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A patient called my office for an emergency appointment complaining of a toothache. My receptionist booked the new patient in an emergency time slot for examination. The patient’s chief complaint is acute pain in a particular quadrant. Examination reveals that there is a badly broken-down second molar without opposing dentition. My differential diagnosis and treatment plan includes extraction or endodontics with future prosthetic replacement of opposing dentition. Before I began discussing the treatment alternatives, a review of the patient’s medical records reveals a history of HIV-positive status. May I refer the patient to another practitioner?
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Code Section 4.A of the American Dental Association’s Principles of Ethics and Code of Professional Conduct ("the Code") states, "While dentists, in serving the public, may exercise reasonable discretion in selecting patients for their practices, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, sex or national origin."
Advisory Opinion 4.A.1 of the Code specifically addresses patients with HIV and other bloodborne pathogens. The advisory opinion states, "A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual is infected with Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus or another bloodborne pathogen, based solely on that fact, is unethical. Decisions with regard to the type of dental treatment provided or referrals made or suggested should be made on the same basis as they are made with other patients. As is the case with all patients, the individual dentist should determine if he or she has the need of another’s skills, knowledge, equipment or experience. The dentist should also determine, after consultation with the patient’s physician, if appropriate, if the patient’s health status would be significantly compromised by the provision of dental treatment."
The proper handling of this situation would be to treat the patient as any other patient would be treated, regardless of this patient’s HIV-positive status. The ethical dentist is bound to give this patient a proper diagnosis, treatment options and alternatives. He or she has a duty to perform the necessary treatment and make other appropriate observations and suggestions for further treatment without regard to the patient’s HIV-positive status. If this patient requires a referral, the referral should be based on the patient’s diagnostic and treatment needs, not the patient’s HIV status. There is also an ethical duty to protect the patient confidentiality under Section 1.B of the ADA Code on patient records.
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