Providing Preventive Periodontal Treatment to Hospitalized Patients With Diabetes

Almost 20% of all patients admitted to the hospital carry a diagnosis of diabetes. Diabetes
and periodontal disease have a bi-directional relationship; people with diabetes are at
higher risk of tooth loss and poor oral health may impact nutrition and inflammation. Even
among those with access to medical treatment for their diabetes, access to dental care may be
challenging. In spite of their higher oral health risk, diabetic adults are less likely than
their peers to attend a dental visit annually. While oral hygiene measures for
ventilator-dependent patients have become standard of care, the oral health of less
critically ill hospitalized patients has been noted to decline over the course of their
hospitalization and patients generally do not have access to dental treatment., However,
invasive dental treatment (restorations, tooth extraction, and periodontal scaling) has been
demonstrated to be safe even for critically ill hospitalized patients. The inpatient setting,
where patients are already receiving services from multiple disciplines and patients do not
need to travel to see a healthcare provider, presents a unique opportunity to make
integrative oral healthcare services accessible to diabetic patients, and to increase oral
health knowledge of those health professionals caring for patients on an inpatient medical
ward.

This study will involve provision of dental prophylaxis ("tooth cleaning") as well as
motivational interviewing focused on oral health care-seeking behaviors provided by a dental
hygienist to patients with a diagnosis of Type II diabetes who are hospitalized on a medicine
floor of Massachusetts General Hospital.

Inclusion Criteria:

- Patient has diagnosis of type 2 diabetes

- Patient has a primary care provider of record

- Patient is currently admitted to the house staff service of the Department of Medicine
at MGH

- Patient is "ready or nearly ready for discharge," based on the assessment of the
patient's medical team.

Exclusion Criteria:

1. History of cardiac conditions for which antibiotic prophylaxis is indicated prior to
dental treatment per American Dental Association/American Heart Association
guidelines:51

1. Prosthetic cardiac valve or prosthetic material used for cardiac valve repair

2. Previous infective endocarditis

3. Congenital heart disease (CHD) encompassing:

i. Unrepaired cyanotic CHD, including palliative shunts and conduits ii. Completely
repaired congenital heart defect with prosthetic material or device, whether placed by
surgery or by catheter intervention, during the first six months after the procedure
iii. Repaired CHD with residual defects at the site or adjacent to the site of a
prosthetic patch or prosthetic device (which inhibit endothelialization) d. Cardiac
transplantation recipients who develop cardiac valvulopathy

2. Anticoagulated with International Normalized Ratio>2.5

3. History of prosthetic joint replacement in the last two years

4. Medical team declines enrollment

5. The patient is unable to participate in the provision of dental prophylaxis due to a
medical condition such as altered mental status or altered cognitive status

6. Edentulous