Diagnosing diabetes in the dentist chair

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“In light of these findings, the dental visit could be a useful opportunity to conduct an initial diabetes screening—an important first step in identifying those patients who need follow-up testing to diagnose the disease,” says Shiela Strauss, who determined that 93 percent of subjects who had periodontal disease were considered to be at high risk for diabetes and should be screened for diabetes. This compares to 63 percent of those without periodontal disease.

NYU (US)—An overwhelming majority of people with periodontal disease are also at risk for diabetes and should be screened, a new study finds.

Further, half of those at risk had seen a dentist in the previous year, according to research by Shiela Strauss, associate professor of nursing at New York University. She concludes that dentists should consider routinely offering diabetes screenings in their offices.

The study examined data from 2,923 adult participants in the 2003-2004 National Health and Nutrition Examination Survey who had not been previously diagnosed with diabetes.

The survey, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, was designed to assess the health and nutritional status of adults and children in the United States.

Using guidelines established by the American Diabetes Association, Strauss determined that 93 percent of subjects who had periodontal disease were considered to be at high risk for diabetes and should be screened for diabetes.

This compares to 63 percent of those without periodontal disease.

“In light of these findings, the dental visit could be a useful opportunity to conduct an initial diabetes screening—an important first step in identifying those patients who need follow-up testing to diagnose the disease,” Strauss says.

The guidelines recommend diabetes screening for people at least 45 years of age with a body mass index (a comparative measure of weight and height) of 25 or more, as well as for those under 45 years of age with a BMI of 25 or more who also have at least one additional diabetes risk factor.

In Strauss’s study, two of those additional risk factors—high blood pressure and a first-degree relative (a parent or sibling) with diabetes—were reported in a significantly greater number of subjects with periodontal disease than in subjects without the disease.

Strauss’s findings, published Dec. 14 in the online edition of the Journal of Public Health Dentistry, add to a growing body of evidence linking periodontal infections to an increased risk for diabetes.

Strauss also examined how often those with gum disease and a risk for diabetes visit a dentist, finding that three in five reported a dental visit in the past two years; half in the past year; and a third in the past six months.

“It’s been estimated that 5.7 million Americans with diabetes were undiagnosed in 2007,” Strauss adds, “with the number expected to increase dramatically in coming years.

“The issue of undiagnosed diabetes is especially critical because early treatment and secondary prevention efforts may help to prevent or delay the long-term complications of diabetes that are responsible for reduced quality of life and increased levels of mortality among these patients. Thus, there is a critical need to increase opportunities for diabetes screening and early diabetes detection.”

Strauss says dentists could screen patients for diabetes by evaluating them for risk factors such as being overweight; belonging to a high-risk ethnic group (African American, Latino, Native American, Asian American, or Pacific Islander); having high cholesterol; high blood pressure; a first-degree relative with diabetes; or gestational diabetes mellitus; or having given birth to a baby weighing more than nine pounds.

Alternatively, dentists could use a glucometer—a diagnostic instrument for measuring blood glucose—to analyze finger-stick blood samples, or use the glucometer to evaluate blood samples taken from pockets of inflammation in the gums.

“The oral blood sample would arguably be more acceptable to dentists because providers and patients anticipate oral intervention in the dental office,” Strauss notes.

In an earlier study involving 46 subjects with periodontal disease published in June 2009 by the Journal of Periodontology, an NYU nursing-dental research team led by  Strauss determined that the glucometer can provide reliable glucose-level readings for blood samples drawn from deep pockets of gum inflammation, and that those readings were highly correlated with glucometer readings for finger-stick blood samples.

Researchers from Lehman College of the City University of New York contributed to the study.

New York University news: www.nyu.edu/public.affairs/

chat49 Comments

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49 Comments

  1. Futurity.org – Diagnosing diabetes in the dentist chair | Diabetes mellitus and treatments

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  2. Stephen W. O'Driscoll

    This study tends to confirm the assumption that diabetes causes changes in the body long before it is detected by the person. People with elevated blood sugar tend to have slower healing and one of the quickest healing areas is the mouth owing to the abundent blood supply. Periodontal disease would therefore be one of the first signs of diabetes that would be noted by the person. Dentists should be taught to do a glucose evaluation on every patient, not just those in an “at risk” group.

  3. Las Vegas Dentist

    Very interesting post regarding using dental visits to screen. Early cancer detection is also possible this way. We have a few articles about this at our website http://www.absolutedentalonline.com/oral_cancer_screening.htm

  4. Dr Ron Schefdore

    I used a glucometer in my office but there were some issues…The glucometer requires a dentist to get a CLIA lisense and opens the dentist up for a random inspection by CLIA. The glucometer has a 10-15% inaccuracy. My malpractice carrier said since I was giving the patent the lab results there could be a liabilty issueand they would not cover me..

    All of these issues were solved with a FDA approved test kit found at http://www.healthyheartdentistry.com Dental office training is at http://www.dentistryagainstdiabetes.com

    This is a simple and inexpensive way for dentists to acuurately screen for diabetes and prediabetes. We routinely have been identifying prediabetes and diabets this way for several years.

  5. Chicago mother

    My recommendation is that anyone with diabetics should inform the dentist and put the needs of diabetics first, one who is qualified to treat the needs of diabetics. I found a really good dentist, Chicago Dentist, http://www.bigsmiledental.com/ that helped my father with diabetes.

  6. Dr Ron Schefdore

    There is no special training for a dentist in treating a diabetic- dentists do not specialize in diabetics. However a cutting edge dentist will take blood screening tests, blood pressure, oral screenings before doing any dental invasive procedure or full mouth reconstruction. The blood screenings can also tell the efficacy of the dental treatment. Patients and physicians really appreciate the professional lab report

  7. Dentist in Las Vegas

    Speaks to the gap that exists between dental care and regular health care. The need is there for more of a crossover between the two and initial diabetes screenings is a good start.

  8. Dentist Thornhill

    Many people see their dentist more often than their family doctor, so dentist should be the first line in detecting possible diabetes. Their are many manifestations of diabetes in the mouth including candidiasis fungal infection that can be diagnosed by a dentist.

  9. children dentist

    Dentists should be taught to do a glucose evaluation on every patient, not just those who are in an “at risk” group.

  10. emergency dental

    People who have diabetes are at risk of gum disease (periodontal disease) and should be visiting the dentist regularly for prevention.

  11. Dr. Ron Schefdore

    We do train dentists to take a diabetes screening tests on dental patients –go to http://www.dentistryagainstdiabetes.com. We identify prediabetes and diabetes every week in most of the dental offices that use our lab accurate tests.The patients are usually not aware they have a problem. We refer the dental patient to their physician with our lab report for a diagnoses.

  12. Altoona Dentists

    I agree, “at risk”, is such a broad term, why not just test everyone. The more opportunities we have to catch this at an early stage the better in my opinion.

  13. rotationalviscometer

    Cool concept. I’m always for taking small steps in screening at any convenient chance we get. This sounds like a pretty good idea. I also like the idea of the medical and the dental systems working a bit more closely together. This can bring nothing but positive results.

  14. dentist spring hill

    That is really some great information. I had no idea that you could be diagnosed and see the signs of diabetes. So there is another great reason to go to the dentist twice a year and get your teeth checked out. Not only does it help keep you healthier, but also can give you the warning signs of being a diabetic.

  15. Wesley Jethro

    I hate to be negative – not least as a dentice practice ownwer, so the story opinion was not what was like, the headline was a bit misleading tbh – what do others have to say?

  16. Dr. Chris Mohler

    Yeah I agree Wesley Jethro, the title is a bit misleading. Although I agree that dentists can help you find and prevent diabetes. they do not usually check for it though, but can recognize signs of it especially if they see something unusual in your throat.

  17. JKW

    It is important to detect diseases and illnesses in any way you can. This is really interesting how diabetes can diagnosed by a dentist. Please visit this site for more information on other dental practices http://www.rexburgsmiles.com/site/patient-education

  18. Austin_Smile

    Many dental practices perform oral cancer screenings at every visit. We do it every day, as a courtesy to our patients. We also spend a great deal of time educating our patients about the links between oral heakth and general health. The latest research has proven beyond doubt the strong links between periodontal disease ( gum disease) and heart disease. Medical professionals should start sending their patiens to the dentists to get their gum desease under control. Read more about it here:
    http://www.austinsmilecreations.com/Html/austin_dental_education/austin_dental_articles.html

  19. dentist Falls Church

    Cool Austin_Smile! I didnt really know much about heart disease and the link it has with gum disease. I hope more and more dentists are going to be aware of this and that they can see the signs so that they can refer a patient to a cardiologist or their regular doctor. I will have to check out your link when I have more time.

  20. dentist eidson

    I am going to ask my dentist if he has been trained to do that kind of stuff when he is checking patients. If not I will have to sent him over to this article and make sure he finds to proper training. Just think of how many people he could help when he has this training and knowledge.

  21. Dr Schefdore

    You are right -think how much healthier America would be with dentists and hygeniests identifying patients at risk.Have your dentists go to http://www.healthyheartdentistry.com to order tests and training
    .

  22. Buzz Nabers

    Thanks for the post, I love reading about dentistry and the different styles and techniques! How long have you worked in the industry?

  23. Dr. Schefdore

    Buzz,

    I have been serving my patients for 27 years. (www.yourcelebritysmile.com)

    Another helpful product for people that have easily bleeding gums or sensative teeth are Pharmaden products(www.pharmaden.net). Thier Periotherapy product is the only oral supplement with a double blind study showing a significant improvement. Click on Periodontal nutritional bibliography located at the top of the site for more info.

  24. Mendel Potok

    Unless it is relevant to the dental procedure, diabetes screenings at the dentist are not only impractical, but irresponsible. Should a dentist be doing blood work? Should a dentist get a patients genetic history? Not unless it’s related to the procedure. Otherwise, you have laymen doing what specialists are there for.

  25. Dr Schefdore

    Mendel,

    One of the first signs of diabetes is easily bleeding gums.Why not take a blood screening test on a patient that has easily bleeding gums and other risk factors per the American Diabetes Association?? This way I know which patient to refer to their physician for a diagnosis.

    If I treat a patient with gum disease and they had undiagnosed diabetes I would never get them orally well and they would wasre their money on treatment with me..

  26. Shmit Lorrie

    Dr. Schefdore is right. It’s a dentists’ obligation to see to the patients’ overall oral health, and diabetes sure isn’t going to contribute to that.

  27. Maplewood Laser Dental Clinic

    I agree. It would be better to test everyone. It seems simple enough and inexpensive. Better safe than sorry. What would an estimated cost be?

  28. Dr Schefdore

    Hi Maplewood,

    Please Go to healthyheartdentistry.com to order and dentistryagainstdiabetes.com. for training You might want to also consider the A1C/CRP combo test. The key with this blood screening test is the lab report that is sent tothe dentist and the patient. The patient has a report to bring to their physician and the dentist has a report to share with the physician. The test is $20. If the glucose is over 100 send it in for the A!C lab report for $10 .

    The reasons dentist should not use an over the counter glucose test in the office:
    -Up to 10%-15% inaccuracy -No patient consent form
    -No lab report by a third party which opens the dentist up to liability for inaccurate lab reporting to the patient
    -No lab report to share with physicians. A lab report and a letter from the dentist is the key in starting a mutually referring relationship with physicians
    -Government CLIA certificate required
    -Possible random government CLIA inspection

    Have you also considered the patient taking a product (periotherapy/osteotherapy)that shows a reduction of pocket depth , plaque, and bleeding when doing scaling? Also great when doing implants

    Dr Ron

  29. dentist Hartford

    thanks Dr Schefdore for posting the link. I will take a look at that and see what I can do to get all of my dentist’s trained so that they know the signs and symptoms to look for.

  30. Dr Schefdore

    Dentist Hartford,

    You are welcome. My training which consists of a staff DVD, 70 page manual, and 1 hour teleconference with me and your staff is free when you order a periopack of blood screening kits at healthyheartdentistry.com and a periopack of nutraceuticals. The nutraceuticals are evidance based and peer reviewed supplement shown to reduce pocket depth, bleeding, and plaque(www.Pharmaden.net.). They are used as an adjunct to scaling and root planing.

    I am always glad to help like minded dental professionals

  31. WISDOM TEETH REMOVAL UTAH

    i think that is a great idea. What cost would it be to the dentist, and would it be cheap enough for them that they could offer it without charging the customers more.

  32. Dr Shefdore

    Wisdom,

    I charge my patients exactly my cost for the blood screening service before .Costs vary depending on the test you want to use .Costs can be found at http://www.healthyheartdentistry.com.

    Some oral surgeons also like to use a high absorbing supplement which can be found at http://www.pharmaden.net.

  33. Dentist

    I think it’s great that a dentist is able to detect other problems in the body using their expertise in oral hygiene. So many diseases go undetected for too long, but if medical professionals in whatever field pay close enough attention, lives could definitely be saved.

  34. dentist dude

    Who knew that a dentist could help diagnose diabetes. That’s great that they are working together with other medical professionals. What will they learn next? Plantar warts found at the ophthalmologist?

  35. shyloh J

    Wow this is fascinating! It’s amazing what dentists can tell just by looking at someones teeth! Although, now I have the sudden urge to go see my dentist!

  36. Udayan Chattopadhyay

    Enlightening article. Keep up the good work!

  37. Saratoga Springs Dentist

    This is a great article! The advances in medical technology are truly incredible! Thanks for sharing!

  38. Dr. Schefdore

    Are there any dentists that want to incorporate this great idea into their office?
    Tell your dentist about theis program

    I am always happy to help dentists get started on the dental wellness protocol

    go to http://www.healthyheartdentistry.com to see the informative TV interview

  39. Chicago Dentist

    Gum disease is not a game and less for diabetics. Is important to check periodically with dentist.

  40. Hilton Head Dentist

    The mucosal tract which begins in the mouth and continues down through the entire digestive/urinary is capable of unveiling any disease process. It’s great to see articles of this nature which highlight that fact.

  41. FletcherG

    I have noticed a strange thing. In the local areas or in the rural areas. Specially in Texas there are many fake dentists who dont have a recognized degree are working there. I have complaint about some of them. Lets see what does the states do. My grandma lived there and i was there after 20 years to visit her.
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  42. Delta Dental of Iowa

    Delta Dental of Iowa has written a blog answering the most commonly asked question by patients with diabetes. It is intended for use as a quick reference and should not be taken as medical advice. Visit our blog for more information.

    http://www.deltadentaliablog.com/2012/05/diabetes-and-the-dentist-faqs/

  43. Moe

    I think that it would be really cool if the dentist could do multiple check ups while I was there. I guess that it would mean that he/she would have to go to school and get more training. I think that it is great that they can diagnose diabetes. I know a few people that really struggle with their diabetes and I know that I would want to find out right away if I had this. Thanks for the great article!

  44. Taylor Parker

    This article is so interesting! I’ve always been scared of getting diabetes, ever since I was a little kid. One of my best friends growing up had diabetes, and she always had to prick her finger every time she ate. That always made me so sad. But what really bothered me was that she had to wear a insulin pump, and that the insulin pump had a long needle that had to be taken in and out. Needles really really bother me, and it always made me so sad that the insulin pump had a needle. I am, incidentally enough, going to see the dentist next week, and I’m curious, if I can ask him if he notices any risks for diabetes. I know that I really should be going to see a doctor, instead of a dentist for something like this, but I hate doing anything that would cause an alarm to my doctor. What should I ask my dentist when I go to see him for a check up? What kind of test can he run to see if I am at risk for diabetes?

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  46. Sonrisa Family Dental

    Very interesting article. There is a strong correlation here and it is prudent for people to schedule regular appointments with their dentists.

  47. Sam Brach

    I’ve shared this information with my Minneapolis dentist. I would love knowing that my local dentist is well trained in wellness protocol. The training doesn’t sound overwhelming and I think any dentist should only see it as a benefit for their office and their patients. I will have to chat about it at my next appointment when I can bring the article. I’m sure she will be very interested after a little research.

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  49. Matt

    One of the things we try to do is educate our patients about their teeth and how its related to their health. If we can get them to take care of their teeth, in the long run their health will benefit.

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