Dental care needs for HIV patients continue to rise

People with HIV now are living longer and the number of dental patients treated monthly at the Oregon Health & Science University School of Dentistry's Russell Street Clinic continues to grow. In the first five months of 2005, the Russell Street Clinic saw 200 patients with HIV a month - three years ago it saw 100 a month.

HIV-positive individuals require more dental care than the average person, and with the number of people living with HIV expected to grow, the 30-year-old Russell Street Clinic provides an essential service to Oregonians, said David Rosenstein, D.M.D., M.P.H., professor emeritus of community dentistry, School of Dentistry, (www.ohsu.edu/sod), and director and founder of the Russell Street Clinic.

"In the early 1980s when the AIDS epidemic reached Portland - about five years after the Russell Street Clinic opened its door - we were the first and only providers of dental care to HIV-positive patients," said Rosenstein, "and we continue to be the main source of dental care to HIV-positive folks in the Portland area. Even though the rate of HIV infection has stayed the same over the past few years and the death rate from HIV and AIDS has dropped, we are seeing more patients with HIV because they are living longer."

The Russell Street Clinic at 214 N. Russell Street is the state's only Title I provider, under the Ryan White Care Act passed in 1990. Today the clinic provides about $60,000 worth of HIV services each month, compared with about $15,000 three years ago. The Ryan White Care Act provides some reimbursement for the HIV services offered. Recent funding from the National Institutes of Health (NIH) has enabled OHSU to hire outreach workers who help HIV-positive individuals further access dental care in Oregon.

Longtime Russell Street patient Jack Cox, 65, can remember the days when most dentists didn't want to treat HIV patients and access to care was extremely difficult. "In the early days of HIV and AIDS, people drove up to the Russell Street Clinic from way south - Medford, Coos Bay, Eugene -just to have their teeth cleaned," said Cox, who has been coming to Russell Street for 16 years. "David Rosenstein is a real hero to the HIV community."

Individuals with HIV, like Cox, have more dental needs than the average person, said Rosenstein, because their immune systems are compromised, and the antiretroviral drugs they take decrease salivation, increasing the incidence of tooth decay and necessitating more frequent cleanings. The number of methamphetamine and other drug users who've contracted HIV also have increased, though they have different oral health needs, explained Rosenstein.

Cox visits the Russell Street Clinic at least three times a year for cleanings and more if additional oral health care like fillings or root canals are needed. "I think the dentists at Russell Street happen to be the best around," said Cox. "They don't take shortcuts. They take the view that poor people deserve the same health care as rich people.

"I think the reason people keep going to Russell Street is because of the quality of care," added Cox. "Dr. Rosenstein and the other dentists there make it clear that if you take care of the 'easier' health stuff like your teeth, that your immune system has a much better chance of fighting more serious infections. Russell Street has had great heart right from the get-go."

At the end of 2003, the Centers for Disease Control and Prevention estimated 351,614 people were living with HIV/AIDS in 33 areas in the United States that have a history of confidential name-based HIV reporting -Oregon is not among them. However, the true number of people in the United States living with HIV/AIDS is probably closer to 1 million, according to Avert, an international AIDS charity.

According to Avert, there were an estimated 2,586 people in Oregon living with AIDS by the end of 2003. However, because Oregon does not require reporting of people diagnosed with HIV, and people with HIV do not necessarily acquire AIDS, they are not included in the 2,586 figure. The number of people with HIV in Oregon is unknown.

At the Russell Street Clinic, OHSU School of Dentistry students and faculty care not only for HIV-positive patients, but the homeless, low-income families and migrant workers. A recent Kellogg Foundation grant helps support the training of all dental care providers at Russell Street.

Currently five School of Dentistry faculty see about 2,400 patients annually at the Russell Street Clinic. Fourth-year dental students do part of their clinical rotation there.

Rosenstein's compassion for the poor and mentally ill took root while growing up in Boston on welfare in a housing project. His parents were both physically handicapped and there were gangs in the projects that were hard to avoid. Rosenstein landed in reform school by the time he was 13.

"I always wanted to get out of the projects," he said. After high school, Rosenstein won a full scholarship to Boston University, all while supporting himself working full time loading trucks. He also received degrees from Harvard, University of California at Berkeley and Columbia University.

Now, a leading national consultant for migrant community health centers responsible for writing health policy and setting up review standards for the federal government, Rosenstein could easily turn the day-to-day operation of Russell Street over to someone else, but, he still works at the clinic seeing patients one to two days a week.

"I feel like I'm doing something important and it's helping people," said Rosenstein. "It's about being able to sleep at night because you're doing the right thing."