Sir, I read with interest the paper by Professor Crossley, (BDJ 2004, 196: 749) and would like to confirm that the problem of people with HIV and other blood borne viruses being refused treatment is not confined to South Cheshire. Both as a Senior Community Dentist, and as an Associate Specialist for Sheffield Teaching Hospitals, I receive a regular stream of requests to see patients where the only or main criterion is the patient's positive status for blood-borne viruses. I do, however, have to comment on the opening paragraph where the author states 'dental associations have issued recommendations indicating that dentists are obliged to provide care for patients with infectious diseases'. This is an understatement.

To quote from the GDC Maintaining Standards 'It is unethical for a dentist to refuse to treat a patient solely on the grounds that the person has a blood borne virus or any other transmissible disease or infection'1 Also, 'Failure to employ adequate methods of cross-infection control would almost certainly render a dentist liable to a charge of serious professional misconduct.'1 and 'Detailed guidance on cross-infection control has been issued ... by the BDA, and is endorsed by the council'1

From the BDA, there is 'The medical history and examination may not identify asymptomatic carriers of infection disease and universal precautions must be adopted. This means that the same infection control procedures must be used for all patients.'2

I submit that these are not recommendations but direct instructions, with the threat of sanctions against dentists who break them. There are also issues to be considered with regard to the Disability Discrimination Act.

For those dentists who cite increased cost of cross-infection control measures for these patients, my answer is straightforward – either you are simply panicking because on this occasion you know the patient's status and are going over the top, or your current measures are inadequate to meet the GDC requirements. I was most disappointed that these themes were not brought out in the paper.

I would hope that the paper and this response will enable some dentists to reconsider their position, and provide care for patients with blood borne viruses –which they are already doing, they just do not know on whom!