Dentists' attitudes towards chairside medical conditions screening in a dental setting in Saudi Arabia: an exploratory cross-sectional Study.

BACKGROUND: Screening for medical conditions (MCs) of public health importance is a first step in disease prevention and control. Prior studies in the United States found oral health care providers (OHCPS) embrace screening for increased risk of medical conditions in the dental setting. Our objectives were to assess Saudi Arabian (SA) dentist's attitudes, willingness and perceived barriers towards implementing screening for MCs into their dental practices. METHODS: A self-administered, 5-point Likert Scale (1 = very important/willing to 5 = very unimportant/unwilling) questionnaire was given to a convenience sample of 190 practicing dentists. Friedman nonparametric analysis of variance was used to compare responses within each question. RESULTS: Of the 143 responding dentists the mean age was 31 years; 102 (71%) were men. The majority felt it was important for a dentist to screen for cardiovascular disease (98.6%), hypertension (97.9%), diabetes (97.9%), human immunodeficiency virus (HIV) (97.9%), and hepatitis C virus (98.6%). Respondents were willing to refer a patient to a physician (97.9%); send samples to an outside laboratory (96.1%); conduct screening that yields immediate results (96.2%); and discuss results immediately with the patient (93.7%). Respondents were willing to measure/collect blood pressure (67.2%); weight and height (63.7%); and finger stick blood (54.6%). The whole responding dentists (100%) reported time as an important barrier. Respondents were significantly more willing to refer a patient for consultation than send samples to an outside laboratory (mean ranks: 2.32, 2.81, P < 0.001); significantly more willing to measure blood pressure than take oral fluids for salivary diagnostics (mean ranks 2.22, 2.75, p = 0.003). Insurance was significantly (P < 0.05) less important barrier than time, cost, patients' willingness or liability (mean ranks 3.56, 2.63, 3.00, 2.79, 3.02, respectively). CONCLUSIONS: The majority of dentists in this study reported positive attitudes towards and willingness to perform medical screenings in their practice. Time was an important factor.

Indian patients' attitudes towards chairside screening in a dental setting for medical conditions.

BACKGROUND: India has a high prevalence of cardiovascular disease (CVD), diabetes mellitus (DM), tuberculosis (TB), human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and hepatitis B. United States-based studies indicate provider and patient support for medical screening in the dental setting. We assessed patient attitudes towards, and willingness to participate in, medical screening in the dental setting in India. METHOD: A 5-point Likert scale survey (with scores ranging from 1=very important/willing to 5=very unimportant/unwilling) was given to a convenience sample of adult patients visiting five university-based dental clinics (clinic group) and one private-practice setting (private group). The Mann-Whitney U-test was used to compare mean response scores between patient groups. Logistic regression was used to assess factors associated with a favourable outcome. RESULTS: Both patient groups felt it important for dentists to identify increased risk for medical conditions (89.3% vs. 94.9%, respectively; P=0.02). The majority of patients were willing to have a dentist screen for the specified conditions: CVD (80.6% clinic and 84.5% private); DM (84.5% clinic and 77.5% private); TB (76.7% clinic and 73.2% private); hepatitis (73.3% clinic and 67.5% private); and HIV/AIDS (71.0% clinic and 70.5% private). The majority of patients were willing to participate in chairside screening that yielded immediate results (84.6% clinic and 86.1% private), discuss results immediately (85.8% clinic and 87.2% private) and pay 150 Indian rupees (55.9% clinic and 91.7% private). Younger patients (<40 years of age) were significantly less likely to respond favourably to: importance of medical screening in dental settings [adjusted odds ratio (OR)=0.63; 95% confidence interval (95% CI): 0.26-0.84] and be available for screening that yielded immediate results (adjusted OR=0.63; 95% CI: 0.40-0.99). CONCLUSIONS: Indian dental patients were in favour of chairside medical screening.

The effect of chairside chronic disease screenings by oral health professionals on health care costs.

OBJECTIVES: We estimated short-term health care cost savings that would result from oral health professionals performing chronic disease screenings. METHODS: We used population data, estimates of chronic disease prevalence, and rates of medication adherence from the literature to estimate cost savings that would result from screening individuals aged 40 years and older who have seen a dentist but not a physician in the last 12 months. We estimated 1-year savings if patients identified during screening in a dental setting were referred to a physician, completed their referral, and started pharmacological treatment. RESULTS: We estimated that medical screenings for diabetes, hypertension, and hypercholesterolemia in dental offices could save the health care system from $42.4 million ($13.51 per person screened) to $102.6 million ($32.72 per person screened) over 1 year, dependent on the rate of referral completion from the dental clinic to the physician's office. CONCLUSIONS: Oral health professionals can potentially play a bigger role in detecting chronic disease in the US population. Additional prevention and monitoring activities over the long term could achieve even greater savings and health benefits.

Dentists' willingness to provide expanded HIV screening in oral health care settings: results from a nationally representative survey.

OBJECTIVES: Using a nationally representative survey, we determined dentists' willingness to provide oral rapid HIV screening in the oral health care setting. METHODS: From November 2010 through November 2011, a nationally representative survey of general dentists (sampling frame obtained from American Dental Association Survey Center) examined barriers and facilitators to offering oral HIV rapid testing (n = 1802; 70.7% response). Multiple logistic regression analysis examined dentists' willingness to conduct this screening and perceived compatibility with their professional role. RESULTS: Agreement with the importance of annual testing for high-risk persons and familiarity with the Centers for Disease Control and Prevention's recommendations regarding routine HIV testing were positively associated with willingness to conduct such screening. Respondents' agreement with patients' acceptance of HIV testing and colleagues' improved perception of them were also positively associated with willingness. CONCLUSIONS: Oral HIV rapid testing is potentially well suited to the dental setting. Although our analysis identified many predictors of dentists' willingness to offer screening, there are many barriers, including dentists' perceptions of patients' acceptance, that must be addressed before such screening is likely to be widely implemented.

Patients' attitudes toward screening for medical conditions in a dental setting.

OBJECTIVES: Previous studies demonstrated the efficacy of chairside medical screening by dentists to identify patients who are at increased risk for developing cardiovascular-associated events and the favorable attitude of dentists toward chairside medical screening. This study assessed patient attitudes toward chairside medical screening in a dental setting. METHODS: A self-administered questionnaire of eight five-point response scale questions was given to a convenience sample of adult patients attending an inner-city dental school clinic and two private practice settings. Wilcoxon-Mann-Whitney tests and t-tests were used to compare responses between study groups. Friedman nonparametric analysis of variance was used to compare response items within each question. RESULTS: Regardless of setting, the majority of respondents was willing to have a dentist conduct screening for heart disease, high blood pressure, diabetes, human immunodeficiency virus infection, and hepatitis infection (55-90 percent); discuss results immediately (79 percent and 89 percent); provide oral fluids, finger-stick blood, blood pressure measurements, and height and weight (60-94 percent); and pay up to $20 (50-67 percent). Respondents reported that their opinion of the dentist would improve regarding the dentist's professionalism, knowledge, competence, and compassion (48-77 percent). The fact that the test was not done by a physician was ranked as the least important potential barrier. While all respondents expressed a favorable attitude toward chairside screening, the mean score was significantly lower among clinic patients across most questions/items. The priority rankings within an item were similar for both groups. CONCLUSIONS: Acceptance by patients of chairside medical screening in a dental setting is a critical element for successful implementation of this strategy.

Intermaxillary tooth-size discrepancies in different sexes, malocclusion groups, and ethnicities.

INTRODUCTION: To achieve proper occlusion, practitioners must consider tooth-size discrepancies between the jaws. Previous studies have shown considerable differences in tooth sizes between sexes, ethnicities, and malocclusion categories. The aim of this study was to compare mean tooth-size statistics between these groups, specifically determining a maxillary or a mandibular excess tooth-size discrepancy in clinically relevant cases. METHODS: This study involved 306 subjects of varying sex, ethnicity, and malocclusion category, randomly chosen from the treatment population of the orthodontic clinic at the New Jersey Dental School, University of Medicine and Dentistry of New Jersey. The prevalence of discrepancies (±1 and 2 SD) between all groups and within groups was measured. RESULTS: Fifty percent of the subjects had anterior Bolton tooth-size discrepancies, and 41% had overall Bolton tooth-size discrepancies of ±1 SD. Tooth-size ratios compared with analysis of variance (ANOVA) showed no significant correlation between and among the sexes, ethnicities, and malocclusion groups. Compared with Caucasian and Hispanic patients, African-American patients had significantly greater odds of having a clinically significant (±2 SD) anterior ratio. When we compared the numbers of subjects above or below the clinically significant ratio, there was equal distribution of maxillary and mandibular excess in Class II and Class III patients. Caucasian and African-American patients had equal distributions of maxillary and mandibular excess, whereas Hispanic patients displayed a higher bias toward mandibular excess. CONCLUSIONS: Tooth-size discrepancies are common in orthodontic populations and are evenly distributed among sex, ethnicity, and malocclusion category, with some exceptions.

An improved cost-effective, reproducible method for evaluation of bone loss in a rodent model.

AIM: This study was designed to investigate the utility of two "new" definitions for assessment of bone loss in a rodent model of periodontitis. MATERIAL AND METHODS: Eighteen rats were divided into three groups. Group 1 was infected by Aggregatibacter actinomycetemcomitans (Aa), group 2 was infected with an Aa leukotoxin knock-out, and group 3 received no Aa (controls). Microbial sampling and antibody titres were determined. Initially, two examiners measured the distance from the cemento-enamel-junction to alveolar bone crest using the three following methods; (1) total area of bone loss by radiograph, (2) linear bone loss by radiograph, (3) a direct visual measurement (DVM) of horizontal bone loss. Two "new" definitions were adopted; (1) any site in infected animals showing bone loss >2 standard deviations above the mean seen at that site in control animals was recorded as bone loss, (2) any animal with two or more sites in any quadrant affected by bone loss was considered as diseased. RESULTS: Using the "new" definitions both evaluators independently found that infected animals had significantly more disease than controls (DVM system; p<0.05). CONCLUSIONS: The DVM method provides a simple, cost effective, and reproducible method for studying periodontal disease in rodents.

The clinician's guide to the literature: interpreting results.

BACKGROUND: Oral health care professionals must have up-to-date information to guide clinical practice. The peer-reviewed literature contains the most reliable and current information. The clinical research literature relies on statistical analysis of data to make inferences and draw conclusions. In this article, the authors explore the fundamental principles that underlie statistical testing. CONCLUSIONS AND PRACTICE IMPLICATIONS: Having the fundamental tools to critically interpret the results presented in the literature is one of the essential elements for appropriately translating clinical research into practice.

Dental case management: increasing access to oral health care for families and children with low incomes.

BACKGROUND: Medicaid beneficiaries have lower rates of dental visits and higher rates of dental disease compared with the rest of the population. Beneficiaries ascribe their low use of services to difficulties finding dentists who treat patients with Medicaid. Dentists cite low reimbursement rates, excessive paperwork, and patients' not keeping appointments and poor oral health literacy as reasons for not accepting patients with Medicaid. The authors pilot-tested the effectiveness of a dental case management program (DCMP) in increasing dentists' participation in Medicaid and Medicaid beneficiaries' use of services. METHODS: A dental case manager recruits dentists to participate in the Medicaid program, arranges training in billing procedures, resolves billing and payment problems, educates clients about the use of dental services and keeping appointments, links clients to dental offices, identifies potential barriers to care and helps clients obtain transportation to appointments. The authors evaluated the levels of participation of dentists in the DCMP in Medicaid and Medicaid beneficiaries' use of services. RESULTS: Dentists accepting new Medicaid patients increased from two to 28, with 145 dental visits a month provided to Medicaid beneficiaries. The percentage of Medicaid beneficiaries receiving dental services increased from 9 to 41 percent after the DCMP was implemented. CONCLUSIONS: The authors found that the DCMP was effective in increasing Medicaid beneficiaries' use of services, increasing dentists' participation in Medicaid, minimizing administrative burdens related to Medicaid participation, and increasing oral health literacy and treatment compliance among clients with low incomes.

Providing Health Screenings in a Dental Setting to Enhance Overall Health Outcomes.

Data suggest that providers and patients have a favorable attitude toward chairside screening in the dental setting and are willing to participate in these activities. Likewise, efficacy studies indicate this strategy can effectively identify patients who are at increased risk of disease or have the presence of disease risk factors and could benefit from medical follow-up. Studies suggest it is feasible to conduct these screenings in the dental setting. Although the American Dental Association has established screening treatment codes, challenges to widespread implementation still exist, including developing a provider reimbursement strategy and the need for adequate provider training.

Comorbidities in older patients with HIV: a retrospective study.

BACKGROUND: The number of older adults with HIV is increasing. The authors conducted a retrospective study to determine the prevalence of selected comorbidities that may affect the delivery of oral health care to this population. METHODS: The authors reviewed the charts of 162 patients with HIV who were 50 years or older who had sought dental treatment from 2000 through 2006. The authors abstracted patients' self-reported clinical comorbidities and laboratory-verified HIV-related and hematologic values. RESULTS: A total of 88.8 percent of the study subjects had at least one comorbidity. Comorbidity prevalence was 44.4 percent for hepatitis C virus, 41.4 percent for hypertension, 16.7 percent for psychiatric disorders, 16.1 percent for chronic obstructive pulmonary disease, 15.4 percent for anemia and 14.8 percent for heart disease. Significantly more subjects with a CD4+ cell count of less than 200 per cubic millimeter were anemic compared with subjects with counts of 200/mm(3) or more. CONCLUSIONS: HIV-positive patients 50 years or older have a broad range of comorbidities that may affect the provision of oral health care. CLINICAL IMPLICATIONS: Whether these patients have clinically severe or less well-controlled comorbidities that may require modification of oral health care treatment remains to be determined.

Screening for cardiovascular risk factors in a dental setting.

BACKGROUND: The authors assessed the utilization of oral health care professionals (OHCPs) as a resource for identifying patients who were unaware of their increased risk of developing cardiovascular disease (CVD). METHODS: OHCPs administered a CVD risk-screening questionnaire, measured blood pressure and tested cholesterol levels, high-density lipoprotein levels and hemoglobin A1c (HgA1c) levels using "finger-stick" blood testing in 100 patients treated in a dental school clinic who were unaware of their CVD risk status. The authors determined the prevalence of specific risk factors (that is, smoking and abnormal levels of systolic blood pressure, lipids, body mass index and HgA1c) and calculated Framingham 10-year coronary heart disease (CHD) risk scores. RESULTS: Seventeen percent of the 100 patients (35 percent of men, 5 percent of women) had an increased global risk of experiencing a CHD event within 10 years (Framingham risk score>10 percent). Seventy-three percent of participants had one or more risk factors and 31 percent had two or more risk factors present. More men than women had low levels of high-density lipoprotein (45 percent [18/40] of men versus 3.3 percent [2/60] of women; P<.0001). The mean Framingham CHD risk score increased with increasing risk factor burden. CONCLUSIONS: OHCPs identified patients with an increased CHD risk who could benefit from primary prevention activities. A substantial proportion of study patients who were unaware of their risk status were at an increased risk of experiencing a CHD event within 10 years. OHCPs could contribute to public health CHD control efforts.

Toothbrush bristle wear and adherence of Streptococcus mutans.

PURPOSE: The purpose of this study was conducted to determine if bristle wear impacts the adherence of Streptococcus mutans on toothbrushes and to evaluate whether it affects the extent of adherence at 0, 8, and 24 hours after air-drying. METHODS: Sixty toothbrushes--composed of 20 each from 3 different groups and defined by brand, brush trim, and head shape--were used in this study. Bristle wear on half of the toothbrushes was achieved using an orthodontic typodont with metal bonds and brackets and evaluated by 4 independent observers. New and worn toothbrushes were inoculated with 5 mutans, rinsed in tap water, and air-dried for 0, 8, and 24 hours. Four tufts were removed from the brush heads at each time point, placed in saline and vortexed to remove bacteria. Bacteria were aerobically grown on Mitis Salivarius Agar plates until colony-forming units could be counted. RESULTS: The toothbrush group impacts adherence of 5 mutans on both new and worn toothbrushes at 0, 8, and 24 hours after air-drying, with new toothbrushes harboring significantly more S mutans than worn toothbrushes at 0 hours. CONCLUSIONS: The results have implications for the design of toothbrush tufts as well as storage of toothbrushes in the home.

Addressing obesity in the dental setting: What can be learned from oral health care professionals' efforts to screen for medical conditions.

PURPOSE: This scoping review focused on what can be learned from oral health professionals' (OHCPs) efforts to provide screenings for medical conditions in the dental setting that could guide strategies for addressing childhood obesity. METHODS: PubMed, Embase, Cochrane, Grey Literature, and CINAHL were searched (limitation English language). Search terms covered OHCPs and various oral systemic conditions of interest (details provided in the paper. Nineteen unduplicated, relevant articles were categorized based on relationship to question. RESULTS: Screening for diabetes and heart disease risk in the dental setting has been shown to be effective and patients and providers are willing to participate, although not yet routinely implemented. Screening/counseling for tobacco-cessation has been shown to be effective, but few (<10 percent) OHCPs provided this activity or received tobacco cessation training. For obesity screening/counseling, the majority of dentists (82 percent) reported they would be more willing to offer this service if obesity were directly related to oral disease. The one healthy weight intervention pilot study was well received by caregivers/patients and resulted in improved food choices. Successful implementation included a dedicated staff member, the dental hygienist. Lack of adequate training was a commonly reported barrier for all of these conditions; in addition, for obesity screening/counseling fear of appearing judgmental, and fear of patient rejection were also commonly reported. CONCLUSIONS: Systematic studies are needed building on existing literature and exploring best implementation practices. Enhanced training is needed on relationship of oral health and systemic health and OHCPs' role.

The Role of Oral Health Care Professionals in Providing Medical Services.

Integration of oral health care professionals (OHCPs) into medical care could advance efforts to control increasingly prevalent conditions such as cardiovascular disease, diabetes mellitus, human immunodeficiency virus infection, and hepatitis C infection, each of which is associated with significant morbidity and health care costs. Prevention and early intervention are effective for reducing the incidence and severity of these diseases, while increasing cost of health care may drive the need for nontraditional models of health education and delivery. Studies have suggested that a dental office is a suitable setting for the purpose of screening and referrals for these conditions and may result in medical expenditure savings. Such innovations would challenge the current dental educational model and the education and training of faculty. Implementing this change would require recognizing opportunities and challenges for the profession and the need for new competencies in dental curricula. Challenges and opportunities are described, including reimbursement models and integration of OHCPs into emerging health care delivery models. Ideas for curricular change are presented, including the need for added emphasis on biological sciences and the introduction of new courses to address systems thinking and forces driving preventive behavior. To embrace the evolving health care arena and be a part of the future interprofessional health care delivery dynamic, dental curricula should also include substantive interprofessional education opportunities. Such opportunities would provide the basic skills and training to recognize and appreciate patients' oral health issues in the broader context of their overall health and well-being. This article was written as part of the project "Advancing Dental Education in the 21st Century."

A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux.

Importance: Laryngopharyngeal reflux (LPR) is a common disorder with protean manifestations in the head and neck. In this retrospective study, we report the efficacy of a wholly dietary approach using alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions compared with that of the traditional treatment approach of proton pump inhibition (PPI) and standard reflux precautions. Objective: To determine whether treatment with a diet-based approach with standard reflux precautions alone can improve symptoms of LPR compared with treatment with PPI and standard reflux precautions. Design, Setting, and Participants: This was a retrospective medical chart review of 2 treatment cohorts. From 2010 to 2012, 85 patients with LPR that were treated with PPI and standard reflux precautions (PS) were identified. From 2013 to 2015, 99 patients treated with alkaline water (pH >8.0), 90% plant-based, Mediterranean-style diet, and standard reflux precautions (AMS) were identified. The outcome was based on change in Reflux Symptom Index (RSI). Main Outcomes and Measures: Recorded change in the RSI after 6 weeks of treatment. Results: Of the 184 patients identified in the PS and AMS cohorts, the median age of participants in each cohort was 60 years (95% CI, 18-82) and 57 years (95% CI, 18-93), respectively (47 [56.3%] and 61 [61.7%] were women, respectively). The percentage of patients achieving a clinically meaningful (≥6 points) reduction in RSI was 54.1% in PS-treated patients and 62.6% in AMS-treated patients (difference between the groups, 8.05; 95% CI, -5.74 to 22.76). The mean reduction in RSI was 27.2% for the PS group and 39.8% in the AMS group (difference, 12.10; 95% CI, 1.53 to 22.68). Conclusions and Relevance: Our data suggest that the effect of PPI on the RSI based on proportion reaching a 6-point reduction in RSI is not significantly better than that of alkaline water, a plant-based, Mediterranean-style diet, and standard reflux precautions, although the difference in the 2 treatments could be clinically meaningful in favor of the dietary approach. The percent reduction in RSI was significantly greater with the dietary approach. Because the relationship between percent change and response to treatment has not been studied, the clinical significance of this difference requires further study. Nevertheless, this study suggests that a plant-based diet and alkaline water should be considered in the treatment of LPR. This approach may effectively improve symptoms and could avoid the costs and adverse effects of pharmacological intervention as well as afford the additional health benefits associated with a healthy, plant-based diet.

Implementation of cystic fibrosis clinical pathways improved physician adherence to care guidelines.

INTRODUCTION: There is significant variability in clinical outcomes, including growth and lung function, between the various cystic fibrosis (CF) centers. No specific or unique therapeutic practices have been identified to account for these differences. However, more uniform care within centers was associated with better outcomes. The objective of this study was to implement clinical pathways for diagnosis and treatment of nutritional failure and lung inflammation in order to achieve better health care provider adherence to center-specific, agreed-on practices. METHODS: Agreed-on clinical pathway treatment plans for both nutrition and lower airway inflammation were implemented on January 1, 2010. The primary outcome measure was to evaluate if patients' diagnoses and treatments were consistent with the agreed-on clinical pathways. RESULTS: The proportion of clinic visits from baseline to 18 months post-intervention where the provider completely followed nutrition clinical pathway increased from 57.72% to 79.49% (P = 0.049) and the proportion for lower airway inflammation clinical pathway increased from 65.85% to 86.32% (P = 0.035). The use of nutritional diagnosis and documentation of associated clinical pathway in the clinical plan increased from 16.26% to 61.54% and 56.10% to 94.87%, respectively. Similarly, diagnosis of lower airway inflammation and documentation related to their treatment plans increased from 1.63% to 43.59% and 30.08% to 87.18%, respectively. CONCLUSION: Implementation of clinical pathways for nutrition and lower airway inflammation issues resulted in more uniform care of CF patients. Having objective criteria for diagnoses and agreed-on treatment plans for each of those diagnoses allowed for monitoring and individual feedback. Increases in utilization of correct diagnoses and discussion of specific therapeutic interventions in the clinic notes were associated with increased adherence to clinical pathways. Pediatr Pulmonol. 2017;52:175-181. © 2016 Wiley Periodicals, Inc.

The potential role of dentists in identifying patients' risk of experiencing coronary heart disease events.

BACKGROUND: A substantial proportion of people with risk factors for cardiovascular disease (CVD) are not identified before they develop clinical signs and symptoms. A multidisciplinary approach that includes a cardiovascular screening by oral health care providers can affect the identification of people at risk of experiencing cardiovascular events. METHODS: The authors extracted data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) and the 2001-2002 NHANES for people aged 40 to 85 years with no reported specific risk factors for coronary heart disease (CHD) and who had not seen a physician in the previous 12 months but had seen a dentist. They used these data to estimate the 10-year Framingham-based risk calculation scores for each subject to determine their global risk of experiencing acute CHD events. RESULTS: Eighteen percent of the male subjects had an increased 10-year global risk of experiencing a CHD event (> 10 percent risk score), 14.3 percent had a moderate, above-average risk score (> 10-< 20 percent), and an additional 4.3 percent had a high risk score (> or = 20 percent). Only one female subject had a risk score greater than 10 percent. When the authors extrapolated these results to the 2000 U.S. census data, they found that among men aged 40 to 85 years without reported risk factors who had not seen a physician but had seen a dentist in the previous 12 months, 332,262 had a greater than 10 to less than 20 percent risk of experiencing a CHD event, and 72,625 had a 20 percent or greater 10-year risk of experiencing a CHD event. CONCLUSION: Dentists can play an important role in identifying people in need of primary prevention strategies for CVD.

Physicians' attitudes toward medical screening in a dental setting.

OBJECTIVES: We assessed primary care physicians' attitudes toward medical screening in a dental setting. METHODS: A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide sample of primary care physicians in the United States. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multipart questions. RESULTS: Of 1,508 respondents, the majority felt it was valuable for dentists to conduct screening for cardiovascular disease (61 percent), hypertension (77 percent), diabetes mellitus (71 percent), and HIV infection (64 percent). Respondents were willing to discuss results with the dentist (76 percent), accept patient referrals (89 percent), and felt it was unimportant that the medical referral came from a dentist rather than a physician (52 percent). The most important consideration was patient willingness (mean rank 2.55), and the least important was duplication of roles (mean rank 3.52). Level of dentist's training was significantly (P < 0.05) more important than duplication of roles and reimbursement (mean ranks 2.84, 3.52, and 3.14, respectively), and significantly less important than patient willingness (mean rank 2.55). CONCLUSIONS: Primary care physicians considered chairside medical screening in a dental setting to be valuable and worthwhile.