During initial dental visits, patients routinely complete a medical history questionnaire. Yet a new study reveals that striking inconsistencies exist between patients' self-reported medical history and their actual health status, as determined by laboratory testing.

In the October issue of the Journal of Periodontology (www.perio.org/journal/journal.html), researchers from the University of Missouri at Kansas City School of Dentistry report that many dental patients have no idea that they have undiagnosed and uncontrolled health problems, including cardiovascular disease and diabetes, both of which can affect oral health.

The study compared patients' self-reported medical histories to the results of a laboratory work-up that included a urinalysis, complete blood count and a blood chemistry panel. None of the patients reported having diabetes, but 15 percent tested positive for the disease; only 5 percent of the participants reported having high cholesterol, while 56

"I expected there would be differences, but I was surprised at the degree of discrepancy," said Dr. Charles Cobb, professor of periodontics and co-author of the study. "It is surprising that people know so little about their own health."

The authors explained that the findings were alarming from a practitioner's point of view because uncontrolled medical conditions can have a profound impact on oral health and can affect treatment procedures and outcomes.

"We now know there is a strong relationship between disease and periodontal conditions," explained Dr. Milton Pallat, a periodontist at New York University Kriser Dental Center, New York City. "Diabetics have a difficult time healing from insults to their body, and periodontal disease is an infection."

Periodontal disease and diabetes influence each other. Diabetics are more likely to develop periodontal disease, and having periodontal disease, in turn, makes it more difficult for people with diabetes to control their blood sugar. disease and periodontal disease. People with periodontal disease are at greater risk for heart disease and are twice as likely to have a fatal heart attack than patients without periodontal disease, according to the American Academy of Periodontology (www.perio.org).

Dr. Cobb said that clinicians need to be rigorous in their questioning of patients. He suggested that dentists follow up the written medical history questionnaire with a verbal interview paying special attention to diabetes, cholesterol, heart disease and date of last physician visit.

"A surprising number of people don't see a doctor regularly," explained Dr. Cobb. "Also, many people, particularly the elderly, may be taking multiple medications for a variety of physical ailments, and may not remember what they are taking or why."

The authors emphasized the need for collaboration between dentists and physicians. They concluded that dentists as well as all other health care providers need to emphasize the importance of routine physical examinations to patients.

Journal of Periodontics (1999;70:1153-1157)