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• W2463619792 abstract "It is now common knowledge that oral conditions, especially inflammatory disease, will impact multiple organ systems. Likewise, it is common knowledge that systemic diseases, such as diabetes, will affect the oral cavity and the services that we provide therein.The recent article “Evidence from ElderSmile for Diabetes and Hypertension Screening in Oral Health Programs,” July 2015, vol. 43, pp. 379–87, continues a trend of dentists advocating for the screening for systemic disease outside the scope of practice prescribed by law.The authors of the article may be practicing under an institutional license with medical supervision that has not been disclosed. The authors also do not disclose where they stand under the Clinical Laboratory Improvement Act of 1988 (CLIA) and if they have individual or institutional CLIA waivers for HgA1c testing (a waived test under CLIA). They also do not disclose if this study was reviewed by an IRB.Their conclusion that “integration of diabetes and hypertension screening and monitoring into routine oral health care would be acceptable and attractive for older adults” is most likely correct. However, the screening for diabetes via point of care testing is not within the scope of practice of dentistry.Obtaining a CLIA waiver is an expensive proposition for the general dentist; these costs will be passed along to the patient in many cases. However, with Medicare-aged patients it is unlikely that Medicare reimbursement will cover the costs of obtaining a waiver with the attendant necessity of a medical director, training sessions, validation of results and calibration of the equipment.As editor, I believe that in addition to reviewing manuscripts for grammar, spelling, etc., that you have a duty to ascertain if the studies presented were compliant with Institutional Review for Human Subjects, if proper federal certifications were obtained and if the study was done within the scope of practice defined by the licensing board of the state that the study was completed in.MICHAEL E. CADRA, MD, DMDModesto, Calif.Dr. Marshall RespondsWe appreciate Dr. Cadra's careful reading of our recently published article titled “Evidence from ElderSmile for diabetes and hypertension screening in oral health programs.”1 First, we need to clarify a distinction between clinical research and state laws governing scope of practice in the United States. The article reports the results of a clinical research study, and all appropriate Columbia University, New York University and University at Buffalo Institutional Review Board and Health Insurance Portability and Accountability Act safeguards were followed. Second, as noted by Dr. Cadra in his correspondence, the glycosylated hemoglobin (HbA1c) test is waived under the Clinical Laboratory Improvement Act of 1988 (CLIA), which is important from the perspective of introducing diabetes screening into dental settings. These regulations regarding a waived test are not an “expensive proposition” as stated by Dr. Cadra. For instance, the New York State Department of Health (DOH) regulations require completion and submission of a Limited Service Laboratory Registration Application, form DOH-4081, along with a fee of $200 to be considered for a CLIA waiver to perform HbA1c testing.2 Taking and recording blood pressures by dental providers, including dental hygienists, before patients undergo procedures, especially under anesthesia, is considered sound dental practice, but here again, regulations vary by state. To use these blood pressure readings to screen for hypertension in settings where there is one of several models of integration of oral health care with primary health care systems and/or electronic health records is part of the research agenda that our team and several others are exploring.If clinical research such as ours provides evidence that these primary care activities improve patient health by identifying people with undiagnosed or poorly managed diabetes or hypertension, then this information can be (and is being) used to change the definition of the scope of dental practice. One of us (I.B.L.) is currently funded by the New York State Health Foundation to further develop the role and rationale for primary care screening in dental offices, identify barriers to primary care screening in this setting, provide recommendations to policymakers to improve population health, and change the scope of practice for dentists in New York state to allow them to assess dysglycemia in their offices. As part of this research, the scope of dental practice across the 50 states was examined. Results were that half of the states include in their definition a statement to the effect that the scope of practice for a dentist is the treatment of oral and dental diseases and their effect on the body [emphasis ours]. The remaining half of the states currently defines dental practice more narrowly. New York is a state with a broad definition of dental practice. (Data are available upon request from the author.)Likewise, dentistry was defined by the 1997 American Dental Association House of Delegates as follows: Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law.3 [emphasis ours]Far too many racial/ethnic minority older adults living in impoverished communities fail to receive screening and care for primary care sensitive conditions.4 Our overarching purpose lies in improving the oral and general health of our patients, and supporting moves to expand the scope of dental practice in states based upon the best available scientific evidence.5" @default.
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• W2463619792 date "2015-12-01" @default.
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• W2463619792 title "Dentists and Health Screenings" @default.
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