Screening for Unidentified Increased Systemic Disease Risk in a Dental Setting

We were pleased to read the article by Strauss et al.,¹ who used Medical Expenditure Panel Survey (MEPS) data to assess the proportion and characteristics of patients who saw a dentist in 2008 but did not see a primary care health provider that year. Their study supports similar findings we published in the dental literature in 2005 in which data from the 2001–2003 National Health and Nutrition Examination Survey (NHANES), a nationally based representative sample of the US population, was used. Our study also found a substantial proportion of adults who see the dentist in a given year but do not see their physician in that same period.² NHANES, unlike MEPS data, also has data on clinical diagnoses, medication use, and measurements of well-recognized risk factors for systemic conditions such as heart disease and diabetes. Therefore, in the 2005 study we were able to determine the proportion of individuals at increased risk of developing disease yet unaware of that increased risk, and who could potentially benefit from primary prevention or early medical intervention. Using the available clinical data, the study estimated the Framingham Risk Score and found that 17% of the participants were at increased risk for a severe coronary heart disease event, yet were unaware of their increased risk.² Similar to what Strauss et al.¹ did, our 2005 study extrapolated from the 2000 census data for men and found that 288 999 adult men aged 40 to 85 years who were unaware of their risk for cardiovascular events had not visited a physician within 12 months but had visited a dentist, were at increased risk for developing a severe coronary heart disease event within 10 years, and could potentially benefit from early intervention.²

Subsequently, studies have shown the utility and potential efficacy of screening for medical conditions in a dental setting.^3–5 We and others have reported the willingness of general dentists to screen for or address medical conditions and the willingness of dentists and patients to obtain or provide the necessary samples and data.^6–8 We are glad to see corroborating data and the extension to young adults and children. We are encouraged that these data could propel collaboration between the public health community and oral health care professionals in efforts to prevent and control growing chronic disease epidemics.