Are you screening in your dental office?

Data indicates that more than estimated $100 million could be saved each year if certain medical screenings such as diabetes, high blood pressure, and high cholesterol were conducted in dental offices. Maria Perno Goldie, RDH, MS, talks about the practicality of screening in the dental office with an emphasis on the need for interprofessional collaboration.

Chronic Disease Screening Fo

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)

“Research has shown that uncontrolled diabetes is associated with an increased progression of periodontal disease,” Robert J. Genco, DDS, PhD, SUNY Distinguished Professor of Oral Biology and Microbiology and Immunology, University at Buffalo.

An example of a screening that could be performed in a dental office is diabetes testing. Of the U.S. population, 25.8 million have diabetes, about 8.3 percent. Of these, 7 million are undiagnosed.(6) Ninety to 95 % of all diagnosed cases of diabetes in adults are Type II.

Keeping sugar levels controlled is vital to avoid complications of the marcrovasculature and the microvasculature. These could include: skin complications; retinopathy; neuropathy; foot complications; ketoacidosis (DKA); nephropathy; hypertension; stroke; Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS); gastroparesis (delayed gastric emptying); heart disease, periodontal disease; and others. To aid earlier detection of diabetes, University at Buffalo researchers conducted a study that concentrated specifically on the diabetic HbA1c blood test and whether or not it was practicable to perform it chair side in dental office practices.(7)

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!

References
1. http://ada.org/sections/professionalResources/pdfs/HPRgraphic_0214_A.pdf.
2. Nasseh K, Greenberg B, Vujicic M, and Glick M. The Effect of Chairside Chronic Disease Screenings by Oral Health Professionals on Health Care Costs. American Journal of Public Health. e-View Ahead of Print. 2014. doi: 10.2105/AJPH.2013.301644.
3. CDC. Chronic Diseases and Health Promotion. http://www.cdc.gov/chronicdisease/overview/index.htm.
4. Wu SY, Green A. Projection of chronic illness prevalence and cost inflation. Santa Monica, CA: RAND Health; 2000.
5. http://ndep.nih.gov/diabetes-facts/.
6. http://adap-old.pub30.convio.net/diabetes-basics/diabetes-statistics/.
7. Genco RJ, Schifferle RE, Dunford RG, Falkner KL, Hsu WC, Balukjian J. Screening for diabetes mellitus in dental practices: a field trial. J Am Dent Assoc. 2014 Jan;145(1):57-64. doi: 10.14219/jada.2013.7.
8. Personal correspondence Dr. Robert Genco.

Maria Perno Goldie, RDH, MS

To read previous RDH eVillage FOCUS articles by Maria Perno Goldie, click here.

To read more about screening and dental hygiene, click here.

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