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'Every year the numbers go up'

September 26, 2017

By Michelle Manchir

Baltimore — As a person with Type 1 diabetes, Dr. Gary Hack wears an insulin pump and a continuous glucose monitor at all times to manage the condition he's had for 30 years.


Dr. Hack
"I understand how hard it is to deal with this disease," he said.
 
As a professor at the University of Maryland School of Dentistry, he's working to ensure future dentists can appropriately assist patients affected by the disease.

Through a pilot program launched in 2014, all second-year dental students learn how to measure the blood glucose levels of university dental clinic patients, when appropriate, by using a blood glucose meter, or glucometer. The test is offered to patients who have diabetes risk factors such as obesity or a family history of the disease. Students refer patients with high blood glucose levels to medical colleagues at the university or to their primary care providers. The program is supported by the Maryland Office of Oral Health, which provided the glucometers.

Many of the students see the instruction as a crucial part of their dental education.

"Diabetes is a public health epidemic that requires all health care professionals to be on board," said Alexandra Fitzgerald, president of the dental school's chapter of the American Student Dental Association.

Since the pilot program launched in 2014, Dr. Hack said, the importance of dentists' awareness of diabetes has only increased.

"Every year, the numbers go up for this condition," he said. "The evidence that there's an association between gum disease and diabetes continues to increase and the number of people suffering goes up."

Indeed, nearly half of all Americans have diabetes, or are at high risk for developing condition (prediabetes), according to data released in July from the CDC. Of the 86 million people with prediabetes, about 90 percent of them don't know they have it, according to the CDC.

The ADA currently has no policy related to diabetes screenings, though it does offer an online CE course and information for dentists about oral diseases and conditions related to diabetes. Dr. Jerry Brown, a retired clinical dentist who has diabetes and was the first health professional with a dental degree to earn board certification as a Certified Diabetes Educator from the National Certification Board for Diabetes, leads the course. To access the course, visit ADACEonline.org and search for the course title, "Diabetes Mellitus and the Dental Professional."

The ADA Science Institute has compiled information about diabetes on its Oral Health Topics website. Visit ADA.org for more information.

Furthermore, earlier this year, the Code Maintenance Committee for the ADA's Code on Dental Procedures and Nomenclature (CDT Code) approved a code to report a chairside glucose screening procedure.  "D0411 Hb1Ac in-office point of service testing" is the new code in CDT 2018. It covers finger-stick random capillary HbA1c glucose testing. Hemoglobin A1c, or HbA1c for short, is a measure of the amount of hemoglobin that is glycosylated — meaning that it has glucose attached. It provides an indication of circulating levels of glucose over the previous three months.

The ADA's guide to D0411 is available online at the ADA's Coding Education page, ADA.org/cdt. It includes information about how this chairside screening procedure aids in obtaining objective data that can be given to the patient's physician through a referral, and helps the dentist determine possible effects on treatment plans.

Dr. Hack said the new D0411 code might not be enough to motivate dentists to incorporate screening into their day-to-day practices, especially considering the high price of HbA1c devices. Because of that, he is working on submitting a request for a code to cover a procedure that uses glucometers, which are less expensive.

Dr. Hack's efforts regarding dental professionals and diabetes don't stop there. He also serves as a consultant to the American Diabetes Association, he said, which earlier this year for the first time included "Screening in Dental Practices" in its Standards of Medical Care in Diabetes 2017 document.

It states, "Because periodontal disease is associated with diabetes, the utility of chairside screening and referral to primary care as a means to improve the diagnosis of prediabetes and diabetes has been explored … with one study estimating that 30% of patients ≥30 years of age seen in general dental practices had dysglycemia. Further research is needed to demonstrate the feasibility, effectiveness, and cost-effectiveness of screening in this setting."

For Dr. Hack, screening for diabetes in at-risk dental patients in dental offices can't come soon enough, though he emphasizes that diagnosing diabetes is "outside of our scope of practice, but screening and referring when appropriate is absolutely needed now."

"Dentists can play a critical role in mitigating the spread of this disease," he said.