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Columbia University investigators studied new patients who
presented for dental care at the Columbia University College of Dental Medicine
Triage Clinic between April 2009 and March 2010. They included in their study
people who had not previously been told they had prediabetes or diabetes and
who were non-Hispanic white individuals older than 40 years of age or Hispanic
or nonwhite individuals older than 30 years of age.
Study subjects also self-reported at least one of the
following risk factors: family history of diabetes, hypertension, high
cholesterol, overweight/obesity, and continuing to receive a periodontal
examination and a point-of-care HbA1C test.
A total of 535 patients received a periodontal examination
and a point-of care HbA1C test. HbA1c testing was done with a fingerstick blood
sample and a benchtop analyzer. Following an overnight fast, 506 patients also
returned for a second appointment for a fasting plasma glucose test to identify
potential prediabetes (100-125 mg/dL) or diabetes (0.126 mg/dL).
The team identified 182 individuals as having abnormal
fasting plasma glucose. Of these, 21 (4.2%) were potentially diabetic and 161
(31.8%) were potentially prediabetic. The average age among people with
abnormal fasting plasma glucose was significantly higher than among the other
patients, at 51.4 versus 55.6 years (p 0.01).
Furthermore, the number of missing teeth and percent of deep
pockets were both significantly higher in the abnormal fasting plasma glucose
group. The prevalence of self-reported hypertension, hypercholesterolemia, and
being overweight was also significantly higher in the abnormal fasting plasma
glucose group.
Using statistical analyses, the investigators determined
that the optimal cut-off for identifying diabetes or prediabetes is the
presence of at least 26% of deep pockets or at least four missing teeth. They
found that, together, these two measures could correctly identify 73% of true
cases with previously unrecognized hyperglycemia. The addition of a point-of-care
HbA1c of 5.7% increased correct identification to 92%.
"This should be part of what we do; we're treating the
whole patient so we should care about their overall health," said lead
author Evie Lalla, DDS, of the Columbia University College of Dental Medicine.
"The main goal of the study was to make this screening procedure as simple
as possible and as quick as possible so we don't interfere a lot with the
everyday doings. This is nothing outside of what we do every day -- except the
HbA1c, which is optional -- it's just putting the pieces of the puzzle
together. Our findings provide a simple approach that can be easily used in all
dental-care settings."
However, it is unclear how many dentists will actually add
diabetes screening to their daily practice, even with the simplified technique
described by Dr. Lalla and her colleagues. Marc Whitmore, DDS, who heads
Whitmore DDS in Plano, TX, said that while he agrees the suggested screening
procedure is easy and that screening is important, it is unlikely most dental
offices will do it.
"In fact, much like comprehensive oral cancer
screening, it is unfortunately a niche service," he told DrBicuspid.com.
"Some dentists and dental personnel are actively educating patients about
their overall systemic health and the implications of the oral health markers.
But is this level of concern common in our profession? Sadly, no."
Nonetheless, Dr. Lalla believes in having "more
dentists embrace the idea and become more willing to do this."
Article from: dentist.net
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Thanks for sharing such interesting tips on study which suggest dentists can accurately screen patients for diabetes. Dr. Sandeep Walia prepare, educate, and enhance the skills of Internationally trained dentists, allowing them to serve their patients and community with confidence and excellence.
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