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Dental Public Health Activities: Descriptive Summaries

Michigan Assessment of Blood Pressure and Diabetes Screening Practices among Oral Health Professionals

Practice Number: 25011
Submitted By: Oral Health Program, Michigan Department of Health and Human Services
Submission Date: March 2017
Last Reviewed: March 2017
Last Updated: March 2017
Best Practice Approach Example -

There is growing evidence of an association between gum disease and chronic diseases such as heart disease and diabetes.  A leading health indicator of Healthy People 2020 is to increase the proportion of children, adolescents, and adults who used the oral health care system in the past year.  Almost 70% of Michigan adults reported visiting a dentist or dental clinic in the past year (MiBRFSS 2014). The dental office has such a large population which could make dentists and dental professionals an important source for identification of chronic diseases and referral for further diagnosis and treatment.  Michigan was interested in learning what the screening practices in Michigan dental offices are for hypertension and diabetes. 

The Oral Health Unit along with the Heart Disease and Stroke Prevention Unit and the Michigan Diabetes Prevention and Control Program at the Michigan Department of Health and Human Services and Delta Dental of Michigan, Ohio and Indiana collaborated on the project.  The Michigan Oral Health Unit was recently moved from under the Division of Maternal Child Health to the Division of Chronic Disease.  This move along with collaboration agreements already in place made it possible to bring these partners together.

Program staff with expertise in hypertension and diabetes screening protocols were asked to participate, along with oral health staff, in the development of a survey to answer questions related to hypertension and diabetes. (See Attachment A) Questions included: screening methods used, patients screened, current knowledge, follow-up practices, comfort level of performing screenings and preferences on future educational resources.

The survey was disseminated through two different methods.  The first was a paper survey mailed to dental offices identified through a Delta Dental mailing list of their providers which included a $2 bill as an incentive.  The second was sent electronically as a Survey Monkey link through the following dental professional associations; the Michigan Dental Association, the Michigan Dental Hygienists Association, the Michigan Dental Assistants Association, and the Michigan Oral Health Coalition. 

A total of 1,715 completed surveys were returned through the two dissemination methods, 1,452 from the mailed method and 263 from Survey Monkey.  Surveys were returned from 465 different zip codes across the state and 82.1% of the surveys were completed by a dentist, 9.4% by a dental hygienist and 7.5% by a dental assistant.

Results showed: 1. Dental health professionals were more comfortable screening for hypertension than diabetes; 2. The reported comfort level among those who didn’t screen for hypertension or diabetes was lower than those who did screen their patients; 3. Knowledge of current hypertension and diabetes guidelines was low. 

By understanding the current practices and knowledge among dentists around chronic disease and chronic disease screening, Michigan can use the data to drive educational messages and outreach.  Future steps include, developing chairside reference guides that will offer assistance on when to refer a patient and increasing educational and hands on training opportunities for proper hypertension and diabetes screening methods.  Utilization of the partnered association’s conferences and newsletters will spread educational messages across the state.

The use of dental health professionals as a data source was such a success that the Michigan Oral Health Unit will next be collaborating with the Michigan Cancer Section to follow a similar surveillance activity to survey dental health professionals on their screening practices for oral cancer. 

Lessons Learned:

Needed staff with expertise in five areas (oral health, diabetes, heart disease, epidemiology, and evaluation) to develop a survey instrument that provided reliable estimates and appropriate knowledge and screening questions.

A $2 bill was included in the paper survey mailings.  The response rate from this dissemination method yielded a higher number of returned surveys (1,452 returned and 4,646 mailed) than the electronic method (263 returned) which did not include an incentive 

It was beneficial to record the zip code  the dental health professional worked in the most to show the distribution of the surveys completed.  This ensured the sample was representative of the state.

The same survey monkey link was used for each of the email distributions.  Since there was not a unique identifier for each survey it was not possible to determine which association mailing generated the most completed surveys.  There also was no way to know if a dental health professional completed a survey by paper and electronically and were double counted.

In the future it would be beneficial to use different links to determine which association obtains the greatest return and to include an identifier or question that would illicit identifying information such as name of respondent or clinic name as to reduce duplication bias.

Contact Person(s) for Inquiries:

Beth Anderson, Oral Health Epidemiologist, Michigan Department of Health and Human Services, PO Box 30195, Lansing MI 48909, Phone: 517-335-9785, Fax: 517-335-9790, Email:

Christine Farrell RDH, BSDH, MPA, Oral Health Program Director, Michigan Department of Health and Human Services, 109 W. Michigan Ave, Lansing MI 48913, Phone: 517-335-8388, Fax: 517-335-8697, Email: