Jarvie Journal - College of Dental Medicine - Columbia University

Volume 56, Spring 2013
Utilization Patterns of Dental and Medical Services in Dental Patients at Risk for Diabetes
Karla J. Perez 1 , Carol Kunzel 1* , Evie Lalla 1* , Sandra Burkett 1 , Bin Cheng 2 , Ira B. Lamster 2
1 College of Dental Medicine, Columbia University, NY, NY;
2 Mailman School of Public Health, Columbia University, NY, NY
*Faculty Mentor
Introduction: Type 2 diabetes is a serious chronic disease that negatively affects oral health and often remains
undiagnosed. A larger study aimed to evaluate screening protocols for undiagnosed diabetes and pre-diabetes in
patients presenting at Columbia University College of Dental Medicine (CUCDM) was recently completed. Patients
new to CUCDM were initially screened to target a group at-risk for diabetes. Study participants had to be: ≥40
years of age, if non-Hispanic white; ≥30 years of age, if Hispanic or non-white; never have been told that they had
diabetes or pre-diabetes; and had to self-report at least one of the following diabetes risk factors: family history of
diabetes, hypertension, overweight/obesity, high cholesterol.
Objective: Our objective was to analyze the demographic characteristics and medical and dental utilization patterns of
this high-risk patient population in order to obtain a better understanding of their co-utilization of medical and dental
health services.
Materials & Methods: Participants were asked to fill out a questionnaire regarding their demographic characteristics
(age, race, education), utilization of dental and medical services (frequency of visits, length of time since last visit),
health insurance, health-related habits (smoking) and presence of readily reported risk factors for diabetes. Those
who fulfilled the entry criteria described above received a chairside HbA1c finger stick test and a periodontal
examination. A diagnostic blood test (fasting plasma glucose or hemoglobin A1c) was used to define metabolic
status (healthy, pre-diabetes, diabetes). Available test results were reviewed with each patient at the conclusion of the
screening process.
Results & Conclusions: A total of 1097 subjects were included in the current analysis. The majority were
Hispanic (67.4%), female (64.4%), and had Medicaid as their dental (66.7%) and medical (57.7%) insurance. The
most prevalent risk factor was being overweight or obese (78.6%). Based on the diagnostic blood test result, 75.8%
of participants were considered to be healthy, while 17.9% were found to be pre-diabetic and 6.3% diabetic. A
periodontal examination indicated that 37% of participants had 25% or more of their teeth with at least one
periodontal pocket ≥5mm. Study data further indicated that study participants were more active users of medical
services than of dental services, with 83.2% visiting their physician for an exam/physical every year, compared to 59.2%
visiting their dentist/hygienist that often. When the frequency of visits was combined with time since last visit, in
order to create a measure of intensity of medical and dental utilization, 69% of participants had high intensity medical
utilization, while 29% had high intensity dental utilization.
Discussion: Preliminary analyses indicate that these dental patients, identified as at risk for undiagnosed diabetes, are
frequent users of medical services. Study data further suggest that visits for medical care, although prevalent, may be
narrowly focused, limited to the patient’s presenting complaint, and that some underlying systemic risk factors may be
overlooked. This interpretation suggests that the dental practice setting can provide an important opportunity to identify
individuals unaware of their diabetic status, as well as potentially a number of other systemic diseases. While the
majority of study participants were found to be healthy, all of the participants had one or more modifiable risk factors
that could be detrimental to their metabolic and cardiovascular health. Informed by the considerable literature on
models of health care utilization, further analysis of this data can help us understand the rationale for the pattern of
co-utilization of medical and dental health care services followed by these patients.
This research was supported by grants from Colgate-Palmolive and the New York State Health Foundation.
Karla Perez was supported by a College of Dental Medicine Pre-Doctoral Summer Research Fellowship.
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