Miriam E Tucker

May 26, 2015

Nashville, Tennessee — Dentists' offices may represent a novel setting for diabetes screening, a new study suggests.

The work, aimed at validating a diabetes screening tool specific to dentists' offices, was presented May 14 at the American Association of Clinical Endocrinologists' 2015 Annual Scientific and Clinical Congress by Saleh Aldasouqi, MD, an endocrinologist at Michigan State University College of Human Medicine, East Lansing.

The 14-item questionnaire was developed by study coauthor Susan Maples, DDS, a dentist in Holt, Michigan. It is one of several online screening tools she has developed for use specifically in the dentist's office, including those aimed at picking up patients at high risk for medical conditions with oral involvement, including obstructive sleep apnea and acid reflux in addition to diabetes.

The idea stems from the fact that many people who regularly see dentists don't necessarily see their physicians as often. The patient could complete the questionnaire in the dentist's waiting room. Those who score positively would then be referred to their physician for follow-up. Point-of-care HbA1c testing in the dentist's office might even be possible, Dr Aldasouqi told Medscape Medical News.

"I believe dentists would be happy to do that, especially if they can negotiate with insurance companies about reimbursement," he said.

These findings follow on from another study recently published in the American Journal of Public Health, which also suggests that diabetes could be diagnosed at the dentist.

American Dental Association Mulling the Issue

Indeed, the American Dental Association's council on dental practice is currently preparing a report for the organization's house of delegates on the implications of incorporating the medical screening methods into patient evaluations in the dental office, including HbA1c testing, according to a statement provided by the organization to Medscape Medical News.

Dr Maples noted that there is a bidirectional relationship between diabetes and periodontal disease. "Diabetic patients have earlier-onset [periodontal] disease, more severe disease, and failure to respond to traditional treatment methods due to interrupted healing capability. Conversely, a patient with active periodontal disease has more difficultly achieving glycemic control," she said.

The purpose of the study, she said, "was to create a validated self-screening tool for dental offices — one that did not require weighing the patient and calculating [body mass index] because I didn't think we'd be able to get dental offices to start weighing patients."

In a statement provided to Medscape Medical News, Jane Chiang, MD, senior vice president of medical affairs and community information for the American Diabetes Association, said that the association "prefers screening for prediabetes and diabetes mellitus be performed at the individual's routine healthcare provider's (ie, physician's) office, since follow-up is readily available. Screening HbA1c is acceptable at [alternative health settings such as] health fairs and dental offices, provided that there is appropriate follow-up at the physician’s office. Proper follow-up and education are imperative in prediabetes and diabetes management."

The American Diabetes Association has its own diabetes-risk screening tool.

But Sandeep Dhindsa, MD, chief of endocrinology and associate professor of medicine at Texas Tech University, Odessa, thinks diabetes screening in the dental office is a good idea.

"Certainly, multimodal opportunities for diabetes screening would be most welcome. I think this is an untapped area, an untapped opportunity, and would be a good healthcare advance. I would support it," he told Medscape Medical News.

Identifying Diabetes at the Dentist

The 14 items in Dr Maples's diabetes risk-assessment tool include asking the patient to self-report being more than 10% over ideal body weight and having a higher-than-ideal waist circumference.

Other questions assess family history for diabetes, race/ethnicity, medication use, and symptoms such as excessive thirst/hunger/urination, blurred vision, numbness/tingling, skin infections/foot ulcers, recurrent yeast infections, and bleeding gums.

Dr Aldasouqi said that the questions related to symptoms of acute hyperglycemia (eg, numbness, thirst, polyuria) were included "because we don't want to miss somebody sitting in that chair with a blood sugar of 300 to 400 [mg/dL] unknown, and the dentist starts drilling and digging, and [the patient] ends up with an infection."

In the study, a total of 500 patients (302 women and 198 men) with a mean age of 48 years completed the survey and underwent a validated fingerstick test for HbA1c, which identified 1.2% (six patients) with diabetes and 19.2% (96 patients) with prediabetes.

Predictors of diabetes/prediabetes from the questionnaire included age, being 10% over ideal body weight, waist size above 40 in for men or 35 in for women, hypertension, abnormal lipids, tingling of hands or feet, and visual symptoms or conditions (ie, blurring, cataracts, glaucoma).

The rate of undiagnosed prediabetes in the study is similar to that of other studies and in line with the risk in the general population. However, the rate of diabetes detection was lower. This could be because of the particular demographics of the local population, as well as the ongoing health preventive and educational activities at Dr Maples's dental practice, Dr Aldasouqi noted.

The paper has been submitted for publication to a major dental journal, and Dr Maples has taken a position with Henry Schein Dental, a distributor/practice management company, "to lead the total wellness curriculum for dentistry in the country," adding that she teaches approximately 25 days a year, using her screening tools as part of the curriculum.

Regarding diabetes screening in the dental office, Dr Dhindsa told Medscape Medical News, "I don't see any downsides....I think it's a step in the right direction of trying to pick up more undiagnosed people."

Dr Maples funded the study and owns the screening tool. Dr Aldasouqi is a speaker for Takeda, Janssen, and Sanofi. Dr Dhindsa is a speaker for AbbVie. Dr Chiang is an employee of the American Diabetes Association.

American Association of Clinical Endocrinologists' 2015 Annual Scientific and Clinical Congress. May 15, 2015; Nashville, Tennessee. Abstract 727.

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