June 27 marks National HIV Testing Day, a day that encourages people to get tested and know their status. The Delta Dental Community Care Foundation partners with several clinics across our 15-state plus D.C. enterprise that provide services to HIV/AIDS patients. As COVID-19 continues to stretch resources and increase the need for health clinics that serve vulnerable communities, we are dedicated to ensuring the continued operations of clinics like the Grady Health’s dental clinic for HIV/AIDS patients. We recently spoke with Dr. David Reznik, chief of Grady Health System’s Dental Service, to learn more about how they are serving patients amid the current crisis.
What is the history of the Grady dental clinic for HIV/AIDS patients?
The first cases of what would later be known as Acquired Immunodeficiency Syndrome (AIDS) occurred in 1981. As the pandemic spread across the United States, dentistry had to make significant changes to infection control practices, including Universal precautions. Regretfully, there was an extraordinary stigma attached to the disease. People who were positive for the causative agent of AIDS, Human Immunodeficiency Virus (HIV) – who had been able to access routine and emergent dental care for years – were being denied service. Many of these same people had lost their jobs, housing and loved ones.
A dentist in Atlanta began working with local AIDS service organizations and Grady Health System to provide care on a sliding fee schedule. As fate would have it, no one in the office knew how to work with a sliding fee schedule, so the care was offered at no charge. In 1991, the Oral Health Center officially opened, albeit off campus, in the Buckhead office due to the passage of the Ryan White CARE Act. The effort to open as an integral component of the Grady Health System’s Infectious Disease Program occurred in July 1993, when all HIV related services were relocated to the Ponce Center.
How has COVID-19 affected your community and your clinic?
COVID-19, the newest pandemic to hit the United States, is creating an enormous unmet dental need for most communities throughout our country. Simple procedures we took for granted (e.g., restorative dental care) have the potential to put dental healthcare workers at risk for COVID-19. For a few months, we were only able to see emergency patients. We have now slowly reopened to deliver and provide removable prosthetics.
Dental care has long been one of the top unmet needs for low-income people living with HIV in our Atlanta community and around the United States. Since we have greatly limited the number of patients and procedures that can be provided, this unmet need will only continue to grow. To address this, significant efforts have been put in place to ensure safe, quality care. Working with the remarkable infection prevention staff at Grady Health System, we are confident that we are taking the necessary steps to protect our dental healthcare workers and safely provide care to this very vulnerable population.
What changes have you had to make to your operations and procedures to meet these new challenges?
The changes to dental care have been significant. We are pre-screening all patients who have appointments in the Oral Health Center, asking appropriate questions and taking temperatures. We have a clinical staff person managing the screening process. Our waiting room maximum capacity has been reduced by half, and our clinic schedule is a fraction of what it was prior to the onset of this new pandemic.
We are waiting on new equipment to ensure that we can provide the safest dental visit possible, including a chairside extraoral evacuation [ed note: suction] system as a component of our new respiratory protection program. HEPA filtration is great; however, every step we can take to ensure the safety and well-being of our patients and staff is key!
What long-term changes do you see health clinics like yours facing as a result of the current reality?
Infection control practices are significantly changing. Respiratory protection programs need to be comprehensive and include administrative as well as operational changes. We will need to look at how dentistry can meet optimal air exchange rates, which will require engineering controls. The medical side will see a continued increase in virtual visits. Whereas teledentistry has a place in these new efforts, we are a procedure driven field that requires in-person visits. People cannot be healthy without oral health; therefore, we need to take all steps possible to regain full operation. With the new expanded Oral Health Center scheduled to open next year, we hope to make a significant dent in the unmet need and return to a semblance of normalcy for those we have served for the past 29 years.
How can people support you?
We are in the midst of creating a new Oral Health Center, which will expand our ability to provide comprehensive dental care for people with HIV. Community assistance is an important piece of our ability to be successful in our work. You can donate to the Oral Health Center and the Infectious Disease Program through the Grady Health Foundation