Dispassionate Assessment
British Dental Journal FEB 24 2007
David Croser

Sir, Written off (BDJ 2006; 201: 497) was a plea to UKAP for ‘a scientific assessment of the risks, without any emotional or political considerations’. Lady Winifred Tumim and Professor Jeremy Bagg responded on behalf of UKAP (BDJ 2006; 201: 740) with plenty of science quoted to explain their perpetuation of the existing guidance. But how dispassionate are they in their assessment of the potential risk posed by an HIV infected dentist?

They say, ‘recommended standards of cross infection control for the dental profession have been strengthened significantly since HIV was first described. However, these standards are not universally implemented’. Apart from being an indictment of British dentistry, if this statement is correct about the transmission of HIV, it would also apply to hepatitis B and C which are far more easily transmitted; but we are not seeing clustered outbreaks of hepatitis (B or C) associated with UK dental surgeries — and have not done so since HIV was first discovered. The facts don’t support what UKAP implies in this statement: ‘Without very close monitoring, a missed dose could result in a transient increase in viral load. Following a precautionary principle, it was recommended that those whose viral load was suppressed on therapy should not be allowed to resume unrestricted practice.’

This hypothetical conceit is insulting to the healthcare workers involved. If anti-retroviral therapy is stopped, the immune system suffers and the patient feels ill, sometimes very ill. There is also the possibility that the retrovirus will develop resistance to the medication. Two simple reasons why people living with HIV are extremely well motivated to take their medications regularly. If necessary a simple check could be instituted (perhaps by another member of the dental team) before the dentist starts work for the day, but UKAP doesn’t seem to be interested in resolving the problems for the affected dentist.

A cynic might consider that this letter was motivated more by politics than a concern for the dentists who are being written off. It certainly doesn’t encourage one to think that the scientific evidence is being assessed unemotionally or that UKAP cares about the dentists whose careers are destroyed as a result of their guidance.