Effectiveness of multi-stage diabetes screening in the dental care setting: a scoping literature review

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BACKGROUND: Diabetes is of great interest globally, given the associated health and economic costs. It may impact long-term systemic and oral health with unfavourable outcomes when undetected or poorly controlled, leading to various oral manifestations, including premature tooth loss and reduced quality of life. Early detection can enable early diagnosis, intervention and improve treatment and health outcomes. AIMS: To synthesise evidence on risk‑targeted screening and early case‑detection protocols for Type 2 Diabetes (T2D) that incorporate HbA1c or glucose point-of-care testing (POCT) using finger‑stick (FSB) or gingival crevicular blood (GCB) with a clinical risk assessment, to ascertain the value and potential impact of chair-side testing if implemented in primary care dental settings. METHODS: Electronic databases were searched using a pre-defined strategy, identifying 21 eligible studies; nine studies focused primarily on identifying at-risk individuals through finger-stick testing and twelve through gingival crevicular blood testing. Returned articles and grey literature were screened and used as supportive material for later discussion. A descriptive synthesis of 21 articles was undertaken, with focus of the review on multi-stage chair-side diabetes screening protocols incorporating risk questionnaires and periodontal examinations and HbA1c or glucose POCT testing. RESULTS: Chair-side HbA1c-or glucose POCT may identify potentially new T2D cases. Identification rates were shown to range between 20-66%. CONCLUSION: When a POCT is added as part of a two-staged screening protocol, it enhances the ability to identify more cases correctly and is easily integrated into the dental appointment for chair-side screening. Gingival crevicular blood may be used as an alternative blood source; however, the screening method has limitations. Therefore, the most promising solution seems to be a multi-staged predictive model involving tandem risk questionnaires, periodontal examination, and capillary testing with a chair-side POCT.

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