Diabetes screening in the dental office: detection rates between 20 and 66%

Questionnaire, probing, then a drop of blood — a three-step model

The group around M. K. Sandhu published a review of the evidence on type 2 diabetes screening in the dental office in BMC Oral Health. They wanted to know whether HbA1c or chairside glucose tests — from capillary blood from the finger or from gingival crevicular blood — combined with a risk assessment are useful enough to enter the routine of primary dental care.

A database search following a predefined strategy included 21 studies: nine relied primarily on a finger-prick blood sample and twelve on gingival crevicular blood. The synthesis was descriptive, with an emphasis on multistage protocols combining a risk questionnaire, a periodontal examination and a point-of-care test.

Detection rates for potentially new cases of type 2 diabetes ranged between 20 and 66%. When a point-of-care test is added as the second step of a two-stage protocol, the share of correctly identified people rises, and the procedure fits easily into a regular appointment. Gingival crevicular blood is usable as an alternative sample, but with limitations, so the authors see a multistep prediction model as the most promising solution: a risk questionnaire, periodontal status, then a capillary test.

Limitations

This is a descriptive synthesis of 21 studies, without a meta-analysis, so the range of 20 to 66% must not be read as one transferable figure but as a composite picture of different protocols and populations.

For your practice

• You take periodontal status anyway; a diabetes risk questionnaire adds a minute and costs nothing — that is a step you can introduce immediately.
• A point-of-care test is a sieve, not a diagnosis: a positive result means a referral to the family physician, not a diagnosis made in the dental office.
• In patients with advanced periodontitis, the question about their last blood sugar result and a family history of diabetes makes the most sense of all.