For many people few things are scarier than a trip to the dentist's chair: the drilling and filling, the occasional touched nerve and not knowing if the dentist will discover a cavity or worse -- the need for a root canal.
But Catrise Austin, New York City's dentist to the stars -- whose clientele has included movie stars and celebrities, including Toni Braxton, rapper Common, Paula Abdul, model Eva Pigford and Isaac Hayes -- says there is one thing that is definitely scarier than a visit to the dentist: not knowing your HIV status.
So, since 2009 Austin has gone where few dentists have gone before, offering her clients free HIV testing with routine dental services. Austin is one of only two private dentists in New York City who offer the test through a program funded in part by the state Department of Health. The test includes a simple swab of the mouth and a 20-minute wait for results.
"I know for some people think the dentist's office is scary in itself," Austin said. "But I want them to feel like they don't have to go to a clinic or anywhere else to get tested. Most of all I want everyone to know their status."
According to the Centers for Disease Control and Prevention, more than 1.1 million people in the United States are infected with HIV. Some 232,700 don't know that they are infected.
In recognition of Worlds AIDS Day and AIDS Awareness Month, Austin's VIP Smiles will be offering free HIV tests for the general public by appointment from December 1 to December 15.
Health officials said dentists are an under-utilized asset in HIV and AIDS detection. Many of the early symptoms of the disease appear in the mouth, including extreme gum disease.
"There are millions of people in the U.S. that see a dentist on a regular basis and don't see a general care medical provider," said Howard Lavigne, the Deputy Director for HIV Clinical Education for the New York State Department of Health's AIDS Institute, and founder of the initiative that has secured the testing kits used by Austin and 49 other dental clinics across the state.
Lavigne said that the program, seeded in 2009 with Austin as its first participant, is still in its infancy but is showing tremendous growth potential. He said data gathered from the testing could be a major asset in fighting the spread of the disease.
There have been a few hurdles in spreading the use of the kits. Lavigne said that currently dentists cannot be reimbursed by patients' insurance for the test, which cost about $12. And convincing both dentists and patients to embrace a change in their general practice and habits has proven difficult.
A patient going in for a yearly cleaning whose dentist springs an HIV test on them could be a little taken aback. But in recent years health officials have taken extraordinary, if not unorthodox, steps to get as many people tested as possible.
In Washington, D.C., a city with one of the highest rates of people living with HIV or AIDS in the country, health officials last October began offering tests at the Department of Motor Vehicles. Since the inception of the program, more than 5,000 people have been tested there. Officials are now growing the program, offering tests where Washington residents register for food stamps, Medicaid and other government assistance. Test-takers are also given an added incentive: a $5 gift card to a local grocery store.
A nonprofit group got a $250,000 grant to do the testing through the city's health department.
Lavigne said a small grant from the New York New Jersey Aids Education Training Center has provided under $200,000 for "HIV Testing in the Dental Chair," the program behind the state's program.
Since 2009 Austin has tested more than 1,000 patients, with only one HIV positive result.
It was December 23, 2009, she recalled. The patient was an African American in his early 20s, and he had the classic signs from a dental perspective, including a severe oral yeast infection and advanced gum disease.
Austin said she swabbed beneath his upper and lower lips, placed the swab in the required solution and "it went positive almost immediately."
"It was very scary," Austin recalled. "I had to think about how to do it."
She took about 15 minutes to compose herself, and then after going over his X-rays, she revealed the results. She told him that the diagnosis was just preliminary and that he would need to get further tests done. The young man showed little reaction, Austin recalled. He left the office and she never heard from him again.
"I'm very surprised there has been only one positive since 2009," she said. Meanwhile, cases of tests sit in her office as she hopes to get more people tested and encourages other dentists to join the effort.
"I spent a lot of time with her and getting her up and running," Lavigne said of Austin. "I think she sees the bigger picture, that this is a public health issue and she is looking to address it."