said in its determination of the case:

"The committee accepts that that the risk of transference of the HIV virus (from infected dentist to patient) is regarded by contemporary medical opinion as negligible, provided appropriate safeguards are in place."

(The dentist in this case was suspended for a period for choosing to go against the DoH guidance but has since been fully restored to the register without any conditions other than he is expected to comply with the current guidance and avoid performing invasive procedures)

With this being the way the GDC considers the matter, making a clear statement that they consider the risk to patients as "negligible", then it is really disappointing that they don't take a stand against the DoH and release a proper formal statement that they support the ability and right of an HIV+ dentist to practise. I completely agree with the view expressed by Frasse that this matter has to be taken to the courts if it does not get sorted out reasonably.


One final thing to illustrate the pervasive continued discrimination of the current DoH policy is this fact: in its guidance, when listing the sorts of behaviour that they claim should make a healthcare worker such as a dentist go forward for an HIV test includes the usual scenarios such as engaging in unprotected anal sex between men, sharing of intravenous needles, working in an area like Africa with a high prevalence of HIV etc .....at no place in the guidance does it mention unprotected heterosexual contact occurring in the UK as a reason for a dentist to go and get tested. Outrageous really, because if you look at the latest Health Protection Agency figures, the rates of heterosexually acquired HIV is the fastest growing affected group in the UK, particularly in the over 50s, due in no small part to the increasing social use of the internet as a way of arranging sexual contacts and organising adult private parties where heterosexual casual unprotected sex is common.

The HPA state that approximately one-third of people with HIV in the UK are unaware they have it (that amounts to around 30,000 people in the UK unaware that they are HIV positive) and this is particularly the case in the heterosexual community where there still exists the general notion that HIV doesn't affect them. I wonder how many of the UK's male and female dentists are currently practising and are unaware that they are HIV positive (and therefore "breaking the rules") and who are led to believe by this guidance issued by the DoH that they are not at risk-I strongly suggest that it's more than you might think. This is an issue that has the potential to affect every current dentist, future dentist and anyone who ever wants to become a dentist in the UK regardless of what their sexual orientation is. It is of vital importance that the profession takes action against this grossly unfair, outdated and dangerous policy.




--This post was last edited on 25/10/10 at 14:31--

Posted by allan.reid9@btopenworld.com 23/10/10 at 13:52