Donald A. Schneider

Use of Dental Care by HIV-infected Medical Patients:

Although increasing attention has been paid to the use of dental care by HIV patients, the existing studies do not use probability samples, and no accurate population estimates of use can be made from this work. The intent of the present study was to establish accurate population estimates of the use of dental services by patients under medical care. The study, part of the HIV Cost and Services Utilization Study (HCSUS), created a representative national probability sample, the first of its kind, of HIV-infected adults in medical care. Both bivariate and logistic regressions were conducted, with use of dental care in the preceding 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Forty-two percent of the sample had seen a dental health professional in the preceding 6 months. The bivariate logits for use of dental care show that African-Americans, those whose exposure to HIV was caused by hemophilia or blood transfusions, persons with less education, and those who were employed were less likely to use dental care (p < 0.05). Sixty-five percent of those with a usual source of care had used dental care in the preceding 6 months. Use was greatest among those obtaining dental care from an AIDS clinic (74%) and lowest among those without a usual source of dental care (12%). We conclude that, in spite of the high rate of oral disease in persons with HIV, many do not use dental care regularly, and that use varies by patient characteristics and availability of a regular source of dental care.

DENTAL SERVICE USE AMONG ADULTS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION

Human immunodeficiency virus (HIV) infection increases the importance of obtaining dental and oral health care. Dental care is necessary because oral health problems (such as abscessed teeth or nonvirulent periodontal disease) may cause pain, interfere with normal diet, and jeopardize health and quality of life.1 Without early detection and provision of effective treatment, oral opportunistic infections may have serious health consequences for immunocompromised patients.2-14 People with HIV and acquired immunodeficiency syndrome (AIDS) may face substantial barriers to needed dental services. Some dentists may be reluctant to provide care to infected people.15-22 People with HIV infection also may confront access barriers that affect Americans generally, including lack of private dental insurance coverage, and limited availability of publicly supported dental care.23-26 Prior reports of limited access to dental care lead to the expectation that use among people with HIV infection will be unlikely