General health screening as part of a periodontal examination

Figures & data

Table 1. The major risk factors for cardiovascular disease as defined in the Framingham heart study 13 14

Major independent risk factors for cardiovascular disease
Cigarette smoking
Elevated blood pressure
Elevated serum cholesterol
Elevated serum LDL-cholesterol
Low serum HDL-cholesterol
Diabetes mellitus
Advancing age

Table 2. The conditional and predisposing risk factors for cardiovascular disease as defined Grundy et al. 13

Predisposing risk factors	Conditional risk factors
Obesity	Elevated serum triglycerides
Abdominal obesity	Small LDL particles
Physical inactivity	Elevated serum homocysteine
Family history of premature CHD	Elevated serum lipoprotein (a)
Ethnic characteristics	Prothrombotic factors (e.g. fibrinogen)
Psychosocial factors	Inflammatory markers (e.g. C-reactive protein)

Table 3. Emerging risk factors for CHD as reviewed by Helfand et al. 15

Risk factor	Strength of evidence
C-reactive protein level	Good
Coronary artery calcium score	Fair
Lipoprotein (a) level	Fair
Homocysteine level	Fair
Leukocyte count	Fair
Fasting glucose concentration	Fair
Periodontal disease	Fair
Ankle-brachial index	Poor
Carotid intima-media thickness	Poor

Table 4. The classification of diabetes by the American Diabetes Association 27 63

Type of diabetes	Characteristics
Type 1 diabetes	Results from -cell destruction
	Usually leads to absolute insulin deficiency
	Accounts for 5–10% of people with diabetes
Type 2 diabetes	Results from progressive insulin secretory defect on the background of insulin resistance
	Accounts for approximately 90–95% of people with diabetes
Other types of diabetes	Due to other causes e.g. genetic defects, endocrinopathies, and drug- or chemical-induced
Gestational diabetes mellitus (GDM)	Diabetes diagnosed during pregnancy
	Complicates approximately 4% of pregnancies in the USA

Table 5. American Diabetes Association: criteria for testing asymptomatic adults younger than 45 years who are overweight 63

Additional risk factors
Physical inactivity
First-degree relative with diabetes
Members of high-risk ethnic populations
Women who delivered a baby weighing >9 lb or were diagnosed with GDM
Hypertension (≥140/90 mmHg or on therapy for hypertension)
HDL-C level <35 mg/dl and/or triglyceride level >250 mg/dl
Women with polycystic ovarian syndrome
People with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on prior test result
Other clinical conditions associated with insulin resistance
History of CVD

Table 6. Screening for risk of type 2 diabetes – recommendations from the International Diabetes Federation 31

Risk factor
Age	≥45 years
Obesity
Most easily measured by waist circumference with cut points that are gender and ethnic group specific. Example is for Europid adults	Male ≥94 cm Female ≥80 cm
Family history
Immediate family member or other relatives diagnosed with diabetes
Cardiovascular history
History of raised blood pressure and/or heart disease
Gestational history
Previous occurrence of gestational diabetes
Drug history
Use of drugs that predispose to type 2 diabetes	Nicotinic acid
	Gucocorticoids
	Thyroid hormone
	Beta-adrenergic antagonists
	Thiazides
	Dilantin
	Pentamidine
	Antipsychotic agents
	Interferon-alpha therapy

Table 7. A summary of the 5 As for smoking cessation from the smoking cessation guidelines for Australian general practice found at Quit Now http://www.quitnow.info.au/internet/quitnow/publishing.nsf/Content/home 51

The 5 As
Ask	Do you smoke?
	Have you ever smoked?
Assess	How do you feel about your smoking at the moment?
	Are you ready to stop smoking now?
Advise	While I respect that it is your decision, I strongly suggest you stop smoking.
Assist	Minimal intervention is to provide written information on smoking cessation and offer referral.
	Affirm decisions to quit, offer encouragement to quit, and congratulate recent smoking cessation.
Arrange follow-up	Monitor progress, congratulate and affirm decision to quit, review progress, and encourage use of support services.

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