Screening for traditional risk factors for cardiovascular disease: a review for oral health care providers

Comparative Clinical Study on Periodontal Health Status and Early Diagnosis of Periodontal Diseases Quantified through Clinical Periodontal Indices on a Group of Children and Adolescents with and without Cardiovascular Diseases

It is well known that bacterial plaque is the main etiological factor that causes the appearance of periodontal diseases and carious disease. Periodontal diseases can affect children and adolescents and are manifested in the form of gingivitis, but also the early form of chronic periodontitis as well as aggressive marginal periodontitis associated with local or general factors. Early periodontitis is frequently undiagnosed by clinicians due to a lack of knowledge of the specific symptoms. Certain systemic diseases, such as cardiovascular diseases, can create favorable conditions for the appearance and progression of severe manifestations of periodontal disease; also, recent research highlights that individuals with periodontal disease present an increased risk of developing cardiovascular diseases. Children with congenital or acquired cardiovascular diseases are at increased risk for complications resulting from the growth of microorganisms in the oral cavity, presenting a risk of infective endocarditis. The specific aim was to highlight the existing differences between the periodontal health of children with cardiovascular diseases and that of children without these diseases. The analyzed group included 124 patients, represented by children and adolescents, aged between 7 and 17 years, who were divided into four subgroups depending on the presence or absence of cardiovascular diseases and periodontal disease. A specialized clinical examination was performed for each patient, and periodontal clinical parameters were quantified (plaque index, gingival bleeding index, gingival index, community periodontal index of treatment needs) and associated with the diagnosis of general condition. Patients diagnosed with periodontal disease underwent specialized treatment and were called to a control visit 3 months after treatment. Statistical analysis showed significant differences between subgroups with much higher values of clinical parameters for patients with cardiovascular disease. Also, the response to the treatment was better in the case of patients in the control subgroup without cardiovascular diseases. The present study highlighted the interaction of three factors in the progression of periodontal diseases: subgingival microbiota, immune system response and environmental factors.

Dentists' willingness to screen for cardiovascular disease in the dental care setting: Findings from a nationally representative survey

OBJECTIVE

Dental clinics offer an untapped health care setting to expand access to screening and early identification of cardiovascular disease (CVD) risk. This study examined the correlates of dentists' willingness to provide CVD screening in the dental care setting.

METHODS

Private practice and public health general dentists in the U.S. participated in a nationally representative survey from 2010 to 2011. The survey examined dentists' willingness to provide a finger stick test to support CVD screening and agreement that their professional role should include CVD screening.

RESULTS

Data analysed from 1802 respondents indicated that 46.6% of dentists were willing to provide CVD screening. The adjusted odds ratio (AOR) of dentists' willingness to screen for CVD was associated with currently screening for hypertension (AOR = 1.49, 95% CI 1.01, 2.20), screening for obesity (AOR = 1.66, 95% CI 1.17, 2.36) and agreement that their role as health care professionals includes CVD screening (AOR = 3.03, 95% CI 2.15, 4.29). Dentists' agreement that their role includes CVD screening was associated with self-rated knowledge of CVD (good vs none or limited) and CVD training during their professional education (5 to 8 hours of training vs none or limited), (AOR = 5.75, 95% CI 2.26, 14.62) and (AOR = 3.84, 95% CI 2.17, 6.80), respectively.

CONCLUSIONS

Our study highlights strategies that may be employed to expand future access to early detection of CVD risk. Including CVD screening instruction and clinical screening experiences in dental school curriculum may serve as catalysts to reshape the future scope of dental practice.

Are dental providers the next line of HPV-related prevention? Providers' perceived role and needs

The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance “primordial prevention,” or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists’ perceived roles and needs regarding HPV-related primordial prevention.

We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests.

Participants affirmed dental professionals’ roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention.

Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers’ professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers’ needs for following professional organizations’ guidance to advance prevention efforts and reduce HPV-related cancer incidence.

Medical Risk Assessment in Patients Referred to Dental Clinics, Mashhad, Iran (2011-2012)

Advances in medical and dental techniques have led to a growing aged population living with complex medical conditions. This study focuses on the detection of medically compromised dental patients by means of a validated patient-administered medical risk-related history questionnaire.

MATERIALS AND METHODS

We used the questionnaire EMRRH (European Risk Related Medical History) in order to study the prevalence as well as the risk assessment of past medical problems in a population who visited dental centers (dental university, dental offices and clinics) for treatment in Mashhad, Iran.

RESULTS

A total number of 1,188 patients were registered, 871 of whom had a medical history that was of some interest to us. From the population with medical problems which was 30.6% of the total (N=219), 26.7% of the patients were classified as risk ASA I; 37.3% as ASA II, 16.9% as ASA III; and 19.1% as ASA IV. Among the diverse pathologies, the highest percentage was hypertension (11.6%), followed by allergies to different drugs (8.37%).

CONCLUSION

It seems absolutely essential for dental practitioners to take a detailed medical history prior to any therapeutic procedure, as certain medical conditions, if unnoticed, will lead to unfavorable consequences and/or repercussions.

The effect of chairside chronic disease screenings by oral health professionals on health care costs

OBJECTIVES

We estimated short-term health care cost savings that would result from oral health professionals performing chronic disease screenings.

METHODS

We used population data, estimates of chronic disease prevalence, and rates of medication adherence from the literature to estimate cost savings that would result from screening individuals aged 40 years and older who have seen a dentist but not a physician in the last 12 months. We estimated 1-year savings if patients identified during screening in a dental setting were referred to a physician, completed their referral, and started pharmacological treatment.

RESULTS

We estimated that medical screenings for diabetes, hypertension, and hypercholesterolemia in dental offices could save the health care system from $42.4 million ($13.51 per person screened) to $102.6 million ($32.72 per person screened) over 1 year, dependent on the rate of referral completion from the dental clinic to the physician's office.

CONCLUSIONS

Oral health professionals can potentially play a bigger role in detecting chronic disease in the US population. Additional prevention and monitoring activities over the long term could achieve even greater savings and health benefits.

Prevalence and management of hypertension in the inpatient setting: a systematic review

BACKGROUND

Hypertension (HTN) is a major cardiovascular risk factor yet control rates remain suboptimal. Thus, improving recognition, treatment, and control of HTN by focusing on novel populations such as hospitalized patients is warranted. Current consensus guidelines do not address inpatient HTN, and little is known about HTN prevalence or patterns of care in this setting.

METHODS

We conducted a systematic review of English-language studies published in 1976 or later that reported on HTN prevalence and care patterns among adult inpatients. We included MEDLINE-indexed randomized-controlled trials, meta-analyses, and observational studies that: (1) reported estimates of the prevalence of HTN in the inpatient setting, and (2) used HTN diagnosis or treatment as a primary focus. We excluded randomized, controlled trials that recorded measures of inpatient blood pressure but whose focus was not HTN.

RESULTS

We identified 9 studies meeting inclusion criteria, and in those studies, HTN was highly prevalent among inpatients, ranging from 50.5% to 72%. Intensification of antihypertensive treatment was inconsistent, and 37% to 77% of hypertensive patients remained hypertensive at the time of discharge. Most patients with inpatient HTN continued to have elevated blood pressures at outpatient follow-up.

CONCLUSIONS

Inpatient HTN is prevalent and a large percentage of those with this condition remain hypertensive at the time of discharge and at follow-up. The potential exists for improved recognition and treatment of newly diagnosed and known, but uncontrolled, HTN observed in the inpatient setting.

Need for an Ethical Framework for Testing for Systemic Diseases in Dental Clinics

Testing for systemic diseases in dental clinics is a potentially attractive avenue for oral health professionals and may be viewed as an opportunity to increase professional reach, expand practice, and improve financial returns. However, several ethical questions arise that must be addressed before such activities are adopted. (1) What should be the level of training dentists must acquire to deal with challenges associated with testing? (2) How well are dental practices aware of and compliant with the Health Insurance Portability and Accountability Act and procedures related to informed consent? (3) What is the evidence regarding acceptability and effectiveness of testing? (4) What should be the acceptable standard of practice for conduct of invasive and noninvasive tests? (5) What is the boundary delineating "testing" and "reporting" vis-à-vis counseling? (6) What is the value of testing without counseling? (7) What assurances need to be in place to ensure voluntariness of testing? (8) How would data from testing be used in "research," especially with the growth of practice based research networks? and (9) Does the American Dental Association Code of Ethics need to incorporate guidance for practicing dentists? We discuss how ethical principles can be used to develop a framework of guidelines for potential testing for systemic diseases in dental clinics..

Assessing the prevalence of dental caries among elementary school children in North Korea: a cross-sectional survey in the Kangwon province

OBJECTIVES

The lack of epidemiological studies has made it difficult to assess the extent of public health problems in North Korea. In the absence of empirical data, less intrusive study designs acceptable to the North Korean government could be developed to gauge the public's health. To this end we developed a basic oral health survey in order to assess the prevalence of untreated dental caries among children.

METHODS

A cross-sectional survey of 854 elementary school students was conducted in the city of Wonsan, North Korea. Students were screened and classified into one of three states of oral health: no caries, minor caries or severe dental caries. Verbal surveys were concurrently administered on children to collect basic information on oral health behaviours and demographic characteristics. Statistical analyses were performed to determine if any variables were significant predictors of oral health status category.

RESULTS

Among the 854 students screened, we found 255 students with no caries (29.9%), 316 students with minor caries (37.0%), and 283 students with severe caries (33.1%). The majority of students (70.1%) screened had dental caries. Almost all of the students (98.5%) claimed to brush their teeth daily and 71.2% of students visited a dentist in the past year. There were no significant predictors of oral health status.

CONCLUSIONS

The oral health of children in Wonsan, North Korea is comparable if not slightly better than the oral health status of children of similar age in countries with similar Social-Economic Status (SES). Basic oral health screens are useful to produce a snapshot of general oral health status among children in North Korea and may provide insight as to the general health of these children.

Integration of oral health into primary health care: the role of dental hygienists and the WHO stewardship

Interest in addressing the unmet oral health needs of the citizens of the world has manifested itself, lately, in noteworthy expressions of commitment. Oral health is integrated with general health and support for community programmes offering 'essential oral health' within primary health care (PHC) is increasing. The WHO Global Goals for Oral Health 2020 has assumed a more directed public health orientation, and the Global Oral Health Programme has its focus on modifiable oral risk behaviours. Last, but not the least, opportunities are being created, under the 'stewardship' of the World Health Organization (WHO), for the expansion of oral disease prevention and health promotion knowledge and practices in communities. A review of the literature on community-oriented oral health primary care reveals one dominant and disease-oriented practice model with dental practitioners being the principal and exclusive actors. One alternative to this biomedical model of care that may be better suited to translate health promotion principles into action at community levels is the practice that involves hygienists serving as primary oral health care providers. The WHO 'stewardship' should include the support of dental hygiene practice within PHC, many legislative restrictions and regulatory barriers would be relaxed, thus enabling dental hygienists to respond to the WHO's call for community-based demonstration projects. With their focus on preventive oral care, hygienists are 'best poised' to help accelerate the integration of oral health with primary care, particularly in the light of the compelling evidence confirming the cost-effectiveness of the care delivered by intermediate providers.

Clinical and laboratory assessment of nutrition status in dental practice

There is a dynamic, two-way relationship between nutrition status and local oral health/systemic disease. Functional alterations in the oral cavity can impact the ability to ingest and swallow a typical diet. Nutrition status may influence disease progression and recovery from infection and surgery. Malnutrition and individual nutrient deficiencies can affect tissue integrity and muscle function. The benefits of a nutrition screening program in dental practice are many. First and foremost, it provides another critical component of the comprehensive health evaluation of the patient. Other positive outcomes are numerous and include improved oral and overall health, early detection of diet and nutrition problems, improved probability of successful treatment, improved wound healing and tissue resistance, and increased communication with patients. The extent to which practitioners provide oral health-related diet information in their practices or refer patients to a registered dietitian for medical nutrition therapy varies. Registered dietitians provide comprehensive nutrition care as a component of medical nutrition therapy. The American Dietetic Association (www.eatright.org) provides a nationwide nutrition network available at their Web site to locate a registered dietitian in a particular geographic area. As the primary care provider for the oral cavity (the entry point to the gastrointestinal track), the dental professional should screen patients to determine nutrition risk, integrate the finding into the patient s treatment plan, offer appropriate guidance to manage nutrition issues related to dental sequellae, and provide the necessary referrals.