CDA Essentials 2019 • Volume 6 • Issue 7

I ssues and P eople ➜ Stigma lingers around HIV, even now that the virus can be controlled with medication, and many HIV activists say that living with social stigma can be harder than living with the virus itself. The Clinic Positive Living Community Dental Clinic is a state-of- the-art dental office for people living with HIV and other underserviced communities. It’s located within the headquarters of Positive Living Society BC, an advocacy and service organization that since 1986 has been run for and by people living with HIV. The newly renovated dental office opened in February 2018 and offers restorative dentistry, endodontics, minor oral surgery, oral medicine, and oral support with oral hygiene advice. It is the only dental office in BC that offers care specifically for people living with HIV and is housed within an HIV service organization. The dental office, a 500-square foot, 2-operatory facility, was made possible by a $420,000 grant from the British Columbia Ministry of Health for the purpose of providing ongoing, professional, free-to-user care. But even before the new office was built, indeed, since 2007, University of British Columbia (UBC) Faculty of Dentistry students provided dental care at the Positive Living BC head- quarters. “Dental hygiene students used massage therapy tables rather than proper dental chairs to treat patients,” said Neil Self, former chair of Positive Living BC’s Board of Directors. “Headlamps were used in lieu of proper lighting systems and dental instruments had to be brought to and from UBC as there was no ability to sterilize or store dental instruments.” Between 2007 and 2016, hundreds of dental and hygiene students provided care in the modest office. UBC professors Dr. Mario Brondani and Dr. Leanne Donnelly, Dr. Allan Hovan of the BC Cancer Agency, and Jocelyn Johnston, executive director of the British Columbia Dental Association, created and grew the program, which provided invaluable experience for students and oral health care for people who would not otherwise have been able to afford it. The Day-to-Day Dentistry After finishing a residency in New York City, Dr. Aytoglu moved back to Vancouver, where he’d studied dentistry at UBC, to work at the clinic. He started in July 2018 and soon became the clinic manager. He is one of four dentists and a hygienist that work part-time at the clinic, which provides care for between 10 and 20 patients a day. “Every day is different,” says Dr. Aytoglu. “On Mondays, UBC residents come to the clinic. Tuesdays, I do dentures and removable. It’s a great place to learn because we deal with novel challenges all the time.” Dr. Aytoglu also works biweekly at the BC Cancer Agency and three to four days a week in private practice. Dr. Aytoglu says that there are benefits to a dental clinic designed to serve a specific population that often lacks access to dental care. “We understand the barriers and obstacles that people living with HIV have accessing dental care,” he says. “And we can help address those obstacles.” He says that there are often socio-economic and mental health impacts of an HIV diagnosis that create barriers to access. “Diagnosis can cause depression, which makes it harder for people to take care of their health in myriad ways. People may have to go on disability. May not be able to work. Then there are social factors, such as not feeling comfortable talking about HIV status with a doctor or dentist. That all hinders access to health care.” Studies show that dental problems can arise as symptoms of HIV disease. Some medications have side effects, such as dry mouth, that cause decay and tooth loss. “Thankfully, the new drugs used in HIV treatment are much better and have fewer side effects,” says Dr. Aytoglu. Dental treatment can be riskier for people with compromised immune systems because they are more vulnerable to infection. “I think that some dentists are fearful about working with people living with HIV because they don’t want to cause harm. Will oral surgery or other treatment lead to an infection? There is fear around that.” Dr. Aytoglu gave a lecture on HIV medicine to UBC residents. To prepare, he did a literature review, and found gaps that surprised him. “I realized that we lack guidelines that would help dentists more confidently treat people who are immunocompromised. We need greater guidance about when to use antibiotic prophylaxis. What kind of work up do we need to do in advance to know what kind of treatments will be safe for our patients?” Dr. Aytoglu believes that researchers and dentists need to discuss these issues so that more 36 | 2019 | Issue 7