Eric K. Curtis, DDS

In 1979, Los Angeles physician Joel Weisman noticed among young male gay patients a mononucleosis-like syndrome distinguished by fever, weight loss and swollen lymph nodes. By 1980, he recognized a pattern. The clinical picture of Weisman’s patients suggested some deficiency in the immune system. When one of them, suffering also from pulmonary distress, was admitted to the immunology department of the University of California at Los Angeles hospital in February 1981, the case reminded another doctor, Michael Gottlieb, of a similar situation he had seen a few months earlier. The blood work-ups were identical, showing a reduction of lymphocytes and the nearly complete disappearance of T-helper cells. By May 1981, there were five such patients hospitalized in Los Angeles. Quietly the alarm was sounded. In June 1981, the Centers for Disease Control in Atlanta published the first official announcement of what seemed like a new illness. It was incurable. AIDS had arrived.

Not that anyone knew what it was. At first doctors hypothesized a combined attack of the cytomegalovirus and the Epstein-Barr virus. Others later postulated some mixture of feline leukemia and hepatitis. Rumors of a gay cancer began to circulate. By 1982, the clinical characteristics of the new disease were defined. Target populations were identified. American epidemiologists called the groups most at risk the "Four-H Club": homosexuals, Haitians, heroin addicts and hemophiliacs. Two other exposed groups—recipients of blood transfusions and infants infected in utero—were intentionally left unmentioned in an attempt to reassure the public. In the summer of 1982, the sickness got a name: Acquired Immune Deficiency Syndrome.

The AIDS epidemic spread like wildfire. In 1982, ten new cases were reported each week in the United States. In 1984, that number had grown ten times larger, and the cumulative number of cases doubled about every six months. By the time actor Rock Hudson’s death of AIDS in 1985 galvanized the popular imagination, twelve thousand people had already died of the disease. Two teams, one under Luc Montagnier at the Pasteur Institute in France and the other headed by American Robert Gallo of the National Institutes of Health, competed to identify what was now thought to be different viruses. Gallo was chasing what he called a "Human T-cell Leukemia Virus" (HTLV), with "leukemia" in the acronym being replaced eventually by "lymphoma," then "lymphotrophic." Montagnier was trying to isolate a virus he named "Lymphadenopathy Related Virus," or LAV. The two viruses were in fact one complicated and variable retrovirus, finally dubbed Human Immunodeficiency Virus (HIV), whose structure and mechanism of action scientists understood by 1986.

Every age has had its defining plague, the pestilence that serves as a dark metaphor for society. Once, long ago, the plague was bubonic. Later, when tuberculosis swept the world, it was consumptive. Still later it was cancerous. American society’s latest metaphor is AIDS. "With its links to sex, drugs, blood and [even] informatics [because computer sabotage is called a virus]," medical historian Mirko Grmek wrote in History of AIDS, "and with the sophistication of its evolution and of its strategy for spreading itself, AIDS expresses our era."

In AIDS and its Metaphors, Susan Sontag notes that AIDS is a repository of people’s fears about the future. "AIDS occupies such a large part in our awareness because of what it has been taken to represent. It seems the very model of all the catastrophes privileged populations feel await them." AIDS is a disaster in slow motion, Sontag points out, like the threat of nuclear holocaust and global warming: "AIDS is a long-running serial: not ‘Apocalypse Now’ but ‘Apocalypse From Now On.’"

For dentists, the most visible expression of the AIDS era became the lack of one. AIDS literally hid the face of dentistry as dental office personnel disappeared behind masks and gloves. Racing to implement enhanced infection control, dentists learned to cover their faces and hands and wear fluid-resistant gowns, even as they demanded autoclavable hand pieces and wrapped their offices in plastic. (Infection control measures set off their own cascade of unintended consequences. Latex allergies increased. Citing reports of warehouse fires caused by the spontaneous combustion of powder-free latex gloves, the Food and Drug Administration at one point issued an advisory cautioning against storing large quantities of patient exam gloves.)

All rapid epidemics give rise to similar practices of what Sontag calls "avoidance and exclusion." The "universal precautions" of wearing mask and gloves taken by health care workers today are the same ones taken centuries ago. An etching from 1720 shows a doctor approaching plague patients wearing gloves, gown and a curious full-face beaked mask stuffed with perfume-soaked rages to filter the stench. Dentists routinely worn masks and gloves during the influenza pandemic of 1918.

Yet AIDS is different. Sanitation and antibiotics consigned bubonic plague—which was cyclical and sporadic in the first place—to history. And while the infamous influenza contagion killed twenty million people, it ran its course in eighteen months. In both cases, the protections came quickly off. AIDS, on the other hand, made masks and gloves a way of life, one that forever altered the culture of dentistry. "Wet-fingered" dentists gloved up and herpetic whitlow was swapped for chronic suspicion. "With a slow motion epidemic, [the] same precautions [of mask and gloves] take on a life of their own," Sontag wrote. "They become part of social mores, not a practice adopted for a brief period of emergency, then discarded." In his novel Toward the End of Time, set in the year 2020, John Updike envisions a post-AIDS world. Masks and gloves are a constant reminder that that time is still distant.