Dr. Stuart M. Hirsch leads team to study prevalence of periodontal disease in diabetic patients.
Dr. Stuart M. Hirsch, Vice Dean of International Initiatives, Development & Students at the New York University (NYU) College of Dentistry, first visited Ghana approximately five years ago. NYU had students studying in Ghana, and was looking for joint opportunities with the University of Ghana to expand its presence.
Dr. Hirsch and the NYU team — Rachel Hill, Dr. Peter Loomer and Hannah Coakley — and the doctors and staff at the Korle-Bu Teaching Hospital and Dental School were interested in finding out the prevalence of periodontal disease in diabetic patients at the hospital. Type II diabetes is increasing around the world and there is mounting data that suggests an oral-systemic link.
“We wanted to find out the prevalence of periodontal disease in diabetic patients. Previously, we’d conducted a qualitative analysis of periodontal health and diabetes, assessing the knowledge base people have; what they know about diabetes and what they’re doing about it,” Dr. Hirsch explained. “In putting together this new quantitative study, we hope to lay the groundwork for implementation on how to better control periodontal disease in developing countries or impoverished areas. This is a very big deal, as access to care in these environments is limited.”
What does limited mean, in real terms? Consider first, that in the United States, the ratio of patients to dentists is 2,500 to 1. In the developing world, that number is as high as 180,000 to 1. The hardship is great, as is the need for realistic solutions.
This study in Ghana looks at a 220-person patient group. Each individual had a health history taken, as well as Hemoglobin A1c (HbA1c) measurement and a panoramic radiograph to assess the percentage of bone loss around individual’s teeth.
“HbA1c is a way to measure sugar glucose in the blood; the goal for people with diabetes is a level less than 7%, but we saw were as high as 13%,” Dr. Hirsch shared. “We worked with a diabetes clinic in Accra — Ghana’s capital. We would take the HbA1c measurements right before the panoramic digital pan. This is where the OP200D panoramic imaging system provided by Instrumentarium DentalTM was essential. In my opinion, without this equipment to tell us the bone levels, this prevalence study would not have occurred. In my experience, bone levels are
important because they never improve, only worsen. My team can use these acquired images and through our analysis and experience, we can determine the extent of periodontal disease for such a patient population.”
Barbara Nordquist, the VP for Academic Sales & Professional Relations at KaVo Kerr Group, was instrumental in making the donation possible, in coordination with Brian Broncatti, Senior Regional Sales Manager for Instrumentarium. Having worked with Nordquist for a number of years, and recently at NYU on choosing Pelton & CraneTM equipment for a clinic renovation, Dr. Hirsch turned to her for help on the Ghana project.
In addition to providing the necessary imaging equipment, KaVo Kerr Group provided on-site training for the team in Ghana, facilitated by David Bangert, VP/GM of Special Markets for KaVo Kerr Group, who traveled to the country himself. In addition to setting up the team for success, he made himself available for ongoing support during the study.
“Our partnership with KaVo Kerr Group is an example of how educators and the dental industry need one another. There is — or there needs to be — a relationship in order to move forward ideas and desires on both ends,” Dr. Hirsch shared. “We cannot exist in isolation.”
At this point, the data collection in Ghana is complete. Dr. Hirsch intends to have a small group of post-doctoral students help analyze the data — primarily reading the digital panoramic radiographs — with a targeted completion date of Fall 2015. Dr. Hirsch believes that there will be strong correlations between diabetes and periodontal disease, demonstrated by loss of bone as well as soft tissue.
With that analysis in hand, the real work can begin.
“Hopefully, what we get from this is data to support firm decisions on how to best implement preventive care since we can’t offer surgical care in these areas,” Dr. Hirsch said. “This is a very difficult thing. Even patients in a private office struggle to brush and floss consistently; how much more so, then, in areas like Ghana?”
This is why the dual work of helping patients understand the connections between diabetes and periodontal disease is the first phase; it can help create the motivation necessary for preventive care. The second is to figure out what simple, sustainable, preventive care measures can be employed.
“We’re not sure what those tools are yet, but assuming the prevalence is what we think it will be, that is the crucial next step,” Dr. Hirsch proposed. “And once our work is finished in Ghana, we will try to connect what we learn there with the issues we face here at home.”