Developing and pilot testing an oral health screening tool for diabetes care providers

Ajesh George; Prakash Poudel; Ariana Kong; Amy Villarosa; Hanny Calache; Amit Arora; Rhonda Griffiths; Vincent W Wong; Mark Gussy; Rachel E Martin; Phyllis Lau

doi:10.1186/s12875-022-01798-5

Developing and pilot testing an oral health screening tool for diabetes care providers

BMC Prim Care. 2022 Aug 11;23(1):202. doi: 10.1186/s12875-022-01798-5.

Authors

Ajesh George^{1

2

3

4

5

6}, Prakash Poudel^{7

8

9}, Ariana Kong^{7

8}, Amy Villarosa^{7

8}, Hanny Calache^{7

10

11

12}, Amit Arora^{13

14

15

16

17}, Rhonda Griffiths¹⁸, Vincent W Wong¹⁹, Mark Gussy^{10

20

21}, Rachel E Martin^{7

12}, Phyllis Lau^{12

22

23}

Affiliations

¹ Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia. [email protected].
² Ingham Institute for Applied Medical Research, Liverpool, NSW, 1871, Australia. [email protected].
³ School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Surry Hills, NSW, 2010, Australia. [email protected].
⁴ South Western Sydney Local Health District, Liverpool, NSW, 1871, Australia. [email protected].
⁵ La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia. [email protected].
⁶ Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia. [email protected].
⁷ Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, NSW, 1871, Australia.
⁸ Ingham Institute for Applied Medical Research, Liverpool, NSW, 1871, Australia.
⁹ South Western Sydney Local Health District, Liverpool, NSW, 1871, Australia.
¹⁰ La Trobe Rural Health School, La Trobe University, Bendigo, VIC, 3552, Australia.
¹¹ School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, Burwood, VIC, 3125, Australia.
¹² Melbourne Dental School, The University of Melbourne, Carlton, VIC, 3053, Australia.
¹³ Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia.
¹⁴ School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia.
¹⁵ Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.
¹⁶ Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, 2050, Australia.
¹⁷ Sydney Dental Hospital/Sydney Local Health District, Surry Hills, NSW, 2010, Australia.
¹⁸ School of Nursing & Midwifery, Western Sydney University, Penrith, NSW, 2751, Australia.
¹⁹ South-Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, 2170, Australia.
²⁰ Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, United Kingdom.
²¹ School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
²² School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
²³ Department of General Practice, The University of Melbourne, Melbourne, VIC, 3010, Australia.

Abstract

Background: People with poorly managed diabetes are at greater risk of periodontal disease. Periodontal disease that is not effectively managed can affect glycaemic levels. Diabetes care providers, including general practitioners and diabetes educators, are encouraged to promote oral health of their clients. However, valid and reliable oral health screening tools that assess the risk of poor oral health, that are easy to administer among non-dental professionals, currently do not exist. Existing screening tools are difficult to incorporate into routine diabetes consultations due to their length. Thus, this study aimed to develop and pilot a short oral health screening tool that would identify risk of existing oral diseases and encourage appropriate referrals to the dental service.

Methods: A three-item screening tool was developed after a comprehensive review of the literature and consensus from an expert panel. The tool was then piloted as part of a larger cross-sectional survey of 260 adults with diabetes who were accessing public diabetes clinics at two locations in Sydney, Australia. As part of the survey, participants completed the three-item screening tool and a 14-item validated tool, the Oral Health Impact Profile (OHIP-14), which has been used previously in the preliminary validation of screening tools. Sensitivity and specificity analyses were then undertaken comparing the results of the two tools.

Results: A statistically significant correlation was found between the shorter screening tool and the OHIP-14 (rho = 0.453, p < 0.001), indicating adequate validity. The three-item tool had high sensitivity (90.5%, 95% CI 84.9%, 94.7%), with a specificity of 46.3% (95% CI 37.7%, 55.2%). The negative predictive value was 81.4% (95% CI 71.3, 89.3). No single item performed as well regarding sensitivity and negative predictive value when compared to the three items collectively.

Conclusions: The three-item screening tool developed was found to be valid and sensitive in identifying risk of poor oral health, requiring oral health referrals, among people with diabetes in this pilot. This is a simple, accessible tool that diabetes care providers could incorporate into their routine consultations. Further validation against comprehensive dental assessments is needed to reassess the tool's specificity and sensitivity in diverse settings.

Keywords: Diabetes; Health personnel; Oral health; Periodontal disease; Screening.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Diabetes Mellitus*
Humans
Mass Screening / methods
Oral Health
Periodontal Diseases*