Chairside Screening Research Articles

Indian patients’ attitudes towards chairside screening in a dental setting for medical conditions

India has a high prevalence of cardiovascular disease (CVD), diabetes mellitus (DM), tuberculosis (TB), human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and hepatitis B. United States-based studies indicate provider and patient support for medical screening in the dental setting. We assessed patient attitudes towards, and willingness to participate in, medical screening in the dental setting in India. A 5-point Likert scale survey (with scores ranging from 1=very important/willing to 5=very unimportant/unwilling) was given to a convenience sample of adult patients visiting five university-based dental clinics (clinic group) and one private-practice setting (private group). The Mann-Whitney U-test was used to compare mean response scores between patient groups. Logistic regression was used to assess factors associated with a favourable outcome. Both patient groups felt it important for dentists to identify increased risk for medical conditions (89.3% vs. 94.9%, respectively; P=0.02). The majority of patients were willing to have a dentist screen for the specified conditions: CVD (80.6% clinic and 84.5% private); DM (84.5% clinic and 77.5% private); TB (76.7% clinic and 73.2% private); hepatitis (73.3% clinic and 67.5% private); and HIV/AIDS (71.0% clinic and 70.5% private). The majority of patients were willing to participate in chairside screening that yielded immediate results (84.6% clinic and 86.1% private), discuss results immediately (85.8% clinic and 87.2% private) and pay 150 Indian rupees (55.9% clinic and 91.7% private). Younger patients (<40 years of age) were significantly less likely to respond favourably to: importance of medical screening in dental settings [adjusted odds ratio (OR)=0.63; 95% confidence interval (95% CI): 0.26-0.84] and be available for screening that yielded immediate results (adjusted OR=0.63; 95% CI: 0.40-0.99). Indian dental patients were in favour of chairside medical screening.

A pilot study of an HbA1c chairside screening protocol for diabetes in patients with chronic periodontitis: the dental hygienist's role.

To assess effectiveness, convenience and cost of point-of-care diabetes screenings performed by a dental hygienist for patients with periodontitis, using a diabetes risk questionnaire, periodontal findings and a glycosylated haemoglobin (HbA1c) analyser. A purposive sample of 50 participants with periodontitis, never diagnosed with diabetes, reporting ≥one diabetes risk factor, were administered an HbA1c test. Spearman's correlation measured relationships between HbA1c and diabetes risk test scores, numbers of missing teeth, percentage of deep pockets ≥5mm and percentage of bleeding sites (BOP). Cost and time were assessed. Analyses used 0.05 alpha levels. Thirty-two per cent (n=16) of participants presented HbA1c values indicating prediabetes; one HbA1c value indicated type 2 diabetes, totalling 34% (N=17). No relationships existed between HbA1c values and diabetes risk scores (rs=0.153; P=0.144), numbers of missing teeth (r=0.190; P=0.093), percentage of deep pockets (rs=-0.048; P=0.370) or percentage of BOP sites (rs=0.066, P=0.324). Direct cost for each HbA1c was $9US, excluding follow-up medical diagnosis. Mean screening time including patient education was 14min (SD=6.2). Fifty-three per cent (n=9 of 17) of participants with elevated HbA1c values contacted their primary healthcare provider within 2weeks as recommended. Point-of-care HbA1c screenings by dental hygienists were effective and convenient for identifying undiagnosed prediabetes and provide opportunity for interprofessional patient care; cost or lack of dental insurance may inhibit implementation. Identification of patients at risk for diabetes requires further evaluation.

Screening for prediabetes and type 2 diabetes in dental offices.

ObjectivesMost Americans see dentists at least once a year. Chair‐side screening and referral may improve diagnosis of prediabetes and diabetes. In this study, we developed a multivariate model to screen for dysglycemia (prediabetes and diabetes defined as HbA1c ≥5.7 percent) using information readily available to dentists and assessed the prevalence of dysglycemia in general dental practices.MethodsWe recruited 1,033 adults ≥30 years of age without histories of diabetes from 13 general dental practices. A sample of 181 participants selected on the basis of random capillary glucose levels and periodontal status underwent definitive diagnostic testing with hemoglobin A1c. Logistic models were fit to identify risk factors for dysglycemia, and sample weights were applied to estimate the prevalence of dysglycemia in the population ≥30 years of age.ResultsIndividuals at high risk for dysglycemia could be identified using a questionnaire that assessed sex, history of hypertension, history of dyslipidemia, history of lost teeth, and either self‐reported body mass index ≥35 kg/m2 (severe obesity) or random capillary glucose ≥110 mg/dl. We estimate that 30 percent of patients ≥30 years of age seen in these general dental practices had dysglycemia.ConclusionsThere is a substantial burden of dysglycemia in patients seen in general dental practices. Simple chair‐side screening for dysglycemia that includes or does not include fingerstick random capillary glucose testing can be used to rapidly identify high‐risk patients.Practical implicationsFurther studies are needed to demonstrate the acceptability, feasibility, effectiveness, and cost‐effectiveness of chair‐side screening.

Oral potentially malignant disorders in a large dental population

Objectives Oral cancer (OC) may be preceded by clinically evident oral potentially malignant disorders (OPMDs). Oral carcinogenesis is a multistep process that begins as epithelial hyperplasia and progresses to oral epithelial dysplasia and finally to fully malignant phenotypes. The aim of our study was to estimate the prevalence of OPMDs in a large population of dental patients.Methods Patients were seen in the Oral Diagnosis and Oral Medicine clinics at Boston University Henry M. Goldman School of Dental Medicine between July 2013 and February 2014 and received a comprehensive oral examination to identify any possible mucosal lesions. Patients with a suspected OPMD (submucous fibrosis, oral lichen planus, leukoplakia and erythroplakia) that did not resolve in 2–3 weeks received a biopsy for definitive diagnosis. Logistic regression models were used to explore the relationship between OPMDs and associated risk factors.Results A total of 3,142 patients received a comprehensive oral examination [median age: 43 (range: 18–97); 54.3% females]. Among these, 4.5% had an oral mucosal lesion with 0.9% being an OPMD (one submucous fibrosis, three epithelial dysplasias, fourteen with hyperkeratosis/epithelial hyperplasia and nine with oral lichen planus). Males and current smokers were associated with higher odds of having OPMD (OR 1.7, 95% CI 0.8–3.8; OR 1.9, 95%CI 0.8–4.1). Increasing age was associated with having OPMDs (p<0.01).Conclusion Optimal oral visual screening for OC remains a simple and essential tool to identify any suspicious lesions and potentially increase survival. Although OPMDs were rare, our results confirm the importance of a thorough chairside screening by dentists and dental students to detect any mucosal changes.

Modified schirmer test–A screening tool for xerostomia among subjects on antidepressants

ObjectiveThe aim of the present study is to assess salivary flow rate in the subjects who were on antidepressant medications and its comparison with healthy controls and assessment of unstimulated salivary flow rate by modified Schirmer test (MST) and volumetric method (spitting method) for evaluation of xerostomia and whether any correlation exists between two methods. Material and MethodsThirty subjects who were on antidepressants were divided into two groups: tricyclic antidepressants (TCA) and selective sertonin reuptake inhibitors (SSRI) of 15 each, compared with 30 age and gender matched controls. Unstimulated salivary flow rate was measured by both MST and spitting method. ResultsThe unstimulated salivary flow rate measured by MST at the end of 3rd minute was 13.7±10.08, 19.86±8.95 and 31.0±5.4mm and by spitting method was 0.12±0.07, 0.19±0.10 and 0.30±0.75ml/min in TCA, SSRI and controls respectively (p<0.001). The Pearson correlation coefficient of r=0.85 shows excellent correlation between the two screening tests. Sensitivity and Specificity of MST was 90.9% and 31.5%. ConclusionSalivary flow rate was less in antidepressant subjects when compared to the healthy controls. Results of the present study showed an excellent correlation excellent correlation between the two screening tests which suggests that MST can be routinely used as chair-side screening tool to evaluate hyposalivation which is time saving, patient friendly and specific of salivary secretions.

Health care reform brings new opportunities

Health care reform brings new opportunities

Patients' attitudes towards screening for diabetes and other medical conditions in the dental setting

To determine the attitudes of patients attending routine appointments at primary care dental clinics and general dental practices towards the possibility of chair-side screening for medical conditions, including diabetes, in the dental setting. A brief, anonymous, self-administered questionnaire distributed to adult patients (≥18 years) attending 2 primary care dental clinics and 16 general dental practices in South-West England. One hundred and ninety-seven completed questionnaires were received from patients at primary care dental clinics and 429 from general dental practice patients. Overall, 87% of respondents thought that it was important or very important that dentists screened patients for medical conditions such as diabetes; 79% were very willing to let a dental team member carry out screening. The majority indicated willingness to be screened for various medical conditions during a visit to the dentist, with significantly higher proportions of respondents in the primary care clinics indicating willingness (hypertension: 83% vs 74%; heart disease: 77% vs 66%; diabetes 82% vs 72% [all p <0.02]). Nearly two thirds of primary care clinic respondents and over half of general practice patients indicated that they would be willing to discuss test results with the dental team. Overall, 61% had never knowingly been screened or tested for diabetes; 20% reported that they had been tested within the previous 12 months. The majority of respondents supported the concept of medical screening in a dental setting and were willing both to have screening tests and discuss their results with the dental team. Patient acceptance is paramount for successful implementation of such screening programmes.

Salivaomics

The ability to monitor health and wellness, as well as detect oral and systemic illnesses early through noninvasive means, are highly desirable goals in health care promotion and delivery. Saliva is an emerging medium to be explored for health and disease surveillance, as well as for personalized medicine. A major mandate is to demonstrate clinicians' ability to use saliva to detect and monitor systemic diseases. To realize the translational and clinical vision of salivary diagnostics, two prerequisites are essential. The first is the need to develop and optimize diagnostic tools tailored to saliva. The second is the need to substantiate the scientific underpinnings of salivary biomarkers reflecting systemic diseases. The author describes five diagnostic alphabets (proteome, transcriptome, microRNA, metabolome and microbiome) and point-of-care technology platforms that are in place to advance the translational and clinical path. For mechanistic studies (that is, basic science studies), animal models are in place to elucidate the scientific mechanisms of systemic diseases reflected in saliva. Significant advancements have been made in the development of salivary diagnostic tools. The translation of the scientific mechanisms of systemic diseases reflected in saliva is in progress. On the scientific credentialing of salivary biomarkers for the detection of systemic diseases, salivary diagnostics will have an effect on access to care, health disparities and global health. Dentistry can advance into the realm of primary health care with integration of chairside screening for medical conditions.

Patients' attitudes toward screening for medical conditions in a dental setting

Previous studies demonstrated the efficacy of chairside medical screening by dentists to identify patients who are at increased risk for developing cardiovascular-associated events and the favorable attitude of dentists toward chairside medical screening. This study assessed patient attitudes toward chairside medical screening in a dental setting. A self-administered questionnaire of eight five-point response scale questions was given to a convenience sample of adult patients attending an inner-city dental school clinic and two private practice settings. Wilcoxon-Mann-Whitney tests and t-tests were used to compare responses between study groups. Friedman nonparametric analysis of variance was used to compare response items within each question. Regardless of setting, the majority of respondents was willing to have a dentist conduct screening for heart disease, high blood pressure, diabetes, human immunodeficiency virus infection, and hepatitis infection (55-90 percent); discuss results immediately (79 percent and 89 percent); provide oral fluids, finger-stick blood, blood pressure measurements, and height and weight (60-94 percent); and pay up to $20 (50-67 percent). Respondents reported that their opinion of the dentist would improve regarding the dentist's professionalism, knowledge, competence, and compassion (48-77 percent). The fact that the test was not done by a physician was ranked as the least important potential barrier. While all respondents expressed a favorable attitude toward chairside screening, the mean score was significantly lower among clinic patients across most questions/items. The priority rankings within an item were similar for both groups. Acceptance by patients of chairside medical screening in a dental setting is a critical element for successful implementation of this strategy.

Dentists Consider Medical Screening Important and are Willing to Incorporate Screening Procedures into Dental Practice

Dentists' attitudes toward chairside screening for medical conditions. Greenberg BL, Glick M, Frantsve-Hawley J, Kantor ML. J Am Dent Assoc 2010;14(1):52-62. Brian Laurence, DDS, PhD. The purpose of the study was to obtain information about dentists' attitudes toward, acceptance of, and perceived barriers regarding screening for medical conditions in a dental setting. Information not available. Survey. Level 3: Other evidence. Not applicable.

Dentists' attitudes toward chairside screening for medical conditions

of previous studies demonstrated the effectiveness of chairside medical screening by dentists to identify patients at increased risk of experiencing cardiovascular-associated events. In this study, the authors assessed dentists' attitudes, willingness and perceived barriers regarding chairside medical screening in the dental office. A national, random sample of U.S. general dentists was surveyed by mail by means of an anonymous questionnaire that involved a five-point Likert scale (1 = very important/very willing; 5 = very unimportant/very unwilling). Friedman nonparametric analysis of variance was used to compare response items within each question. Of 1,945 respondents, most were male (82.3 percent), white (85.7 percent) and 40 to 60 years old (59.4 percent) and had practiced for more than 10 years (84.5 percent). The majority thought it was important for dentists to conduct screening for hypertension (85.8 percent), cardiovascular disease (76.8 percent), diabetes mellitus (76.6 percent), hepatitis (71.5 percent) and human immunodeficiency virus infection (68.8 percent). Respondents were willing to refer patients for consultation with physicians (96.4 percent), collect oral fluids for salivary diagnostics (87.7 percent), conduct medical screenings that yield immediate results (83.4 percent) and collect blood via finger stick (55.9 percent). Respondents were significantly more willing (P < .001) to collect saliva than height and weight measurements or blood via finger stick (mean ranks: 2.05, 2.96 and 3.05, respectively). Insurance was significantly less important (P < .001) than time, cost, liability or patients' willingness (mean ranks: 3.51, 2.96, 2.94, 2.83 and 2.77, respectively). Dentists considered medical screening important and were willing to incorporate it into their practices. Additional education and practical implementation strategies are necessary to address perceived barriers. The findings of this study regarding chairside medical screening may lead to changes in our approach to dental education and may help define the practice of dentistry in the future.