Abstract
Objective: Emerging evidence-based information supports incorporation of point-of-care screening of individuals at-risk for undiagnosed medical conditions in dental settings. In this study, dental provider’s knowledgeability, attitude and behavior regarding chairside medical screening was assessed across nine federally qualified health center (FQHC)-operationalized dental centers integrated into a large Midwestern US healthcare organization to establish receptivity among regional dental providers. Further, this pilot effort informed the study design and survey tool for conducting a larger statewide study. Methods: Knowledgeability surrounding point-of-care screening, was piloted via a multiple-choice survey targeting 100 regional FQHC dental providers (dentists and dental hygienists) utilizing SurveyMonkey®. The survey captured provider demographics, medical knowledgeability, attitudes, and current practice patterns with conduct of chairside medical screening. Chi-square analysis compared responses based on the respondent’s gender, year of graduation and clinical role. Results: A 26% response rate was achieved. The 26 responding dental providers reported screening for hypertension, diabetes mellitus, prediabetes, obesity, chronic kidney disease, human papilloma virus, hepatitis, human immunodeficiency virus and adverse events of chemotherapy and radiotherapy, with a frequency of 88%, 37%, 8%, 42%, 21%, 29%, 25%, 25% and 37% respectively. Willingness to incorporate chairside screening into clinical practice that yielded immediate results was indicated by 57% of respondents. The most important factors associated with engagement of medical screening included time investment (92%), patient willingness (88%), liability (84%), insurance coverage (56%) and cost (52%). Conclusions: Overall, this pilot study indicated that dental providers’ attitude relative to chairside screening for medical conditions was favorable. While respondents indicated willingness to collect oral fluids for salivary diagnostics and blood pressure and height/ weight measurements, lack of willingness to utilize finger-stick approaches for assessing glycemic status was identified. A statewide study is currently being planned to establish a comprehensive understanding of barriers impeding adoption of chairside screening for medical conditions in a dental setting.
Highlights
While dental practice has historically been confined to delivery of oral and maxillofacial care, mounting scientific evidence supporting the interrelationships between oral and systemic diseases has launched a new era that casts dental professionals as central, proactive participants in establishing interprofessional collaborations [1,2]
A total of 26 dental providers responded to the survey, for a response rate of 26%
Compared to the 25.9% (1945/7500) response rate achieved in the national survey sample [13], basic characteristics of responses for this study sample were similar to those of the full national survey sample despite the lower response rate of participants in this pilot study (26/100) and the fact that it was conducted in rural dental clinics areas as opposed to the national survey
Summary
While dental practice has historically been confined to delivery of oral and maxillofacial care, mounting scientific evidence supporting the interrelationships between oral and systemic diseases has launched a new era that casts dental professionals as central, proactive participants in establishing interprofessional collaborations [1,2]. The United States (U.S.) Surgeon General Report of 2000 highlighted the overall need for incorporating screening procedures for individuals and communities into dental practice, to establish relative risk for disease [3]. The first step in disease prevention and control is the identification of subpopulation at risk for developing disease. These trends promote the need to redefine dental practice to include incorporation of medical screenings and risk assessment tools to undertake necessary preventive steps and tailor treatment options. The study further highlighted that approximately 93% of individuals who exclusively sought dental care, carried some health insurance benefit to support follow up on referrals to other healthcare providers [6]
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