Dental Screenings Get to the Heart of the Matter
words by merry sue baum / photograph by john emerson
ral healthcare professionals could play a pivotal role in efforts to control two major public health epidemics, heart disease and diabetes mellitus. A study conducted at UMDNJ-New Jersey Dental School (NJDS) found dentists who performed simple, chair-side screenings on asymptomatic patients were able to identify those at increased risk of developing the diseases. Patients who screen positive are then referred to a physician for follow-up care aimed at preventing the development or easing the severity of disease.
Barbara Greenberg, PhD, acting associate dean of research, and her colleague Michael Glick, DMD, dean, School of Dental Medicine at the University at Buffalo, developed a chair-side screening method for coronary heart disease and diabetes mellitus for use in a dental setting. Greenberg, who is also an associate professor, Glick and NJDS clinical faculty members Michael Conte, DMD, Jason Goodchild, DMD and Peter Duda, DMD, pilot-tested the chair-side screening strategy in the adult dental clinics in Newark.
The 100 patients participating in the study were at least 40 years of age, had no reported history of heart disease or diabetes mellitus, were not on any medications for either disease, and had not seen a physician in the last year. During routine visits to the clinic, the dentists measured blood pressure, obtained a brief medical
history and drew a finger-stick blood sample. They tested the blood for total cholesterol, high-density lipoprotein (HDL) and hemoglobin (A1c) levels with hand-held medical-testing devices. Using the laboratory, clinical and demographic data, a well-validated risk score was calculated that assesses a person’s chances of developing a severe cardiovascular event within 10 years. The study results showed that 17 percent of the male study participants were at increased risk for developing a severe cardiac event within that period. Based on recommended guidelines for using hemoglobin A1c levels for screening, 22 percent of participants were found to be at risk of developing diabetes mellitus. Glick and colleagues in Sweden conducted a preliminary study that showed 50 percent of patients referred to a physician for follow-up care were given a medical intervention. Larger community-based studies are being planned.
Greenberg, Glick and colleagues from NJDS and the American Dental Association followed this with survey studies to assess attitudes, knowledge and behavior regarding medical screening in a dental setting. In a national survey among U.S.-based general practitioners, they found that the overwhelming majority of dentists felt chair-side medical screening in the dental setting was important and they were willing to participate in such activities. A survey among inner-city dental clinic patients and community-based dental patients showed that both groups thought this was important and also were willing to participate in such activities. Preliminary data from a survey of primary care physicians in the U.S. indicate that they, too, feel the screening is worthwhile, and they would accept patient referrals from oral healthcare providers.
Research has shown that primary and secondary prevention activities to control blood pressure, cholesterol and obesity reduce the incidence of these diseases, yet a significant number of people are unaware of their risk factors. While many people forgo annual routine visits to the physician, a large percentage of adults make annual routine visits to the dentist. The investigators believe that a successful public heath strategy to control these two growing epidemics is likely to require an integrated approach that involves healthcare professionals across disciplines. .