Dr. David W. Handelsman doesn't stop to worry as he automatically pulls on his rubber gloves, mask and eye goggles. But the risk always lurks in the back of his mind.
Ever since the first dentist pulled a tooth, Handelsman's profession has been haunted by fear, a gut reaction to the possibility of pain. These days, however, dentists are often just as scared as their patients.
The threat of being exposed to AIDS has prompted most dental workers in the nation to don protective gear. They assume that some day they could care for a patient infected with HIV, the human immunodeficiency virus.
"It is a concern," Handelsman said. "We try not to let it become an obstacle or an obsession, but we're cognizant of it every day."
The Annapolis dentist intends to join 160 colleagues from across the county today to learn more about AIDS at a workshop in Annapolis. The daylong symposium on safety standards, infection control and ethical issues was sponsored by the county Health Department, the Anne Arundel County Dental Society and the University of Maryland Dental School.
County health officials started planning the workshop last January, just before a Florida woman claimed she contracted the AIDS virus from her dentist.
A recent study concluded that she and two other patients probably were infected in the office of Dr. David Acer, who died as a result of AIDS. All three patients have HIV strains similar to those of the dentist, but different from other viral samples in the community, the study found.
The case is the first in which a link has been documented between a health care professional and the spread of AIDS, said Dr. Harry Curland, director of dental health with the Anne Arundel Health Department.
"It's very disturbing because we don't know how it happened," he said. "It really underscores the need for more information so dental professionals can protect themselves and the public, too."
Professors from the University of Maryland Dental School and other medical experts will discuss the latest research and provide tips at today's workshop, Curland said.
A standing-room-only crowd of 160 dentists and hygienists signed up, more than hoped for by the workshop organizers.
"Every dentist today operates with the philosophy that the patient could have the AIDS virus," Curland said. "Everybody that comes into our office is a possible HIV patient."
The risk is much lower in Anne Arundel County than in cities like Baltimore, which documented 1,499 full-blown AIDS cases since 1981. But the county has the fifth most AIDS cases in the state -- behind the city, Prince George's, Baltimore and Montgomery counties. Anne Arundel is the fifth largest jurisdiction in Maryland.
No dentists in the county are known to have AIDS. Linda Joe, communicable diseases specialist with the health department, said she doesn't know if any have tested positive for HIV because the state only requires reporting full-blown AIDS cases.
People who have clear symptoms of the disease are reported, but not those who test positive for the virus but have not developed AIDS.
Forty-four of the 108 people in the county diagnosed with AIDS since 1982 have died, Joe said. She said she would urge anybody who has tested positive for HIV to notify their dentists and doctors to guarantee the best possible care.
"I think it's wise for someone who is HIV-positive to notify their health-care provider because they may have conditions that are kind of obscure," she said. "They may be doing themselves a grave disservice by not doing so."
One goal of the workshop is to encourage open communication between dentists and AIDS patients, Curland said. The risk of being exposed to the virus, as a dentist or as a patient, grows when both are afraid to discuss the disease.
"By not discriminating, patients will be more forthcoming with their medical history, and hopefully we can prevent the spread of this disease," Curland said.
Workshop leaders will discuss the ethics of caring for AIDS patients, as well as provide information on sterilizing equipmentand following proper precautions. Curland also expects discussion ona joint recommendation by the American Medical Association and the American Dental Association last week that their AIDS-infected membersrefrain from performing surgery or similar invasive procedures on their patients.
The associations urged health-care professionals to either avoid surgery or inform their patients that they have the AIDS virus. At the same time, the Centers for Disease Control in Atlanta is debating whether hospitals and other medical facilities should impose restrictions on AIDS-infected workers who perform invasive procedures. CDC is expected to release a new set of guidelines after March 1.