Development and External Validation of a Multivariable Prediction Model to Identify Nondiabetic Hyperglycemia and Undiagnosed Type 2 Diabetes: Diabetes Risk Assessment in Dentistry Score (DDS)

[Construction of the Framework of a Prediagnostic Risk Assessment System for Outpatient Dental Care]

Objective

To establish the framework of a prediagnostic risk assessment system for outpatient dental care and to provide references for ensuring patient safety and improving the quality of medical services.

Methods

A total of 15 medical workers in a tertiary-care stomatology hospital in Sichuan Province were selected for qualitative interviews between October 2019 and December 2019. On the basis of the results of literature analysis and the interviews, an expert consultation form for prediagnostic risk assessment system for outpatient dental care was developed. Then, consultation of 10 experts in the field of oral health care and nursing was conducted between June 2020 and December 2020. Eventually, the framework of prediagnostic risk assessment system for outpatient dental care was formulated.

Results

Four themes emerged from the qualitative interviews. Firstly, prediagnostic risks of dental outpatients involved mainly syncope, cardiovascular emergencies, and other emergency medical risks. Secondly, medical risks came from three sources, patients, healthcare professionals, and the environment. Thirdly, medical professionals of outpatient dental care had limited awareness of the prediagnostic medical risks of patient. Fourthly, medical professionals of outpatient dental care showed inadequate response to and management of the prediagnostic medical risks of patient. The expert consultation helped finalize the Dental Outpatient Prediagnostic Risk Assessment Questionnaire, which included 3 primary indicators (namely, general information, medical history [including history of allergy], and medication assessment), 12 secondary indicators (including patient demographics, patients' status upon admission, oral hygiene habits and special lifestyle habits, sensory disorders, special periods for female patients [ie, menstruation, pregnancy, and breastfeeding], allergy history [history of oral treatment-related allergies], past/present medical history, types of medication, route of medication administration, duration of medication administration, accuracy of medication administration, and adverse drug reactions), and 39 tertiary indicators. The effective recall rate of the expert consultation form was 100%, expert positivity was 100%, and the authority coefficient was 0.83. Kendall's harmony coefficient ranged from 0.808 to 0.839, which was statistically significant (P<0.001).

Conclusion

The framework of prediagnosis risk assessment system for outpatient dental care is found to be scientific and specific, but its applicability still needs further validation in clinical practice.

Current scientific evidence for why periodontitis should be included in diabetes management

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.