Patients' attitudes toward screening for medical conditions in a dental setting

Point of care HIV testing in dental settings in high-income countries: A mixed-methods systematic review

OBJECTIVES

Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation.

METHODS

A mixed-methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis.

RESULTS

POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider-initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting.

CONCLUSIONS

POCT uptake in dental settings was comparable with other non-specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient-practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting.

Perceptions of mental health screening and referral to treatment in National Dental-Practice Based Research Network practices: A qualitative study

OBJECTIVES

Dental practices can have additional positive impacts on public health by implementing mental health screening and referral to treatment in dental care workflows. In this study, we examined how dental practices identify and address adult patient mental health concerns, attitudes about implementing mental health screening and referral, and potential barriers and facilitators to treatment.

METHODS

We conducted semi-structured focus groups with 17 dentists, 10 dental hygienists, and 5 dental assistants/office staff in the South-Central region of the National Dental Practice-Based Research Network. Transcribed interviews were analyzed using thematic analysis.

RESULTS

We identified five main themes from dental practitioners and office staff responses. Practitioners and office staff: (1) discover patient mental health concerns through record review, patient/caregiver disclosure, and patient observation; (2) respond to patients' mental health concerns by making the patient more comfortable, documenting the concern in the patient's chart, and directly addressing the mental health concern; (3) want a systematic process for mental health screening and referral to treatment in their dental office; (4) recognize potential barriers in implementing health screening and referral to treatment processes; (5) desire training on mental health matters. An overarching theme emerged: developing a trusting relationship with patients.

CONCLUSIONS

Participants noted the importance of implementing systematic procedures for mental health screening and referral to services into dental practices, while also recognizing the potential barriers for integrating such processes. They also expressed a desire for quality training and resources that can support better care for patients with mental health concerns.

Point-of-care diabetes testing in the dental setting: A national scope of practice survey

OBJECTIVES

The aim of this study was to assess the knowledge of state dental directors regarding their state's professional practice act, specifically scope of practice laws regarding point-of-care chairside screening for diabetes.

METHODS

A cross-sectional study design was used to examine the 50 state dental directors' knowledge of policy around point-of-care diabetes testing in their state. A five-item survey instrument was designed in a web-based platform and electronically distributed in 2022.

RESULTS

Thirty-seven states (74%) responded to the survey. Regarding whether it was within the scope of practice for dentists to provide chairside point-of-care HbA1c screening, 17 states (46.0%) responded "yes," 5 states (13.5%) responded "no," and 15 states (40.5%) responded "don't know." Of the 17 states who provide diabetes testing, four states (23.5%) reported that dentists were reimbursed, nine states (53.0%) reported they were not reimbursed, and four states (23.5%) reported they did not know regarding reimbursement.

CONCLUSIONS

There is significant state heterogeneity with regard to laws, regulations, and reimbursement for chairside diabetes testing in the United States. This is accompanied by vagueness and lack of specificity in the state education laws. For more widespread promotion and adoption of this evidence-based screening, the entire dental community including clinicians, educators, policymakers, payers, and professional organizations at all levels are encouraged to work together to advocate for clarification and specificity in the language of state education laws as well as reimbursement for this vital service.

Mental health screening and referral to treatment in dental practices: A scoping review

OBJECTIVE

The purpose of this study was to conduct a scoping review to examine and summarize the characteristics of research related to mental health (MH) screenings and/or referrals to treatment in dental practices.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews and searched multiple databases for terms connected with dental care, MH concerns, screening, and referral. Included articles: (1) described care provided in a dental practice, (2) described a situation where the patient is experiencing the potential MH problem, (3) did not involve dental anxiety exclusively, and (4) involved some form of MH screening and/or referral to treatment. Article analysis included a summary of key study characteristics, types of evidence, study design, and central concepts and definitions.

RESULTS

The search generated 2050 records, with 26 ultimately included. Most studies involved only adults (22, 85%), but only three (12%) reported on rurality (two urban; one mixed) and only two each (8%) reported race or ethnicity. Fifteen (58%) articles were prospective and 11 (42%) were retrospective. The studies varied widely in study designs, from 11 (42%) cross-sectional methodologies to only one (4%) randomized controlled trial. Thirty-four screening tools were used to screen for symptoms of 43 MH conditions, with depression and anxiety screened for most frequently. Few articles discussed making referrals, practice workflows, or follow-up outcomes.

CONCLUSIONS

Included studies provide evidence of viable options for dental practitioners regarding MH screening, referring, and conducting follow-up, but lack specificity regarding these processes. Overall, more research is needed to clarify what workflows are most efficient for dental practitioners and efficacious in identifying patients with MH concerns.

Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study

An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.

Patients' comfort with and receipt of health risk assessments during routine dental visits: Results from the South Atlantic region of the US National Dental Practice-Based Research Network

OBJECTIVES

To understand patients' comfort with health risk assessments (HRAs) and patient and dentist factors associated with the provision of HRAs.

METHODS

In this cross-sectional study, 857 patients seen by 30 dental practitioners in the United States National Dental Practice-Based Research Network reported their comfort receiving HRA for six risk factors (tobacco use, alcohol use, dietary sugar intake, human immunodeficiency virus risks, human papillomavirus risks and existing medical conditions) and whether they discussed any of the risk factors during their visits. Multi-level logistic models were used to examine the impacts of patient, practitioner, practice characteristics on the (1) number of risk factors patients were comfortable discussing and (2) number of risk factors assessed in the current dental visit.

RESULTS

Only a small percentage (4%) of patients reported being uncomfortable receiving any HRA during their dental visits. However, over half of the patients (53%) reported that they did not receive any HRAs during the current visit. In the regression analyses, patients who were older, male and from the suburban were more likely to be comfortable with more HRAs. Dentists were more likely to provide HRA if they were younger, not non-Hispanic white, less likely to feel that providing HRAs was beyond their scope of practice, yet more likely to feel occasional discomfort in providing HRA.

CONCLUSIONS

Interventions should focus on reducing dental practitioner perception that conducting HRAs is beyond their scope of practice and standardizing screening assessments for multiple risk factors.

Patients' thoughts about assessment of fracture risk in a dental setting using FRAX-a qualitative interview study

FRAX is a tool based on questions that identifies persons at risk of fragility fractures. We interviewed patients about their thoughts on doing FRAX in a dental setting. They were generally positive but had some concerns that need to be considered before introducing FRAX in a dental setting.

PURPOSE

To investigate patients' thoughts about assessing the risk of fragility fractures using the FRAX tool in a dental setting. Sweden has a high incidence of fragility fractures, but many of these are preventable. The most common method for identifying persons with a high risk of sustaining fragility fractures is FRAX, a validated instrument for assessing the risk of suffering fragility fractures within 10 years. In the Nordic countries, most of the adult population has regular contact with their dentist, which could be useful in identifying high-risk individuals.

METHODS

A qualitative inductive approach to content analysis, with individual semi-structured interviews, was used. Seven women and three men, aged 65-75 years, were interviewed and assessed with FRAX.

RESULTS

An overarching theme was that patients considered a FRAX assessment in the dental setting a good service but doubted that the dentists would have the interest, time, and knowledge to do it. The patients had little knowledge and experience of osteoporosis and fragility fractures. They were positive towards assessing the fracture risk with the FRAX instrument. If they were found to have a high fracture risk, they expected the dentist to send a referral for further investigation and to collaborate in the risk assessment with their family physician. They thought risk assessment in a dental context would be a good service if the fee was the same as that in primary care.

CONCLUSION

Most participants were positive about having FRAX and other health assessments done in the dental clinic, but this study shows that patients have concerns that need to be addressed before introducing FRAX in this context.

Oral health professionals screening for undiagnosed type-2 diabetes and prediabetes: the iDENTify study

BACKGROUND

As part of an evaluation of an oral healthcare practice-based model that identifies patients with prediabetes or type-2 diabetes, this study reports on the proportion of patients identified with clinically confirmed type-2 diabetes (T2D)/prediabetes and barriers of implementation of the model.

METHODOLOGY

Urban and rural oral healthcare practices were invited to participate. Participating practices invited eligible patients to participate in the screening program using the Australian Type-2 Diabetes Risk Assessment Tool (AUSDRISK). Participants were categorised as low, intermediate, or high-risk for prediabetes/T2D. Patients in the intermediate or high-risk category were referred to their General Medical Practitioner (GP) for further investigation.

RESULTS

Fifty-one oral healthcare practices and 76 Oral Health Professionals (OHP) participated (60 Dentists, 8 Dental Hygienists, 8 Oral Health Therapists). 797 patients were screened; 102 were low-risk; 331 intermediate-risk; and 364 high-risk for T2D. Of the 695 participants in the intermediate or high-risk groups, 386 (55.5%) were referred to their GP for T2D assessment. Of them, 96 (25.0%) results were returned to OHPs. Of the returned results, six were (6.3%) diagnosed with pre-T2D.

CONCLUSION

Patients found to have undiagnosed T2D/prediabetes (6.3%) were within the expected range reported in the literature. Findings indicate that identifying individuals at an elevated risk of having or developing T2D is effective, feasible and could be incorporated into oral healthcare settings. However, this integration may require additional OHPs training and education to ensure that patients at elevated risk of T2D are referred for further assessment.

Patient acceptance of HIV rapid testing in the dental care setting

Dental settings are untapped venues to identify patients with undiagnosed HIV who may otherwise lack testing opportunities. Perceived lack of patient acceptance has been a significant barrier limiting dentists' willingness to offer HIV testing. This study implemented rapid HIV testing in dental settings located in an HIV prevalent region to evaluate patient acceptance. Two South Florida community health centers implemented routine oral rapid HIV testing as part of clinical practice, followed by exit interviews with patients immediately after to determine patient acceptance. The binary primary outcome was patient's acceptance of the rapid HIV test. Multivariable logistic regression assessed associations between patient characteristics and acceptance. Overall acceptance by dental patients (N = 600) was 84.5%. Patients who were more likely to participate in other medical screenings in dental settings were more than twice as likely to accept the test compared to those who were neutral/less likely (OR: 2.373; 95% CI: 1.406-4.004). Study findings highlight the high patient acceptance of HIV testing in dental settings. Widespread implementation of such testing will require an expanded societal view of the traditional role of the dentist that will embrace the potentially valuable role of dentistry in preventive health screenings and population health.

Perceptions and Practices of Oral Health Care Professionals in Preventing and Managing Childhood Obesity

In this study, we aimed to explore the perceptions of oral health care professionals (OHCPs) on childhood overweight and obesity screening and management in oral health settings in the Greater Sydney region in New South Wales, Australia. OHCPs involved in the Healthy Smiles Healthy Kids (HSHK) birth cohort study were purposively selected for this nested qualitative study. A sample of 15 OHCPs completed the face-to-face interviews, and thematic analysis was undertaken to identify and analyse the contextual patterns and themes. Three major themes emerged: (1) obesity prevention and management in dental practice; (2) barriers and enablers to obesity prevention and management in dental settings; and (3) the role of oral health professionals in promoting healthy weight status. This study found that OHCPs are well-positioned and supportive in undertaking obesity screening and management in their routine clinical practice. However, their practices are limited due to barriers such as time constraints, limited knowledge, and limited referral pathways. Strategies including capacity building of OHCPs, development of appropriate training programs and resources, and identification of a clear specialist referral pathway are needed to address the current barriers. This study provides an insight into opportunities for the oral health workforce in promoting healthy weight status among children.

Protocol for a Case Control Study to Evaluate Oral Health as a Biomarker of Child Exposure to Adverse Psychosocial Experiences

Background: The early identification of children who have experienced adversity is critical for the timely delivery of interventions to improve coping and reduce negative consequences. Self-report is the usual practice for identifying children with exposure to adversity. However, physiological characteristics that signal the presence of disease or other exposures may provide a more objective identification strategy. This protocol describes a case–control study that assesses whether exposure to adversity is more common in children with tooth enamel anomalies compared to children without such anomalies. Methods: For 150 mother–child pairs from a pediatric dental clinic in Toronto, Canada, maternal interviews will assess the child’s adverse and resilience-building experiences. Per child, one (exfoliated or extracted) tooth will be assessed for suspected enamel anomalies. If anomalies are present, the child is a case, and if absent, the child is a control. Tooth assessment modalities will include usual practice for dental exams (visual assessment) and modalities with greater sensitivity to identify anomalies. Conclusion: If structural changes in children’s teeth are associated with exposure to adversity, routine dental exams could provide an opportunity to screen children for experiences of adversity. Affected children could be referred for follow-up.

The dilemma of different dental degrees: DDS and DMD

Although the Doctor of Dental Surgery (DDS) evolved from the surgical and the Doctor of Medicine in Dentistry (DMD) from the medical (DMD) roots of the dental profession, dental schools in the US currently award both degrees, verified as equivalent by finding no differences between them in standards of admissions, accreditation, or state licensure requirements while continuing to be subjectively perceived as different enough to create professional and public confusion. In contrast, Doctors of Osteopathy (DOs) and Doctors of Medicine (MDs) are both objectively and subjectively perceived as different in philosophy and healthcare training while objectively passing similar examinations to be licensed as physicians. Following from the history of both dental degrees and their implications for training and dental practice, the objective of this manuscript is to update the scientific, socio-political, and professional reasons for awarding only the DMD for future graduates while continuing to recognize the contributions of DDS graduates to oral healthcare. Working with the American Dental Association (ADA), American Dental Education Association (ADEA), and dental school librarians, a historical review was undertaken of the establishment of two doctoral degrees for dentists in the United States, including beliefs and attitudes of faculty and local dentists at the times of initiation or change in degrees awarded. Among the current 68 dental schools in the United States, there are approximately equal numbers of DDS- and DMD-granting schools. Except for some Harvard physicians, some of whom practiced dentistry, who wanted dentistry to be a specialty of medicine and the unexpected, serendipitous substitution of "medicine" for "surgery" which could not be translated into required Latin in 1867, all dental schools would have awarded only the DDS degree. Now, with the ongoing reorganization of the healthcare workforce in the United States, a single degree with broader healthcare connotations of the DMD will facilitate the integration of dentistry with overall healthcare, without changing the fundamental oral healthcare responsibilities of both DDS and DMD graduates.

Dentists' Attitudes toward Diabetes Mellitus Screening in Thai Dental Clinics

Diabetes mellitus (DM), especially type 2 DM, has become a common problem worldwide. Previous studies have demonstrated that chairside screening can effectively identify undetected type 2 DM patients. This study was conducted to determine dentists' attitudes toward DM screening in dental clinics. A total of 632 currently active dentists with more than 1 year of working experience participated. The six-part (importance, barriers, willingness, readiness, knowledge, and routine management) anonymous, self-administered questionnaire of five-point response scales was then distributed. The results illustrated that most dentists (86.3%) realized the importance of DM screening and that patients' willingness was the main potential barrier (86.4%). Of the respondents, 98.1% and 82.4% were willing to measure blood pressure and weight and height for their patients, whereas only 45.4% and 38.8% were willing to collect blood from the fingertip or oral fluids for salivary diagnostics, respectively. Moreover, 73.7% of respondents were ready to refer patients to physicians, and 59.5% could explain the relationship between DM and oral diseases. However, only 44.3% and 27.9% were prepared to provide education about DM awareness or were able to perform screening, respectively. In addition, 67.2% and 65.8% knew the screening criteria and risk factors of DM, respectively, but only 45.1% knew what to do. The result of our study provided essential knowledge with respect to dentists' attitudes in the screening for DM in Thai dental clinics.

Implementation and analysis of an enhanced screening and testing protocol for prediabetes in a dental school patient population

OBJECTIVES

This project aimed to enhance the identification of patients at-risk for prediabetes or diabetes within a dental school patient population by introduction of a modified screening tool and related training of dental residents and students.

METHODS

The American Diabetes Association Risk Tool (ADART) was modified by addition of three diabetes-linked oral health questions. Of the 1477 dental patients screened, 551 (37.3%) indicated an at-risk status using the modified tool. A subset of 138 patients received follow-up chairside HbA1c blood testing conducted by dental residents and students. Data was analysed to determine a) the influence of the modifications on the tool's discrimination strength and b) change in the tool's predictive value.

RESULTS

The addition of the 3 oral health questions to the 7-item ADART resulted in a 9.4% increase in identification of patients at-risk for pre-diabetes/diabetes. The predictive value of the tool remained stable. Residents and students successfully incorporated the new screening activities within their assigned clinics.

CONCLUSIONS

This project demonstrates that screening for risk for prediabetes/diabetes is both prudent and practical in the dental setting. Dental personnel, including trainees, can successfully incorporate enhanced screening methods within their traditional activities. Further, screening tools used in the dental setting might be enhanced by inclusion of certain oral health variables associated with diabetes. These findings add to emerging knowledge on the importance of screening for prediabetes/diabetes in dental settings and have particular relevance and application to institutional practice.

Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics

Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.

Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored.

Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures.

Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.

Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study

Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder that often remains undiagnosed and untreated. OSAS prevalence is increasing exponentially. Starting on the dentist's role as an epidemiological and diagnostic "sentinel", the purpose of this study was to assess the prevalence of OSAS. The clinical diaries of 4659 patients were reviewed through a single-center retrospective analytic study. Descriptive statistical analysis was performed. Only 0.26% of patients reported to suffer from sleep apnea and were then diagnosed with OSAS. It was found that, out of 4487 patients, 678 suffered from hypertension (14.80%), 188 from gastro-esophageal-reflux-disease (GERD = 4.10%) and 484 from gastritis (10.78%). These results could be related to a difficult diagnosis of OSAS and to the absence of a dedicated section on sleep disorders in medical records. Therefore, the introduction of a question dedicated to sleep disorders, the administration of questionnaires (such as the STOP-BANG questionnaire) for early diagnosis, a multidisciplinary approach and pneumological examination could support the dentist in identifying patients at risk of OSAS.

Public Attitudes Toward Chairside Screening for Medical Conditions in Dental Settings

OBJECTIVE

The aim of this study is to investigate the public's attitudes and knowledge toward chairside dental screening and laboratory investigations based on demographic data.

METHODS

A self-administered structured questionnaire regarding chairside screening was designed employing a 5-point Likert-type scale. The questionnaire was distributed to among sample of adults. Data were collected and statistically analyzed using descriptive statistics, t-tests, ANOVA, and P values.

RESULTS

A total of 573 questionnaires were completed. Most respondents were willing to have a dentist conduct screening for diseases, in particular blood measurement (89%), hypertension (85.7%) and lab result discussion (83.1%), having medical condition did not affect the willingness. The lowest reported willingness was to undergo biopsy (54%) and hepatitis screening (67.6%) Age, education, hospital, and prior chairside screening were found to be significant factors for willingness.

CONCLUSION

The population's willingness to undergo chairside medical screenings in the dental office is crucial for the implementation of this strategy and to deliver a holistic approach to treating patients' medical conditions.

Screening of undiagnosed hyperglycaemia in the dental setting: The DiabetRisk study. A field trial

AIM

To evaluate the efficacy of different screening protocols for undiagnosed hyperglycaemia in a Research Network of Dental Clinics coordinated by the Spanish Society of Periodontology (SEPA).

MATERIAL AND METHODS

A total of 1143 patients were included in the study. Participants filled a questionnaire considering diabetes risk factors (FINDRISC) and received a periodontal screening examination. Patients with a slightly elevated score according to the Findrisc (≥7), received a point-of-care HbA1c and were eventually referred to their physician for confirmatory diagnosis. Receiver Operating Characteristic (ROC) curves were used to assess the performance of various predictive models with confirmed hyperglycaemia as outcome.

RESULTS

From this population, 97 (8.5%) were finally diagnosed of diabetes (n = 28; 2.5%) or prediabetes (n = 69; 6.0%). When only including the results from the FINDRISC questionnaire, the model reported an area under the curve (AUC) of 0.866 (95% confidence interval - CI [0.833; 0.900]). This model significantly improved when a basic periodontal examination (EPB Code; AUC = 0.876; 95% CI [0.845: 0.906]; p = .042) or a point-of-care HbA1c were added (AUC = 0.961; 95% CI [0.941; 0.980]; p < .001).

CONCLUSIONS

The tested protocol, combining the FINDRISC questionnaire and a point-of-care HbA1c, showed to be feasible when carried out in a dental clinic setting and was efficient to identify subjects with undiagnosed diabetes or prediabetes.

HIV screening in dental settings: Challenges, opportunities, and a call to action

HIV is responsible for tremendous suffering and loss around the world, but many advances in HIV screening, diagnosis, treatment, and prevention provide hope for an end to the HIV epidemic. Global and national campaigns facilitate access to these HIV advances, but some individuals and communities still lack access, particularly in developing countries. To reach those who remain under-served, campaigns encourage greater integration of HIV services with non-HIV services. As members of the healthcare team with a clinical stake in HIV, dental care providers have a unique contribution to make. Much research on the role of dental care providers in HIV has focused on HIV screening in the dental setting, and researchers have identified possible ways forward but also daunting challenges. Approaches for screening, brief intervention, and referral to treatment used in primary care and dental care settings for other health risks may help overcome challenges related to provider scope of practice and need for training. Approaches to managing distress and uncertainty in other clinical contexts may help overcome challenges related to patient acceptability, equipping providers to manage sensitive topics and emotional aspects of HIV screening. While not panaceas, these approaches may be useful to dental care providers interested in answering the global "call to action" for contributing to ending the HIV epidemic.

Use of dental practices for the identification of adults with undiagnosed type 2 diabetes mellitus or non-diabetic hyperglycaemia: a systematic review

AIM

Type 2 diabetes is a growing global challenge. Evidence exists demonstrating the use of primary care (non-hospital based) dental practices to identify, through risk assessments, those who may be at increased risk of type 2 diabetes or who may already unknowingly have the condition. This review aimed to synthesize evidence associated with the use of primary care dental services for the identification of undiagnosed non-diabetic hyperglycaemia or type 2 diabetes in adults, with particular focus on the pick-up rate of new cases.

METHOD

Electronic databases were searched for studies reporting the identification of non-diabetic hyperglycaemia/type 2 diabetes in primary care dental settings. Returned articles were screened and two independent reviewers completed the data-extraction process. A descriptive synthesis of the included articles was undertaken due to the heterogeneity of the literature returned.

RESULTS

Nine studies were identified, the majority of which utilized a two-stage risk-assessment process with risk score followed by a point-of-care capillary blood test. The main barriers cited were cost, lack of adequate insurance cover and people having previously been tested elsewhere. The pick-up rate of new cases of type 2 diabetes and non-diabetic hyperglycaemia varied greatly between studies, ranging from 1.7% to 24% for type 2 diabetes and from 23% to 45% for non-diabetic hyperglycaemia, where reported.

CONCLUSION

This review demonstrates that although it appears there may be benefit in using the dental workforce to identify undiagnosed cases of non-diabetic hyperglycaemia and type 2 diabetes, further high-quality research in the field is required assessing both the clinical and cost effectiveness of such practice. (Prospero Registration ID: PROSPERO 2018 CRD42018098750).

HIV screening in the dental setting in New York State

While primary care providers in New York State (NYS) are mandated to offer all patients a HIV test, still many NYS residents miss the HIV screening opportunity. To fill the gap, and as the CDC recommends, this study aimed to examine the feasibility of implementing HIV screening in dental setting, identify patient characteristics associated with acceptance of HIV rapid testing, and discuss best practices of HIV screening in dental setting. New York State Department of Health (NYSDOH) collaborated with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC) and three dental schools in New York State to offer free HIV screening tests as a component of routine dental care between February 2016 and March 2018. Ten clinics in upstate New York and Long Island participated in the study. HIV screening was performed using the OraQuick™ In-Home HIV Test. 14,887 dental patients were offered HIV screening tests; 9,057 (60.8%) were screened; and one patient (0.011%) was confirmed HIV positive and linked to medical care. Of all dental patients, 33% had never been screened for HIV; and 56% had not had a primary care visit or had not been offered an HIV screening test by primary care providers in the previous 12 months. Multi-level generalized linear modeling analysis indicated that test acceptance was significantly associated with patient's age, race/ethnicity, gender, country of origin, primary payer (or insurance), past primary care visits, past HIV testing experiences, and the poverty level of patient's community. HIV screening is well accepted by dental patients and can be effectively integrated into routine dental care. HIV screening in the dental setting can be a good option for first-time testers, those who have not seen a primary care provider in the last 12 months, and those who have not been offered HIV screening at their last primary care visit.

Patient preferences on sharing private information in dental settings

BACKGROUND

The authors conducted a study to understand patients' preferences and comfort levels in discussing personal medical, behavioral, and social information with their oral health care providers.

METHODS

A self-report survey was completed by US adults 18 years and older (N = 387) using Amazon Mechanical Turk, an online research portal for survey-based research. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with oral health providers.

RESULTS

Factor analysis suggested that participants were comfortable discussing demographics and standard dental questions but were less comfortable answering questions about trauma, stress, coping, and living and behavioral patterns. Demographics did not predict comfort with disclosure, and many participants did not feel personal information was relevant to oral health care.

CONCLUSIONS

Community education efforts can focus on helping patients understand how oral health is related to behavioral health and social conditions.

PRACTICAL IMPLICATIONS

Dental education should focus on helping oral health care providers communicate comfortably around these topics, balancing education with respect for a patient's willingness to disclose.

Innovations in pre-doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with substance use disorders (SUD). Historically, SUD were seen as a criminal issue and access to treatment was limited, but that paradigm is shifting and substance abuse is now being recognized as a disease state and the management of patients with SUD is increasingly within the healthcare system starting with primary healthcare settings including dental facilities. In a new training initiative, first-year dental students (DDS1) attended a 90-minute SBIRT training. An Attitudes and Opinion Survey (AOS) consisting of 8 questions that separately assesses DDS1 attitudes toward alcohol and drug use disorders was utilized to evaluate the training. Assenting DDS1 anonymously completed the AOS before and following the training. Over 3 years, we analyzed changes in the AOS of 230 DDS1 using Chi-squared test for bivariate comparison. We then applied a Bonferroni correction to the P-values. Response rate was 95.5%. The SBIRT training improved DDS1 attitudes and opinions toward patients with SUD with respect to all AOS questions. There was a statistically significant improvement (P < 0.003) in DDS1 attitudes and opinions with respect to whether other patients care suffers because of time and resources spent on patients with SUD and whether the SBIRT training provided adequate education to prepare DDS1 to manage patients with SUD. SBIRT training is relevant to dental education. It fills an important educational gap and is a suitable model for other dental schools.

Dentists' attitudes towards chairside medical conditions screening in a dental setting in Saudi Arabia: an exploratory cross-sectional Study

Background

Screening for medical conditions (MCs) of public health importance is a first step in disease prevention and control. Prior studies in the United States found oral health care providers (OHCPS) embrace screening for increased risk of medical conditions in the dental setting. Our objectives were to assess Saudi Arabian (SA) dentist’s attitudes, willingness and perceived barriers towards implementing screening for MCs into their dental practices.

Methods

A self-administered, 5-point Likert Scale (1 = very important/willing to 5 = very unimportant/unwilling) questionnaire was given to a convenience sample of 190 practicing dentists. Friedman nonparametric analysis of variance was used to compare responses within each question.

Results

Of the 143 responding dentists the mean age was 31 years; 102 (71%) were men. The majority felt it was important for a dentist to screen for cardiovascular disease (98.6%), hypertension (97.9%), diabetes (97.9%), human immunodeficiency virus (HIV) (97.9%), and hepatitis C virus (98.6%). Respondents were willing to refer a patient to a physician (97.9%); send samples to an outside laboratory (96.1%); conduct screening that yields immediate results (96.2%); and discuss results immediately with the patient (93.7%). Respondents were willing to measure/collect blood pressure (67.2%); weight and height (63.7%); and finger stick blood (54.6%). The whole responding dentists (100%) reported time as an important barrier. Respondents were significantly more willing to refer a patient for consultation than send samples to an outside laboratory (mean ranks: 2.32, 2.81, P < 0.001); significantly more willing to measure blood pressure than take oral fluids for salivary diagnostics (mean ranks 2.22, 2.75, p = 0.003). Insurance was significantly (P < 0.05) less important barrier than time, cost, patients’ willingness or liability (mean ranks 3.56, 2.63, 3.00, 2.79, 3.02, respectively).

Conclusions

The majority of dentists in this study reported positive attitudes towards and willingness to perform medical screenings in their practice. Time was an important factor.

Willingness to pay for osteoporosis risk assessment in primary dental care

BACKGROUND

Fragility fracture related to osteoporosis among postmenopausal women is a significant cause of morbidity. The care and aftercare of these fractures are associated with substantial costs to society. A main problem is that many individuals suffer from osteoporosis without knowing it before a fracture happens. Dentists may have an important role in early identification of individuals with osteoporosis by assessment of dental radiographs already included in the dental examination. The aim of this study was therefore to investigate postmenopausal women's preferences for an osteoporosis risk assessment in primary dental care.

RESULTS

Most respondents (129 of 144 (90%)) were willing to pay for an osteoporosis risk assessment in primary dental care. The overall mean willingness to pay (WTP) including respondents that denoted none or zero WTP was 44.60 € (CI 95% 38.46-50.74 €) (median 34.75 €). A majority (80.6%) of the respondents that denoted WTP also gave a motivation for their answer. The two most common reasons denoted for being willing to pay for osteoporosis risk assessment were the importance of early diagnosis and preventive care to avoid fractures (41.0%) and the importance of knowledge of a risk of osteoporosis (26.4%). A majority of respondents (67.8%) considered it valuable if dental clinics would offer osteoporosis risk assessment.

CONCLUSIONS

Postmenopausal women seem to find it valuable to be offered osteoporosis risk assessment in primary dental care and are willing to pay for such a risk assessment. From a societal perspective early diagnosis of osteoporosis by risk assessment in primary dental care could prevent osteoporotic related fractures and benefit women's health and quality of life, as well as have a major impact on the health-care budget in terms of cost-savings.

The role of oral health care professionals in preventing and managing obesity: A systematic review of current practices and perceived barriers

INTRODUCTION

There is a growing interest to expand the role of oral health care professionals in obesity prevention and management. The aim of this systematic review was to synthesise the evidence on current practices of, and perceived barriers to, oral health care professionals' involvement in obesity screening and management.

METHODS

Key search strings were developed and used in seven databases from inception through February 6, 2019. Data were screened against inclusion criteria, independently extracted, and quality appraised by two reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Ten studies were included in this review. The practices of oral health care professionals in relation to obesity assessment, counseling, and specialist referrals were found to be very limited. Oral health care professionals believed in their role to support patients for achieving weight-loss goals, however just over one-third were trained in anthropometry. Perceived barriers included lack of time, limited knowledge or training, patients' unwillingness to listen to oral health care professionals' advice, and lack of appropriate specialist referrals.

CONCLUSION

Oral health care professionals are well-positioned and supportive in undertaking healthy weight interventions in their clinical practice; however, their practices are limited due to barriers such as lack of time, limited training and lack of referrals.

Results of offering oral rapid HIV screening within a dental school clinic

To broaden the availability of human immunodeficiency virus (HIV) testing, we offered rapid HIV screening tests to 811 patients attending a dental school for routine dental hygiene care. Study design is a prospective cross-sectional study. The 319 (39.3%) agreeing to test, self-identified as: Hispanic (34.4%), White (25.8%), African American (13.1%), Asian (8.3%), Native American/Pacific Islander (0.9%), more than one race/ethnicity (1.1%) or declining to state (16.5%). Over 35% (n = 113) were first time HIV test takers, with another 2.2% (n = 7) unaware of their testing history. Approximately 60% of the decliners choose "just don't want test today" as the reason. Following a strictly structured algorithm, four possible undiagnosed infections were initially identified, with one completing the algorithm to case confirmation. In conclusion, the confirmed incidence rate finding of HIV seropositivity of 0.31% found through initial screening at the dental clinic, compared with the 0.018% incidence rate of HIV with confirmed diagnosis in Los Angeles County, indicates that a rapid HIV screening test offered in a dental school clinic can potentially play an important role in discovering undiagnosed HIV individuals.

Identification of Preferred Healthy Weight Counseling Approaches for Children in the Dental Setting

OBJECTIVE

There is a gap in the literature regarding optimal methods for the dental team to help address the childhood obesity epidemic; accordingly, this investigation sought to identify preferred communication approaches the dental team can rely upon to initiate dialogue with caregivers regarding the weight of their children.

STUDY DESIGN

A structured interview guide containing seven potential Healthy Weight Counseling (HWC) approaches and eight follow up questions was developed, pilot-tested, revised and utilized as a structured interview guide. Interviews were conducted at the Children's Clinic at the School of Dentistry at the University of North Carolina at Chapel Hill (UNC-CH) with 50 participants who are English-speaking caregivers of children ages 4-12.

RESULTS

Ninety-four percent of the participants were receptive to HWC in the dental setting. Caregivers indicated varying levels of acceptance for the seven HWC-approaches based on specific word choices in each approach. Sixty percent preferred HWC to be delivered with the child not present while 34% preferred the child's presence and 6% had no preference.

CONCLUSIONS

Caregivers were open to weight-related conversations in the dental setting but to be well received, the dental team must choose their approach carefully and establish the proper doctor/patient relationship prior to HWC delivery. An individualized HWC-approach tailored to the specific needs of each family is indicated.

Prediabetes and Diabetes Screening in Dental Care Settings: NHANES 2013 to 2016

Introduction

Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted.

Objectives

The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes.

Methods

Data from 10,472 adults in the National Health and Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression.

Results

A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test (Centers for Disease Control and Prevention), and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old.

Conclusion

Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications.

Knowledge Transfer Statement

Screening for prediabetes and diabetes during dental visits has the potential to raise patients' awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being.

Bridging the dental-medical divide: Case studies integrating oral health care and primary health care

BACKGROUND

The National Academies of Sciences, Engineering, and Medicine commissioned an environmental scan describing the status of health care integration of oral health and primary care services.

METHODS

The authors conducted an environmental scan of US integration activities with publications from January 2000 through August 2017. They categorized services as preventive oral health services (POHS) provided by medical care providers, POHS provided by dental providers in nondental settings, preventive health services provided by dental providers, or care coordination using dedicated personnel and technology. The authors chose 4 programs as case studies and interviewed key personnel in each program. One case study illustrates each category of integrated services; additional examples describe category variation.

RESULTS

The case study involving Into the Mouth of Babes illustrates medical professionals delivering POHS to children. The case study involving Grace Health presents dental hygienists embedded in the obstetrics-gynecology clinic to provide oral screening, prophylaxis, and education to pregnant women. At HealthPartners, medical care providers refer patients with diabetes to dentists and waive copays for periodontal care. The InterCommunity Health Network Coordinated Care Organization uses dedicated patient coordinators, technology, and coordinated payment and referral mechanisms to facilitate care.

CONCLUSIONS

Integration of dental and medical care increased access to and coordination of patient care by means of offering health care services traditionally provided by the other profession.

PRACTICAL IMPLICATIONS

Integration models demonstrate the incorporation of POHS by primary care professionals, the embedding of dental professionals into primary care clinics, and the incorporation of care coordination to increase the delivery of oral health care. Similarly, dentists identify and refer patients with medical needs or preventive gaps to medical homes.

The Expanding Dental Workforce: The Impact of Nondental Providers

This article describes the evolution of nondental health providers engaging in oral health and the influences that have played a role. This discussion is followed by a review of why oral health is a natural fit for medical care, an examination of the current trends and successes in oral health education and practice in the health professions, and the need for a comprehensive approach. The article concludes by reviewing the impact these efforts are having and defining roles for each profession in the future with thoughts about what will be required to obtain these goals.

Providing Health Screenings in a Dental Setting to Enhance Overall Health Outcomes

Data suggest that providers and patients have a favorable attitude toward chairside screening in the dental setting and are willing to participate in these activities. Likewise, efficacy studies indicate this strategy can effectively identify patients who are at increased risk of disease or have the presence of disease risk factors and could benefit from medical follow-up. Studies suggest it is feasible to conduct these screenings in the dental setting. Although the American Dental Association has established screening treatment codes, challenges to widespread implementation still exist, including developing a provider reimbursement strategy and the need for adequate provider training.

Facilitators and barriers to referral compliance among dental patients with increased risk of obstructive sleep apnea

OBJECTIVE

Our aims were to determine the adherence rate to dentist referrals for sleep apnea evaluation and the barriers and facilitators to referral compliance.

MATERIAL AND METHODS

A sample of 1099 patients was screened with the STOP-Bang questionnaire. Those with elevated risk were referred for a sleep evaluation. An interview was conducted over the phone to determine compliance to referral and the barriers and facilitators to compliance.

RESULTS

Of the 1099 patients (mean age: 45.1 ± 10 years) screened, 224 (20.4%) patients were determined to be at-risk for obstructive sleep apnea (OSA). Only 41 (18.3%) patients with increased risk adhered to referral recommendation. Demographic and health characteristics did not show significant differences between the compliant and non-compliant patients. The most common facilitators to compliance were increased awareness about OSA (N = 25, 65%) and dentist recommendation (N = 14, 34.1%), whereas the most common barriers to referral compliance were misconceptions about OSA (N = 69, 37.7%) and work responsibilities (N = 44, 24%).

CONCLUSIONS

Only a small percentage of patients adhered to the recommendation of their dentist to see a sleep specialist. Increased awareness about OSA and dentist recommendation were the most common factors that facilitated compliance, whereas misconceptions about OSA and work responsibilities were the most common barriers to patient compliance.

Screening for Diabetes Risk Using Integrated Dental and Medical Electronic Health Record Data

Undiagnosed diabetes and prediabetes present a serious public health challenge. We previously reported that data available in the dental setting can serve as a tool for early dysglycemia identification in a primarily Hispanic, urban population. In the present study, we sought to determine how the identification approach can be recalibrated to detect diabetes or prediabetes in a White, rural cohort and whether an integrated dental-medical electronic health record (iEHR) offers further value to the process. We analyzed iEHR data from the Marshfield Clinic, a health system providing care in rural Wisconsin, for dental patients who were ≥21 y of age, reported that they had never been told they had diabetes, had an initial periodontal examination of at least 2 quadrants, and had a glycemic assessment within 3 mo of that examination. We then assessed the performance of multiple predictive models for prediabetes/diabetes. The study outcome, glycemic status, was gleaned from the medical module of the iEHR based on American Diabetes Association blood test cutoffs. The sample size was 4,560 individuals. Multivariate logistic regression revealed that the best performance was achieved by a model that took advantage of the iEHR. Predictors included age, sex, race, ethnicity, number of missing teeth, percentage of teeth with at least 1 pocket ≥5 mm from the dental EHR, and overweight/obesity, hypertension, hyperlipidemia, and smoking status from the medical EHR. The model achieved an area under the receiver operating characteristic curve of 0.71 (95% confidence interval, 0.69-0.72), yielding a sensitivity of 0.70 and a specificity of 0.62. Across a range of populations, informed by certain patient characteristics, dental care team members can play a role in helping to identify dental patients with undiagnosed diabetes or prediabetes. The accuracy of the prediction increases when dental findings are combined with information from the medical EHR. Knowledge Transfer Statement: Prediabetes and diabetes often go undiagnosed for many years. Early identification and care can lead to improved glycemic outcomes and prevent wide-ranging morbidity, including adverse oral health consequences, in affected individuals. Information available in the dental office can be used by clinicians to identify those who remain undiagnosed or are at risk; the accuracy of this prediction increases when combined with information from the medical electronic health record.

Patients’ attitude toward diabetes mellitus screening in Thai dental clinics

Purpose

Diabetes mellitus (DM) is an important health problem throughout the world. Association between DM and oral diseases has been reported and dental clinic is indicated to be one of the suitable venues for the screening of DM. The purpose of this paper is to determine patients’ attitude toward DM screening in dental clinics.

Design/methodology/approach

The anonymous, self-administered questionnaires of five-point response scale questions were distributed to convenience samples of adult patients (⩾25 years) attending one of the dental settings. These dental settings were divided into the university/hospital-based dental clinics (encompassing two university-based and five hospital-based dental clinics) or the private dental clinics (encompassing two private, and one special (after office hour) clinic of a faculty of dentistry). The questions could be categorized into three groups regarding importance, willingness, and agreement of DM screening in dental settings. Results are presented as percentage by respondents based upon the number of responses for each question. The favorable outcomes which were defined as responses of either scale of 4 or 5 were also summarized according to dental settings. The χ2 test for comparison was used to compare the favorable outcomes between the two settings.

Findings

A total of 601 completed questionnaires were collected; 394 from university/hospital-based dental clinics and 207 from two private clinics and a special (after office hour) clinic of a faculty of dentistry. Overall, the majority of respondents in both university/hospital-based and private practice settings felt that it is important to have a dentist conduct a screening (84.8 vs 79.5 percent). The majority of patients in both groups were willing to receive blood pressure examination (95.0 vs 92.0 percent), weight and height measurements (94.7 vs 94.0 percent), saliva/oral fluid investigation (86.4 and 86.9 percent) and finger-stick blood test (83.8 vs 83.9 percent). More than 75 percent of all respondents agreed with diabetes screening in dental clinics.

Originality/value

The majority of respondents supported the screening of DM in dental settings and they were willing to have a screening test by the dentist. Patient acceptance is an important key to be successful in the screening of DM in dental settings.

Screening for Diabetes in a Dental School Clinic to Assess Interprofessional Communication Between Physicians and Dental Students

If a dental student diagnoses a patient in a dental school clinic as being at high risk of prediabetes or diabetes, the patient should be referred to his or her physician for further diagnostic evaluation, and the physician should send back the evaluation results so that the dental team can optimize treatment and health care choices if the diagnosis is confirmed. The primary aim of this study was to evaluate physicians' responses to written and oral requests for information regarding follow-up diabetes testing. A secondary aim was to evaluate patients' compliance with recommendations to seek medical care after being determined to be at high risk of prediabetes or diabetes in the dental clinic. Based on at least one positive risk factor for diabetes, 74 patients in one U.S. dental school's clinic were screened by third- and fourth-year dental students for prediabetes or diabetes and underwent point of care HbA1C (glycalated hemoglobin) blood tests between June 2014 and June 2015. Patients with an HbA1C value of 5.7% or above were referred to their physicians for follow-up testing. The physician was mailed the patient's HIPAA release and a request for updates to the student regarding the patient's diabetes status. If the physician did not provide the requested information, a dental student telephoned him or her to obtain the patient's diabetes status. Of the 74 patients, 34 (46%) tested positive with HbA1C tests and were referred to their physicians. Of those 34 referred patients, 20 (59%) saw their physicians for additional evaluations within six months of referral. None of the 20 physicians responded to the written requests for information on additional diabetes testing. After one or two telephone requests, all 20 physicians provided the test results. This study found that most of the patients (59%) followed their dental practitioner's advice to seek follow-up care with their physician, supporting the value of conducting these tests in a dental clinic. However, the results also suggested that a single written request may be insufficient to prompt physicians to return those results and that follow-up communication in a phone call may be more effective.

Acceptability of Chairside Screening for Racial/Ethnic Minority Older Adults: A Qualitative Study

An aging and more racially and ethnically diverse population, coupled with changes in the health care policy environment, is demanding that the dental profession both redirect and expand its focus. Challenges include providing comprehensive care for patients with complicated medical needs while improving access to care for underserved groups. The purpose of this study is to examine the acceptability of screening for hypertension and diabetes in the dental setting for African American, Puerto Rican, and Dominican older adults who attend senior centers in northern Manhattan, New York City. Focus groups were conducted with 194 racial/ethnic minority men and women aged 50 y and older living in northern Manhattan who participated in 1 of 24 focus group sessions about improving oral health for older adults. All groups were digitally audio-recorded and transcribed for analysis. Groups that were conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Five themes were manifest in the data regarding the willingness of racial/ethnic minority older adults to receive hypertension and diabetes screening as part of routine dental visits: 1) chairside screening is acceptable, 2) screening is routine for older adults, 3) the interrelationship between oral and general health is appreciated, 4) chairside screening has perceived benefits, and 5) chairside screening may reduce dental anxiety. Reservations centered on 4 major themes: 1) dental fear may limit the acceptability of chairside screening, 2) there is a perceived lack of need for dental care and chairside screening, 3) screening is available elsewhere, and 4) mistrust of dental providers as primary care providers. This study provides novel evidence of the acceptability of screening for hypertension and diabetes in the dental setting among urban racial/ethnic minority senior center attendees. Knowledge Transfer Statement: The results of this study may be used by oral health providers when deciding whether to conduct chairside screening for medical conditions such as hypertension and diabetes that could affect, or be affected by, the oral health of their patients. Patient experiences of care-along with clinical outcomes, avoidable hospital admissions, equity of services, and costs-are important outcomes to consider in meeting the needs of an aging and racially and ethnically diverse US population.

Blood pressure and blood sugar assessment by recent dental school graduates

OBJECTIVE

Recent dental school graduates' willingness to assess blood pressure and blood sugar in practice is positively influenced by having a workplace policy fostering these assessments. Negative influences toward these assessments include practice culture issues and time management concerns. The aim of this study was to determine whether 2010-2014 graduates of the School of Dental Medicine at Buffalo, NY (UB-SDM) continue to assess blood pressure and capillary blood sugar after graduation.

STUDY DESIGN

Starting in 2010, UB-SDM predoctoral students were required to assess blood pressure (BP) on all patients and capillary blood sugar (CBS) on all patients with diabetes at every clinic appointment. UB-SDM graduates from 2010-2014 were sent an anonymous survey consisting of 34 questions to determine whether these assessments continue after graduation. The survey consisted of BP and CBS assessment parameters, including benefits and barriers to assessments.

RESULTS

Although UB-SDM graduates generally assessed BP (77%) and CBS (23%), most did not follow the school's strict educational policies when providing these services. Dental practice policies mandating BP and CBS assessments were positively correlated with UB-SDM graduates' actually providing these services. Lack of time and poor practice support were cited as negative factors toward BP and CBS assessments.

CONCLUSIONS

Disparities between UB-SDM educational efforts and entrenched dental practice cultures must be addressed in order for our graduates to fully embrace BP and CBS assessments in practice.