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Dental care

Dental care is an important part of everyone’s overall health. It is particularly important for people with HIV, especially pregnant women and people who use drugs or who are taking drug substitution therapy.

Some medications, including some used to treat HIV, hepatitis and depression and those used for drug substitution therapy, can reduce the amount of saliva that is produced in the mouth. This can result in a dry mouth (a condition also known as xerostomia). Saliva has natural antibacterial agents in it and the flow of saliva washes food particles and associated bacteria away from spaces in teeth where they can do harm. People with xerostomia experience an increase in tooth decay and infections in the soft tissue of their mouths.

People with a weakened immune system are prone to developing specific oral health problems, such as oral candidiasis (thrush), mouth ulcers and gingivitis. These problems are more likely to occur in people with a very low CD4 cell count (usually 150 and below).

People with HIV are also more prone to infection with the human papillomavirus (HPV), some strains of which cause can cause cell changes in the oral cavity that can lead to oral cancer. Smoking is also associated with mouth and throat cancer. Dentists are well-placed to diagnose these changes, which might not be picked up by a doctor.

The risk of developing some other health conditions is increased if you also have gum disease; these include heart disease and diabetes.

Hormonal changes during pregnancy can increase the risk of inflammation, bleeding and gum disease.

Visiting a dentist regularly will help to keep your mouth, teeth and gums healthy.

Eligibility for NHS dental services

You should be able to receive dental care without having to prove your immigration status. You will normally be asked to prove your identity when registering with a dentist.

Finding and choosing a dentist

As with finding and choosing a GP practice, you may find it helpful to talk with friends, your HIV clinic or other people with HIV to see if they can recommend a dentist.

Dental practices do not restrict access to patients based on catchment areas, unlike GP practices. You can make an appointment with any dental practice. You should not be asked to have a dental check before a dentist places you on their patient lists.

If you want NHS dental treatment, you will first need to find out which dentists in your area provide NHS treatment, and then find one who is prepared to accept you for a course of treatment as an NHS patient. Some dentists do not provide NHS treatment, or only provide this treatment to certain groups of people; for example children, or people getting benefits or tax credits.

The alternative to NHS dental treatment is registering as a private patient, but this is usually more expensive than registering as an NHS patient. However, private treatment may be a useful option in some situations. If you do decide to explore this, it’s worth asking at several practices to compare costs, and asking about payment plans. Many practices offer ways to spread the cost of treatment.

Everyone is entitled to receive NHS dental treatment, but it is not always easy to access in some parts of the country. Community dental services, dental access centres and dental hospitals provide dental services to people who have difficulty accessing standard dental services, or who have very specialised dental needs.

To find dentists who do NHS work in your area, visit your local NHS website. See Getting more information.

Confidentiality and non-discriminatory treatment

There is no legal obligation to disclose your HIV status to a dentist. But it is a good idea to do so. If you have a good CD4 cell count (above 350), you’re unlikely to have HIV-specific complications and few drugs used in dentistry have interactions with HIV medications. However, drug interactions do exist, such as with sedatives for people who have dental phobia or some antibiotics. Not knowing your HIV status may also make it harder for your dentist to make a diagnosis of certain conditions.

Your dentist, as with other healthcare professionals, is required by law – and by professional regulatory standards – to ensure your medical information remains confidential.

Dentists are bound by the Equality Act 2010, an anti-discrimination law, in the same way as other healthcare professionals. They cannot refuse to treat you because you have HIV. This is the case for both NHS and private dentists.

Some people with HIV have found that dentists think they need to take extra care when they have a patient with HIV. But standard infection control procedures are designed to prevent transmission of infection, including HIV.

According to the Department of Health and the British Dental Association:

  • The same procedures should be used for all patients.
  • It’s unethical as well as unlawful to refuse dental care to people with HIV.
  • As lots of people have HIV without knowing it, dentists treat people who have HIV anyway. Taking the right precautions all the time will protect both patients and staff.

You can only be refused dental treatment on reasonable grounds (these include regularly missing appointments, not paying for treatment, or abusing staff). If you think you have been discriminated against or have a complaint, you can use the same complaint mechanisms as for GPs to complain about NHS dental services, starting with trying to resolve any problems directly with the practice (see Making a complaint). The British Dental Health Foundation can also explain how to make a complaint – call 0845 063 1188 or go to www.dentalhealth.org. The Dental Complaints Service can help resolve complaints about private dental services: www.dentalcomplaints.org.uk or call 08456 120540.

NHS dental services, prices and exemptions

Unlike GP services, you will generally be required to pay to have an appointment with a dentist. NHS dental services are not free, but are cheaper than private dental services. There are some situations where you may be exempt, or able to apply for help with the costs. If you are not ‘ordinarily resident’ in the UK you can still apply for help with dental treatment costs. You can find out if a dentist offers NHS services by asking when you register.

NHS dental services are those needed to keep a person’s mouth, teeth and gums healthy and free from pain. The NHS does not cover ‘cosmetic’ dental services – those that improve the way your teeth look but have no medical benefits.

Services are grouped into different bands, each with its own price. These are Band 1 (an examination, X-rays and minor or emergency treatments); Band 2 (treatment such as fillings, extractions and root canal treatment); and Band 3 (which includes crowns, bridges and dentures). NHS dental charges vary in different countries in the UK.

If you are not entitled to free dental treatment, but you will have trouble paying, talk to your dentist. There are several different payment schemes and one of these might help you.

Some people are exempt from paying NHS dental charges. NHS dental services are free if you are:

  • under 18 years old.
  • under 19 and in full-time education.
  • pregnant or have had a baby in the last year.
  • receiving Income Support, income-related Employment and Support Allowance, income-based Jobseeker’s Allowance or Pension Credit guarantee credit when your treatment starts.
  • named on a valid NHS tax credit exemption certificate or on a valid HC2 certificate (see NHS costs and exemptions)
  • staying in an NHS hospital and your treatment is carried out by the hospital dentist.
  • an NHS hospital dental service outpatient.

HIV, GPs & other primary care

Published October 2012

Last reviewed October 2012

Next review October 2014

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.