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The Outcomes of the Dental Patients’ Screening for Diabetes Mellitus
Abstract
The aim of our research was to study the results of diabetes mellitus (DM) screening in dental patients in a dental clinic. Two models of DM screening during a routine dental examination in a dental clinic were evaluated in the study. The first screening model was the questioning of the participants (N = 216) for DM risk assessment followed by the referral of the patients with DM risk to their physicians for diagnostic. The second screening model included the same questioning of 441 periodontal patients with and without hyperglycemia history, identifying the patients at high and very high DM risk for the immediate glucose measuring in gingival crevicular blood (GCB) using a self-monitoring device. Glucose levels of GCB and finger stick blood (FSB) were measured in 15 patients with DM. The patients with glucose level in GCB ≥ 7.8 mmol/l were referred to their physicians for a diagnosis. The patients' compliance with the referrals and the physicians' feedback were assessed. The proportions (%), 95% Confidence Intervals (CI), mean values with standard error (M±m), and Pearson correlation coefficient (r) were calculated. Chi-square test was used to assess the differences at p-value 0.05. According to the first screening model about 30% of dental patients were identified as having high risk of DM development. The compliance of DM-risk patients with the referrals to their physicians was less than 50%. The hyperglycemia was diagnosed in 24.2% (95% CI 9.5-18.6%) patients who were referred to the physicians. The second screening model revealed 33.3% (95% CI 29.1-37.9%) periodontal patients being at high DM risk. The increased GCB glucose levels were found in 38.1% (95% CI 30.6-46.2%) of them. The correlation between glucose levels in GCB and FSB was high (r = 0.879, p<0.0001). The patients with the increased glucose level in GCB were referred to their physicians and all of them followed the recommendations. The hyperglycemia (associated with prediabetes or DM) was diagnosed in 67.9% (95% CI 54.8-78.6%) of the referred patients. Also, the GCB glucose test revealed poor glycemic control in every second diabetic patient. So, both studied screening models are feasible for identification of dental patients with high risk of DM development. However, questioning of periodontal patients followed by glucose measuring in GCB using glucometer significantly increased the patients' compliance with the referrals to the physicians and elevated the rate of hyperglycemia diagnosing. The second screening model helps not only to identify hyperglycemia among dental patients with no diabetes history but also to control glycemia in DM patients. Clinical article (J Int Dent Med Res 2020; 13(3): 1071-1080)
... ИЛ-6 сурункали яллиғланиш жараёнларини зўриқишига ва ўткир босқичини сурункаланишига олиб келади. У қонда ҳар қандай яллиғланиш жараёнларида ошади [12,13,14]. Сурункали вирусли гепатит билан касалланган беморларда яллиғланишга қарши ИЛ-6 цитокинларининг концентрацияси аниқланганда назорат гуруҳига нисбатан ҳаққоний даражада ошгани қайд этилди. ...
Стоматология соҳасида, жумладан жарроҳлик стоматология йўналиши бўйича ўтказилган кўп сонли тадқиқотларга қарамасдан, тиш олингандан кейинги яллиғланиш асоратларининг этиология ва патогенези охиригача аниқланмаган. Бу эса тиш катакчасининг битиш жараёнини ва суяк тўқимасининг меъёрий шаклланишини секинлаштиради. Шу билан бирга ёндош касаллиги бор беморларда тиш катакчасининг битиши ҳам турли ҳил асоратларни келиб чиқишига сабаб бўлади. ЖССТнинг янги ҳисоботларига кўра, “...бутун дунё бўйлаб В ва C сурункали гепатит билан 354 миллион киши касалланган. Европа минтақасида жигар циррози ва саратонининг асосий сабабчиси бўлган В ва C турдаги гепатит билан мос равишда 14 ва 12 миллион киши яшайди...” . Ҳозирги вақтда нафақат тиббий, балки ижтимоий жиҳатдан ҳам глобал муаммолардан бирини жигарнинг вирусли касалликлари ҳисобланади. Аввало, бу ўтказилаётган профилактик тадбирларга қарамасдан, вирусли гепатитнинг сезиларли даражада тарқалганлиги билан боғлиқ. Замонавий жарроҳлик стоматологиясининг долзарб муаммоси бўлиб, сурункали гепатит билан касалланган беморларда тиш олингандан кейин профилактика ва даволаш усулларини такомиллаштириш ҳисобланади.
... На современном этапе выявлена взаимосвязь между минеральной плотностью костной ткани различных отделов скелета и высотой альвеолярного гребня в интерпроксимальных отделах. На основании результатов исследования сделаны выводы, что уменьшение костной массы скелета ведет к уменьшению высоты межзубной костной перегородки и снижению прикрепления десны, а постменопаузальный остеопороз является фактором риска заболеваний пародонта [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. ...
Цель: изучение клинических и рентгенологических особенностей остеопороза у женщин в период менопаузы в зависимости от степени минерализации костной ткани. Материал и методы. Проведено клиническое и рентгенологическое исследование 80 женщин с остеопорозом в период менопаузы с учетом минеральной плотности костной ткани. Результаты. У женщин в постменопаузальном периоде отмечено снижение показателей гигиенических индексов, прогрессирующих при нарастании степени тяжести ХГП. Определена обратная связь значений пародонтального индекса со значениями минеральной плотности костной ткани в 1-й группе: — 0,9 (р<0,05), во 2-й группе: — 0,5 (р<0,05), в 3-й группе: — 0,79 (р<0,05). Проведенная конусно-лучевая компьютерная томография (КЛКТ) позволила выявить начальные проявления краевого остеопороза межзубных перегородок при легкой степени ХГП и признаки пятнистого и равномерного остеопороза челюстных костей, остеопороз межзубных перегородок с остеолизом при ХГП средней и тяжелой степени тяжести. Заключение. Клиническое обследование в комплексе с КЛКТ и денситометрией дает наиболее точную информацию о состоянии костной ткани. Полученные результаты позволят грамотно планировать остеотропную терапию и контролировать динамику процесса
... Важным аспектом является изучение процесса регенерации костной ткани, а также морфологическая оценка новообразованной кости и тканей реципиентного ложа. Всё вышеперечисленной обуславливает необходимость детальной морфометрии и микроскопии биоптатов костной ткани в отдалённые сроки после НКР с применением костнопластических материалов различного происхождения [9,11,12,13,14]. ...
Дефицит мягких тканей при атрофии альвеолярного гребня создаёт сложности для выполнения направленной костной регенерации (НКР), успех которой в определенной степени зависит от закрытия раны без натяжения. В исследовании была изучена влияние метода предварительного расширения мягких тканей на последующие процессы ремоделирования костной ткани путём гистологического исследования биоптатов после НКР с применением остеопластических материалов различного происхождения.
Background:
To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM).
Methods:
Four electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA.
Results:
A total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR = 4.04, p = 0.000), and vice versa (OR = 1.58, p = 0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p = 0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p = 0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p = 0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR = 1.28, p = 0.007) was less robust.
Conclusions:
There is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding. Our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other's incidence.
Objectives
To identify predictors in patient profiles and to develop, internally validate, and calibrate a screening model for diabetes mellitus (DM) in patients with periodontitis in dental settingsMaterials and methodsThe study included 204 adult patients with periodontitis. Patients’ socio-demographic characteristics, general health status, and periodontal status were recorded as potential predictors. The diabetic status was considered the outcome, classified into no DM, prediabetes (pre-DM), or DM. Multinomial logistic regression analysis was used to develop the model. The performance and clinical values of the model were determined.ResultsSeventeen percent and 47% of patients were diagnosed with DM and pre-DM, respectively. Patients’ age, BMI, European background, cholesterol levels, previous periodontal treatment, percentage of the number of teeth with mobility, and with gingival recession were significantly associated with the diabetic status of the patients. The model showed a reasonable calibration and moderate to good discrimination with area under the curve (AUC) values of 0.67 to 0.80. The added predictive values for ruling in the risk of DM and pre-DM were 0.42 and 0.11, respectively, and those for ruling it out were 0.05 and 0.17, respectively.Conclusions
Predictors in patient profiles for screening of DM and pre-DM in patients with periodontitis were identified. The calibration, discrimination, and clinical values of the model were acceptable.Clinical relevanceThe model may well assist clinicians in screening of diabetic status of patients with periodontitis. The model can be used as a reliable screening tool for DM and pre-DM in patients with periodontitis in dental settings.
Aim:
Periodontal disease is associated with gingival bleeding. Thus, the present study was aimed towards evaluating, whether the blood oozing during routine periodontal examination can be used for evaluating blood glucose levels.
Materials and methods:
A total of 100 patients reporting to Department of Oral Medicine and Radiology, within the age group of 25-55 years were enrolled. In fasting condition, gingival crevicular blood (GCB), finger-stick blood (FSB) was measured using a glucometer and venous blood (VB) glucose values were measured in the laboratory with glucose oxidase method. All the parameters thus recorded were then subjected to statistical analysis.
Results:
When compared, the GCB glucose values, VB glucose values and the FSB glucose values measured with glucometer in the diabetic and nondiabetic group were found to be highly statistically significant (p = 0.000).
Conclusion:
Gingival crevicular blood collected during diagnostic periodontal examination can provide a valid and acceptable source for measuring blood glucose levels using a glucometer. In addition, the technique described is quick, safe, easy to perform and more acceptable to the patients.
Clinical significance:
Dental surgeon can play an active role in screening of patients for glucose levels during routine periodontal examination and help to increase the frequency of diabetes screening in dental offices especially in undiagnosed diabetic cases which can be referred to the physician for appropriate management of the condition.
Dear Colleagues!
We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.
The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the “Standards” also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.
Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045.
Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) – Type 2 DM, 6% (256 202) – Type 1 DM and 2% (89 870) – other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment ant have high risk of vascular complications.
Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.
In сurrent edition of the “Standards”:
New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given.
Added a snippet that describes the continuous glucose monitoring.
Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism.
Proposes more stringent target levels of blood pressure.
It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion.
In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.
Recommendations for psychosocial support are added.
The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated.
Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added.
For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation.
This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums.
These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM.
On behalf of the Working Group
Pre-diabetes and diabetes are strongly associated with periodontal disease (gingivitis and periodontitis), and these conditions are known to upregulate aMMP-8 in inflamed gingiva and oral fluids. Thus, it would be feasible to screen for prediabetes and diabetes at the dental office by chairside tests. Chair-side assessment of HbA1c and a quantitative point-of-care (PoC) active matrix metalloproteinase (aMMP)-8 oral rinse immunotest developed for periodontal diseases, were performed on patients (n = 69) attending a Periodontology University Clinic who fulfilled the criteria for testing according to the screening questionnaire of the Centers for Disease Control and Prevention, USA. Clinical parameters of periodontal disease were also recorded with an automated probe. Twenty seven-point-five percent of the subjects were found with previously unknown hyperglycemia (HbA1c ≥ 5.7%). There was a statistically-significant positive association between the aMMP-8test and prediabetes (p < 0.05, unadjusted and adjusted for BMI and age ≥ 45 years logistic regression models). The dental setting is suitable for opportunistic screening for undiagnosed diabetes and pre-diabetes and point-of-care HbA1c, especially when combined with aMMP-8 assessment by dental professionals, being convenient and effective.
Background and objective
Approximately 75% of diabetic patients in Saudi Arabia had poor glycaemic control. A high proportion of these patients will attend dental surgery clinics for treatment. Therefore, dentists should be well-prepared to control any complications they might arise on the dental chair during the dental procedures. Management of the associated risk factors is important to limit disease complications and improve the health of patients with diabetes.
The objectives of this review were to determine the maximum acceptable level of blood glucose for tooth removal in diabetics, show a systematic technique for the management of patients with diabetes on the dental chair. By using PRISMA guidelines, analysis of the published articles and reports across the world is considered one of the most appropriate available methods to obtain strong evidence about the acceptable levels of blood glucose where teeth extraction can be done safely.
Results
A total of 1080 studies were retrieved using the search strategy. After screening 185 titles, abstracts and 85 full-text articles, 36 studies were included. The outcome of this systematic review revealed that fasting blood glucose level of 240 mg/dl is a critical point for any dental treatment because the warning signs of diabetes start coming out. Maximum acceptable levels of blood glucose for removal of teeth in diabetics are 180 mg/dl (before meal) and 234 mg/dl (2 h after a meal). High blood glucose levels reduce the secretion of nitric oxide (powerful vasodilator) in the body which leads to poor circulation and slow-healing socket. Uncontrolled diabetics are at high risk of infection because of the high ketone levels in the blood.
Conclusion
Fasting blood glucose level of 180 mg/dl is a cut-off point for any selective dental extraction. However, Random blood glucose level of 234 mg/dl (13 mmol/l) is a cut-off point for an emergency tooth extraction. Tightly controlled diabetic patients (blood glucose level below 70 mg/dl) are susceptible to hypoglycemia.
Keywords
Management; Tooth extraction; Diabetic patients; Blood glucose cut-off points
1. Introduction
74.9% of the patients with type 2 diabetes mellitus in Saudi Arabia had poor blood glycaemic (Alzaheb & Altemani., 2018). Therefore, dental practitioners must have a better understanding of the factors affecting glycaemic control to improve the management of diabetic patients in the dental office. In the literature, there is a lack of information regarding the determination of the maximum permissible blood glucose level recommended for emergency tooth extraction in diabetic patients (Albarrak et al., 2018). A state of uncertainty exists among dental practitioners once they experience uncontrolled diabetic patient need an emergency tooth extraction. Dental practitioners become incapable of making a clinical decision to go ahead with tooth extraction because they have poor knowledge in this regard. The cut-off point of blood glucose level for an emergency tooth extraction is still not understandable (Zehani et al., 2017).
Normal fasting blood glucose is <100 mg/dl (63–99 mg/dl). Random blood glucose (2 h after meals) is <144 mg/dl (de Bedout et al., 2018). The patient is diagnosed with diabetes if fasting blood glucose ≥126 mg/dl or random blood glucose ≥200 mg/dl in addition to the presence of diabetes symptoms (American Diabetes Association, 2019a). Oral Glucose Tolerance Test (OGTT) 2-hour blood glucose ≥200 mg/dl can be used to confirm accurately the diagnosis. However, the blood test for HbA1c level is performed to determine how well the diabetes is controlled [in diabetic patient HbA1C ≥ 6.5%. Table 1] (Zehani et al., 2017, Franck et al., 2014).
Table 1. Representing the relationship between A1C and average blood glucose.
Background:
It is predicted that by 2030 diabetes may affect 79.4 million individuals in India. Early diagnosis and prompt treatment of diabetes are essential to prevent or delay its acute or chronic complications. It is observed that the number of patients visiting dentists is significantly increased. This opportunity can be used for early identification of diabetes in dental office. This study assesses the feasibility of high-risk screening for diabetes and prediabetes in private dental care center.
Materials and methods:
A cross-sectional study was conducted among patients reporting to the dental clinic. A total of 1150 patients above 40 years of age having one or more risk factors such as family history of diabetes, hypertension, smoking, loss of teeth, and periodontitis were included in the study. Patients were subjected to high-risk screening by random blood sugar (RBS) test. American Diabetes Association criteria indicating normal (RBS 79-140 mg/dL), prediabetic (RBS 140-200 mg/dL), and diabetic (RBS >200 mg/dL) was considered for screening.
Results:
Among 1150 participants, 64.69% had RBS level within normal range and 20.69% had prediabetic range while 14.60% had RBS level above 200 mg/dL, suggestive of having diabetes. A total of 35.29% patients had hyperglycemia based on random blood glucose level.
Conclusion:
The study concluded that patients who are unaware about their diabetic status visiting a dental clinic having one or more risk factors of diabetes can be used as potential sources for high-risk screening for diabetes using a simple RBS test and oral examination.
Background:
Previous studies of diabetes in Eastern Mediterranean Region (EMRO) did not assess the prevalence of either unknown diabetes or prediabetes. We conducted a systematic review and meta-analysis to estimate the prevalence of undiagnosed type 2 diabetes and prediabetes as well as variations by region in EMRO, using the relevant publications since 2000.
Methods:
We carried out a comprehensive electronic search on electronic databases from January 1, 2000 to March 1, 2018. We selected cross-sectional and cohort studies reporting the prevalence of undiagnosed type 2 diabetes, prediabetes, or both. Two independent reviewers initially screened the eligible articles; then, synthesized the target data from full papers. Random or fixed effects model, subgroup analysis on Human Development Index (HDI), and publication year and sensitivity analysis to minimize the plausible effect of outliers were used.
Results:
Among 849 identified citations, 55 articles were entered into meta-analysis, involving 567025 individuals. The forest plots estimated 5.46% (confidence intervals [CI]: 4.77-6.14) undiagnosed diabetic and 12.19% (CI: 10.13-14.24) prediabetics in EMRO. Low HDI countries and high HDI countries had the highest (7.25%; CI: 4.59-9.92) and the lowest (3.98%; CI: 3.11-4.85) undiagnosed diabetes prevalence, respectively. Very high HDI countries and low HDI countries had the highest (13.50%; CI: 8.43-18.57) and the lowest (7.45%; 1.20-13.71) prediabetes prevalence, respectively. In addition, meta-regression analysis showed a statistically significant association between publication year and prevalence of prediabetes (Reg Coef = 0.059, P = 0.014). But such finding was not observed for undiagnosed diabetes and publication year (Reg Coef = 0.034, P = 0.124), prediabetes and HDI (Reg Coef = 0.128, P = 0.31) and undiagnosed diabetes and HDI (Reg Coef = - 0.04, P = 0.96).
Conclusion:
The prevalence of undiagnosed diabetes and prediabetes was high and increasing. The notion of universal health coverage is a priority; that is the integration of the primary, secondary and tertiary health levels, as well as employing the available action plans. Therefore, future studies, using identical screening tool and diagnostic criteria, are warranted to make an accurate picture of diabetes in EMRO.
Periodontitis and diabetes are complex chronic diseases, linked by an established bidirectional relationship. Risk for periodontitis is increased two to three times in people with diabetes compared to individuals without, and the level of glycaemic control is key in determining risk. In people who do not have diabetes, periodontitis is associated with higher glycated haemoglobin (HbA1c) and fasting blood glucose levels, and severe periodontitis is associated with increased risk of developing diabetes. In people with type 2 diabetes, periodontitis is associated with higher HbA1c levels and worse diabetes complications. Treatment of periodontitis in people with diabetes has been shown to result in improved glycaemic control, with HbA1c reductions of 3-4 mmol/mol (0.3-0.4%) in the short term (3-4 months) post-treatment. Given that treatment of periodontitis results in clinically relevant reductions in HbA1c, the dental team has an important role in the management of patients with diabetes. Improved interprofessional working in relation to diabetes and periodontitis has been advocated by professional and scientific organisations, though practical and systemic barriers make this challenging. This paper reviews current evidence linking periodontitis and diabetes, and considers the role of the dental team in the wider context of management of patients with diabetes and periodontitis.