HbA1c in Dental Practices: Enhancing Patient Health Through Blood Glucose Screenings
Deepika Dhama, DDS
Periodontal disease and diabetes are highly prevalent chronic health conditions that have far-reaching implications, impacting health, economic well-being, and overall quality of life. With half of all American adults affected by periodontal disease1 and more than 422 million individuals impacted by diabetes globally,2 the need for effective strategies to manage these conditions is significant. Incorporating hemoglobin A1c (HbA1c) testing into routine dental visits provides dental professionals an opportunity to improve patient health outcomes. This article explores the importance of HbA1c testing in dental practices and the benefits of dental-medical collaboration in managing periodontal disease and diabetes.
Extensive research has established a clear connection between diabetes and periodontal disease.3-5 Individuals with diabetes are more susceptible to periodontal disease, and conversely, periodontal disease can worsen blood sugar control in diabetic patients. Elevated blood sugar levels increase the risk of bacterial infections and impair the body's ability to combat infections. In turn, periodontal disease can cause inflammation, further elevating blood sugar levels and the risk of diabetic complications. Recognizing this bidirectional relationship, dental professionals play a crucial role in detecting and managing periodontal disease.
Dental Professionals' Part in Managing Diabetes
HbA1c testing, a simple blood test that provides an average blood sugar level over the past 3 months, offers valuable insights for dental clinicians. It serves as a screening tool in dental practices, aiding patient education, awareness, and appropriate referrals to primary care providers. With the higher frequency of annual dental visits compared to medical visits, dental practices provide an ideal platform for diabetes screening and early intervention.
Incorporating HbA1c testing into dental visits enables oral health professionals to identify undiagnosed or poorly controlled diabetes, initiate timely interventions, and facilitate appropriate referrals to medical providers. This proactive approach strengthens the collaboration between dental and medical professionals, helping to promote comprehensive patient-centered care and improve health outcomes.
Successful periodontal treatment has been shown to positively impact metabolic control in diabetic patients, leading to reduced HbA1c levels at the 3- to 4-month mark.6 Additionally, periodontitis is significantly associated with elevated HbA1c levels in patients without a previous diabetes diagnosis, with a more pronounced elevation observed in patients with advanced periodontal disease stages.
Benefits of Dental-Medical Collaboration
Incorporating HbA1c testing in dental practices promotes collaborative efforts among healthcare professionals, encouraging them to work together in developing tailored and patient-centric treatment plans. Utilizing a shared dataset that encompasses patients' complete medical and dental health records enhances patient care by granting dental professionals access to a wide range of information, including lab results, prescriptions, medical histories, and other relevant data. This facilitates a more holistic and comprehensive approach to patient care.
The integration of dental and medical care brings numerous benefits for patients, including improved access to care, better coordination of treatment, and more personalized care plans. Within dentistry, assessing a patient's HbA1c levels before providing dental treatment is crucial in determining their overall health and guiding appropriate modifications to the treatment plan if necessary. Furthermore, dental-medical collaboration can help reduce overall medical expenses by identifying undiagnosed or poorly controlled diabetes and initiating timely interventions.
Implementing HbA1c Testing in Dental Practices
Pacific Dental Services initiated a pilot program in 2022 to illustrate the feasibility and effectiveness of HbA1c testing in dental practices. The program aimed to increase awareness of the correlation between oral health and overall health while improving patient understanding of the importance of screening within the dental practice. Patients meeting specific criteria, such as having poor hygiene, inflamed gums, or diagnosed periodontal disease, being a candidate for dental implants or surgical procedures, or being at risk of diabetes, were selected for HbA1c testing.
The implementation of HbA1c testing in dental practices follows a systematic process:
- Obtain prescriptive x-rays and vitals after meeting the patient.
- Recommend HbA1c testing and collect a blood sample through a finger prick (Figure 1).
- Perform chairside testing, which provides results in a few minutes, allowing for customization of the treatment plan based on the patient's specific needs (Figure 2 and Figure 3).
- If HbA1c levels are elevated in previously undiagnosed patients, make appropriate referrals to primary care providers for further testing and diagnosis.
- For patients already diagnosed with diabetes, utilize HbA1c values to guide disease management or inform adjustments to the treatment plan in collaboration with physicians.
- Enter the laboratory results into the patient's health record, which is also accessible to patients through their portal.
This comprehensive process ensures that dental professionals can effectively integrate HbA1c testing into their practice, facilitating early detection, management, and collaboration for patients with diabetes.
Findings from the pilot program demonstrated that patients came to recognize the importance of dental visits, leading to increased return rates for follow-up treatment of periodontal diseases and other oral health findings. Moreover, patients with previously uncontrolled diabetes experienced improved glucose control when they returned for dental surgical procedures that were previously deferred due to elevated HbA1c levels. The pilot program demonstrated that HbA1c testing was convenient and saved time, providing patients with critical health information and uncovering previously undiagnosed risks. It also highlighted the substantial value that the dental team could provide by educating patients about collaborative efforts among medical, dental, and behavioral health disciplines.
Conclusion
The integration of blood glucose screenings, particularly HbA1c testing, in dental practices signifies a transformative approach to patient care. By acknowledging the bidirectional relationship between periodontal disease and diabetes, dental professionals can make a significant impact on patient health outcomes. Dental-medical collaboration, facilitated by electronic health record integration, enhances the coordination of care and promotes personalized treatment plans.
The successful implementation of HbA1c testing in dental practices, as demonstrated by the pilot program conducted by Pacific Dental Services, highlights the potential for widespread adoption. Dental visits become an opportune moment to screen for undiagnosed or poorly controlled diabetes, leading to early interventions and improved overall health for patients. As dentists continue to play an increasingly vital role in managing chronic conditions like diabetes and periodontal disease, the integration of dental and medical care will become ever more crucial for enhancing patient outcomes and reducing healthcare costs.
About the Author
Deepika Dhama, DDS
Practicing general dentist and multi-practice owner of several dental practices in Riverside and Orange Counties, California, supported by Pacific Dental Services
References
1. Centers for Disease Control and Prevention. Periodontal Disease. CDC website. July 10, 2013. www.cdc.gov/oralhealth/conditions/periodontal-disease.html. Accessed August 7, 2023.
2. World Health Organization. Diabetes. WHO website. www.who.int/news-room/fact-sheets/detail/diabetes. Accessed August 7, 2023.
3. Escontrías O, Istrate E, Chandok N. Oral health care and primary health care: stronger together in recognizing and managing diabetes. American Dental Education Association (ADEA) Policy Research Series. February 2022. No. 5.
4. Choi SE, Sima C, Pandya A. Impact of treating oral disease on preventing vascular diseases: a model-based cost-effectiveness analysis of periodontal treatment among patients with type 2 diabetes. Diabetes Care. 2020;43(3):563-571.
5. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol. 2018;45(2):138-149.
6. Preshaw PM, Bissett SM. Periodontitis and diabetes. Br Dent J. 2019;
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