The oral systemic link: Is it practical to test for diabetes during routine dental visits?

New research from the University at Buffalo shows that diabetes testing during regular visits to the dentist is both practical and leads to increased diagnoses in patients who may be unaware of their condition.

Focused specifically on the diabetic HbA_1c blood test, the study set out to determine how practical it was for dentists to check for diabetes as part of a regular dental visit, recognizing that about two-thirds of American individuals visit a dentist at least yearly.  Hemoglobin is a protein red blood cells that carries oxygen, while glycated hemoglobin, or HbA_1cis a form that reflects plasma glucose concentrations.

“Research has shown that uncontrolled diabetes is associated with an increased progression of periodontal disease,” said the study’s lead author, Robert J. Genco, DDS, PhD, SUNY Distinguished Professor of Oral Biology and Microbiology and Immunology. “And those with diabetes and periodontal disease may have worse glycemic control and may be at greater risk for heart and kidney complications.”

The patients in the study were 45 years and older and were unaware of their diabetic status. The researchers evaluated the patients for diabetes risk using the American Diabetes Association (ADA) Risk Test and the HbA_1cmeasurement.

Values for normal HbA_1care less than 5.7%; pre-diabetic levels are 5.7% to 6.4%; diabetic levels are higher than 6.5%.

Of the 1,022 patients screened, 416 had an HbA_1cblood level of 5.7 or greater, while 35.1% of those 416 received a diabetic diagnosis with the following year. Additionally, a large portion of those who received the test at a community health center were confirmed to be at high risk of developing diabetes, compared to fewer than one-fourth of those who received the test at a private dental practice.

Genco said the study showed that it is practical to check the HbA_1cof dental patients, yet some issues arose during the study that required further evaluation. First, only 21.5% of patients seen at a private dental practice who showed an HbA_1c of 5.7 or greater sought further diagnostic workups from their primary physicians. This low compliance occurred despite patients having consented to the process of screening and being referred to a physician prior to the study.

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 diabetes, especially since it is closely linked to periodontal disease.”