The reciprocal relationship between diabetes and oral health has led many experts to call for dentists to play a greater role in diagnosing the disease. So, a researcher at Michigan State University and a local family dentist teamed up to develop a simple yet accurate questionnaire that screens patients for their diabetes risk.
Known as Diabetes Detection in the Dental Office (DiDDO), the 14-question survey doesn’t require patients to step on the scale, nor does it need any body-mass index calculation, laboratory tests, or blood pressure measurement. Yet its results reveal which patients are at moderate to high risk for diabetes mellitus and prediabetes.
Saleh Aldasouqi, an associate professor of medicine and chief of endocrinology at the school, and Susan Maples, a family dentist in Holt, Mich, developed the DiDDO and administered it to 500 patients age 18 years and older who didn’t have a history of diabetes mellitus or prediabetes.
The patients also got finger pricks to measure their A1c, which indicates the sugar in their hemoglobin. After testing the blood, Aldasouqi and Maples measured the results against the positive responses of the questionnaire to finalize their screening tool so it could be validated and easily used in a dental office.
“The results were astonishing,” said Aldasouqi. “About 19% of those patients had prediabetes and they didn’t know it.”
According to Maples, the tool helps identify risk factors in addition to educating patients about recognizing the symptoms of diabetes. For example, its questions include:
- Are you more than 10% above ideal body weight?
- Do you have any biologic family member with a history of diabetes mellitus?
- Do you experience unexplainable hunger, thirst, or frequent urination?
- Do your gums bleed when you brush or floss?
“You might have a loved one that has those same symptoms or years from now say ‘I’m getting tingling and numbness in my hands and feet. I wonder if that’s diabetes?’” Maples said. “You can understand what the disease is and have a discussion about the effects of it.”
The Centers for Disease Control and Prevention predicts that one in 3 American adults will be diabetic by 2050. And while most Americans don’t see their doctor regularly, Aldasouqi says that more than two thirds of Americans see their dentist at least once a year.
“In other words, there’s an opportunity for patients in the dental clinics to be screened for diseases,” said Aldasouqi. “Diabetes and prediabetes are a very difficult public health problem.”
Aldasouqi and Maples would like to influence dentists across the country to start screening for diabetes and help stop the deteriorating health of America. Doing so also may help prevent gum disease. They plan on reaching out to dental organizations and the scientific community nationwide so the DiDDO becomes a standard tool offered in every dental office in America.
“Given the bidirectional relationship between diabetes and periodontal disease, we need to be much more astute about the risk factors and making sure our patients are properly screened. The screening tool will be used as a personalized approach to patient care,” said Maples.
Aldasouqi said dentists can determine for themselves how frequently they should screen low-risk patients, though annual administration is one option. He also said that patients who are suspected to be at high risk could be screened according to the ADA’s guidelines, which include:
- Testing to assess risk for diabetes in asymptomatic adults who are overweight and have one or more additional risk factors;
- Testing all patients age 45 and older;
- If tests are normal, repeat testing at a minimum of every 3 years.
“If the clinician notices the risk factors, the patient can take the assessment. Then, not only would they be screened, but they would be learning the risk factors as they answer the questions,” Maples said, adding that patients who are found to be at high risk of diabetes can be moved to point of care A1C testing or referred to a physician for definitive diagnosis.
And, Aldasouqi and Maples recommend giving the questionnaire to any patient with unknown diabetes or prediabetes status before treating any ongoing acute gum disease or infection due to concerns about healing.
“It’s critical we have this information before treating for such a major bacterial challenge as gum disease,” Maples said.