An exploratory qualitative interview study about collaboration between medicine and dentistry in relation to diabetes management

Abstract

ObjectiveTo explore knowledge and attitudes regarding the links between diabetes and periodontitis of medical and dental healthcare professionals as well as those of people with diabetes.DesignQualitative interview study.Participants4 people with diabetes, four dental professionals, three general practitioners (GPs) with a specialist interest in diabetes, one GP without a specialist interest in diabetes, three diabetic nurse specialists and two consultant diabetologists.SettingPrimary and secondary care in Newcastle upon Tyne.MethodsInterviews were audio recorded and transcribed verbatim. Framework analysis was used iteratively to achieve progressive focusing and to develop conceptual ideas.Results3 inter-related themes emerged: (1) uncertain knowledge—a lack of familiarity about the links between periodontitis and diabetes; (2) unworkable knowledge—that even if the links between periodontitis and diabetes were known, it is impossible for anything to be done for patient benefit given the differing systems that medical and dental health professionals work in and (3) isolated knowledge—the perceived division that exists between the medical and dental professions has the potential to negatively impact on advances in diabetes patient care. The patients simply wanted all the healthcare professionals to be giving the same messages consistently and to help them access the (dental) care they need.ConclusionsThe research on the links between periodontal disease and diabetes appears to have limited impact on the organisation of diabetes care, and the divisions that exist between the medical and dental professions have the potential to negatively impact on patient care.

Diabetes and periodontal disease: a two-way relationship

“…Unfortunately, many patients with diabetes and also many medical clinicians are unaware of the links between periodontitis and diabetes, and of the potential benefits that periodontal treatment may have for diabetic patients. 42,43 Routine periodontal assessment should be performed in all patients, including those with diabetes. Ask the patient about their level of glycaemic control: many will be able to tell you their most recent HbA1c measurements.…”

A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis

“…Notwithstanding, this study found that the evidence for the bidirectional relationship between diabetes and periodontitis was valued by medical clinicians, and informing patients was considered legitimate by the medical team, particularly to the role of nurses [21]. As difficulties with collaborative working between dental and medical clinicians have been reported previously in the literature [22,23], and dissemination of guidelines alone is insufficient in promoting a change in clinical practice [24], this study aimed to explore potential ways to enable improved inter-professional working as outlined in extant diabetes and periodontitis guidance documents.…”

Calculus and survivorship in medieval London: The association between dental disease and a demographic measure of general health

“…In addition to bacterial components (e.g., lipopolysaccharide or LPS), periodontal disease allows locally‐produced proinflammatory mediators (e.g., interleukin‐(IL‐1) 1β, tumor necrosis factor‐α (TNF‐α), IL‐6, and prostaglandin E2 (PGE2)) to pour into the bloodstream, initiating responses in more distant tissues (Gemmell, Marshall, & Seymour, ; Loos, ; Loos, Craandijk, Hoek, Wertheim‐van Dillen, & van der Velden, ; Moutsopoulos & Madianos, ). The dissemination of bacteria and their biproducts into the bloodstream have the added effect of inducing system‐level infection responses that may instigate or affect the progression of cardiovascular diseases (for reviews of the evidence, see Dietrich, Sharma, Walter, Weston, & Beck, ; Dietrich et al, ), chronic obstructive pulmonary disease (Liu et al, ; Wang et al, ; Zeng et al, ), pneumonia (Awano et al, ; El Attar, Zaghloul, & El Menoufy, ; Scannapieco & Mylotte, ; Sharma & Shamsuddin, ; Terpenning et al, ), and diabetes (Bissett, Stone, Rapley, & Preshaw, ; Borgnakke, Ylöstalo, Taylor, & Genco, ; Lalla et al, ; Nelson et al, ; Taylor, Burt, Becker, Genco, & Shlossman, ). For example, platelet aggregation can be induced by oral bacteria such as P. gingivalis and S. sanguis or by the proinflammatory immune cytokines generated in response to them, affecting the formation of thrombi in the arteries and veins (Herzberg & Meyer, ).…”