Abstract
Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bidirectional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: 1) current cross-disciplinary practice patterns, 2) epidemiological updates, 3) status on risk assessment and screening for dysglycemia in the dental setting, 4) status on implementation of quality metrics for oral health, 5) care model pilots, and 6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oral-systemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously- and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.
Footnotes
Authors’ Contributions
AA and GN initiated the idea for the study concept and design, interpreted the data, assisted in the writing of the manuscript, edited and critically revised the manuscript. IG acquired, analyzed and assisted in interpreting the data, wrote the initial draft of the manuscript, edited and critically revised the manuscript. All authors have read and approved the final manuscript.
Author Details
IG is a project scientist in the Institute for Oral and Systemic Health at Marshfield Clinic Research Foundation. She holds a PhD in Microbiology and Immunopathology and has conducted research in the domain of oral and systemic health connections
GN is the executive director of Family Health Center of Marshfield, a designated federally qualified health center which provides care to disparity populations. In collaboration with Marshfield Clinic GN has spearheaded establishment of 10 dental centers and provides administrative and operational oversight to ensure provision of access to dental care for underserved populations and improve overall health of these patients. GN supports research efforts of the Institute for Oral and Systemic Health at Marshfield Clinic Research Foundation and proactively leverages translational value of research outcomes.
AA is the Director of Institute for Oral and Systemic Health at Marshfield Clinic Research Foundation. AA conceived the study plan and procured funding from Delta Dental of Wisconsin which supported conduct of the environmental scan presented in this report as an aspect of defining current status of oral and medical care integration for patients with diabetes. This report summarizes evidence-based findings surrounding this research
- Received October 27, 2016.
- Revision received March 2, 2017.
- Accepted March 24, 2017.
