Aim: To investigate associations between periodontitis and chronic obstructive pulmonary disease (COPD) with and without alpha‐1 antitrypsin deficiency (AATD), including neutrophil functions implicated in tissue damage.Methods: The presence and severity of periodontitis (using two international criteria) and lung disease were assessed in 156 COPD patients with and without AATD accounting for common confounding factors. Saliva and systemic inflammatory markers were measured by ELISA together with neutrophil migration.Results: COPD and AATD patients exhibited higher prevalence of periodontitis (COPD 95%; AATD 88%) than reported in unselected community‐dwelling populations even when risk factors (age, smoking history, socio‐economic status and dental habits) were considered. Periodontitis severity associated with lung disease severity (AATD, periodontitis versus no periodontitis; FEV1 = 56% versus 99% predicted; TLCO = 59% versus 81% predicted, p < .0001 for both). Neutrophil migratory accuracy declined in stage II–IV periodontitis patients with COPD or AATD compared to COPD or AATD with no or stage I periodontitis. Improved dental habits appeared to be associated with a reduction in exacerbation frequency in COPD.Conclusion: The results support shared pathophysiology between periodontitis and COPD, especially when associated with AATD. This may reflect an amplification of neutrophilic inflammation and altered neutrophil functions, already described in periodontitis, COPD and AATD.

Aim: Type 2 diabetes is a growing global challenge. Evidence exists demonstrating the use of primary care (non‐hospital based) dental practices to identify, through risk assessments, those who may be at increased risk of type 2 diabetes or who may already unknowingly have the condition. This review aimed to synthesize evidence associated with the use of primary care dental services for the identification of undiagnosed non‐diabetic hyperglycaemia or type 2 diabetes in adults, with particular focus on the pick‐up rate of new cases.Method: Electronic databases were searched for studies reporting the identification of non‐diabetic hyperglycaemia/type 2 diabetes in primary care dental settings. Returned articles were screened and two independent reviewers completed the data‐extraction process. A descriptive synthesis of the included articles was undertaken due to the heterogeneity of the literature returned.Results: Nine studies were identified, the majority of which utilized a two‐stage risk‐assessment process with risk score followed by a point‐of‐care capillary blood test. The main barriers cited were cost, lack of adequate insurance cover and people having previously been tested elsewhere. The pick‐up rate of new cases of type 2 diabetes and non‐diabetic hyperglycaemia varied greatly between studies, ranging from 1.7% to 24% for type 2 diabetes and from 23% to 45% for non‐diabetic hyperglycaemia, where reported.Conclusion: This review demonstrates that although it appears there may be benefit in using the dental workforce to identify undiagnosed cases of non‐diabetic hyperglycaemia and type 2 diabetes, further high‐quality research in the field is required assessing both the clinical and cost effectiveness of such practice. (Prospero Registration ID: PROSPERO 2018 CRD42018098750).

Objective Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals. Design Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively. Setting Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey. Participants 1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires. Outcome measures The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored. Results 12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions. Conclusions This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.

Purpose of Review: Type 2 diabetes (T2DM) presents a growing global health and economic burden. Dental settings have been employed to identify individuals who may be at high risk of diabetes, who exhibit non-diabetic hyperglycaemia (NDH – also termed “prediabetes”) and who already unknowingly have the condition, through the use of targeted risk-assessments. This review aims to synthesize the existing literature supporting dental teams’ identification of individuals at an increased risk of or suffering from undiagnosed NDH or T2DM in dental specialist care settings. Recent Findings: Electronic databases were searched for studies reporting the identification of NDH and or T2DM, in specialist care dental settings. Screening of returned articles and data extraction were completed by two independent reviewers (RJ, ZY). A descriptive synthesis of the included articles was undertaken. Due to heterogeneity of the literature, a meta-analysis could not be performed. The search yielded 52 eligible studies, of which 12 focused primarily on stakeholder opinions. Opinions of patients, dentists, dental hygienists, dental students and physicians on case identification of T2DM by oral health professionals were generally positive. The main barriers cited were time, cost, inadequate training and low follow-up of participants by primary care physicians. The risk assessment processes varied, with most studies using a combination of methods consisting of a questionnaire followed by a chairside blood sample. Methods utilizing questionnaires, gingival crevicular blood (GCB), fingerstick blood (FSB) and urine samples have all been evaluated. Summary: This review demonstrates that there may be benefit in engaging the dental workforce to identify cases of NDH and undiagnosed T2DM and that such a care pathway has the support of multiple stakeholders. Further high-quality research is required to assess both the clinical and cost-effectiveness of such practice in order to optimize protocols and patient care pathways. Studies should include a comparison of methods, health economic analyses and protocols to ensure those identified as high-risk go on to receive appropriate follow-up care.

Gingivitis is an extremely common oral inflammatory condition and can be induced in humans using an acute 21-day experimental gingivitis model. Neutrophils are known to be highly prevalent in the gingival crevice during gingival inflammation; however, the effect of gingivitis and the associated biofilm on peripheral blood neutrophils (PBN) is not well characterised. Thus, the aim of this study was to examine the impact of inflammation induced by experimental gingivitis and its resolution upon the function of PBN. Fifteen systemically healthy volunteers undertook a split-mouth 21-day experimental gingivitis study followed by a resolution phase of 14 days. PBN function, including reactive oxygen species (ROS) production, neutrophil extracellular trap (NET) release, directional chemotactic accuracy and expression of host mediators in gingival crevicular fluid (GCF), were measured at baseline (day 0), on day 21 and on day 35. NET formation and ROS production were significantly elevated at day 21. Chemotactic speed was also elevated in response to bacterial peptide fMLP at day 21. At day 35, ROS production in response to an Fcgamma stimulant, opsonised Staphylococcus aureus, remained elevated. The data presented suggest a lasting biological impact of the experimental gingivitis on PBN function even after clinical symptoms have abated.