Medical screening in dental settings

Abstract: Background Findings have shown medical screening in dental settings to be cost-effective by achieving both financial savings and health benefits. The general purpose of this thesis was to study the possibility of early identification of individuals with undiagnosed diseases in a cooperative effort between dentistry and healthcare. The aims were to identify patients in a dental setting at risk of having or developing high blood pressure or high plasma glucose, and to investigate possible associations between these conditions and periodontal status, followed by a seven-year term study of the correlation between initial screening results and the progression of health. Further on, the patients’ experiences as well as the attitudes of some relevant authorities and organizations were explored. Methods A total of 170 dental patients were consecutively included at their regular annual check-up. Data on age, weight, height, amount and use of tobacco and pharmacological treatments for cardiovascular disease and diabetes were collected through self-reported information in a written health declaration, along with data on systolic and diastolic blood pressure, and plasma glucose. Clinical and radiographic examinations revealed data about periodontal status by probing periodontal pockets and measuring marginal alveolar bone loss by means of x-rays. Patients who exceeded normal diastolic blood pressure and plasma glucose values were referred to healthcare for diagnosis and care. With a strategic sampling of patients, authorities and organizations, 17 patients and 13 representatives for authorities and organizations were interviewed. The interviews were recorded and transcribed. The transcriptions were coded and categorized in a manifest analysis, followed by a latent, interpretive analysis. The initial screening’s 170 participants were then asked to take part in a seven-year follow-up study. Data were collected through a repeated written health declaration. Results Thirty-nine patients exhibiting risk values were provided referrals and 24 (14.1%) of the 170 participants required additional care. The correlation between dentistry and health care concerning blood pressure was 64.5% (p<0.001), while the correlation was 40.0% (p<0.001) concerning plasma glucose. Among middle-aged men and elderly subjects, the data showed a significant correlation between marginal alveolar bone loss and high systolic blood pressure (p<0.001). The manifest analysis of the patients’ experience resulted in three categories: Positive attitude to screening but dental professionals need to have specific knowledge of medical screening; Dental care provides continuity but is not a neutral environment; and Feedback on the medical screening results and desired cooperation between dental and healthcare services. The manifest analysis of the approached authorities and organizations resulted in four categories: Medical screening ought to be established in the society; Dentistry must have relevant competence to perform medical screening; Dentistry is not the only context where medical screening could be performed; and Medical screening requires cooperation between dentistry and healthcare. The latent analysis of the patients’ experiences pointed out the importance of the patient feeling that the procedure is carried out properly and safely, and identified requests for clear feedback concerning the results of the screening. The representatives for the authorities and organizations were positive to, but uncertain about, the concept of medical screening in dental settings. They requested further scientific knowledge and guidelines as well as long-term follow-up of medical screening. The follow-up study consisted of 151 participants. The risk for pharmacological treatments for hypertension after seven years for those not receiving pharmacological treatment at the initial screening was 54.2 times greater (p<0.0001 CI 9.8-300.3) for those with a systolic blood pressure >160 mm Hg than for those with a systolic blood pressure <140 mm Hg. Regarding diabetes, it was not possible to do risk calculations due to the limited group sizes. The changes in treatment were not significant. Conclusions An opportunistic medical screening seems to identify at least one in ten patients with undiagnosed hypertension or incorrect pharmacological treatment, and risk patients referred by dentistry who are not considered to require further healthcare interventions may benefit from an annual screening. The results also emphasize the need for increased cooperation between dentistry and healthcare.