Strauss et al. Respond

Abstract

We appreciate the response to our article regarding the proportion and characteristics of patients who saw a dentist but not a primary care health provider in 2008. Like Greenberg and Glick, we also performed an earlier analysis using National Health and Nutrition Examination Survey (NHANES) data. We determined the proportion of individuals at increased risk of having diabetes, but who were unaware of that increased risk.1 We found that 93% of US persons over 20 years of age, undiagnosed with diabetes but with moderate or severe periodontal disease, have risk factors indicating the importance of diabetes screening. We determined that 50% of those persons had seen a dentist in the past year and could have been screened for diabetes in the dental office. We appreciate Greenberg and Glick’s analysis regarding the potential use of the dental visit to identify males at increased risk for developing a severe cardiovascular event.2 Like their subsequent analyses demonstrating dental provider and patient willingness to participate in patient screening for medical conditions in the dental office,3,4 our research has shown the willingness of dentists and patients to be screened for diabetes.5 This is especially the case if screening involves the use of oral blood from at-risk patients with periodontal disease. In our article, we report results of a preliminary assessment of the extent to which a dental practice could serve as a site of opportunity to identify a variety of systemic health disorders for patients of all ages. Medical Expenditure Panel Survey (MEPS) data were very useful because they enabled explicit inclusion in our analysis of specific types of primary care health providers (physicians, nurses, nurse practitioners, physician assistants, physical therapists, optometrists, and chiropractors) who saw patients on an outpatient basis in an office, hospital outpatient department, or hospital emergency room.6 Using interactive MEPSnet query tools,7 the analyses were straightforward, enabling researchers who have limited familiarity with complex survey analysis software to conduct other salient analyses. Our finding that 19.5 million people with diverse sociodemographic characteristics only visited a dental practice in 2008 suggests that the potential value of disease screening by dentists cuts across all strata of the US population. Like Greenberg and Glick, we welcome the potential collaboration between oral and systemic health practitioners and researchers that may be stimulated by discussion of our findings. Such a collaboration can serve to improve patients’ health, even as it reduces long-term health care costs resulting from unnecessary delay in disease identification.