摘要：Objectives. We measured and contrasted general dentists’ and periodontists’ involvement in 3 areas of managing diabetic patients—assessment of health status, discussion of pertinent issues, and active management of patients—and identified and contrasted predictors of active management of diabetic patients. Methods. We conducted a cross-sectional mail survey of random samples of general dentists and periodontists in the northeastern United States during fall 2002, using lists from the 2001 American Dental Directory and the 2002 American Academy of Periodontology Directory. Responses were received from 105 of 132 eligible general dentists (response rate=80%) and from 103 of 142 eligible periodontists (response rate=73%). Results. Confidence, involvement with colleagues and medical experts, and professional responsibility were influential predictors of active management for periodontists ( R 2=0.46, P <.001). Variables pertaining to patient relations were significant predictors for general dentists ( R 2=0.55, P <.001). Conclusions. Our findings permitted us to assess and compare general dentists’ and periodontists’ behavior in 3 realms—assessment of diabetic patients’ health status, discussion of pertinent issues, and active management of diabetic patients—and to identify components of potentially effective targeted interventions aimed at increasing specialists’ and generalist dentists’ involvement in the active management of diabetic patients. National survey data have documented that diabetes is a major health problem in both men and women and in all races and ethnic groups in the United States and that its prevalence increases with age. 1 – 5 It is also well established that patients with diabetes are more likely to develop periodontal diseases (inflammatory disorders affecting the supporting structures of the teeth) than are nondiabetic individuals. 6 In 1993, Loe called periodontitis “the sixth complication of diabetes mellitus.” 7 (p329) As both the life expectancy of the US population and the prevalence of diabetes continue to rise, it is expected that dental practitioners will be seeing and treating greater numbers of diabetic patients with periodontal complications. Diabetes is a risk factor for periodontal diseases, 8 , 9 and dentists can help reduce this risk by assessing, advising, and closely monitoring the diabetic patient. 10 , 11 Through such office-based activities, dentists assume functions characteristic of primary and preventive health care clinicians. We think of this expanded role as having 3 phases of involvement: assessment, discussion, and active management. Assessment constitutes dentists’ asking the diabetic patient about the type and severity of disease (regimen used to control blood glucose, duration of disease, and presence of any complications). Discussion represents their communication with the patient (about importance of tight blood glucose control, association of diabetes with oral health, and, conversely, association of dental treatment with blood glucose control). Active management reflects actions taken to ameliorate the diabetic patient’s oral health care (monitoring blood glucose level, communicating with the patient’s physician, adjusting the frequency of dental visits). In this study, we (1) measured general dentists’ and periodontists’ performance within these 3 facets of managing the diabetic patient, (2) examined the association between being a high performer in 1 area and high performance in other areas, and (3) investigated the extent to which attitudes and orientations suggested by theories of behavioral change, especially the Theory of Planned Behavior, 12 , 13 predict general dentists’ and periodontists’ active management of the diabetic patient. By including general dentists—approximately 80% of all dental practitioners—we cast the broadest possible net in terms of access to oral health care. 14 By including periodontists, we examined dental specialists whose postgraduate training emphasized the dental and medical management of patients with periodontal disease, including those with diabetes.
