1
|
Priede A, Lau P, Darby I, Morgan M, Mariño R. Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10102020. [PMID: 36292467 PMCID: PMC9601736 DOI: 10.3390/healthcare10102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals’ (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals’ referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.
Collapse
Affiliation(s)
- Andre Priede
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
- Correspondence:
| | - Phyllis Lau
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Ivan Darby
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - Mike Morgan
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand
| | - Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| |
Collapse
|
2
|
Nibali L, Gkranias N, Mainas G, Di Pino A. Periodontitis and implant complications in diabetes. Periodontol 2000 2022; 90:88-105. [PMID: 35913467 DOI: 10.1111/prd.12451] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Epidemiologic evidence indicates that periodontitis is more frequent in patients with uncontrolled diabetes mellitus than in healthy controls, suggesting that it could be considered the "sixth complication" of diabetes. Actually, diabetes mellitus and periodontitis are two extraordinarily prevalent chronic diseases that share a number of comorbidities all converging toward an increased risk of cardiovascular disease. Periodontal treatment has recently been shown to have the potential to improve the metabolic control of diabetes, although long-term studies are lacking. Uncontrolled diabetes also seems to affect the response to periodontal treatment, as well as the risk to develop peri-implant diseases. Mechanisms of associations between diabetes mellitus and periodontal disease include the release of advanced glycation end products as a result of hyperglycemia and a range of shared predisposing factors of genetic, microbial, and lifestyle nature. This review discusses the evidence for the risk of periodontal and peri-implant disease in diabetic patients and the potential role of the dental professional in the diabetes-periodontal interface.
Collapse
Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Nikolaos Gkranias
- Centre for Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London (QMUL), London, UK
| | - Giuseppe Mainas
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
3
|
Yonel Z, Kuningas K, Sharma P, Dutton M, Jalal Z, Cockwell P, Webber J, Narendran P, Dietrich T, Chapple ILC. Concordance of three point of care testing devices with clinical chemistry laboratory standard assays and patient-reported outcomes of blood sampling methods. BMC Med Inform Decis Mak 2022; 22:248. [PMID: 36138408 PMCID: PMC9493167 DOI: 10.1186/s12911-022-01999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Point of care testing (POCT) devices have been developed to facilitate immediate results with the potential to aid screening for new disease and enable patients to self-monitor their disease. Non-communicable diseases (NCDs) are the major cause of mortality globally and are increasing in prevalence as the population ages. Allied health care professionals (AHPs) are skilled in undertaking risk assessment and delivering preventative advice, providing opportunities to access large proportions of the population who may not visit their doctor, within non-traditional community settings. There is evidence of high levels of support from public, patients and health professionals for engaging AHPs in risk-targeted early case detection of certain NCDs. Thus, POCT devices offer a potential alternative to traditional venous blood collection, as novel care pathways for increasing early case detection and access to preventative care. The objectives of this study were to: (i) determine the concordance of the specific POCT devices with laboratory-based standard assays employed within clinical biochemistry laboratories. (ii) compare the sampling experience of both methods via patient-reported experiences. Methods A prospective, two-centre study was undertaken involving 158 participants who provided informed consent. Venous blood was collected for traditional assays of HbA1c, creatinine/ estimated Glomerular-Filtration-Rate (eGFR) and vitamin-D. Capillary blood was collected by finger prick test and also assayed for the same biochemical indices (Nova StatSensor (creatinine/eGFR); Siemens DCA-Vantage (HbA1C); CityAssays (vitamin-D)). All users were provided with device training. Participants reported any discomfort experienced by each simultaneously applied method (randomised in order) via a 100 mm Visual-Analogue-Scale. Results Results for each POCT device and the laboratory standard were analysed by Bland-Altman plots to determine assay concordance. POCT devices demonstrated good concordance with laboratory testing, with at least 95% of all samples being within two standard deviations, for each of the devices tested. The majority of participants reported less discomfort with POCT than venepuncture, with the average reported discomfort being 17/100 mm less for POCT compared to venous blood sample collection on the visual analogue scale. Conclusions The POCT devices demonstrated acceptable concordance with laboratory-based assays, and patients reported lower levels of discomfort compared to traditional means of blood collection. This study demonstrates the potential of using these devices as acceptable methods for opportunistic testing of “at-risk” individuals within non-traditional community care settings.
Collapse
Affiliation(s)
- Z Yonel
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK.
| | - K Kuningas
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P Sharma
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - M Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Z Jalal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - P Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Webber
- Diabetes Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P Narendran
- Diabetes Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - T Dietrich
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - I L C Chapple
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| |
Collapse
|
4
|
Borgnakke WS, Poudel P. Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.709831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.
Collapse
|
5
|
Yonel Z, Yahyouche A, Jalal Z, James A, Dietrich T, Chapple ILC. Patient acceptability of targeted risk-based detection of non-communicable diseases in a dental and pharmacy setting. BMC Public Health 2020; 20:1576. [PMID: 33081745 PMCID: PMC7576866 DOI: 10.1186/s12889-020-09649-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/07/2020] [Indexed: 12/04/2022] Open
Abstract
Background Non-communicable diseases [NCDs] are the major cause of mortality globally and are increasing in prevalence. Different healthcare professionals’ access different population groups; and engaging allied healthcare professionals in risk-driven early case detection of certain NCDs may be beneficial, especially those who have not been tested for NCDs within the previous 12 months. The objectives of this study were to determine: whether NCD case finding in dental/community pharmacy settings is feasible in terms of patient acceptability, barriers to recruitment, impact on the existing service. Determine time taken to test for: type 2 diabetes risk [T2DM], chronic obstructive pulmonary disease [COPD], hypertension, vitamin D deficiency and chronic kidney disease [CKD]. Determine whether there is added benefit of point of care testing [POCT] to identify diabetes risk compared to a validated screening questionnaire alone. Methods An exploratory study was undertaken to explore issues associated with NCD assessment in one dental practice and one community pharmacy within the West-Midlands, UK. Fifty patients > 40 years-of-age were recruited per site. Participants undertook: a questionnaire providing demographic data, any previous NCD diagnosis or positive family history. Validated questionnaires for determining NCD risk [T2DM/COPD]. Chair-side capillary blood [finger-prick] samples for HbA1C, creatinine/eGFR, Vitamin-D. Prior work had been undertaken to measure the agreement between point of care testing [POCT] devices and a central laboratory method, and to gauge the opinions of participants regarding discomfort experienced using venous (antecubital fossa) and capillary (finger-prick) blood collection, via a 10 cm Visual-Analogue-Scale. The POCT devices demonstrated good concordance with laboratory testing and were acceptable methods of blood collection for participants. Results Recruitment rates demonstrated that 8 days were needed to recruit 50 participants and 60% of those approached opted to participate. The principal barrier to participation was time, with average time taken to test being 19mins. Utilising dental and pharmacy settings identified potential cases of previously undiagnosed disease. Conclusions Risk-targeted testing for NCDs in high street dental and community pharmacies is both attractive and acceptable to patients.
Collapse
Affiliation(s)
- Zehra Yonel
- The Periodontal Research Group, School of Dentistry University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK.
| | - Asma Yahyouche
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Zahra Jalal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Alistair James
- The Periodontal Research Group, School of Dentistry University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - Thomas Dietrich
- The Periodontal Research Group, School of Dentistry University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - Iain L C Chapple
- The Periodontal Research Group, School of Dentistry University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| |
Collapse
|
6
|
Yonel Z, Cerullo E, Kröger AT, Gray LJ. Use of dental practices for the identification of adults with undiagnosed type 2 diabetes mellitus or non-diabetic hyperglycaemia: a systematic review. Diabet Med 2020; 37:1443-1453. [PMID: 32426909 DOI: 10.1111/dme.14324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/14/2022]
Abstract
AIM Type 2 diabetes is a growing global challenge. Evidence exists demonstrating the use of primary care (non-hospital based) dental practices to identify, through risk assessments, those who may be at increased risk of type 2 diabetes or who may already unknowingly have the condition. This review aimed to synthesize evidence associated with the use of primary care dental services for the identification of undiagnosed non-diabetic hyperglycaemia or type 2 diabetes in adults, with particular focus on the pick-up rate of new cases. METHOD Electronic databases were searched for studies reporting the identification of non-diabetic hyperglycaemia/type 2 diabetes in primary care dental settings. Returned articles were screened and two independent reviewers completed the data-extraction process. A descriptive synthesis of the included articles was undertaken due to the heterogeneity of the literature returned. RESULTS Nine studies were identified, the majority of which utilized a two-stage risk-assessment process with risk score followed by a point-of-care capillary blood test. The main barriers cited were cost, lack of adequate insurance cover and people having previously been tested elsewhere. The pick-up rate of new cases of type 2 diabetes and non-diabetic hyperglycaemia varied greatly between studies, ranging from 1.7% to 24% for type 2 diabetes and from 23% to 45% for non-diabetic hyperglycaemia, where reported. CONCLUSION This review demonstrates that although it appears there may be benefit in using the dental workforce to identify undiagnosed cases of non-diabetic hyperglycaemia and type 2 diabetes, further high-quality research in the field is required assessing both the clinical and cost effectiveness of such practice. (Prospero Registration ID: PROSPERO 2018 CRD42018098750).
Collapse
Affiliation(s)
- Z Yonel
- University of Birmingham, Birmingham School of Dentistry, Birmingham, UK
| | - E Cerullo
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - A T Kröger
- University of Birmingham, Birmingham School of Dentistry, Birmingham, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
7
|
Prevalence of Undiagnosed Diabetes and Prediabetes in the Dental Setting: A Systematic Review and Meta-Analysis. Int J Dent 2020; 2020:2964020. [PMID: 32908510 PMCID: PMC7468655 DOI: 10.1155/2020/2964020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background With the close link between diabetes mellitus (DM) and periodontal disease (PD), dentists have an unrealized opportunity to make a chance discovery of a patient's medical condition. Unlike in the medical setting, information on the point of care (PoC) and opportunistic screening for DM in the dental setting is limited. To make a reliable estimate on the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) and prediabetes among dental patients in the dental setting and to assist healthcare planners in making an informed decision, information on the disease frequency and strategies employed to address this issue is of paramount importance. Objectives To summarize the data on the prevalence of undiagnosed T2DM and prediabetes amongst dental patients and further explore the effectiveness of the PoC screening and its implication for use in the dental setting. Methods A MEDLINE-PubMed, EMBASE, Web of Science, and Cochrane Library search was conducted with no time specification. Information on study characteristics and diagnostic parameters was retrieved for meta-analysis. All the studies were assessed for methodological quality using the QUADAS-2 tool. Proportions were presented in tables and forest plots. All statistical analysis was performed using the MedCalc software. Results Nine studies met the inclusion criteria. The proportion of dental patients identified to be at a risk of hyperglycaemia with the PoC screening using random blood glucose (RBG) and HbA1 was 32.47% and 40.10%, whilst the estimated proportion with undiagnosed T2DM and prediabetes was identified as 11.23% and 47.38%. Conclusion A significant proportion of dental patients can be identified as undiagnosed T2DM and prediabetes. Targeted opportunistic screening is a feasible approach and can help reduce the prevalence of undiagnosed T2DM and prediabetes.
Collapse
|
8
|
Prediabetes and diabetes prevalence in the Workers’ Oral Health Study. Clin Oral Investig 2019; 23:4233-4241. [DOI: 10.1007/s00784-019-02875-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
|
9
|
Yonel Z, Sharma P, Gray LJ. Use of Dental Practices for the Identification of Adults With Undiagnosed Type 2 Diabetes Mellitus or Nondiabetic Hyperglycemia: Protocol for a Systematic Review. JMIR Res Protoc 2018; 7:e11843. [PMID: 30455173 PMCID: PMC6277823 DOI: 10.2196/11843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a growing global health burden and is expected to affect more than 590 million people by the year 2035. Evidence exists to demonstrate that dental settings have been used for risk assessment and identification of individuals who may be at high risk for T2DM or who may already unknowingly have the condition. Objective This protocol aims to outline the methodology that will be undertaken to synthesize the literature relating to the use of primary care (nonhospital-based) dental services for the identification of undiagnosed T2DM or prediabetes—often termed nondiabetic hyperglycemia—in adult patients. Methods This paper outlines the protocol that will be followed to conduct a systematic review and meta-analysis of the available literature. The protocol outlines the aims, objectives, search strategy, data extraction and data management methods, as well as the statistical analysis plan. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines were followed in developing the protocol as were elements of the Cochrane handbook. Results We expect the systematic review to be completed within 18 months of publication of this protocol and expect to see a high degree of heterogeneity in the existing literature. Conclusions This review is of importance as it will synthesize the existing evidence base and inform future studies in the field. Following the publication of the protocol, the review will be registered on Prospective Register of Systematic Reviews. Following the completion of the review, results will be published in a suitable peer-reviewed journal. International Registered Report Identifier (IRRID) PRR1-10.2196/11843
Collapse
Affiliation(s)
- Zehra Yonel
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Praveen Sharma
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
10
|
Yonel Z, Sharma P, Yahyouche A, Jalal Z, Dietrich T, Chapple IL. Patients' attendance patterns to different healthcare settings and perceptions of stakeholders regarding screening for chronic, non-communicable diseases in high street dental practices and community pharmacy: a cross-sectional study. BMJ Open 2018; 8:e024503. [PMID: 30391921 PMCID: PMC6231598 DOI: 10.1136/bmjopen-2018-024503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals. DESIGN Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively. SETTING Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey. PARTICIPANTS 1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires. OUTCOME MEASURES The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored. RESULTS 12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions. CONCLUSIONS This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.
Collapse
Affiliation(s)
- Zehra Yonel
- Periodontal Research group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Praveen Sharma
- Periodontal Research group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Asma Yahyouche
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Zahraa Jalal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Thomas Dietrich
- Periodontal Research group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Iain L Chapple
- Periodontal Research group, School of Dentistry, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
11
|
Kocher T, Holtfreter B, Petersmann A, Eickholz P, Hoffmann T, Kaner D, Kim T, Meyle J, Schlagenhauf U, Doering S, Gravemeier M, Prior K, Rathmann W, Harks I, Ehmke B, Koch R. Effect of Periodontal Treatment on HbA1c among Patients with Prediabetes. J Dent Res 2018; 98:171-179. [DOI: 10.1177/0022034518804185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).
Collapse
Affiliation(s)
- T. Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, Unit of Periodontology, University Medicine Greifswald, Greifswald, Germany
| | - B. Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, Unit of Periodontology, University Medicine Greifswald, Greifswald, Germany
| | - A. Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - P. Eickholz
- Department of Periodontology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - T. Hoffmann
- Department of Periodontology, Faculty of Medicine, Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - D. Kaner
- Department of Periodontology, Witten/Herdecke University, Witten, Germany
- Department of Periodontology and Synoptic Dentistry, Charité Centrum 3, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T.S. Kim
- Section of Periodontology, Department of Conservative Dentistry, University Hospital Heidelberg, Heidelberg, Germany
| | - J. Meyle
- Department of Periodontology, Justus-Liebig University Giessen, Giessen, Germany
| | - U. Schlagenhauf
- Department of Periodontology, University Hospital Würzburg, Würzburg, Germany
| | - S. Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - M. Gravemeier
- Department of Periodontology, University Hospital Münster, Münster, Germany
| | - K. Prior
- Department of Periodontology, University Hospital Münster, Münster, Germany
| | - W. Rathmann
- German Diabetes Center, Institute of Biometrics and Epidemiology, Düsseldorf, Germany
| | - I. Harks
- Department of Periodontology, University Hospital Münster, Münster, Germany
| | - B. Ehmke
- Department of Periodontology, University Hospital Münster, Münster, Germany
| | - R. Koch
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| |
Collapse
|
12
|
Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000 2018; 78:59-97. [DOI: 10.1111/prd.12235] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Jörgen König
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor Michigan
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Peter Meisel
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| |
Collapse
|
13
|
Estrich CG, Araujo MWB, Lipman RD. Prediabetes and Diabetes Screening in Dental Care Settings: NHANES 2013 to 2016. JDR Clin Trans Res 2018; 4:76-85. [PMID: 30596147 PMCID: PMC6299263 DOI: 10.1177/2380084418798818] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted. Objectives The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes. Methods Data from 10,472 adults in the National Health and Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression. Results A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test (Centers for Disease Control and Prevention), and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old. Conclusion Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications. Knowledge Transfer Statement Screening for prediabetes and diabetes during dental visits has the potential to raise patients' awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being.
Collapse
Affiliation(s)
- C G Estrich
- Science Institute, American Dental Association, Chicago, IL, USA
| | - M W B Araujo
- Science Institute, American Dental Association, Chicago, IL, USA
| | - R D Lipman
- Science Institute, American Dental Association, Chicago, IL, USA
| |
Collapse
|
14
|
Acharya A, Cheng B, Koralkar R, Olson B, Lamster IB, Kunzel C, Lalla E. Screening for Diabetes Risk Using Integrated Dental and Medical Electronic Health Record Data. JDR Clin Trans Res 2018; 3:188-194. [PMID: 29568804 DOI: 10.1177/2380084418759496] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Undiagnosed diabetes and prediabetes present a serious public health challenge. We previously reported that data available in the dental setting can serve as a tool for early dysglycemia identification in a primarily Hispanic, urban population. In the present study, we sought to determine how the identification approach can be recalibrated to detect diabetes or prediabetes in a White, rural cohort and whether an integrated dental-medical electronic health record (iEHR) offers further value to the process. We analyzed iEHR data from the Marshfield Clinic, a health system providing care in rural Wisconsin, for dental patients who were ≥21 y of age, reported that they had never been told they had diabetes, had an initial periodontal examination of at least 2 quadrants, and had a glycemic assessment within 3 mo of that examination. We then assessed the performance of multiple predictive models for prediabetes/diabetes. The study outcome, glycemic status, was gleaned from the medical module of the iEHR based on American Diabetes Association blood test cutoffs. The sample size was 4,560 individuals. Multivariate logistic regression revealed that the best performance was achieved by a model that took advantage of the iEHR. Predictors included age, sex, race, ethnicity, number of missing teeth, percentage of teeth with at least 1 pocket ≥5 mm from the dental EHR, and overweight/obesity, hypertension, hyperlipidemia, and smoking status from the medical EHR. The model achieved an area under the receiver operating characteristic curve of 0.71 (95% confidence interval, 0.69-0.72), yielding a sensitivity of 0.70 and a specificity of 0.62. Across a range of populations, informed by certain patient characteristics, dental care team members can play a role in helping to identify dental patients with undiagnosed diabetes or prediabetes. The accuracy of the prediction increases when dental findings are combined with information from the medical EHR. Knowledge Transfer Statement: Prediabetes and diabetes often go undiagnosed for many years. Early identification and care can lead to improved glycemic outcomes and prevent wide-ranging morbidity, including adverse oral health consequences, in affected individuals. Information available in the dental office can be used by clinicians to identify those who remain undiagnosed or are at risk; the accuracy of this prediction increases when combined with information from the medical electronic health record.
Collapse
Affiliation(s)
- A Acharya
- Marshfiled Clinic Research Institute, Marshfield, WI, USA
| | - B Cheng
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - R Koralkar
- Marshfiled Clinic Research Institute, Marshfield, WI, USA
| | - B Olson
- Marshfiled Clinic Research Institute, Marshfield, WI, USA
| | - I B Lamster
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - C Kunzel
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - E Lalla
- College of Dental Medicine, Columbia University, New York, NY, USA
| |
Collapse
|
15
|
Rosedale MT, Strauss SM, Kaur N, Danoff A, Malaspina D. Identification of diabetes risk in dental settings: Implications for physical and mental health. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2018; 47:64-73. [DOI: 10.1080/00207411.2017.1377803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mary T. Rosedale
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- New York University Langone Medical Center, New York, NY, USA
| | - Shiela M. Strauss
- Rory Meyers College of Nursing, New York University, New York, NY, USA
- New York University Langone Medical Center, New York, NY, USA
| | - Navjot Kaur
- New York University Langone Medical Center, New York, NY, USA
| | - Ann Danoff
- New York University Langone Medical Center, New York, NY, USA
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| |
Collapse
|
16
|
Hickin MP, Shariff JA, Jennette PJ, Finkelstein J, Papapanou PN. Incidence and Determinants of Dental Implant Failure: A Review of Electronic Health Records in a U.S. Dental School. J Dent Educ 2017; 81:1233-1242. [PMID: 28966189 DOI: 10.21815/jde.017.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/08/2017] [Indexed: 11/20/2022]
Abstract
The aim of this study was to use electronic health care records (EHRs) to examine retrospectively the incidence of and attributes associated with dental implant failures necessitating implant removal in a large cohort of patients treated in the student clinics of a U.S. dental school over three and a half years. EHRs were searched for all patients who received dental implants between July 1, 2011, and December 31, 2014. Characteristics of patients and implants that were actively removed due to irrevocable failure of any etiology ("failure cohort") during this period were compared to those of all other patients who received dental implants during the same time frame ("reference cohort"). Differences in the frequency distribution of various characteristics between the failure and reference cohorts were compared. Of a total 6,129 implants placed in 2,127 patients during the study period, 179 implants (2.9%) in 120 patients (5.6%) were removed. In the multivariate analysis, presence of a removable (OR=2.86) or fixed temporary prosthesis (OR=3.71) was statistically significantly associated with increased risk for implant failure. In contrast, antibiotic coverage (pre- and post-surgery OR=0.16; post-surgery only OR=0.38) and implants of certain manufacturers were associated with lower risk of implant failure. In this sizeable cohort of patients receiving care in dental student clinics, the review of EHRs facilitated identification of multiple variables associated with implant failure resulting in removal; however, these findings do not suggest causative relationships. The adopted analytical approach can enhance quality assurance measures and may contribute to the identification of true risk factors for dental implant failure.
Collapse
Affiliation(s)
- Matthew Parker Hickin
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Jaffer A Shariff
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Philip J Jennette
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Joseph Finkelstein
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Panos N Papapanou
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine.
| |
Collapse
|
17
|
Lamster IB, Myers-Wright N. Oral Health Care in the Future: Expansion of the Scope of Dental Practice to Improve Health. J Dent Educ 2017; 81:eS83-eS90. [PMID: 28864808 DOI: 10.21815/jde.017.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/06/2017] [Indexed: 12/30/2022]
Abstract
The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century."
Collapse
Affiliation(s)
- Ira B Lamster
- Dr. Lamster is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University; Dr. Myers-Wright is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University.
| | - Noreen Myers-Wright
- Dr. Lamster is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University; Dr. Myers-Wright is Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University
| |
Collapse
|
18
|
Greenblatt AP, Estrada I, Schrimshaw EW, Metcalf SS, Kunzel C, Northridge ME. Acceptability of Chairside Screening for Racial/Ethnic Minority Older Adults: A Qualitative Study. JDR Clin Trans Res 2017; 2:343-352. [PMID: 28944291 DOI: 10.1177/2380084417716880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
An aging and more racially and ethnically diverse population, coupled with changes in the health care policy environment, is demanding that the dental profession both redirect and expand its focus. Challenges include providing comprehensive care for patients with complicated medical needs while improving access to care for underserved groups. The purpose of this study is to examine the acceptability of screening for hypertension and diabetes in the dental setting for African American, Puerto Rican, and Dominican older adults who attend senior centers in northern Manhattan, New York City. Focus groups were conducted with 194 racial/ethnic minority men and women aged 50 y and older living in northern Manhattan who participated in 1 of 24 focus group sessions about improving oral health for older adults. All groups were digitally audio-recorded and transcribed for analysis. Groups that were conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Five themes were manifest in the data regarding the willingness of racial/ethnic minority older adults to receive hypertension and diabetes screening as part of routine dental visits: 1) chairside screening is acceptable, 2) screening is routine for older adults, 3) the interrelationship between oral and general health is appreciated, 4) chairside screening has perceived benefits, and 5) chairside screening may reduce dental anxiety. Reservations centered on 4 major themes: 1) dental fear may limit the acceptability of chairside screening, 2) there is a perceived lack of need for dental care and chairside screening, 3) screening is available elsewhere, and 4) mistrust of dental providers as primary care providers. This study provides novel evidence of the acceptability of screening for hypertension and diabetes in the dental setting among urban racial/ethnic minority senior center attendees. Knowledge Transfer Statement: The results of this study may be used by oral health providers when deciding whether to conduct chairside screening for medical conditions such as hypertension and diabetes that could affect, or be affected by, the oral health of their patients. Patient experiences of care-along with clinical outcomes, avoidable hospital admissions, equity of services, and costs-are important outcomes to consider in meeting the needs of an aging and racially and ethnically diverse US population.
Collapse
Affiliation(s)
- A P Greenblatt
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - I Estrada
- Section of Population Oral Health, Columbia University College of Dental Medicine, New York, NY, USA
| | - E W Schrimshaw
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - S S Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA
| | - C Kunzel
- Section of Population Oral Health, Columbia University College of Dental Medicine, New York, NY, USA
| | - M E Northridge
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY, USA
| |
Collapse
|
19
|
Neidell M, Lamster IB, Shearer B. Cost-effectiveness of diabetes screening initiated through a dental visit. Community Dent Oral Epidemiol 2017; 45:275-280. [PMID: 28145564 DOI: 10.1111/cdoe.12286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/20/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To analyse the cost-effectiveness of a screening programme and follow-up interventions for persons with dysglycemia who are identified during a dental visit. METHODS This study is a secondary analysis utilizing data from two relevant publications. Those studies identified persons with dysglycemia who were seen in a dental school clinic for routine dental care and determined compliance with a recommendation to seek medical care. The response site was 59.4%. The Archimedes disease simulation model was utilized to simulate the effect of a weight loss programme for identified subjects on several outcomes. RESULTS Two scenarios for weight loss programmes were considered: a 10% permanent loss in body weight and a 10% loss that decays over time. Both diabetes and prediabetes were analysed. The decay path costs $21 243 per quality adjusted life year (QALY) with 3 years required to achieve the weight reduction. This cost decreases to $6655 if only 1 year is needed to achieve the weight goal. Without decay, the cost per QALY is $15 873 with 20 years of intervention, vs $647 per QALY with 10 years of intervention. For individuals with type 2 diabetes mellitus, the cost per QALY is $48 604 to $56 207 depending on adherence. With the addition of oral medication (a sulfonylurea), the cost is three times higher. CONCLUSIONS Under the conditions described here, identification of persons with dysglycemia in the dental office for initiating prediabetic care is a cost-effective means of identifying and treating affected individuals.
Collapse
Affiliation(s)
- Matthew Neidell
- Department of Health Policy & Management, Columbia University Mailman School of Public Health, New york, NY, USA
| | - Ira B Lamster
- Department of Health Policy & Management, Columbia University Mailman School of Public Health, New york, NY, USA
| | | |
Collapse
|
20
|
Teeuw WJ, Kosho MXF, Poland DCW, Gerdes VEA, Loos BG. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Res Care 2017; 5:e000326. [PMID: 28316794 PMCID: PMC5337701 DOI: 10.1136/bmjdrc-2016-000326] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The early diagnosis of (pre)diabetes mellitus is essential for the prevention of diabetes complications. It has been suggested that gum disease (periodontitis) might be an early complication of diabetes and may be a useful risk indicator for diabetes screening. Therefore, a dental office could be a good location for screening for (pre)diabetes in patients with periodontitis using a validated glycated hemoglobin (HbA1c) dry spot analysis. RESEARCH DESIGN AND METHODS A total of 313 individuals from a university dental clinic participated. From 126 patients with mild/moderate periodontitis, 78 patients with severe periodontitis and 109 subjects without periodontitis, HbA1c values were obtained by the analysis of dry blood spots. Differences in mean HbA1c values and the prevalence of (pre)diabetes between the groups were analyzed. RESULTS The mild/moderate and severe periodontitis groups showed significantly higher HbA1c values (6.1%±1.4% (43 mmol/mol±15 mmol/mol) and 6.3%±1.3% (45 mmol/mol±15 mmol/mol), respectively) compared with the control group (5.7%±0.7% (39 mmol/mol±8 mmol/mol), p=0.003). In addition, according to the American Diabetes Association (ADA) guidelines for diagnosis, there was a significant over-representation of subjects with suspected diabetes (23% and 14%) and pre-diabetes (47% and 46%) in the severe periodontitis group and mild/moderate periodontitis groups, respectively, compared with the control group (10% and 37%, p=0.010). Notably, 18.1% of patients with suspected new diabetes were found among subjects with severe periodontitis compared with 9.9% and 8.5% among subjects with mild/moderate periodontitis and controls, respectively (p=0.024). CONCLUSIONS The dental office, with particular focus on patients with severe periodontitis, proved to be a suitable location for screening for (pre)diabetes; a considerable number of suspected new diabetes cases were identified. The early diagnosis and treatment of (pre)diabetes help to prevent more severe complications and benefit the treatment of periodontitis.
Collapse
Affiliation(s)
- Wijnand J Teeuw
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Madeline X F Kosho
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Dennis C W Poland
- Department of Clinical Chemistry, MC Slotervaart, Amsterdam, The Netherlands
| | - Victor E A Gerdes
- Department of Vascular Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, MC Slotervaart, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Costa KL, Taboza ZA, Angelino GB, Silveira VR, Montenegro R, Haas AN, Rego RO. Influence of Periodontal Disease on Changes of Glycated Hemoglobin Levels in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study. J Periodontol 2016; 88:17-25. [PMID: 27562220 DOI: 10.1902/jop.2016.160140] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little evidence is available regarding the effects of long-term periodontal infection on diabetes mellitus (DM) control. The aim of this retrospective cohort study is to evaluate influence of periodontal status on changes of glycated hemoglobin (HbA1c) levels of patients with type 2 DM (DMt2). METHODS Eighty patients (mean age: 56.0 ± 8.9 years) with DMt2 were included. Patients were non-smokers, aged ≥40 years, and using antidiabetic drugs. Demographics, health history, and HbA1c levels were retrieved from medical charts. Probing depth and clinical attachment loss (AL) were recorded. RESULTS Patients were examined at two time points within a mean interval of 38.6 ± 6.6 months. Increase in HbA1c over time was statistically significant when severe periodontitis was diagnosed at baseline (2.32%, 95% confidence interval [CI]: 1.50% to 3.15%), in patients showing at least one tooth with ≥2 mm of AL progression (2.24%, 95% CI: 1.56% to 2.91%), in males (2.75%, 95% CI: 1.72% to 3.78%), and in those with HbA1c <6.5% at baseline (3.08%, 95% CI: 2.47% to 3.69%). After adjusting for baseline HbA1c, significant changes were still observed for severe periodontitis and progression of AL with increases of 0.85% and 0.9%, respectively. After adjusting for sex and HbA1c, AL progression was also statistically significant, with increases of 0.84%. CONCLUSIONS Periodontitis progression was associated with increase in HbA1c in patients with DMt2. Identification of these risk factors suggests that periodontal treatment may improve glycemic control of patients with DMt2 by eliminating periodontal infection.
Collapse
Affiliation(s)
- Katia L Costa
- Department of Clincal Dentistry, Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Brazil
| | - Zuila A Taboza
- Department of Clincal Dentistry, Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Brazil
| | - Gisele B Angelino
- Department of Dentistry, School of Dentistry, Federal University of Ceara, Sobral, Brazil
| | - Virginia R Silveira
- Department of Dentistry, School of Dentistry, Federal University of Ceara, Sobral, Brazil
| | - Renan Montenegro
- Department of Community Health, Faculty of Medicine, Federal University of Ceara, Fortaleza
| | - Alex N Haas
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo O Rego
- Department of Clincal Dentistry, Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Brazil.,Department of Dentistry, School of Dentistry, Federal University of Ceara, Sobral, Brazil
| |
Collapse
|
22
|
Theile CW, Strauss S, Northridge ME, Birenz S. The Oral Health Care Manager in a Patient-Centered Health Facility. J Evid Based Dent Pract 2016; 16 Suppl:34-42. [PMID: 27236994 PMCID: PMC4888908 DOI: 10.1016/j.jebdp.2016.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. BACKGROUND AND PURPOSE Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. METHODS Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. CONCLUSION A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care.
Collapse
Affiliation(s)
- Cheryl Westphal Theile
- Clinical Professor, Dental Hygiene Programs, New York University College of Dentistry, 212-998-9390 (w), 212-995-4593 (fax)
| | - Shiela Strauss
- Associate Professor, New York University College of Nursing, 212-998-5280 (w), 212-995-3143 (fax)
| | - Mary Evelyn Northridge
- Associate Professor, Department of Epidemiology & Health Promotion, New York University College of Dentistry, 212-998-9728 (w)
| | - Shirley Birenz
- Clinical Assistant Professor, Dental Hygiene Programs and Research Associate, Department of Epidemiology & Health Promotion, New York University College of Dentistry, 212-992-7005 (w)
| |
Collapse
|
23
|
Rosedale MT, Strauss SM, Kaur N, Knight C, Malaspina D. Follow-up with primary care providers for elevated glycated haemoglobin identified at the dental visit. Int J Dent Hyg 2016; 15:e52-e60. [PMID: 27037977 DOI: 10.1111/idh.12214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study examined patient experiences after receiving elevated diabetes screening values using blood collected at a dental clinic. It explores patients' reactions to screening, whether or not they sought recommended medical follow-up, and facilitating factors and barriers to obtaining follow-up care. METHODS At the comprehensive care clinics at a large, urban College of Dentistry in the United States, haemoglobin A1C (HbA1C) values were obtained from 379 study participants who had not been previously diagnosed with diabetes. In all, 169 (44.6%) had elevated HbA1C values. We analysed quantitative and qualitative data concerning these patients' follow-up with primary care providers (PCPs). RESULTS We were able to contact 112 (66.3%) of the 169 study participants who had an elevated HbA1C reading. Of that group, 61 (54.5%) received recommended follow-up care from a PCP within 3 months, and an additional 28 (25.0%) said they intended to seek such care. Qualitative themes included the following: the screening letter - opportunity or burden, appreciation for the 3-month follow-up call and barriers to medical follow-up that included the following: lack of knowledge about diabetes, not understanding the importance of follow-up, busyness, financial concerns, fear and denial. CONCLUSIONS Quantitative and qualitative data demonstrate that dentists, dental hygienists and nurses are well poised to discover and translate new models of patient-centred, comprehensive care to patients with oral and systemic illness.
Collapse
Affiliation(s)
- M T Rosedale
- New York University College of Nursing and Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - S M Strauss
- New York University College of Nursing, New York, NY, USA
| | - N Kaur
- New York University College of Nursing, New York, NY, USA
| | - C Knight
- New York University College of Nursing, New York, NY, USA
| | - D Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| |
Collapse
|