Medical screening in dental settings: a qualitative study of the views of authorities and organizations

Dentists´ knowledge about common risk factors for cardiovascular diseases and periodontitis: An opportunity to be part of a multidisciplinary team

Background

Reducing the disease burden of cardiovascular diseases and periodontitis continues to be a priority and dentists are part of the primary care team. However, it is unclear whether Colombian dentists have the necessary knowledge to identify cardiovascular disease risk factors in clinical practice. The main aim of this study was to investigate Colombian dentists' knowledge about common risk factors for cardiovascular disease and periodontitis.

Material and Methods

A cross-sectional study was conducted. A self-administered electronic survey was validated by experts and completed by 232 dentists who practiced in Colombia. Descriptive and multivariate analyzes were performed, including hierarchical cluster analysis.

Results

Regarding the identification of shared risk factors for the development of cardiovascular disease or periodontitis, 80.6% identified smoking and 72.8% diabetes. The correct identification of cardiovascular disease risk factors was between 34.9% in the case of eating practices and 78.0% for physical inactivity. Being a woman (79.8%), under 40 years of age (64.0%), not having completed a postgraduate degree (68.5%), and working in private institutions (88.8%) were the characteristics of dentists that best identified common risk factors for both cardiovascular disease and periodontitis.

Conclusions

Colombian dentists had good knowledge of common risk factors for both cardiovascular diseases and periodontitis, but limited knowledge about cardiovascular disease risk factors. Younger dentists better identified risk factors. Conversely, older, more experience, and more specialized practitioners could benefit from more training about cardiovascular risk factors in order to truly be part of multidisciplinary teams in primary care. Key words:Dentists, Cardiovascular Diseases, Periodontitis, Health Knowledge, Attitudes, Practice, Patient Care Team.

Observational study of selective screening for prediabetes and diabetes in a real-world setting: an interprofessional collaboration method between public dental services and primary health care in Sweden

OBJECTIVE

Describe a method in a real-world setting to identify persons with undiagnosed prediabetes and type 2 diabetes through an interprofessional collaboration between Public Dental Services and Primary Health Care in Regions Stockholm.

DESIGN

A descriptive observational study.

SETTING

The study was conducted at seven sites in the region of Stockholm, Sweden. Each collaborating site consisted of a primary health clinic and dental clinic.

SUBJECTS

Study participants included adults over 18 years of age who visited the Public Dental Services and did not have a medical history of prediabetes or type 2 diabetes.

MAIN OUTCOME MEASURES

Selective screening is conducted in accordance with a risk assessment protocol at the Public Dental Services. In the investigated method, DentDi (Dental and Diabetes), adults diagnosed with caries and/or periodontitis over a cut-off value are referred to the Primary Health Care clinic for screening of prediabetes and type 2 diabetes.

RESULTS

DentDi, introduced at seven sites, between the years 2017 and 2020, all of which continue to use the method today. A total of 863 participants from the Public Dental Services were referred to the Primary Health Care. Of those 396 accepted the invitation to undergo screening at the primary health care centre. Twenty-four individuals did not meet the inclusion criteria, resulting in a total of 372 persons being included in the study. Among the 372 participants, 27% (101) had elevated glucose levels, of which 12 were diagnosed with type 2 diabetes and 89 with prediabetes according to the study classification.

CONCLUSIONS

DentDi is a feasible method of interprofessional collaboration where each profession contributes with the competence included in everyday clinical practice for early identification of persons with prediabetes and type 2 diabetes with a complete chain of care. The goal is to disseminate this method throughout Stockholm County and even other regions in Sweden.

Opportunistic health screening for cardiovascular and diabetes risk factors in primary care dental practices: experiences from a service evaluation and a call to action

Introduction Substantial evidence has established associations between oral health and chronic diseases, mediated by common risk factors and inflammatory processes. Dental professionals are aptly positioned to screen for cardiovascular disease and diabetes high-risk indicators. This article presents a service evaluation of two dental practices delivering health screening in dental practice, and a call to action for the wider profession.Methods Following training, two general dental practices implemented a suite of health screens, including blood pressure, blood glucose, cholesterol, body mass index (BMI) and waist-to-height ratio. A service evaluation was undertaken to review and improve service provision.Results Most patients (78.4%) had blood pressure values above normal range. More than half (55.8%) were outside of the healthy range for BMI. Out-of-range results for cholesterol were observed in less than one-fifth (16.7%). High blood glucose values were observed for few patients (3.3%).Conclusion Dental professionals can be successfully trained to deliver health screening interventions. Out-of-range health screening results offer an opportunity to provide targeted health advice for both the oral and general health. Clear protocols and careful interpretation of screening tests are required to minimise patients' confusion. More robust alliances between dental and general medical care are recommended.

Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study

An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.

Knowledgeability, Attitude and Practice Behaviors of Dental Providers Toward Provisions of Integrated Care Delivery for Patients With Prediabetes/Diabetes: Wisconsin Statewide Survey

Introduction: To conduct a statewide survey among Wisconsin-based dental providers evaluating current knowledgeability, attitudes and practice behaviors surrounding management of patients with diabetes/prediabetes in the dental setting. The study explored perceptions on feasibility, value, barriers, and current status of integrated care model (ICM) adoption by dental practices

Materials and Methods: A 32-question paper-based survey was mailed to all licensed dentists and dental hygienists practicing in Wisconsin. The study was conducted over a 4 week period in 2019. The survey instrument was adapted from a previous validated survey and was expanded to include questions on ICM adoption. Content and validity analyses and beta testing were conducted prior to dissemination of the survey. Descriptive statistics and chi-square tests were applied for data analyses. Thematic analyses was performed on open-ended questions.

Results: Survey response rate was 12% (N = 854/7,356) representing 41% dentists and 59% dental hygienists. While 68% reported educating patients on oral health-diabetes association, only 18% reported medical consultations to inform dental treatment, and “frequent” (22%) or “occasional” (40%), medical triage. Knowledge-based questions were correctly answered by >70% of participants. While 50% valued chair-side glycemic screening and 85% supported non-invasive chair-side screening to identify at-risk patients,>88% relied on patient-reported diabetic status. Barriers to ICM adoption included time investment (70%), patient activation/cooperation (62%), cost (50%), insurance coverage (50%), infrequent interdisciplinary communication (46%), lack of equipment (33%) and provider (31%).

Conclusion: Low rates of ICM adoption, chair-side testing, medical consultation and triage, and need for educational curricula reform were identified.

Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed

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.

Public Attitudes Toward Chairside Screening for Medical Conditions in Dental Settings

OBJECTIVE

The aim of this study is to investigate the public's attitudes and knowledge toward chairside dental screening and laboratory investigations based on demographic data.

METHODS

A self-administered structured questionnaire regarding chairside screening was designed employing a 5-point Likert-type scale. The questionnaire was distributed to among sample of adults. Data were collected and statistically analyzed using descriptive statistics, t-tests, ANOVA, and P values.

RESULTS

A total of 573 questionnaires were completed. Most respondents were willing to have a dentist conduct screening for diseases, in particular blood measurement (89%), hypertension (85.7%) and lab result discussion (83.1%), having medical condition did not affect the willingness. The lowest reported willingness was to undergo biopsy (54%) and hepatitis screening (67.6%) Age, education, hospital, and prior chairside screening were found to be significant factors for willingness.

CONCLUSION

The population's willingness to undergo chairside medical screenings in the dental office is crucial for the implementation of this strategy and to deliver a holistic approach to treating patients' medical conditions.

IDF Diabetes Atlas: Diabetes and oral health - A two-way relationship of clinical importance

The current scientific evidence for the bi-directional associations between oral health and diabetes is summarized. The universal biologic mechanisms and demographic and behavioral risk drivers underlying these associations in both directions are also described. Dysglycemia, even slightly elevated blood sugar levels, adversely affects oral health, manifesting itself in several oral diseases and conditions. In the opposite direction, any oral infection with its subsequent local and systemic inflammatory responses adversely affects blood glucose levels. Moreover, painful, mobile, or missing teeth may lead to intake of soft food items representing a sub-optimal diet and hence poor nutrition, and thereby contribute to incident type 2 diabetes or to poorer glucose control in existing diabetes. Treatment of inflammation related oral conditions, such as non-surgical periodontal treatment and extraction of infected teeth, can lead to a clinically significant decrease in blood glucose levels. Attention to infectious oral diseases and referral to dental care professionals for treatment can therefore be an important novel tool for medical care professionals in preventing and managing diabetes mellitus. Dental professionals can detect unrecognized potential dysglycemia and refer for medical examination. Such interprofessional, patient centered care may contribute to improved health, wellbeing, and quality of life in people with diabetes.

Can we deliver effective alcohol-related brief advice in general dental practice?

Design Two-arm cluster randomised controlled feasibility trial. Intervention Twelve NHS dental practices were randomised to the intervention and control arms. Patients consuming alcohol above the recommended levels were eligible to participate in the trial. The intervention was delivered by the dentists in the participating practices and entailed the delivery of a short tailored alcohol-related advice tool and a leaflet, which included information about the effects of alcohol on oral health and the benefits of reducing alcohol intake to both oral and general health. Patients in the control arm were given a mouth cancer prevention leaflet only. The level of alcohol consumption was measured by validated tools (AUDIT: Alcohol Use Disorders Identification Test and AUTID-C: Alcohol Use Disorders Identification Test for Consumption). The patients were followed-up after six months by a telephone interview. Outcome Measures The feasibility trial outcomes were the recruitment, retention, eligibility and delivery rate. The primary outcome of the trial was the impact of the intervention in lowering the level of alcohol consumption as captured by the AUDIT tool. Secondary outcomes included health related quality of life and alcohol consumption and abstinence in the last 90 days. The acceptability of the intervention was also assessed.Results The recruitment and retention rate were high (95.4% and 76.9% respectively). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04). Non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT-C between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058) were observed. Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients.Conclusion According to this study, dentists offering screening for alcohol misuse and brief advice in a primary dental care setting is not only feasible but also well-welcomed by both the dental team and patients.