factorial intervention...it is clear that optimal diabetes cal settings adjunctive to hospitals have been very suc-
management requires an organized, systematic approach cessful, ^32-34 leading some to speculate that if standards of
and involvement of a coordinated team of healthcare pro- medical care in diabetes “are to be achieved, then such
fessionals.” ² Optimal diabetes management also requires proven methods of delivery care must be adopted.” ³⁴
a commitment by both dental and medical providers. For
large scale change in the delivery of diabetes care to take For large-scale population-based intervention strate-
place, there are certain things that are a prerequisite, gies, the goal should be to develop highly-coordinated
most importantly the factors necessary for dental and and well-trained provider teams that function as case-
medical providers to become involved in health promo- management teams to provide transdisciplinary care to
tion and risk reduction of diabetes: diabetic patients. These teams could include nurses and
dental hygienists along with other allied healthcare pro-

1. Adequate recognition that the role obesity, and other viders, such as diabetes educators, nutritionists, exercise inflammatory conditions such as periodontal disease, physiologists, sports medicine professionals, pharmacists, may have in amplifying the risk for diabetes and social workers, (among others). Such teams also could 2. A willingness to provide intervention function as delegations of educators by presenting panel 3. Adequate skills and resources to do so. discussions on prevention and treatment of diabetes and periodontal disease. Target audiences could include citi-

Most troubling is the speculation that this level of com- zen groups, PTAs, self-help/support groups, pre-kinder-
mitment may be lacking among dental providers. ³⁰ If garten, elementary, middle, high schools, colleges and
statistics from smoking cessation interventions by dental universities, hospitals, specialty care facilities, churches,
practitioners can be considered a measure of provider nonprofit groups involved with health and human wel-
willingness to offer health promotion and risk reduc- fare, chambers of commerce, Rotary clubs, and the like.
tion interventions for diabetes, it appears that dentists’ The same teams also could function as “swat teams” for
and dental hygienists’ willingness to provide interven- conducting large-scale screenings for diabetes and peri-
tions may be wanting. ³⁰ National surveys suggest that odontal disease at malls, transportation hubs, grocery
only 30-50% of U.S. dentists and 25% of dental hygien- stores, and community fairs. For an excellent template
ists ask patients about smoking, and smoking cessation for organizing community-based initiatives that target
advice provided in dental offices has been described as obesity, readers should contact the National Heart, Lung,
“rather ad hoc and somewhat superficial.” ³⁰ Fewer than and Blood Institute to request We Can! Ways to Enhance
20% of dentists used a system to identify patients who Children’s Activity and Nutrition; Energize our Commu-
smoked, and fewer than 5% provided follow-up services nity: Toolkit for Action, online at http://emall.nhlbihin.net
to help patients quit. ³⁰ One study concluded that among or by phoning (301) 592-8573.
physicians, dentists, mental health counselors, and so-
cial workers, cessation interventions by dental provid- These kinds of intervention strategies take root in health-
ers ranked lowest in terms of both quantity and quality. ³⁰ care communites where the philosophy of care is ground-
Lack of training and incentives were most often cited to ed in wellness over repair. Putting this collaborative
explain the reluctance of dentists and hygienists to pro- model of care into practice will require “thought leaders”
vide tobacco-cessation interventions. ³⁰ If these findings in dentistry and medicine who are willing to collaborate,
hold true for dental practitioners’ willingness to provide and develop a plan for transdisciplinary team training,
diabetes intervention, dentistry’s impact on the pandemic and assign responsibility for coordination. As momentum
of diabetes will be disappointingly small. builds, other healthcare professionals will become will-
ing partners. Teams can expand their reach by enlisting

Rather than adding additional interventions to the work- media support of local newspaper columnists, extending load of already overwhelmed medical providers, there invitations to media representatives to cover an event are complementary roles and aspects of prevention and such as a diabetes and periodontal disease screening day treatment that can be delegated to other healthcare pro- at a mall, or through interviews and discussions on local fessionals. Preventive care increasingly is being delivered talk radio. Another valuable collaborative opportunity is by non-physician and non-dentist clinicians. ³¹ In fact, to partner with state or local professional organizations, nurse-led interventions to treat conditions such as dia- e.g., associations of nurses, diabetes educators, dental betes-related hypertension and hyperlipidemia in clini- hygienists, and dieticians.