COMMENTARY

Should Dentists Screen Their Patients for Diabetes?

Eric T. Stoopler, DMD

Disclosures

January 13, 2016

Clinical Implication of Blood Glucose Monitoring in General Dental Offices: The Ehime Dental Diabetes Study

Harase T, Nishida W, Hamakawa T, et al
BMJ Open Diabetes Res Care. 2015;3:e000151

Study Summary

In the modern practice of dental medicine, oral healthcare providers have been appreciated not only for maintaining healthy teeth and gums, but also for their ability to identify systemic diseases that manifest with signs and symptoms in the oral cavity.[1] Up to 70% of adults visit the dentist in a given year, nearly 20% of whom have not seen a medical provider in the preceding year. This may allow dental practices to function as screening centers for common systemic diseases, such as diabetes.[1,2]

Harase and colleagues examined whether general dentists can contribute to the detection of patients with undiagnosed diabetes and prediabetes by monitoring blood glucose levels. The study was conducted in Japan and enrolled 716 patients visiting general dentists who were members of the Ehime Dental Diabetes Study Group.

A questionnaire about a medical history of diabetes was completed by all patients enrolled in the study. Casual, nonfasting samples of finger capillary blood were obtained from all patients and blood glucose was measured using the Precision Xceed (Abbott Diabetes Care Inc.; Alameda, California) device. Periodontal pocket depth and resorption were measured, and patients with ≥ 20 functional teeth (n = 528) were divided into three groups according to the Kornman criteria for pocket depth and bone loss: none to mild periodontitis, moderate periodontitis, or severe periodontitis.

The study included 403 women and 313 men with a mean age of 61 years (range, 21-90 years), 151 (21.1%) of whom reported a history of diabetes. The mean blood glucose level for all patients was 133 mg/dL.

Of the 528 patients diagnosed with periodontitis:

  • 187 patients (35.4%) with mild periodontitis had a mean blood glucose level of 110 mg/dL;

  • 286 patients (54.2%) with moderate periodontitis had a mean blood glucose level of 137.6 mg/dL;

  • 55 patients (10.4%) with severe periodontitis had a mean blood glucose level of 156.1 mg/dL, and this group had the highest proportion of patients with hyperglycemia (blood glucose ≥ 200 mg/dL); and

  • Approximately 30% of patients with hyperglycemia reported no history of diabetes.

Viewpoint

Diabetes has affected humans for centuries and continues to be one of the most common diseases affecting the population on a global scale.[3] In 2015, the American Diabetes Association reported that in the United States, approximately 30 million children and adults have diabetes and 86 million individuals have prediabetes.[4] It is also estimated that 8.1 million Americans have undiagnosed diabetes.[4]

Longitudinal studies have demonstrated a bidirectional relationship between diabetes and periodontitis. Increased severity of periodontal tissue destruction is seen in patients with diabetes and inferior glycemic control.[5] This study illustrates that periodontal disease is often associated with elevated blood glucose. In addition to periodontal disease, oral complications of diabetes include increased risk for dental caries, tooth loss, oral candidiasis, xerostomia, halitosis, altered taste, and burning sensations.[6]

It is incumbent on oral healthcare providers to recognize oral conditions that may be associated with known and unknown diabetes. For this reason, basic screening for this (and other) common systemic diseases should be considered in the dental office setting. Dental professionals should discuss the results with the patient appropriately, and individuals with positive findings should be promptly referred to a medical provider for further evaluation.

These investigators emphasize that their results are based on nonfasting, casual testing of blood glucose levels. However, general screening for prediabetes and undiagnosed diabetes in the dental office is supported by these findings because a substantial proportion of patients in this cohort were unaware of their hyperglycemia.

Because this study was conducted in Japan, the findings may not be generalizable to other populations. Still, they support the concept that dental professionals are first-line general healthcare providers for many patients, and by performing basic screening measures for common diseases, they can have a substantial impact on the oral and systemic health of their patients.

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