The World Health Organization (WHO) estimates that 422 million people worldwide have diabetes and 1.6 million deaths are directly attributed to diabetes each year. Therefore, not only does the dental team need to ensure they can care for these patients, there is also a role for dentists to screen their patients for the disease itself. Dentists are often the only health professional people see regularly and so this is a good opportunity for screening for diabetes.
What is diabetes?
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose, which over time leads to damage to the heart, blood vessels, eyes, kidneys and nerves. There are 2 types:
- Type 1, or insulin-dependent diabetes - an autoimmune condition where the pancreas produces little or no insulin.
- Type 2, or non-insulin-dependent diabetes - this usually presents in adulthood where the body becomes resistant to insulin often as a result of poor diet and other lifestyle factors, and accounts for the vast majority of cases. Many people who have Type 2 diabetes are unaware of it.
The American Diabetes Association states that, in 2018, there were an estimated 34.2 million adults with diabetes in the USA, 7.3 million of whom were undiagnosed.
How can dentists help?
Screening for Type 2 diabetes in dental offices includes a review of the patient's medical history, an oral examination including an evaluation for oral manifestations associated with diabetes, particularly periodontal disease. Screening for Type 2 Diabetes can include a simple survey or test such as the American Diabetes Association Risk Test to identify those who are at risk and measurement of hemoglobin (Hb) A1c (glycosolated hemoglobin): a measure of average glucose levels over the past 2-3 months. HbA1C levels between 5.7% and 6.4% indicated prediabetes, while levels at or above 6,5% indicate diabetes. Note that you need to consider scope of practice and government regulations applicable to performing this test in the dental office, depending on where you practice. For example, in the US you may need a CLIA Certificate of Waiver to administer finger-prick blood tests.
Patients screened and found to be at risk should be referred to a physician for a diagnosis and care. As dental professionals, we can also equip our patients with knowledge about the two-directional link between diabetes control and periodontal disease and provide advice to help patients improve these. The importance of good oral health and effective oral hygiene measures such as twice daily brushing and interdental cleaning should be emphasized. Although screening does require additional time, the test is simple, quick and can be performed chairside. Dental teams should have appropriate training and protocols, including knowledge of parameters for referrals and prompt liaison with the appropriate medical teams and specialists.
While not all patients will want to have this screening (for example if they are 'needle phobic'), the dental team should be confident in communicating the advantages of screening and how to communicate results with patients. By doing so, patients can be referred, receive medical care and take action to improve their lifestyle, diet, and oral hygiene. It has been stated that screening for diabetes at dental visits has the potential to make an estimated 22.36 million adults aware of their risk for prediabetes or diabetes.
Offering diabetes screening in the dental office is simple, effective and impactful.