In this field trial, the researchers assess the feasibility of screening for diabetes and prediabetes in dental practices and in a community health center. The patients were over age 45, and had not been diagnosed with diabetes. They were screened for diabetes risk with an American Diabetes Association (ADA) Diabetes Risk Test and with hemoglobin HbA1c measurement. Participants with an HbA1c level of 5.7 percent or greater were referred to their physicians for diagnosis.
The study results show that screening for prediabetes and diabetes is indeed practical in a dental office, with good acceptance by the dentist and dental office staff members, patients’ physicians and patients. Patients from the community health center showed good adherence with referrals to medical providers (78.8%). On the other hand, adherence was much worse (21.5%) among those in the private dental offices.
The authors deduced that opposition to follow up could be due to a number of factors, such as: denial, optimism, bias, fear of receiving a diagnosis of diabetes, costs, lack of motivation in patients who are asymptomatic, lack of access to medical care and behavioral issues.(7) Dental hygienists are in a prime position to monitor and follow up with patients to ensure that they heed the medical referral. Dr. Genco mentioned that there are barriers to implementing testing, such as lack of financial incentives for the dental office.(8)
I think it is obvious that screening for diseases like diabetes in the dental office is not only practical, but our responsibility. Interprofessional collaboration is necessary if we wish to end the deadly cycle of chronic diseases. The researchers at the University of Buffalo and ADA Health Policy Resources Center (HPRC) have proposed incentive and a chronic care model whereby dental and medical health care professionals can work together for the health of the patient. Who knows, we might just save a life!
Many people see their oral health care provider once or twice per year, but often do not see their medical provider unless they have a problem. Dental hygieists and dentists also see patients over many years, developing long-term relationships. According to the American Dental Association (ADA), chairside medical screenings could save $102 million a year.(1) This includes screening for diabetes, high blood pressure, and high cholesterol. Data from a number of sources were reviewed to estimate the cost savings associated with conducting medical screenings in the dental office. The pool was among adults age 40 and older who had undiagnosed diabetes, hypercholesterolemia, or hypertension. The patients had no reported history of coronary heart disease or diabetes, no disease specific risk factors, were not taking medication for the conditions, and had not seen a physician in the past year. The authors estimated that the screenings could save somewhere from $42.4 million per year, or $13.51 per person screened, to $102.6 million, or $32.72 per person. The range depends on whether the patients actually visit their physician's office after being referred by their dentist. According to the Centers for Disease Control and Prevention (CDC), many people in the U.S. have disease not diagnosed, such as: 7.8 percent undiagnosed hypertension; 2.7 percent undiagnosed diabetes; and 8.2 percent undiagnosed high cholesterol.(1) We all know that prevention saves money and diseases not diagnosed and left untreated usually leads to more expensive procedures in the future. Chronic diseases are the leading causes of death and disability in the U.S., and are among the most common, costly, and preventable of all health problems in the U.S.(3) In 2005, 133 million Americans, almost 1 out of every 2 adults, had at least one chronic illness.(4) Approximately half of all adults suffer from chronic illnesses, which account for more than 75 percent of health care costs and 70 percent of deaths each year in the United States. Based on a Gallup survey, chronic diseases cost the country $153 billion annually in lost productivity.(1)