I am a retired life member of the American Dental Association. I commend your continuing to maintain and, from my perspective, improve The Journal’s high quality, thus making it even more relevant to dentists and dental students.
As a 50-plus–year insulin-dependent diabetic, I am always interested in dental/medical articles about diabetes—incidence, diagnosis, treatment and, hopefully some day, prevention. Thus, I was especially interested in October JADA’s special supplement, "Managing the Care of Patients With Diabetes."
The supplement’s three articles1–3 are well-written and replete with current information about all types of diabetes mellitus (DM) and special dental considerations. Yet, based on my half-century of living with this disorder, there was at least one major omission for our profession in dealing on a daily basis with this epidemic. I am referring to the regular use of a blood glucose meter in the dental office.
Dr. Brian Mealey wrote that "since almost 8 percent of the U.S. population has DM, dental practitioners should be familiar with this disorder, including its diagnosis, pathophysiology, potential complications, methods of medical management and oral implications."1 The U.S. population in 2000 was approximately 280 million,4 which would equate to approximately 22.5 million people with DM. It has been reported that, among certain populations, DM incidence of all types exceeds 8 percent. The U.S. Department of Veterans Affairs has reported that 19.6 percent of its elderly population have been diagnosed with DM.5
Dr. Ira Lamster and colleagues3 recommend that, when signs and/or symptoms of either poorly controlled or undiagnosed DM are recognized, patients should be referred to a physician for formal medical evaluation, diagnosis and treatment.
Because glycemic measures are the "sine qua non" [a necessity] of DM diagnosis, and because the means of making such determinations is a clinically simple and dependable procedure, it appears that a routine blood glucose determination should be a standard procedure in those cases in which DM is, or may be, a factor both in treatment planning and procedure performance.
Routine blood glucose measurement will do the following:
- – assist the patient with DM with improved knowledge of his or her glycemic control, especially during treatment;
- – enable the dentist to provide optimum care; routinely assessing the glycemic information also may prevent severe hypoglycemia during and immediately following clinical care;
- – elevate the dentist’s knowledge and awareness of DM and its effect on his or her dental practice and on his or her patients’ health.
Arguments against routine blood glucose measurement are, in my opinion, spurious. Blood glucose measuring equipment is uncomplicated, accurate, easy and quick to use and maintain, and not expensive (a single glucose strip costs about $1). The technique can be learned easily by all members of the dental team.
The following dentists should perform blood glucose determination on a routine basis in patients with a history and/or diagnosis of DM, or in those who are suspected of having pre-diabetes:
- – all general dentists (this group represents the majority of practicing dentists);
- – oral and maxillofacial surgeons;
- – pediatric dentists;
- – periodontists;
- – prosthodontists.
The following dentists are less likely to need to measure their patients’ blood glucose values:
- – dental radiologists;
- – endodontists;
- – oral pathologists;
- – orthodontists;
- – public health dentists.
In summary, the routine measurement of blood glucose levels in the dental office is strongly recommended. It is a simple, safe and vitally important diagnostic procedure.
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