Dental professionals key in screening for chronic disease

Franziska Beier, Dental Tribune International

Thu. 11 January 2024

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LIVERPOOL/PLYMOUTH, UK: The connection between oral health and chronic disease has been increasingly supported by substantial evidence, revealing shared risk factors and inflammatory processes. In light of these findings, researchers from the Royal Liverpool University Dental Hospital and the University of Plymouth have conducted a study that involved the introduction of health screenings during regular dental check-ups in general dental practices. They found that dental professionals could make a positive difference to public health by being trained to spot some of the key markers of chronic disease.

According to the study authors, reports show that in the UK alone up to 11% of the adult population is affected by impaired glucose regulation and nearly half of dental patients aged 45 years and older are at risk of developing diabetes within the next decade. These numbers indicate the potential benefits and positive impact of implementing diabetes screening in dental settings, particularly for early intervention in Type 2 diabetes.

The study aimed at evaluating the service of health screening in dental settings, including patient willingness to accept such a service and recommendations for improvement. The data was gathered from two dental practices located in North West England and the Welsh border region, one a predominantly National Health Service (NHS) practice and the other offering a mix of NHS and private dental services. The data collection spanned from August 2020 to November 2021 at the first practice and from February 2021 to January 2023 at the second. At the NHS practice, 4.1% of the 11,200 patients accepted the offer for screening and 6.5% of the 871 patients at the mixed practice.

The screenings included assessments of blood pressure, cholesterol, blood glucose, body mass index (BMI) and waist-to-height ratio—crucial for detecting early signs of cardiovascular diseases and Type 2 diabetes in healthy adults. The selection of these specific screening tests was based on their relevance to oral health and shared risk factors for oral health complications, such as diet and chronic inflammation.

“This study shows there are enormous opportunities for dental teams to support their patients.”—Prof. Robert Witton, University of Plymouth

The findings showed that 78.4% of the patients screened had blood pressure readings above the normal range, 55.8% had BMI values that fell outside the healthy range and 16.7% had cholesterol levels that deviated from the healthy range. Elevated blood glucose levels were observed in just over 3% of the patients.

“We already place significant emphasis on training students to provide holistic care for their patients. We also promote the concept of oral health being an integral part of general health and well-being. While there are resource challenges to consider in NHS dentistry, this study shows there are enormous opportunities for dental teams to support their patients and work more closely with our medical and healthcare colleagues to benefit public health,” commented co-author Dr Robert Witton, professor of community dentistry at the Peninsula Dental School of the University of Plymouth, in a press release.

The authors emphasised that clear protocols and careful interpretation of screening results are required to avoid patient confusion and frustration. Findings should always be interpreted in relation to the context of the dental setting; for example, patients delaying their meal until after having seen the dentist could account for the high proportion of patients with lower blood glucose levels. Additionally, high blood pressure could just be a sign of dental anxiety.

Closer collaboration between dental and medical care

Health screening in dental settings may significantly reduce morbidity, mortality and healthcare costs by preventing the acute onset of advanced chronic diseases. Dental practices, therefore, present a valuable opportunity for early screening, offering personalised interventions and, where necessary, serving as a referral point for early diagnosis.

Lead author Dr Janine Doughty, from the Royal Liverpool University Dental Hospital, said: “A health check at the dentist could provide reassurance for many patients, and a wake-up call for others to become healthier. We have someone already sitting in the chair who visits the dentist every six to 12 months yet who may not have seen a GP for years. It is simple to give them a few minutes of health checks at the same time.”

In order to put the study findings to use, greater alliances between dental and general medical care will be needed, the study authors recommended. Strengthening partnerships between dentistry and other NHS platforms could support the NHS Long Term Workforce Plan’s goal of fostering collaborative efforts for the early detection of conditions linked to cardiovascular disease. By involving the entire dental health team in health screening, dental professionals can expand their practice scope and align with NHS England’s objective to fully utilise dental health teams’ potential.

Dental professionals can make a substantial difference

Health screenings conducted in dental settings provide a new opportunity to identify a significant number of patients who have risk factors for chronic disease, concluded the authors. They added: “Dental professionals can be successfully trained to deliver the screening interventions and are aptly placed for delivering brief lifestyle advice and signposting patients to general medical care or other appropriate clinical services.”

The study, titled “Opportunistic health screening for cardiovascular and diabetes risk factors in primary care dental practices: Experiences from a service evaluation and a call to action”, was published online on 10 November 2023 in the British Dental Journal.