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Oral AIDS clinic a model for teaching and care

By Tim Stoddard

The white spot under Morris' tongue is the sort of thing that most dentists would overlook on a routine checkup. But in Laisheng Lee Chou's Oral AIDS Clinic at the School of Dental Medicine, that innocuous white spot is a tip-off to a potentially dangerous infection or tumor.

At the Oral AIDS Clinic, Laisheng Lee Chou (right) guides senior dental students in the examination and treatment of HIV-positive patients. Photo by Kent Dayton

Chou gently lifts Morris' tongue with a piece of gauze, revealing the white lesion to three dental students hovering around the examination chair. For HIV-positive patients like Morris, it's important that future dentists know how to recognize and treat these lesions in their early stages. Over 90 percent of HIV-infected individuals develop oral lesions, but the majority of these patients do not receive adequate dental care.

"We train students to think of the whole patient, not only their teeth," says Chou, an SDM professor and director of the division of oral medicine. "I tell them, 'Your patient's life might be in your hands.'"

In an effort to "give better service and treatment to HIV patients, and better training to BU's dental students," Chou created the Oral AIDS Clinic in 1995 as part of the preexisting Oral Medicine Clinic. Sponsored by the New England AIDS Education Training Center, it is now a major referral center for HIV patients in New England, serving over 300 individuals every year. That number is only going to grow, Chou says, because of the success of antiretroviral therapy. "Most HIV-positive patients live much longer now," he says. "With a more normal life span, they're now developing oral complications related to the HIV infection."

Researchers don't know why, but HIV somehow compromises the salivary glands, reducing the flow of saliva into the mouth. Saliva contains a slew of antimicrobial proteins that normally protect against infections. With less saliva, HIV patients are at a higher risk of developing caries (tooth decay), periodontal disease, and various infections in the soft tissues of the mouth from bacteria, viruses, or a kind of yeast called Candida. Appearing as white or red lesions, the infections are sometimes precursors to oral cancer.
As director of the Oral Medicine Clinic, Chou mentors groups of senior dental students during a two-week rotation. Under his supervision, each group of six or seven students is involved in the interviewing, examination, and diagnosis of patients.

"The AIDS clinic teaches us how to look for anything suspicious," says Puneet Kocchar (SDM'03), "and follow up on it even though
it might look like an innocuous red spot. If we catch a disease in its initial stages, we might save a patient's life."

The training model at the Oral AIDS Clinic is unique in this country. According to Chou, who won the 2002 Metcalf Cup and Prize, the University's highest teaching honor, SDM is the only dental school that offers this kind of rotation to students before they receive their D.D.M. Most dental schools cover HIV-related oral pathology only in lectures, leaving clinical training to small postgraduate programs. "If they get this information only in the classroom, without any clinical experience, how can they expect to treat HIV patients with confidence in the future?" Chou asks.

	Laisheng Lee Chou

David Parent (SDM'03) says that the oral AIDS rotation is pertinent to his career even though he doesn't plan to specialize in oral medicine. "I think it'll make me a much better practitioner to know what to look for in HIV patients," he says. "It might not be the focus of my practice to treat something like that, but I would definitely have the knowledge to refer that person to the correct place."

Last year, SDM received the largest award from the Ryan White CARE Act of any of the nation's dental schools. Monies allotted to SDM from the federal fund - $555,000 - are allocated to oral health services for people living with HIV. The grant pays unreimbursed costs incurred by dental schools and postdoctoral dental education programs in treating patients with HIV/AIDS.

"We are extremely pleased to receive this funding and continue our work of advocacy and care for our patients living with HIV," says Spencer N. Frankl, a professor and dean of SDM. "This award attests to the efficacy of our program and the steadfast dedication of our providers and staff who manage the program."

For Chou, it's not enough simply to treat patients' immediate problems - a lesion, infection, or tumor - and send them on their way. Instead, he coordinates the comprehensive care of all HIV patients, referring them to other SDM departments, where he consults on their special needs. "We want to carry these patients over their lifetime," he says.

30 August 2002
Boston University
Office of University Relations