Screening for Diabetes in the Dental Office
Chronic diseases diabetes and periodontitis share a common inflammatory burden. In fact, it has been suggested that periodontitis is the sixth complication of diabetes. The dental setting is well positioned to provide screening for the ever-growing numbers of patients with pre-diabetes or undiagnosed diabetes. How much do you know about screening for diabetes in the dental office?
Screening for Diabetes in the Dental Office
Chronic diseases diabetes and periodontitis share a common inflammatory burden. In fact, it has been suggested that periodontitis is the sixth complication of diabetes. The dental setting is well positioned to provide screening for the ever-growing numbers of patients with pre-diabetes or undiagnosed diabetes. How much do you know about screening for diabetes in the dental office?
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Greater Risk
Among individuals who have both diabetes and periodontitis, this combination confers greater risk, as these interrelated chronic disease states act synergistically to amplify the total inflammatory burden. Importantly, when both diseases are present, the total inflammatory burden may be increased.
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Silos of Care
Traditionally, screening for diabetes and periodontitis has occurred in silos within the health care arena, highlighting the historical schism between dentistry and medicine. However, the magnitude of the diabetes and periodontitis epidemics compels both medical and oral health professionals to dismantle these silos in favor of bilateral point-of-care screening, referrals, and co-management of these chronic diseases.
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Declining Oral Health
Type 1 and type 2 diabetes both increase the risk for periodontal disease pathogenesis. The risk for deterioration of the periodontium, including clinical attachment loss, progression of periodontal probing depth, and alveolar bone loss, is increased when diabetes is poorly controlled.
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Treatment Effects
The preponderance of evidence advises that the treatment of periodontal diseases may improve glycemic control; however, this is still inconclusive.
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Stratifying Risk
Given the strong evidence that co-existing diabetes and periodontitis act together to amplify cumulative inflammatory burden, oral health professionals should identify and differentiate dental patients according to four risk categories: patients with diabetes and no periodontitis; patients with diabetes and untreated periodontitis; patients with diabetes who are receiving treatment for periodontitis; and patients with diabetes who are systemically healthy.
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Refer, Refer, Refer
Clinicians should be diligent in recognizing patients who present with the classic signs and symptoms of diabetes (eg, increased thirst and/or dry mouth, increased hunger, unexplained fatigue, increased urination, unexpected weight loss, blurred vision, and slow and/or poor healing) and refer them to physicians as soon as possible.
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Screening
The American Diabetes Association’s most recent guidelines for diabetes care emphasize the importance of screening for prediabetes with assessment tools or informal assessment of risk factors and performing diagnostic testing when appropriate.
