Sir, Doughty et al.1 flag the importance of general health checks in dental patients susceptible to chronic inflammatory diseases in primary care and Yonel et al., the importance of checking the glycaemic conditions (HbA1c) in periodontitis cases to increase the chances of Type 2 cases detection or an early pre-diabetic status in patients.2

Diabetes incidence is increasing, estimated to reach 12.2% of the world population in 2045.3 Therefore, early prevention makes sense with a particular focus on periodontitis as a bidirectional inflammatory connection.4 Early prevention is therefore mandatory at a young age. Figures in the UK in 2021-2022 have shown an increase of Type 1 and Type 2 diabetes new cases (3,883 and 1,144, respectively) with around 96% being between 10-19 years of age.5 Almost 12% are from the Northwest where deprivation impacts diet and access to NHS medical and dental check-ups and testing. The relevant role of Primary Care Centres would help in flagging special investigations in cases of unexpected poor periodontal conditions as potential signs of pre-diabetes or diabetes.

Our university is undertaking a pilot study on the periodontal assessment of teenagers as a potential early sign of diabetes. This will involve primary care support and public engagement in the Northwest area of Lancashire, Liverpool and Cumbria in testing this hypothesis and the current Guidelines for Periodontal Assessment in Children and Teenagers as a relevant and comprehensive diagnostic tool for the staging and grading of the disease.6 Hopefully, the gathered data will be able to address a comprehensive and targeted public health preventative measure with future impact aiming to reduce the number of cases and supporting the role of primary dental care as crucial for a holistic approach to health control in remote areas.