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Detection of Undiagnosed Diabetes in the Dental Setting

  • Systemic Diseases (M Bartold, Section Editor)
  • Published:
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Abstract

Diabetes and periodontitis are multifactorial chronic inflammatory diseases affecting hundreds of millions individuals worldwide. There is a bidirectional relationship between the two diseases, as diabetes is associated with increased prevalence, severity, and progression of periodontitis, and untreated periodontitis is associated with poorer metabolic control in individuals with diabetes. Furthermore, treatment of periodontitis has been shown to improve the metabolic status in patients with diabetes. Therefore, successful prevention and treatment of patients with diabetes and periodontitis requires an interdisciplinary approach involving both dentists and physicians. It has recently been demonstrated that periodontal disease status can be used as a predictor for diabetes and prediabetes risk assessment, and several investigations have reported that chair-side measurement of glycated hemoglobin levels (HbA1C), performed in the dental setting, can help in identifying individuals with potentially undiagnosed diabetes and prediabetes. Thus, since a significant part of the adult population attends the dental office more regularly than their physician, the dental office seems an intriguing venue for screening and prevention of diabetes. In the future chair-side measurements of HbA1C levels in combination with periodontal examination may therefore be performed as a routine in the dental setting. Such an approach might potentially facilitate early identification of individuals with prediabetes and undiagnosed, asymptomatic diabetes and accordingly referred to their general physician for further diagnosis, prevention, and treatment at early stages of disease, thereby reducing potential diabetic complications.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Chapple IL, Genco R. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. 2013;84(4 Suppl):S106–12.

    PubMed  Google Scholar 

  2. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37 Suppl 1:S81-S90.

  3. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20(7):1183–97.

  4. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160–7.

    Article  PubMed  Google Scholar 

  5. Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379(9833):2279–90.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366(9499):1809–20.

    Article  PubMed  Google Scholar 

  7. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914–20.

    Article  PubMed  CAS  Google Scholar 

  8. Kebschull M, Demmer RT, Papapanou PN. “Gum bug, leave my heart alone!”—epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010;89(9):879–902.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  9. Belstrom D, Damgaard C, Nielsen CH, Holmstrup P. Does a causal relation between cardiovascular disease and periodontitis exist? Microbes Infect. 2012;14(5):411–8.

    Article  PubMed  Google Scholar 

  10. Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011;7(12):738–48.

    Article  PubMed  CAS  Google Scholar 

  11. Borgnakke WS, Ylostalo PV, Taylor GW, Genco RJ. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Clin Periodontol. 2013;40 Suppl 14:S135–52.

    PubMed  Google Scholar 

  12. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21–31.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  13. Atieh MA, Faggion Jr CM, Seymour GJ. Cytokines in patients with type 2 diabetes and chronic periodontitis: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2014;104(2):e38–45.

    Article  PubMed  CAS  Google Scholar 

  14. Taylor JJ, Preshaw PM, Lalla E. A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol. 2013;40 Suppl 14:S113–34.

    PubMed  Google Scholar 

  15. Engebretson S, Kocher T. Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J Clin Periodontol. 2013;40 Suppl 14:153–63. This paper is the most comprehensive meta-analysis published, which reports that successful periodontal treatment is associated with improved diabetic outcomes.

    Google Scholar 

  16. Sgolastra F, Severino M, Pietropaoli D, Gatto R, Monaco A. Effectiveness of periodontal treatment to improve metabolic control in patients with chronic periodontitis and type 2 diabetes: a meta-analysis of randomized clinical trials. J Periodontol. 2013;84(7):958–73.

    Article  PubMed  Google Scholar 

  17. Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):421–7.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Shultis WA, Weil EJ, Looker HC, Curtis JM, Shlossman M, Genco RJ, et al. Effect of periodontitis on overt nephropathy and end-stage renal disease in type 2 diabetes. Diabetes Care. 2007;30(2):306–11.

    Article  PubMed  Google Scholar 

  19. Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, et al. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005;28(1):27–32.

    Article  PubMed  Google Scholar 

  20. Strauss SM, Alfano MC, Shelley D, Fulmer T. Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008. Am J Public Health. 2012;102(2):253–5. This paper reported that a substantial proportion of the individuals that did not visit their general physician visited the dentist on a regular basis. Based on this observation the authors suggest that for some individuals the dentist is their only contact with the healthcare system.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Glick M, Greenberg BL. The potential role of dentists in identifying patients’ risk of experiencing coronary heart disease events. J Am Dent Assoc. 2005;136(11):1541–6.

    Article  PubMed  Google Scholar 

  22. Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care. 2011;34 Suppl 2:S184–90.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  23. Wilson PW, Meigs JB, Sullivan L, Fox CS, Nathan DM, D’Agostino Sr RB. Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med. 2007;167(10):1068–74.

    Article  PubMed  Google Scholar 

  24. Kahn HS, Cheng YJ, Thompson TJ, Imperatore G, Gregg EW. Two risk-scoring systems for predicting incident diabetes mellitus in U.S. adults age 45 to 64 years. Ann Intern Med. 2009;150(11):741–51.

    Article  PubMed  Google Scholar 

  25. Borrell LN, Kunzel C, Lamster I, Lalla E. Diabetes in the dental office: using NHANES III to estimate the probability of undiagnosed disease. J Periodontal Res. 2007;42(6):559–65.

    Article  PubMed  CAS  Google Scholar 

  26. Strauss SM, Russell S, Wheeler A, Norman R, Borrell LN, Rindskopf D. The dental office visit as a potential opportunity for diabetes screening: an analysis using NHANES 2003–2004 data. J Public Health Dent. 2010;70(2):156–62.

    PubMed  Google Scholar 

  27. Lalla E, Kunzel C, Burkett S, Cheng B, Lamster IB. Identification of unrecognized diabetes and pre-diabetes in a dental setting. J Dent Res. 2011;90(7):855–60. This study was the first to present data showing that undiagnosed diabetes and prediabetes could be identified by simple means in the dental office.

    Article  PubMed  CAS  Google Scholar 

  28. Lalla E, Cheng B, Kunzel C, Burkett S, Lamster IB. Dental findings and identification of undiagnosed hyperglycemia. J Dent Res. 2013;92(10):888–92.

    Article  PubMed  CAS  Google Scholar 

  29. Lamster IB, Cheng B, Burkett S, Lalla E. Periodontal findings in individuals with newly identified pre-diabetes or diabetes mellitus. J Clin Periodontol. 2014;41(11):1055–60.

    Article  PubMed  Google Scholar 

  30. 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;145(1):57–64. This study clearly demonstrated that the majority of patients are positive towards having the dentist perform simple screening procedures for systemic diseases. However, a substantial proportion of the individuals who were diagnosed with potential prediabetes or diabetes by the dentist failed to comply with the dentists appeal to seek their general physician for further diagnostics.

    Article  PubMed  Google Scholar 

  31. Reimers Holm N-C, Belstrøm D, Østergaard J, Holmstrup P, Grauballe MB. Identification of subjects with undiagnosed diabetes and pre-diabetes in a Danish cohort attending dental treatment. J Periodontol. 2016. doi:10.1902/jop.2016.150266.

  32. Greenberg BL, Kantor ML, Jiang SS, Glick M. Patients’ attitudes toward screening for medical conditions in a dental setting. J Public Health Dent. 2012;72(1):28–35.

    Article  PubMed  Google Scholar 

  33. Barasch A, Safford MM, Qvist V, Palmore R, Gesko D, Gilbert GH. Random blood glucose testing in dental practice: a community-based feasibility study from The Dental Practice-Based Research Network. J Am Dent Assoc. 2012;143(3):262–9.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Rosedale MT, Strauss SM. Diabetes screening at the periodontal visit: patient and provider experiences with two screening approaches. Int J Dent Hyg. 2012;10(4):250–8.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  35. Feinstein-Winitzer RT, Pollack HA, Parish CL, Pereyra MR, Abel SN, Metsch LR. Insurer views on reimbursement of preventive services in the dental setting: results from a qualitative study. Am J Public Health. 2014;104(5):881–7.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Al-Khabbaz AK, Al-Shammari KF, Al-Saleh NA. Knowledge about the association between periodontal diseases and diabetes mellitus: contrasting dentists and physicians. J Periodontol. 2011;82(3):360–6.

    Article  PubMed  Google Scholar 

  37. Quijano A, Shah AJ, Schwarcz AI, Lalla E, Ostfeld RJ. Knowledge and orientations of internal medicine trainees toward periodontal disease. J Periodontol. 2010;81(3):359–63.

    Article  PubMed  Google Scholar 

  38. Forbes K, Thomson WM, Kunzel C, Lalla E, Lamster IB. Management of patients with diabetes by general dentists in New Zealand. J Periodontol. 2008;79(8):1401–8.

    Article  PubMed  Google Scholar 

  39. Kunzel C, Lalla E, Lamster I. Dentists’ management of the diabetic patient: contrasting generalists and specialists. Am J Public Health. 2007;97(4):725–30.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Kunzel C, Lalla E, Lamster IB. Management of the patient who smokes and the diabetic patient in the dental office. J Periodontol. 2006;77(3):331–40.

    Article  PubMed  Google Scholar 

  41. Lalla E, Cheng B, Kunzel C, Burkett S, Ferraro A, Lamster IB. Six-month outcomes in dental patients identified with hyperglycaemia: a randomized clinical trial. J Clin Periodontol. 2015;42(3):228–35.

    Article  PubMed  CAS  Google Scholar 

  42. Albert DA, Ward A, Allweiss P, Graves DT, Knowler WC, Kunzel C, et al. Diabetes and oral disease: implications for health professionals. Ann N Y Acad Sci. 2012;1255:1–15.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Glurich I, Acharya A, Shukla SK, Nycz GR, Brilliant MH. The oral-systemic personalized medicine model at Marshfield Clinic. Oral Dis. 2013;19(1):1–17.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

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Correspondence to Palle Holmstrup.

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Daniel Beltrøm, Morten Bay Grauballe, Niels-Christian Reimers Holm, Allan Flyvbjerg, and Palle Holmstrup declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Systemic Diseases

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Beltrøm, D., Grauballe, M.B., Holm, NC.R. et al. Detection of Undiagnosed Diabetes in the Dental Setting. Curr Oral Health Rep 3, 1–6 (2016). https://doi.org/10.1007/s40496-016-0077-z

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  • DOI: https://doi.org/10.1007/s40496-016-0077-z

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