Should You Worry About Getting AIDS From Your Dentist?

By Christine Gorman

Mary Lynne Desmond thought she had found the perfect dentist. Philip Feldman, a graduate of the School of Dental Medicine at the University of Pittsburgh, had an engaging manner and seemed meticulous. Soon Desmond, a fourth-grade teacher who lives in Coram, N.Y., and her two children, husband, sister and brother-in-law all became Feldman's patients. "But in the last five or six years, he changed," Desmond recalls. "He did three shoddy root canals on me and even left a drill bit in one tooth." Now she has a lot more than a few botched operations to worry about. Last week state health authorities confirmed that they are trying to determine whether Feldman, 45, who died of pneumonia in June, had unwittingly infected any patients with the AIDS virus.

Chances are that Desmond will not test positive. In the past decade, out of the nearly 200,000 people who have developed AIDS in the U.S., only five are known to have been infected by a health-care worker. And epidemiologists quickly point out that all five cases can be traced to the same Florida dentist, David Acer. But the fact remains that it did happen, despite the odds and with devastating results. Already one of Acer's patients, Kimberly Bergalis, is near death; her plight and her understandable fury have moved millions to feel insecure when they go for teeth cleaning or an annual physical exam. Nearly 6,800 health-care workers in the U.S. are known to have AIDS -- including 170 dentists and dental hygienists, 730 physicians and more than 1,450 nurses. Should they tell patients? Should they get out of medicine altogether?

In response to public concern, the Centers for Disease Control in Atlanta last week restated the strict standards of infection control that it began developing in 1982 and that it believes should eliminate any opportunity for doctor-to-patient transmission. But for the first time, the federal agency also urged dentists, doctors and nurses who perform invasive procedures such as surgery to get tested for HIV, the AIDS virus. If they are HIV-positive, said the CDC, they should stop doing operations unless they reveal their condition to patients.

Soon after that policy was announced, the U.S. Senate moved aggressively beyond the CDC and passed two measures to make the agency's recommendations, including disclosure, mandatory. Under one proposal, sponsored by Senator Jesse Helms of North Carolina, physicians could receive prison terms of 10 years and fines of up to $10,000 if they refused to reveal their HIV infection before an operation -- whether or not they passed on the virus to their patients. The second bill, backed by Senators Robert Dole of Kansas and Orrin Hatch of Utah, threatens any state that does not implement the CDC guidelines over the next year with loss of its federal public-health funding. Congressional leaders expect the Dole-Hatch proposal to attract greater support from the House of Representatives.

Not content to wait for federal action, the Illinois legislature overwhelmingly passed a new law last week that would authorize the state's health department to notify patients when their medical-care providers are diagnosed with AIDS. The bill was prompted by the revelation that the only dentist in the town of Nokomis, Ill. (pop. 2,700), died of AIDS last October; his patients were not notified until early this month, after a state legislator threatened to make the circumstances of the dentist's death public.

Is the rush to legislate a case of hysterical overreaction? Nothing has happened to make researchers change their minds on how the AIDS virus is spread. Almost all infections occur in the expected ways: people share contaminated needles or have unprotected sex with an HIV-positive partner. "The risk of getting AIDS from your doctor is lower than the risk of dying in a car crash on the way to the hospital," says Dr. James Mason, Assistant Secretary for Health at the Department of Health and Human Services.

In fact, medical workers are more vulnerable to being infected by patients than vice versa. The CDC has documented 40 such cases -- most of them involving accidents with hypodermic needles that contained contaminated blood. "Because there is mass hysteria, and because this is a fatal disease, and because people don't know very much about this, people's common-sense reaction, including Senators', is to act first and think later," says Geri Palast, a lobbyist for the Service Employees International Union, which represents 350,000 health-care workers.

The evidence strongly suggests that good sterilization procedures will prevent doctors from endangering patients. Last year, after one of the surgeons at Johns Hopkins Hospital died of AIDS, officials at the medical center in Baltimore informed 1,800 people on whom he had operated that they may have been exposed to the virus. So far, none of them have tested positive, and all the lawsuits filed against his estate have been dismissed. Delaware health officials have offered free HIV tests to more than 1,200 patients of a Wilmington dentist who died of AIDS in March. Of the 600 who have taken the state up on its offer, none have tested positive.

The guiding principle of standard infection control is to act as if everyone and everything is infected with something -- whether it be Staphylococcus bacteria, tetanus toxins or the AIDS virus. That is why instruments should be sterilized in an autoclave, physicians should change gloves or wash hands between patients, and disposable swabs, syringes and other items should not be reused. Although the CDC's disease detectives are still not sure what went wrong in Acer's office, they are zeroing in on just such a breach in infection control.

The danger is not from the doctor but from slipshod practices, says Jack Rosenberg, a Manhattan dentist and founder of a gay and lesbian dental guild. "Asking your dentist whether or not he is gay is not going to protect you," Rosenberg says. "Instead, you should ask, 'Do you sterilize your instruments? Do you follow standard infection control?' Those are the questions that will protect you." Rosenberg caused a ruckus last week when he publicly declared that he knew several dentists who are HIV-positive and that he advises them not to tell their patients.

Knowing the HIV status of a surgeon or dentist should not necessarily reassure a patient. "These are people who are exposed to patients every day," says Dr. Michael Callahan, chairman of an AIDS task force for the American College of Emergency Physicians. Yet it can take a person six months after infection to make enough antibodies against HIV to test positive. Says Callahan: "If I got tested yesterday and was negative, I might get exposed to HIV tomorrow." In addition, the danger of bad sterilization practices is that the virus passes from one patient to the next, rather than from the doctor.

Instead of becoming enemies, doctors and patients need to communicate better about the risk and fear of AIDS. Dr. Nancy Dickey, a Richmond, Texas, family practitioner and a trustee of the American Medical Association, says patients should not hesitate to voice concern if, for example, they see blood on their doctor's hands, even if the physician says, "Don't worry about it." They also have a right to ask exactly how each piece of equipment has been sterilized. As the AIDS epidemic enters its second decade, professionals and private citizens alike should choose a path of reasoned caution, rather than dismissive bravado or irrational hysteria.

With reporting by Barbara Dolan/Chicago and Anne E. West/Washington