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Kalmus O, Smits K, Seitz M, Haux C, Robra BP, Listl S. Evaluation of a Digital Decision Support System to Integrate Type 2 Diabetes Mellitus and Periodontitis Care: Case-Vignette Study in Simulated Environments. J Med Internet Res 2023; 25:e46381. [PMID: 37782539 PMCID: PMC10580131 DOI: 10.2196/46381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND As highlighted by the recent World Health Organization Oral Health Resolution, there is an urgent need to better integrate primary and oral health care. Despite evidence and guidelines substantiating the relevance of integrating type 2 diabetes mellitus (T2DM) and periodontitis care, the fragmentation of primary and oral health care persists. OBJECTIVE This paper reports on the evaluation of a prototype digital decision support system (DSS) that was developed to enhance the integration of T2DM and periodontitis care. METHODS The effects of the prototype DSS were assessed in web-based simulated environments, using 2 different sets of case vignettes in combination with evaluation surveys among 202 general dental practitioners (GDPs) and 206 general practitioners (GPs). Each participant evaluated 3 vignettes, one of which, chosen at random, was assisted by the DSS. Logistic regression analyses were conducted at the participant and case levels. RESULTS Under DSS assistance, GPs had 8.3 (95% CI 4.32-16.03) times higher odds of recommending a GDP visit. There was no significant impact of DSS assistance on GP advice about common risk factors for T2DM and periodontal disease. GDPs had 4.3 (95% CI 2.08-9.04) times higher odds of recommending a GP visit, 1.6 (95% CI 1.03-2.33) times higher odds of giving advice on disease correlations, and 3.2 (95% CI 1.63-6.35) times higher odds of asking patients about their glycated hemoglobin value. CONCLUSIONS The findings of this study provide a proof of concept for a digital DSS to integrate T2DM and periodontal care. Future updating and testing is warranted to continuously enhance the functionalities of the DSS in terms of interoperability with various types of data sources and diagnostic devices; incorporation of other (oral) health dimensions; application in various settings, including via telemedicine; and further customization of end-user interfaces.
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Affiliation(s)
- Olivier Kalmus
- Section for Translational Health Economics, Heidelberg University Hospital, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany
| | - Kirsten Smits
- Department of Dentistry, Quality and Safety of Oral Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Max Seitz
- Institute of Medical Informatics, Heidelberg University, Heidelberg, Germany
| | - Christian Haux
- Institute of Medical Informatics, Heidelberg University, Heidelberg, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University, Magdeburg, Germany
| | - Stefan Listl
- Section for Translational Health Economics, Heidelberg University Hospital, Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany
- Department of Dentistry, Quality and Safety of Oral Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Portes J, Bullón B, Gallardo I, Fernandez-Riejos P, Quiles JL, Giampieri F, Bullón P. Prevalence of undiagnosed diabetes and prediabetes related to periodontitis and its risk factors in elderly individuals. J Dent 2023; 132:104480. [PMID: 36948381 DOI: 10.1016/j.jdent.2023.104480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE The prevalence of undiagnosed diabetes was estimated to increase with age and can reach 3.5%. The purpose of the study was to evaluate the prevalence of undiagnosed diabetes and prediabetes in the elderly patients who attended a dental clinic and to find common risk factors. METHODS Male patients, older than 50 years, attended their first dental visit to the School of Dentistry for a period of two years, and it was proposed to evaluate undiagnosed type 2 diabetes mellitus. Periodontal, biochemical, microbiological examinations, nutritional profile, and physical activity were performed. RESULTS A total of 106 patients were examined, 6 (5.6%) had diabetes, and 37 (34.9%) had prediabetes without prior diagnosis. The severity of periodontitis was greater in patients with diabetes. Most of the patients were overweight and had increased systolic blood pressure. Patients with prediabetes and periodontitis had a low adherence to the Mediterranean diet. Tannerella forsythia was present in more patients with periodontitis, and the prevalence of Aggregatibacter actinomycetemcomitans is practically absent in groups with periodontitis, except for the group with diabetes. CONCLUSIONS In the population studied, the prevalence of patients without a diagnosis of diabetes and prediabetes was very high and underestimated. The increased severity of periodontitis in patients with diabetes and in conjunction with the high level of cortisol seen in patients with periodontitis, especially those with diabetes, emphasize the dysregulation of the immunoinflammatory system. CLINICAL SIGNIFICANCE It is essential to add all this data to our dental practice to cover patient health with a broader landscape.
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Affiliation(s)
- Juliana Portes
- Department of Periodontology, Dental School, University of Seville, C/Avicena, s/n, 41009 Seville, Spain; Dental School, Veiga de Almeida University, Rua Ibituruna, 108, 20271-020, Maracanã, Rio de Janeiro, Brazil
| | - Beatriz Bullón
- Department of Periodontology, Dental School, University of Seville, C/Avicena, s/n, 41009 Seville, Spain
| | - Isabel Gallardo
- Department of Periodontology, Dental School, University of Seville, C/Avicena, s/n, 41009 Seville, Spain
| | | | - Jose Luis Quiles
- Department of Physiology, Institute of Nutrition and Food Technology 'José Mataix', Center for Biomedical Research, Universidad de Granada, 18071 Armilla, Spain
| | - Francesca Giampieri
- Resarch Group on Food, Nutritional Biochemistry and Health. Univeridad Europea del Atlantico.39011 Santander, Spain
| | - Pedro Bullón
- Department of Periodontology, Dental School, University of Seville, C/Avicena, s/n, 41009 Seville, Spain.
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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; 10:2020. [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.
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Affiliation(s)
- Andre Priede
- Melbourne Dental School, University of Melbourne, Parkville 3010, Australia
| | - 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
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Chairside Screening for Undiagnosed Diabetes and Prediabetes in Patients with Periodontitis. Int J Dent 2022; 2022:9120115. [PMID: 35669587 PMCID: PMC9167070 DOI: 10.1155/2022/9120115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/14/2022] [Accepted: 05/13/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Globally, it is estimated that half of all people with diabetes are undiagnosed. Because of the well-documented bidirectional link between diabetes and periodontitis, dentists and dental hygienists may have the possibility to screen a targeted population for diabetes during routine dental visits. The aim of the present study is to investigate the effectiveness of one device for diagnosis of diabetes/prediabetes used in one private dental practice and investigate the correlation between the levels of HbA1c and periodontal parameters. Methods Periodontal patients that were never diagnosed with diabetes were asked to fill a risk assessment questionnaire for type 2 diabetes mellitus. PD, CAL, FMBS%, FMPS%, and HbA1c through a prick-finger test were measured before and after periodontal therapy or only once in patients following supportive periodontal therapy. Results A total of 98 subjects were screened, and among them, one had diabetes and 30 had prediabetes. The mean value of HbA1c was 5.62% for patients with untreated periodontitis and 5.42% for periodontally treated patients. The diagnosis of diabetes resulted to be correlated to FMBS% and FMPS%, while HbA1c levels were correlated to FMBS%, FMPS%, and periodontitis grade. Conclusion The present chairside diabetes-screening protocol allowed a consistent proportion of patients to become aware of their pathological or prepathological condition and to seek proper and timely medical care. Thus, dentists and dental hygienists could provide health promotion services and preventive measures.
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Talakey AA, Hughes FJ, Bernabé E. Can periodontal measures assist in the identification of adults with undiagnosed hyperglycaemia? A systematic review. J Clin Periodontol 2022; 49:302-312. [PMID: 35066921 DOI: 10.1111/jcpe.13596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/18/2022]
Abstract
AIM The aim of this review was to answer the following question: Can periodontal measures be used to identify dental patients with undiagnosed hyperglycaemia? MATERIALS AND METHODS Systematic searches of electronic databases and the grey literature were carried out to identify studies developing and/or validating prediction models, based on any periodontal measure, to screen adults for undiagnosed hyperglycaemia (pre-diabetes and diabetes). Risk of bias was evaluated using the PRediction mOdel risk-of-Bias ASsessment Tool (PROBAST). RESULTS Ten studies were identified, of which eight were model development studies. The remaining two studies reported the external validation of one existing prediction model. The periodontal prediction model with some evidence of external validation showed moderate diagnostic performance in the development sample but lower performance in the external validation samples. According to PROBAST, all studies had high risk of bias mainly due to methodological limitations in data analysis, but also in the recruitment of participants, choice and measurement of periodontal predictors and diabetes. CONCLUSIONS There is a need for more robust external validation studies of existing prediction models adhering to current recommendations. Dental professionals who see patients at risk of diabetes and routinely collect periodontal measures have an important role to play in their identification and referral.
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Affiliation(s)
- Arwa A Talakey
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.,Department of Periodontics and Community Dentistry, Faculty of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Francis J Hughes
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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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.
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Rice AO. Alzheimer's Disease and Oral-Systemic Health: Bidirectional Care Integration Improving Outcomes. FRONTIERS IN ORAL HEALTH 2021; 2:674329. [PMID: 35048018 PMCID: PMC8757752 DOI: 10.3389/froh.2021.674329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022] Open
Abstract
Dentistry is an effective healthcare field that can impact Alzheimer's disease through prevention and education. Every day dental providers use an arsenal of assessment protocols directly coinciding with modifiable Alzheimer's risk factors. An innovative way to help in the prevention of Alzheimer's disease is to utilize oral health professionals who reach the public in ways other health care providers may not. Bidirectional care integration is needed to stifle many systemic diseases and Alzheimer's disease is no different. Ultimately with collaborative care the patient reaps the benefits. Alzheimer's is associated with many etiologies and pathophysiological processes. These include cardiovascular health, smoking, sleep, inflammatory pathogens, and diabetes. In the United States, dental providers assess each of these factors daily and can be instrumental in educating patients on the influence of these factors for dementia prevention. Globally, by 2025, the number of people with Alzheimer's disease is expected to rise by at least 14%. Such increases will strain local and national health care systems, but for the US if Medicare were expanded to include dental services, many older adults could be spared needless suffering. The goal of this perspective article is to highlight existing practices being used in the field of dentistry that can easily be adapted to educate patients in preventive care and treat risk factors. It is the duty of healthcare professionals to explore all opportunities to stem the advance of this disease and by integrating oral and systemic health into transdisciplinary science, health care and policy may do just that.
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Affiliation(s)
- Anne O. Rice
- Oral Systemic Seminars, Conroe, TX, United States
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