Embracing Change In Dental Practice To Deliver Better Health Outcomes

A Type 2 Diabetes Screening and Oral Health Pilot Program

The Australian National Oral Health Plan for 2015-2024 highlighted the importance of reducing the incidence, prevalence and effect or oral disease across the Australian population.  Coincidentally, diabetes is a National Health Priority Area in focus with the Australian Government.  Due to the link between periodontal disease and diabetes, we hypothesized that undiagnosed diabetes may well be present in those with poor oral health.

Diabetes is a global epidemic (AIHW, 2012).  Dental complications of diabetes include periodontal disease (Dunning 2009; Lamster et al., 2014), tooth loss, xerostomia (dry mouth) and dental decay and these conditions could indicate the individual has undiagnosed diabetes.  Hyperglycaemia may be present before diabetes is diagnosed.  Within Australia future projections for type 2 diabetes by 2030 will affect 8.4% of the Australian adult population (Shaw et al., 2009). 

The community dental clinic at Colac Area Health in partnership with Barwon Health is piloting an innovative approach into screening for diabetes within the oral health setting.  Adults attending the Colac Area Health Oral Health Service completed the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) questionnaire with those at a high risk offered an Alere Afinion™ HbA1c (%) blood test (AS100 analyser) to determine the likelihood of diabetes.  Six hundred and forty-eight adults were invited to participate.  Thirty-one percent reported already confirmed diabetes or currently being monitored by their General Practitioner.  Of those agreeing to be screened, 51% were in the highest risk for diabetes and 33% at intermediate risk.  Participants were further assessed using the blood test screening and either referred on to the Oral Health Educator for oral health education and nutritional advice and to their General Practitioner or the Diabetes Educator for follow up for diabetes confirmation.

Conclusion:     Seventy percent of participating patients had either been diagnosed with diabetes, were being investigated for diabetes or were in the high risk category for diabetes according to AUSDRISK assessment tool. 

Wide Smiles

Barwon Health Oral Health Service manages the Community Dental Clinics supporting the Greater Geelong, Surf Coast Shire and Colac-Otway region.  Children with an average age as young as 6 years have required dental procedures under general anaesthetics due to gross decay and long waiting times for such procedures have occurred.  These children presented with an average of 8 decayed, missing or filled teeth, 40% of their deciduous teeth.  Dental treatment under general anaesthetic or emergency procedures can be a traumatic experience for both the child and carer, potentially imprinting a negative experience of dental services on the child for life.  We identified that we needed to action a generational change of attitude towards oral health.

The Wide Smiles Oral Health program is a joint initiative by Barwon Health and Colac Area Health to improve access to dental services.  Oral Health Services visited Kindergartens, Early Learning Centres and Schools in the region and screened children (aged 3-7 years) for initial carious lesions.  After obtaining consent from parents, dental technicians used minimal intervention dentistry to apply fluoride directly to affected tooth surfaces (white spot lesions). Changes in tooth surfaces were recorded at follow up visits to the centres.  A dental kit was used at each visit and included: fluoride varnish, micro brushes, cotton roll, gauze, gloves, glasses, mirrors, rubbish bags, antiseptic hand scrub and head-torch.  Every child was supplied with a toothbrush and toothpaste.  Oral Health Therapists, dentists and dental assistants participated in the program.  At each visit, a communal place would be chosen for dental examinations so children did not feel that they were being separated from the main group.  A small table and two chairs were often used.  The teacher would bring the children to the screening area.  Parents were given a report of the visit and if advanced decay was detected, a referral was sent home with the child.

Early learning centres provide the ideal opportunity to introduce the child to dental screening in a friendly welcoming atmosphere.  As many as 13,537 children have received dental screening in just four years with 92% of early carious lesions remineralized or remaining stable.  Each child will now have a new imprint of what visiting the dentist is to them with being introduced in a friendly, comfortable known setting.  The Oral Health outreach program has broken tradition and brought dental screening and remineralization to the children.