Diabetes screening

When we talk about prevention in the dental setting we tend to think mainly of decay, gum disease and tooth-wear. Dentists

however, are health practitioners. Though our specialist area may be the mouth we should be looking after the whole patient. As we tend to see those who are generally healthy, we can really offer a great service to our patients if we help them avoid life threatening conditions. Smoking and alcohol related diseases are obvious ones for the dental setting due to the links between oral health and general health, but I believe diabetes screening and prevention should also be welcomed by dentists as a service to offer patients. There is plenty of evidence that inflammation in the mouth can have an impact on someone’s ability to control their diabetes and also the risk of someone getting type 2 diabetes, so diabetes and dental care are closely related.

 

• There are approximately 850,000 people in the UK with undiagnosed diabetes; about 50 per cent of these will have irreversible organ damage by the time they are diagnosed. Approximately 60-75 per cent of the population visit the dentist regularly, the UK dental profession could help diagnose between 500,000-650,000 people with diabetes.

• As screening can be carried out multiple times (if patients attend their dentist regularly) it helps eliminate false negatives.

• There are many more who are at risk and by identifying them you can have a significant impact on prevention of diabetes so helping their lifespan and quality of life (I feel this is where the true hidden benefit lies-this is where we really can help prevent disease).

• You can reinforce the prevention message in those who attend regularly.

• This has a benefit on other chronic diseases with similar risk factors.

How can diabetes screening help you and your practice?

• Patients really appreciate the extra service when you incorporate a screening programme in your practice.

• It raises the profile of the practice and increases word-of-mouth referrals.

• It helps reinforce the message that dental treatment you recommend is not solely to benefit their mouths but to benefit their general health as well.

• It’s a hot topic with the media and so you are likely to get free publicity for your practice. When my practice began the scheme we were featured in both national and local newspapers as well as the TV.

• If this were to become the ‘norm’ it would help the public and the politicians see the profession in a better light.

There are three levels of screening programme that can be incorporated into dental practice (table 1). The first option requires the lowest investment in terms of time and money, the second one requires slightly more than the third

one slightly more still. However the benefit to the patients and therefore the practice increases also.

 

 

This is by far the simplest to implement and requires minimal financial investment by the practice.

 

The aim of this level of screening programme is to raise the awareness in the patient’s mind of the importance of diabetes, and the importance of early detection. They are then directed them to an appropriate screening programme. A simple way to do this is to have an A5 printed sheet just outlining a few details about diabetes, the links with the mouth and directing them to a website such as www.diabetes.org.uk/Riskscore/ Here the patient will carry out their own risk assessment. The biggest downside of this type of programme is it relies on the patient taking action; a lot of them will not.

 

 

This level requires slightly more time investment by the dental team and means that all patients will be screened (unless they opt out). At this level of screening the risk assessment is carried out in the surgery, instead of simply directing the patient to a risk assessment as above. If someone’s score indicates that they should be tested then you would

direct them to the GP or perhaps a local pharmacy that carries out diabetes screening.

 

All of those who are identified as ‘at risk’ could be tagged for oral and general health prevention packages (if you offer any).

 

 

Level 3 is exactly the same as level 2 except that instead of referring to someone else for the blood sugar test, this is carried out by you or your team.

 

This does take a little bit more time however once you have a good system up and running it can be very slick. It can also be done by the nursing team.

 

The cost of each individual test is

around about £1.

 

 

Personally I do not charge, however this really comes down to your own choice on whether this is an additional free service or something where you ask the patient pay to cover the costs. Offering it as additional free service adds a lot of perceived benefit in the patient’s eyes, and means that you do not have to spend time discussing the benefits of having the test to justify the fee.

 

If you want more specific information on how to incorporate this into your practice, particularly if you are looking at Level 2 or 3 screening just go to http://diabetesanddentistry.co.uk/diabetesanddentistry_010.htm and click on the link ‘How to incorporate a diabetes screening programme into your dental practice’. I wish you good luck with this initiative and I’m sure you will find it a great practice builder as we do.

 

Screening level	1	2	3
Time taken per patient	20-30 seconds	1-2 minutes	2-3 minutes
Cost per patient	Printing only	Printing only	£1 + printing
Extra equipment needed	No	No	Yes: £13 for a blood sugar monitor
Likelihood of take-up	Low	Moderate to High	Very High
Who controls the process	Patient	You and Patient	You
Team training needed	10 minutes	30-60 minutes	2-3 hours
Likelihood of media interest	Low	Moderate	High
Credibility and word of mouth referrals	Low	Moderate	High

Table 1