Sir, we read with great interest the recent article Obesity, diabetes and periodontitis – a triangular relationship (BDJ 2013; 215: 35–39), and in particular the suggestions that 'dentists should be more proactive in working with medical colleagues in diagnosing and managing diabetic patients ... dentists have the opportunity to identify unrecognised diabetes and pre-diabetes in their patients and refer them to a physician for further evaluation and care'.

Last year we established an extensive multi-disciplinary team of consultant dental clinicians and endocrinologists, primary dental and medical practitioners and research methodologists who all share an interest in oral health and medical conditions such as diabetes and obesity. After successfully completing initial pilot work in collaboration with the diabetes and primary care research networks, we have made no fewer than five applications for research funding, to both national and international organisations, to study a novel approach for risk-assessment for diabetes and pre-diabetes in the dental setting. None of these applications has been successful. Of particular note was the disappointing feedback recently received following one application to a large UK charity: 'The committee also questioned how keen GPs would be to deal with referrals resulting from this screening'.

Prevailing attitudes such as this are worrying and indeed suggest it may prove difficult to secure the evidence required to change clinical practice in the UK, including financial aspects, and encourage dental professionals to help identify at risk patients, particularly those with pre-diabetes, and refer in a timely manner for appropriate care.

If these fairly straightforward procedures can be implemented within the dental setting, the more serious implications of full diabetes may be obviated, thereby improving patients' quality of life and helping reduce the high cost of both treating and managing the serious complications of this condition, including its oral manifestations.

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