Making diabetes screening more available at the dentist's office

March 11, 2014 by Sara Saldi
Making diabetes screening more available at the dentist’s office
While dentists have been conducting patient blood sugar tests for some time, very little in the way of field trial research is available regarding dental visits and HbA1c testing.

(Medical Xpress)—You may have diabetes and not even know it. According the Centers for Disease Control and Prevention, 25.8 million people have diabetes. Of these, 7 million have undiagnosed disease.

Getting treatment for diabetes early is crucial to avoid complications such as kidney failure, blindness and increased risk of heart disease and stroke. In order to target the undiagnosed, health care providers are working to make diabetes testing available in a variety of health care settings.

With this in mind, University at Buffalo researchers have published results on one of the first studies that focused specifically on the diabetic HbA1c blood test and whether or not it was feasible to perform it chair side in dental office practices.

The results recently appeared in the Journal of the American Dental Association.

According to the study's first author Robert J. Genco, DDS, PhD, SUNY Distinguished Professor of Oral Biology and Microbiology and Immunology, while dentists have been conducting patient blood sugar tests for some time, very little in the way of field trial research is available regarding dental visits and HbA1c testing.

Hemoglobin is a protein in red blood cells that carries oxygen. Glycated hemoglobin, or HbA1c, is a form of hemoglobin that reflects plasma glucose concentrations.

The HbA1c blood test is considered essential for patients with diabetes and pre-diabetes because its results can reflect an individual's blood sugar control anywhere from four weeks to three months—not just that day. It also doesn't require fasting and can be done with a finger stick.

Genco said the goal of the study was to determine how practical it was to perform the HbA1c test for diabetes as part of a regular dental visit, recognizing that about two thirds of individuals in the U.S. visit a dentist at least yearly.

"Research has shown that uncontrolled diabetes is associated with an increased progression of ," said Genco. "And those with diabetes and periodontal disease may have worse glycemic control and may be at greater risk for heart and kidney complications."

Genco noted the treatment of periodontal disease in patients with uncontrolled diabetes may actually improve glucose control in some patients.

The patients in the study were 45 years and older and were not aware of their diabetic status. Genco and his team evaluated the patients for diabetes risk using the American Diabetes Association Diabetes (ADA) Risk Test and the HbA measurement.

Values for a normal HbA1c are less than 5.7 percent; pre-diabetic levels are 5.7 percent to 6.4 percent; diabetic levels are higher than 6.5 percent.

Of the 1,022 patients screened, 416 (40.7 percent) had an HbA1c blood level of 5.7 or greater and were referred to physicians for diagnosis and follow-up. Of those 416, 35.1 percent received a diagnosis of diabetes within one year.

The patients were further studied according to where they received treatment and testing: 78.8 percent were seen in a center and 21.4 percent were seen in private dental offices.

Of the patients who were given the ADA Diabetes Risk Test, more than half seen in the community health center were at high risk of developing diabetes. In contrast, in private dental offices, fewer than one fourth of the patients were at high risk.

Genco said the study showed that it is practical to check HbA1c of dental patients. However, there were some issues that emerged during the study that needed further evaluation.

First, only 21.5 percent of patients who were seen in the private dental offices who had an HbA1c of 5.7 percent or greater sought diagnostic workup from their physicians. This low compliance occurred despite patients having consented to the process of screening and possibly being referred to a physician prior to taking part in the study.

Conversely, in the community health center, 78.8 percent of the patients who were referred to physicians sought and obtained a medical diagnosis.

Genco was surprised by these results and said there are a number of possibilities that might cause poor compliance among study subjects, among them denial, fear of being diagnosed diabetic, costs, lack of motivation for patients who are not experiencing symptoms and lack of access to medical care.

He added that the patients in the community health center were primarily African-American and Hispanic. In those populations, because of a higher incidence of diabetes, there may have been greater awareness about the disease and its complications.

"Also, most of the dental patients in the community health center were of record of a primary physician in that same center with shared electronic medical and dental records," said Genco. "What this tells us is that in the future, we need to consider within the study the reasons for poor compliance. We should also take from this the success of the community health center and the importance of a shared medical-dental home."

The study also found dental offices need standardized criteria for documenting and diagnosing periodontal disease more accurately.

Inspired by the fact that he never met either of his grandfathers, both of whom died early due to complications related to diabetes, Genco has devoted a good deal of his research to the relationship between diabetes and periodontal disease.

"Because of this, I would like to make a contribution to the understanding and control of , especially since it is closely linked to periodontal disease."

Explore further: Study indicates the potential of new tests in long-term diabetes complications

Related Stories

Study indicates the potential of new tests in long-term diabetes complications

January 14, 2014
Monitoring glucose levels is imperative for diabetes patients, but for some the standard Hemoglobin A1c (HbA1c) test is not valid. Researchers from Johns Hopkins University, the University of Wisconsin, and the University ...

Change in guidelines for Type 2 diabetes screening may lead to under-diagnosis in children

February 11, 2014
New American Diabetes Association (ADA) screening guidelines may lead to the missed diagnoses of type 2 diabetes in children, according to a new study by University of Michigan.

Most patients at diabetes risk consider themselves healthy

January 24, 2014
(HealthDay)—Nearly 80 percent of patients at elevated risk for type 2 diabetes think they are in excellent or very good health, according to a new survey from the American Diabetes Association (ADA).

Fasting plasma glucose beats HbA1c for diabetes screening

January 17, 2013
(HealthDay)—For patients without diabetes undergoing coronary angiography (CAG), fasting plasma glucose (FPG) performs better in diabetes screening than glycated hemoglobin (HbA1c), according to a study published online ...

Dentists can identify people with undiagnosed diabetes

July 14, 2011
In a study, Identification of unrecognized diabetes and pre-diabetes in a dental setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found ...

Many at risk for diabetes and don't know it, study finds

December 4, 2013
(HealthDay)—New research shows that many Americans who are at risk for type 2 diabetes don't believe they are, and their doctors may not be giving them a clear message about their risk.

Recommended for you

Understanding genetic synergy in cleft palate

July 19, 2017
Like all of the individual elements of fetal development, palate growth is a marvel of nature. In part of this process, ledges of tissue on the sides of the face grow downwards on each side of the tongue, then upward, fusing ...

Use of prefabricated blood vessels may revolutionize root canals

June 12, 2017
While root canals are effective in saving a tooth that has become infected or decayed, this age-old procedure may cause teeth to become brittle and susceptible to fracture over time. Now researchers at OHSU in Portland, Oregon, ...

Recreational cannabis, used often, increases risk of gum disease

May 24, 2017
Columbia University dental researchers have found that frequent recreational use of cannabis—including marijuana, hashish, and hash oil—increases the risk of gum disease.

Grape seed extract could extend life of resin fillings

May 9, 2017
A natural compound found in grape seed extract could be used to strengthen dentin—the tissue beneath a tooth's enamel—and increase the life of resin fillings, according to new research at the University of Illinois at ...

Crooked bite may indicate early life stress

April 13, 2017
Research has repeatedly confirmed that the first 1,000 days after conception strongly influence a person's life expectancy and susceptibility to chronic diseases. The primary marker used to identify early life stress is low ...

New study identifies successful method to reduce dental implant failure

March 24, 2017
According to the American Academy of Implant Dentistry (AAID), 15 million Americans have crown or bridge replacements and three million have dental implants—with this latter number rising by 500,000 a year. The AAID estimates ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.