Dentists could play a greater role in detecting diabetes and cardiovascular disease, says the Faculty of Dental Surgery

Dentists could play a greater role in detecting health conditions – given the link between oral health and conditions such as diabetes and cardiovascular disease, the Dean of the Faculty of Dental Surgery has said. 

Professor Michael Escudier, Dean of the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons, spoke out as the FDS published its ‘Position Statement on oral health and general health’.

Professor Escudier said: “Good oral health is essential for our overall wellbeing.  In recent years there has been increasing evidence of the link between oral health and general health. Dentists and other members of the oral healthcare team always inspect a patient’s mouth in the course of treatment. This provides them with an opportunity to monitor, on an ongoing basis, how their patient’s health is changing.  While checking a patient’s oral health, they can look for relevant signs of other conditions – chronic gum disease can be an indicator of diabetes and cardiovascular disease, for example. They can also offer advice on what dietary and lifestyle changes patients could make to improve their overall health, which can also help to prevent conditions such as obesity and oral cancer.”

The recently published NHS Long Term Plan[1] places a major emphasis on the importance of preventing ill health and includes commitments around improving the oral health of children, older people, and those with learning disabilities. The government’s Green Paper on Prevention is also due to be published later this year. In this context, there is an opportunity to reflect on what dentistry is for and how oral health professionals can provide the best possible care for their patients. The FDS’ Position Statement suggests that they could play a greater role in supporting patients’ general health, both by helping to diagnose certain wider health problems and by providing preventative health advice.

In order to maximise the impact that dentists and oral health professionals can have in supporting their patients’ general health, the FDS recommends that:

• Oral health should be included in the government’s upcoming Green Paper on Prevention, which the Department for Health and Social Care has suggested will be published later this year. 

• The Healthy Living Dentistry programme, which has already been established in Greater Manchester^[2], should be rolled out nationally, with lessons learned from the successful Healthy Living Pharmacy scheme^[3].

• National and local public health campaigns should always utilise dentists in the delivery of health and lifestyle advice. Awareness should also be raised amongst the general public about the links between oral health and general health, and particularly the importance of seeing a dentist on a regular basis.

• Initiatives to diagnose diabetes and cardiovascular disease, as well as other conditions such as child obesity and eating disorders, should engage dentists and oral health professionals wherever possible.

• All healthcare professionals should cover the links between oral health and general health as part of their initial training and continuing professional development, so that this is understood across different disciplines.

• Concerted action is needed to improve oral care and access to dental services for older people, including those living in care homes.

In 2017, the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons, and other leading dental organisations, supported a series of rapid research reviews. Published in the British Dental Journal, these considered the links between oral health and a number of broader health conditions.^[4] Meanwhile the Cochrane Oral Health Group - which is internationally recognised as producing the best evidence-based research available to clinicians and policy makers - has conducted a series of reviews examining the impact of oral healthcare on a number of health outcomes. 

A rapid research review published in the British Dental Journal highlighted that current evidence indicates a number of associations between diabetes and oral diseases, and that diabetes is a recognised risk factor for gum disease.^[5]  The FDS suggests that there is scope for oral health professionals to play a bigger role in supporting the diagnosis of diabetes, using gum disease as an indicator for the condition. 

A Cochrane Oral Health review, published in October 2013^[6], highlighted that visual inspection of the mouth by a front-line health professional is the most effective method of diagnosing mouth cancers; successfully detecting between 59% and 99% of cases.

There is also a recognised association between oral disease (particularly chronic gum disease) and cardiovascular diseases. The link between the two conditions means that dentists and oral health professionals are well positioned to support those at risk of cardiovascular disease.  The British Dental Journal has suggested that health professionals involved in the diagnosis and management of oral and cardiovascular diseases should be aware of the associations between the two conditions, and a concerted effort made to ensure that cross-referrals and risk assessments take place across both disciplines.[7]

Separately, a Cochrane Oral Health review has found evidence that one-to-one dietary interventions delivered in a dental surgery and similar settings can change behaviour, including around fruit and vegetable consumption and alcohol intake. This suggests dental care settings can be effective sites for the provision of healthy lifestyle advice to help tackle wider public health challenges.[8]

Figures from NHS Digital indicate that over half (50.4%) of adults in England were seen by an NHS dentist in the 24 months to 31 December 2018,^[9] suggesting that dentists and oral health professionals are well placed to play a broader role in supporting patients’ general health. 

[1] https://www.longtermplan.nhs.uk/

[2]http://nebula.wsimg.com/79e743e5f232a5a5f6a51dcbceab1097?AccessKeyId=D53ACF903E48FED9E8A6&disposition=0&alloworigin=1

[3] https://www.healthylivingpharmacies.org/index.php/what-is-a-healthy-living-pharmacy/item/21-what-is-a-healthy-living-pharmacy

[4] C. Klass, K. Wanyonyi, S. White, A. D. Walmsley, N. Hunt and J. E. Gallagher (2017) “A recipe for future research”, British Dental Journal, 222 (5) 310

[5] F. D’Aiuto, D. Gable, Z. Syed and J.E. Gallagher (2017) “Evidence summary: The relationship between oral diseases and diabetes”, British Dental Journal, 222 (2), 944-948

[6] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010173.pub2/full

[7] T. Dietrich, I. Webb, L. Stenhouse, A. Pattni, D. Ready, K. L. Wanyonyi, S. White and J. E. Gallagher (2017) “Evidence summary: the relationship between oral and cardiovascular disease”, British Dental Journal, 222 (5), 381-385

[8] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006540.pub2/full

[9] NHS Digital (2018) NHS Dental Statistics for England, 2018-19, Second Quarterly Report

Notes to editors

1. The Faculty of Dental Surgery at the Royal College of Surgeons of England is committed to enabling dentists and specialists to provide patients with the highest possible standards of practice and care.
2. The oral healthcare team includes dentists, hygienists, dental therapists and dental nurses.
3. For more information, please contact the Press Office:

• Telephone: 020 7869 6047/6052
• Email: pressoffice@rcseng.ac.uk
• Out of hours media enquiries: 07966 486832