Assessing Systemic Disease Risk in a Dental Setting: A Public Health Perspective

https://doi.org/10.1016/j.cden.2012.07.011Get rights and content

Section snippets

Prevention and screening

The integration of oral health care providers into strategies to enhance early identification of individuals at risk of developing chronic disease may be a future public health strategy aimed at preventing and controlling the growing chronic disease epidemics. The purpose of disease prevention and control is to identify individuals who have an increased likelihood of developing disease or experiencing increasing disease severity. Successful prevention is predicated on several underlying tenets,

Why screen for medical conditions in a dental setting?

Screening for risk of developing disease can alert patients to potential disease risks or health issues of which they are unaware. On average, 65% to 70% of adults visit the dentist in a given year, 10% to 20% of whom have not seen a physician in the preceding year, suggesting a potential role for oral health care providers in public health strategies to prevent the onset of, or control the severity of diseases of important public health significance.2, 3, 4 Cardiovascular disease (CVD) and

Burden of CVD and DM

Coronary heart disease (CHD), which constitutes 50% of CVD, is the leading cause of death for both men and women in the United States.17 According to the American Heart Association (AHA), approximately 13 million Americans have symptoms of CHD.17 As the life expectancy and obesity rate increase in the population, CVD and DM are becoming increasingly more prevalent, with 80 million people recognized as having some type of CVD and 26 million with DM; 90% to 95% are type 2 diabetes.18 The

CVD

In December of 2012 the US Department of Health and Human Services released Healthy People 2020, the comprehensive set of national public health goals and objectives. One of the primary goals states: “Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; and prevention of repeat cardiovascular events.”50

In 2012, the AHA presented its new

Is there a role for oral health care professionals?

In previous studies, we developed and pilot-tested a CHD and DM screening strategy for use in a dental setting to identify asymptomatic individuals who are at increased risk for developing DM- and CHD-associated events.3, 65 Demographic (age, gender, smoking history) and clinical data (reported history of hypertension, hypercholesterolemia, CHD, heart attack, stroke, angina, medication use for high blood pressure or high cholesterol) were abstracted from National Health and Nutrition

Summary

In recent years, there has been much written advocating for the creation of a health home to facilitate more effective, coordinated evidence-based health care that integrates medicine dentistry and social/environmental factors.1, 82, 83 As part of this health home concept, screening and monitoring for systemic disease risk in a dental setting are valuable components for more effective disease prevention and control, and health care delivery. Data suggest that this can be an effective strategy

First page preview

First page preview
Click to open first page preview

References (83)

  • K.B. Farris et al.

    Between intention and behavior: an application of community pharmacies' assessment of pharmaceutical care

    Soc Sci Med

    (1999)
  • B. Greenberg et al.

    Attitudes on screening for medical conditions by oral health care professionals

    J Am Dent Assoc

    (2010)
  • M. Glick

    A home away from home

    J Am Dent Assoc

    (2009)
  • M. Glick

    One-stop shopping

    J Am Dent Assoc

    (2007)
  • M.E. Northridge et al.

    Public health support for the health home model

    Am J Public Health

    (2011)
  • Centers for Disease Control. Health, United States, 2010 with special feature on death and dying. Trend tables, table...
  • H.A. Pollack et al.

    Dental examinations as an untapped opportunity to provide HIV testing for high-risk individuals

    Am J Public Health

    (2010)
  • A. Saremi et al.

    Periodontal disease and mortality in type 2 diabetes

    Diabetes Care

    (2005)
  • G.W. Taylor et al.

    Periodontal disease: associations with diabetes, glycemic control and complications

    Oral Dis

    (2008)
  • C. Tsai et al.

    Glycemic control of type-2 diabetes and severe periodontal disease in the US adult population

    Community Dent Oral Epidemiol

    (2002)
  • K.K. Ray et al.

    Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomized controlled trials

    Lancet

    (2012)
  • E. Lalla et al.

    Periodontal changes in children and adolescents with diabetes: a case-control study

    Diabetes Care

    (2006)
  • I. Morita et al.

    Relationship between periodontal status and levels of glycated hemoglobin

    J Dent Res

    (2012)
  • K.J. Mattila et al.

    Dental infections and the risk of new coronary events: prospective study of patients with documented coronary artery disease

    Clin Infect Dis

    (1995)
  • J.D. Beck et al.

    Oral disease, cardiovascular disease, and systemic inflammation

    Periodontol

    (2000)
  • P.B. Lockhart et al.

    Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?

    Circulation

    (2012)
  • American Heart Association Writing Group

    Heart disease and stroke statistics—2009 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

    Circulation

    (2009)
  • Centers for Disease Control and Prevention (CDC). National Diabetes Fact Sheet, 2011. Available at:...
  • Centers for Disease Control and Prevention

    Prevalence of coronary heart disease—United States, 2006-2010

    MMWR Morb Mortal Wkly Rep

    (2012)
  • A. Mozumdar et al.

    Persistent increase of prevalence of metabolic syndrome among US adults: NHANES III to NHANES 1999-2006

    Diabetes Care

    (2011)
  • C.C. Cowie et al.

    Full accounting of diabetes care and pre-diabetes in the U.S. population in 1988–1994 and 2005-2006

    Diabetes Care

    (2009)
  • J.Z. Ayanian et al.

    Undiagnosed hypertension and hypercholesterolemia among uninsured and insured adults in the Third National Health and Nutrition Examination Survey

    Am J Public Health

    (2003)
  • Centers for Disease Control and Prevention

    Vital signs: prevalence, treatment and control of hypertension—United States, 1999-2002 and 2005-2008

    MMWR Morb Mortal Wkly Rep

    (2011)
  • Centers for Disease Control and Prevention

    Vital Signs: prevalence, treatment and control of high levels of low-density lipoprotein cholesterol- United States, 1999-2002 and 2005-2008

    MMWR Morb Mortal Wkly Rep

    (2011)
  • J.P. Boyle et al.

    Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality and prediabetes prevalence

    Popul Health Metr

    (2010)
  • Centers for Disease Control and Prevention. Division of News and Electronic Media. Number of Americans with diabetes...
  • Sox HC, Berwick DM, Berg AO, et al. U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd...
  • J. He et al.

    Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension

    Hypertension

    (2000)
  • J. He et al.

    Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults

    J Am Med Assoc

    (1999)
  • S.P. Whelton et al.

    Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials

    J Hypertens

    (2005)
  • J. He et al.

    Effect of soybean protein on blood pressure: a randomized controlled trial

    Ann Intern Med

    (2005)
  • Cited by (36)

    • IDF Diabetes Atlas: Diabetes and oral health – A two-way relationship of clinical importance

      2019, Diabetes Research and Clinical Practice
      Citation Excerpt :

      Since glucose levels in venous blood obtained by a finger stick and in blood in the gingival crevicular space between the tooth and the gingiva are strongly correlated, it has been suggested to use the latter as a less intrusive method for screening for hyperglycemia [132]. Chair-side screening for diabetes in the dental office is generally well accepted by dental care providers [133–135], physicians [136], medical and dental authorities and professional organizations (although uncertain about the concept) [137], and dental patients [138], inclusive older minority groups [139]. Physicians and other medical care professionals could also play a more active role in addressing the oral health of adults [140].

    • Intimate partner violence screening in the dental setting: Results of a nationally representative survey

      2018, Journal of the American Dental Association
      Citation Excerpt :

      This level of acceptance of IPV screening as part of the dentists’ professional role is lower than has been reported about dentists’ acceptance of substance misuse screening20 (53.9%) and tobacco screening26 (77.9%) and similar to that for human immunodeficiency virus (HIV)21 (40%). Because HIV and IPV are both sensitive and life-threatening issues and because it can be uncomfortable to broach stigmatized conditions, dentists’ support of rapid HIV testing and IPV screening may likely be lower than that for less-stigmatized conditions that are easier to discuss, such as hypertension, cardiovascular disease, and diabetes.25,27-34 These results suggest that barriers exist because of dentists’ attitudes and practices specific to IPV which need to be overcome for dentists to play an active role in screening and referring patients who are experiencing IPV.

    • Interprofessional Collaborative Practice Models in Chronic Disease Management

      2016, Dental Clinics of North America
      Citation Excerpt :

      Periodontal and now endodontic infections have been linked to CVD, including atherosclerosis and systemic inflammation, extensively in the literature.57–61 The incorporation of oral health care professionals in strategies to identify individuals at risk for coronary heart disease and diabetes will compliment preventive and screening efforts necessary to decrease the progression and development of these chronic illnesses and provide a portal for individuals who do not see a physician on a regular basis to gain access to the general health care system.62 The dental practitioner sees these patients on a regular basis for oral health needs and can more readily monitor CVD status, that is, blood pressure status.63

    View all citing articles on Scopus
    View full text