The Hidden Potential of Dentistry in Chronic Disease Prevention

The Mouth and General Health 

The association between oral health and chronic diseases is now well known and backed by considerable high-quality evidence.⁽³⁾ For example, suboptimal oral health has been linked to cognitive decline and dementia, cardiovascular disease, chronic obstructive pulmonary disease (COPD) and pneumonia, and diabetes.^(4,5,6,7,8) It is becoming increasingly evident that even chronic low-level inflammation in the mouth has a negative impact on overall health. To this end, the role of dental care professionals in population health cannot be disputed. 

Dental Professionals as Part of the Interdisciplinary Healthcare Team 

Chronic diseases and the increasingly complex health issues of our aging population necessitate an interdisciplinary approach to the prevention, diagnosis, and management of disease.⁹ Dental professionals may be the first healthcare providers to flag systemic health issues through oral manifestations, and so are uniquely positioned to contribute.⁽⁹⁾ 

Dental professionals can be successfully trained to deliver the screening interventions and are aptly placed for delivering brief lifestyle advice and signposting patients to general medical care or other appropriate clinical services.⁽¹⁾ 

It has been suggested that all healthcare professionals, including dental professionals, should play a role in screening for undiagnosed medical conditions, offering behavior change advice during routine care, and directing patients to other health services when appropriate.^(2,3) Further, it has been suggested that the entire team of professionals in a dental practice can participate, including hygienists.⁽³⁾ 

Screening in Dental Practice 

Most dental professionals gather general health information from their patients, usually in the form of a self-administered questionnaire. The information gathered may provide insight into risk factors or symptoms of serious general health issues, such as depression, obesity, or diabetes. Here, we will look at several ways that dental professionals can further screen and advise patients about systemic illness.  

Smoking Cessation 

Perhaps the greatest preventative health intervention that dental professionals can do is to counsel smokers about quit-smoking strategies and supports that are available to them.6 However, the 2020 NHANES study found that only 42.9% of dental professionals told their tobacco-using patients about the benefits of quitting smoking.1 The Centers for Disease Control and Prevention (CDC) Tips® campaign is an excellent resource for dental healthcare professionals who wish to talk to their patients about quitting smoking.⁽¹⁰⁾ 

Cardiovascular Disease (CVD) 

A large 2019 study found that 46.6% of dental professionals were willing to screen for CVD risk, where their willingness included an acknowledgment of their role in CVD screening as healthcare professionals, as well as screening for hypertension and obesity.⁽¹¹⁾ 

Blood pressure measurement is an important screening vital sign. Taking blood pressure readings on routine in the dental clinic may be very useful in case of adverse events from anaesthetics.⁽¹²⁾ 

Diabetes Mellitus (DM) 

A bidirectional relationship exists between oral health and DM. Hyperglycemia in diabetics promotes the propagation of pathogenic bacteria and impairs the immune response, thereby increasing the risk of periodontal disease.^(8,9) Conversely, poor dental hygiene can elevate blood sugar levels.⁽⁸⁾ Expert consensus guidelines recommend periodontal care as part of the management strategy of diabetes, given the evidence that periodontal care can result in significant lowering of hemoglobin A1C (HbA1C), even in the short term.⁽¹³⁾ 

A sub-group analysis of the NHANES study found that about 18.24% of patients who had seen a dentist in the previous year had undiagnosed prediabetes or diabetes.⁽¹⁴⁾ Further, 55.73% of adults who had seen a dentist in the previous year had a score on the CDC Prediabetes Screening Test sufficient for referral to a medical provider. These results would suggest that even including the CDC Prediabetes Screening Test in the preclinical questionnaire would have a significant impact on diabetes screening. The CDC Prediabetes Screening Test is a single-page, 7-question, self-administered questionnaire. 

Take-Home Message 

Good oral care has a significant impact on patients’ general health, so dental professionals play a significant role in the overall health of any population. Although current guidelines in the United States (U.S.) are open-ended and non-prescriptive, dental professionals have a great opportunity to further engage themselves as part of the interdisciplinary healthcare team through systemic disease screening and health promotion. That may involve as little as asking some questions, taking blood pressure, and referring to other healthcare providers when at-risk patients are identified. 

^References

^{1. Fleming E, Singhal A. Chronic disease counseling and screening by dental professionals: Results from NHANES, 2011-2016. Prev Chronic Dis. 2020;17:E87. doi:10.5888/pcd17.200152}

^{2. Nasseh K, Greenberg B, Vujicic M, et al. The effect of chairside chronic disease screenings by oral health professionals on health care costs. Am J Public Health. 2014;104(4):744-750. doi:10.2105/AJPH.2013.301644}

^{3. Doughty JM, Gallier S, Paisi M, et al. Opportunistic health screening for cardiovascular and diabetes risk factors in primary care dental practices: Experiences from a service evaluation and a call to action. Br Dent J. 2023;235;727-733. doi:10.1038/s41415-023-6449-6}

^{4. Daly B, Thompsell A, Sharpling J, et al. Evidence summary: The relationship between oral health and dementia. Br Dent 2018;223(11):846-853. doi:10.1038/sj.bdj.2017.992}

^{5. Dietrich T, Webb I, Stenhouse L, et al. Evidence summary: The relationship between oral and cardiovascular disease. Br Dent J. 2017;222(5):381-385. doi:10.1038/sj.bdj.2017.224}

^{6. Manger D, Walshaw M, Fitzgerald R et al. Evidence summary: The relationship between oral health and pulmonary disease. Br Dent J. 2017;222:527-533. doi:10.1038/sbdj.2017.315}

^{7. D'Aiuto F, Gable D, Syed Z, et al. Evidence summary: The relationship between oral diseases and diab Br Dent J. 2017;222(12):944-948. doi:10.1038/sj.bdj.2017.544}

^{8. Luo H, Wu B, Kamer AR, et al. Oral health, diabetes, and inflammation: Effects of oral hygiene behaviour. Int Dent J. 2022;72(4):484-490. doi:10.1016/j.identj.2010.00}

^{9. Addressing chronic diseases from the dental chair. The American Academy of Oral and Systemic Health website. Published 2025. Accessed February 11, 2025. https://www.aaosh.org/connect/addressing-chronic-diseases-from-the-dental-chair}

^{10. Talking to your patients about tobacco Centers for Disease Control and Prevention (CDC) website. Published May 15, 2024. Accessed February 11, 2025. https://www.cdc.gov/oral-health/hcp/conversation-tips/index.html}

^{11. Singer RH, Feaster DJ, Stoutenberg M, et al. Dentists' willingness to screen for cardiovascular disease in the dental care setting: Findings from a nationally representative survey. Community Dent Oral Epidemiol. 2019;47(4):299-308. doi:11111/cdoe.12457}

^{12. Hypertension (high blood pressure). American Dental Association (ADA) website. Published Accessed February 11, 2025. https://www.ada.org/resources/ada-library/oral-health-topics/hypertension#:~:text=General%20Patient%20Considerations,pressure%2C%20at%20every%20dental%20visit.&text=Dental%20patients%20may%20experience%20acute,response%20to%20pain%20or%20anxiety.&text=This%20is%20one%20reason%20that,with%20hypertension%2C%20can%20be%20valuable.&text=When%20interviewed%20for%20a%20medication,high%20blood%20pressure%2C%20when%20asked.&text=Symptoms%20of%20hypertensive%20crisis/emergency%20may%20include%20headache%2C%20vision%20changes,stroke%20or%20end%2Dorgan%20damage.&text=Proposed%20blood%20pressure%20thresholds%20and,are%20listed%20in%20Table%203.}

^{13. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol. 2018;45(2):138-149. doi:10.1111/jcpe.12808}

^{14. Estrich CG, Araujo MWB, Lipman RD. Prediabetes and diabetes screening in dental care settings: NHANES 2013 to JDR Clin Trans Res. 2019;4(1):76-85. doi:10.1177/2380084418798818}