Dentists' and dental hygienists' knowledge, opinions and practice behaviors related to patients with uncontrolled or undiagnosed type 2 Diabetes Mellitus

Background. In the United States non-insulin dependent diabetes is on the rise. Individuals with diabetes are at a higher risk for periodontal diseases and both diseases are seen as confounding factors. One goal of Healthy People 2010 is to increase preventive measures for patients at risk for diabetes. Currently research is requested from the National Institute of Health to discover non-invasive methods of diagnosing and managing diabetic patients, as well as screening for undiagnosed cases. Also, the National Diabetes Education Program recognizes a need to set up a referral system for diabetes prevention and management and the CDC recommends an interdisciplinary approach. Within the dental field, there are no current guidelines or recommendations for referring a patient with uncontrolled or undiagnosed diabetes.Purpose. The purpose of this study was to evaluate gaps in knowledge and practice related to uncontrolled or undiagnosed diabetic patients and medical referrals in order to determine if further training is needed for dentists and dental hygienists, and if so, what type of training do they prefer.Methods. This study involved two phases: (1) questionnaire development and validation, and (2) questionnaire administration, implementation and analysis. A 47-item questionnaire was mailed to a random sample of dentists and dental hygienists licensed in California. Surveys were entered in a SPSS Version 11.0 for Mac and were used to compare and analyze data. Demographic characteristics will be presented using descriptive statistics, such as frequencies, percentages, and bi-variate analysis. McNemar's non-parametric tests will compare data between responses from dentists and dental hygienists. Associations and relationships were examined that affect the likelihood of increasing practice behaviors relating to the management of uncontrolled or undiagnosed Type 2 Diabetes Mellitus (T2DM).Results. A response rate of 24.97% was obtained after 3 mailings. A total number of acceptable surveys were received from 128 dentists and 216 dental hygienists. Knowledge was assessed according to signs and symptoms, and risk factors for T2DM. Opinions indicated that most dentists (59%) and dental hygienists (68%) felt they were knowledgeable about T2DM, however, results indicate otherwise with less than 33% of dentists and hygienists identifying at least 9 of 10 signs and symptoms, and less than 15% identifying at least 7 of 8 risk factors. Practice behaviors did not coincide with knowledge and opinions regarding T2DM. While over 90% of RDHs and DDSs agreed that early detection of T2DM reduces complications associated with the disease, and 70% agree that T2DM screening should occur annually, only 35.6% of RDHs and 44.5% of DDSs actually indicated referring patients at risk for T2DM for a medical consultation.Conclusions. Dentists and dental hygienists knowledge and opinions of T2DM did not increase practice behaviors related to patients with uncontrolled or undiagnosed T2DM. Having taken a CE course on diabetes did not affect levels of knowledge, nor change practice behaviors. Multi-level interventions should be developed that target dental/dental hygiene students, current dental providers, and the public.