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Background Periodontal disease and diabetes are widespread comorbid conditions that are detrimental to oral and overall health. Dentists' performing chairside screenings for undiagnosed diabetes mellitus (UDM) can be beneficial to both patients and providers. The authors determined UDM rates in a population-based study and whether UDM and periodontal disease were independently associated. Methods Data from 7,343 participants in the Atherosclerosis Risk in Communities study visit 4 were used to determine rates of UDM by periodontal status, edentulism, and body mass index. The authors used a χ2 test or analysis of variance, along with a 2-stage logistic regression model, to determine relationships with UDM. UDM was defined as no self-reported diabetes and blood glucose levels (fasting glucose ≥ 126 milligrams/deciliter or nonfasting glucose > 200 mg/dL). Periodontal disease was defined using the Periodontal Profile Classes system adapted to stages and the Centers for Disease Control and Prevention and American Academy of Periodontology index. Results UDM rates overall were 5.6%. The highest rates occurred in patients who were obese and edentulous (12.6%) and obese and had severe periodontal disease (12.2%). Significant associations were found for UDM and severe periodontal disease (Periodontal Profile Classes system stage IV) (odds ratio, 1.78; 95% confidence interval, 1.10 to 2.88). Edentulism was significantly associated with UDM in the Periodontal Profile Classes system model (odds ratio, 1.87; 95% confidence interval, 1.27 to 2.75) and Centers for Disease Control and Prevention and American Academy of Periodontology index (odds ratio, 1.70; 95% confidence interval, 1.08 to 2.67). Hyperglycemia was found in participants of all body mass index categories. Conclusions UDM is significantly associated with obesity, edentulism, and periodontitis. These characteristics could help dentists identify patients at higher risk of developing DM. Patients without these characteristics still have UDM, so dentists performing chairside diabetes screening for all patients would yield additional benefit. Practical Implications Dental offices are a major point of contact within the US health care system. Diabetes screening in this setting can provide important health information with direct relevance to patient care.

Background A virtual oral health care help line was established to provide consultation and triage for people with dental questions and concerns. Its goal during a pandemic was to keep patients from seeking unnecessary in-person care from emergency departments and urgent care clinics, especially when dental practices were closed or limited to providing essential urgent and emergency oral health care. Methods The Adams School of Dentistry, University of North Carolina at Chapel Hill, developed the Carolina Dentistry Virtual Oral Health Care Helpline using a quality improvement framework with faculty and staff member feedback. The process included establishing infrastructure (phone, video, protocols, referrals, documentation), personnel (scheduling, training, calibration), and internal and external communication. The authors collected retrospective information for descriptive evaluation of the first month’s operations. Results There were 337 telephone calls answered, of which 65 (19%) were administrative and 272 (81%) were related to dental concerns. Dental pain (54%) was the most prevalent reason for calling. Triage and Providers referred 107 of 175 callers (61%) to the school’s urgent care center. Of the 79 callers who received teleconsultations from virtual providers, 33 (42%) did not require additional follow-up, and 7 (9%) needed a follow-up phone call. Overall, 4 people were referred to community clinics, and 4 were referred to the emergency department. Conclusions The Helpline was launched quickly and improved through quality improvement cycles, and it provided a needed community dental service. The process resolved some patient concerns without their seeking urgent or emergency care. Practical Implications The pandemic has increased teledentistry practice. The authors describe establishing a dental school’s virtual oral health Helpline, which provides a framework for dental practices seeking to use this patient communication modality.

A general dentist referred a 69-year-old woman to an otolaryngologist for evaluation and management of multiple painful oral ulcerations that had been present for seven months. The patient’s symptoms began with mild but increasing burning of the oral cavity, which developed into discrete ulcerations of the tongue and buccal mucosa. The otolaryngologist performed a tongue biopsy. According to the patient, the biopsy results were benign and she was treated with systemic antiviral therapy without relief. She was referred to another otolaryngologist at the quaternary care medical center, Medical College of Georgia, Augusta, where she received prescriptions for both an antifungal and an anesthetic mouthrinse, with minimal resolution of the lesions. The otolaryngologist then referred her to our office for evaluation by one of us (S.S.D.). The patient’s medical history was significant for hypertension and severe asthma. She was treated with antihypertensive medications including enalapril and furosemide, systemic prednisone (7.5 milligrams per day) and both corticosteroid and β-agonist inhalers in combination with montelukast, a leukotriene inhibitor. She had been admitted to the hospital several times because of her asthma, with the most recent hospitalization 18 months before her initial evaluation in our office. The review of systems was significant only for pulmonary symptoms related to asthma (that is, shortness of breath, coughing, wheezing) and her complaint of oral sores. The clinical examination revealed no cervical lymphadenopathy, no lesions on exposed skin and no conjunctival erythema. An oral soft-tissue examination revealed a 1-centimeter, ovoid, shal low ulceration on the left buccal mucosa, areas of which were surrounded by erythema and white keratosis. The patient’s tongue was papillated normally, and an irregularly shaped deep ulceration with indurated and hyperplastic margins was located on the middorsum (Figures 1 and 2).