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Jane, a mother of two young children, is HIV positive and wants to protect her confidentiality. Living in a small town, she wants to shelter herself and her children from the reaction and rejection of others.

Jane's mouth has been hurting for weeks, but she's afraid to make a dental appointment. She's afraid that if she tells her oral care provider about her HIV diagnosis she'll be turned down or worse, that other people will find out.

While good oral health care begins with brushing and flossing our teeth and having a nutritious diet, a big part of keeping our mouths healthy is to have regular dental checkups.

For most Canadians, a trip to the dental office is almost as routine as brushing our teeth. But some, including people living with HIV/AIDS, may not be getting the oral health care they need. Good dental and oral health care are essential for people living with HIV/AIDS because they can suffer from a number of oral health conditions. Protein and vitamin deficiencies can affect different parts of the body, including the mouth. Mouth ulcers, and throat infections like oral thrush are examples of problems that can be painful and may prevent people from chewing and eating. Yet some, like Jane, do not seek out oral health care services for fear of discrimination.

			The mouth is a hotbed for infection
			Abnormal cell growth, gingivitis and fungal infections are just a few of the over 40 oral health conditions associated with HIV/AIDS. According to Project Inform in the United States, it is estimated that 90% of people living with HIV/AIDS develop at least one oral condition associated with HIV/AIDS. Some of the conditions commonly associated with HIV or AIDS are: Oral Candidiasis Gingivitis and Periodontal Disease Hairy Leukoplakia Kaposi's Sarcoma (KS)

What many people in Jane's position don't know is that the perception of people living with HIV/AIDS has changed among oral health professionals. Oral health professionals work as a team that includes dentists, dental hygienists, dental therapists and dental assistants. Dental hygienists play a key role in health promotion and disease prevention, by promoting daily practices to maintain a healthy mouth.

In recent years, there has been an increased focus on client and patient rights. This is particularly important for those living with HIV/AIDS.

The Clients' Bill of Rights, published by the Canadian Dental Hygienists' Association includes the right to be treated with respect and the right to care that meets a person's needs.

The right to confidentiality is essential for people living with HIV/AIDS. Information that is shared between an oral health care provider and his or her client must remain between the two of them. Certain rare exceptions exist, such as instances where disclosure on the part of the oral health care provider is necessary in an emergency situation.

Many people wonder if they have to disclose their HIV/AIDS status to their oral health care provider. The answer is no. When completing a health questionnaire, people are not required to check the box that says HIV/AIDS.

Disclosure is a difficult choice for many people living with HIV/AIDS. According to the Canadian HIV/AIDS Legal Network, "…the act of disclosure can lead to both positive and negative results. This is why people living with HIV/AIDS are entitled to control over this crucial decision… to decide if, when and how they will tell other people about their HIV status." (HIV/AIDS and the Privacy of Health Information.)

While disclosure may be difficult, it's important to consider the benefits of sharing HIV/AIDS status with oral health care providers. Knowing that a client is living with HIV/AIDS can help health professionals to diagnose specific oral conditions and determine the best treatment.

			What dental hygienists do and where to find them
			It's a common misconception that dental hygienists just clean teeth. In fact, they are registered and licensed health professionals with very important responsibilities. Dental hygienists provide services in a variety of settings, although most work in a traditional office environment. They are often the frontline messengers who educate the public on the importance and benefits of regular, preventative oral health care. Dental hygienists are important members of the team of health care providers for people living with HIV/AIDS because: They will design a treatment program to meet the specific needs of each client; They may suggest a saliva substitute to make eating more comfortable; They will refer to another health professional if they see an abnormality in the mouth.

Education is making great strides to remove the fear and stigma associated with HIV/AIDS. In dental hygiene classrooms across the country, for example, students are much more informed about HIV/AIDS.

"Because our understanding has improved so much over the years, the fear associated with treating HIV/AIDS clients has been minimized significantly," explains Bonnie Blank, a Dental Hygiene Program Instructor at Camosun College in B.C.

Many schools have adapted their curriculum to include a focus on "special needs" or "care for exceptional clients". These courses teach students about the social and emotional challenges of people living with infectious or communicable diseases, including HIV/AIDS.

The result is a greater sensitivity and empathy for the personal situations and choices of those living with HIV/AIDS.

From washing hands and protecting eyes to wearing gloves and sterilizing instruments, universal precautions are strictly followed by oral health care professionals across Canada. They are a set of routine safety standards established for the purpose of infection control and are taken to protect everyone.

Some people may not know that they are infected with a communicable condition. Others may choose not to disclose their status. Universal precautions are there to protect both clients and oral health providers-in every situation.