INDICATE-2

We are working with 50 high street dental practices across the UK to recruit up to 10,000 adult patients. Each participant will:

• Complete a diabetes risk questionnaire
• Provide a finger-prick blood sample (HbA1c test)
• Be invited to provide a saliva sample for future research

If a patient’s HbA1c result indicates they are at risk of type 2 diabetes, they will be referred to their GP for further medical assessment and care.

Dental teams are uniquely positioned to support early detection of diabetes. Unlike GP visits, dental check-ups are routine—even when patients feel well. Dentists already advise on lifestyle factors like diet, smoking, and weight management, which are also key risk factors for type 2 diabetes.

Importantly, there is a two-way relationship between diabetes and periodontitis (gum disease):

• People with diabetes are more likely to develop gum disease
• Gum disease can worsen blood sugar control and increase the risk of developing type 2 diabetes

This makes the dental setting an ideal place to identify patients at risk and support early intervention.

This study will:

• Validate two diabetes risk tools—the Diabetes Risk assessment in Dentistry Score (DDS) and the Leicester Risk Assessment (LRA)—in a diverse UK dental population
• Estimate the prevalence of undiagnosed NDH and type 2 diabetes in a multi-ethnic, pan-socioeconomic population
• Track the medical follow-up of patients identified as high-risk in dental settings

Saliva samples will be biobanked and, subject to additional funding, analysed to test patented biomarker panels for non-invasive, point-of-care diabetes and periodontal diagnostics.

This research supports the NHS England Commissioning Standard on Dental Care for People with Diabetes, which encourages dental teams to engage in risk assessment/early case detection of undiagnosed NDH/diabetes and to refer onwards for formal diagnosis and management.

NICE guidelines - Type 2 diabetes in adults: management

This study is led by the University of Birmingham and is funded by Haleon and the National Institute for Health and Care Research (NIHR).

Radio

• ADLM Podcast – available on Spotify / Apple / other major platforms
• BBC Radio 4 - mouth organ

Press articles:

• Dental teams could detect undiagnosed diabetes in more than one million people with new care pathway - NIHR Birmingham BRC (Sept 2024)
• From dental chair to diabetes care: Patient experience highlights potential of new screening pathway - NIHR Birmingham BRC (March 2025)
• Research shows dental teams could improve detection of diabetes - Dentistry
• Detecting type 2 diabetes in the dentist’s chair - Diabetes UK
• Dental staff to help diagnose diabetes through oral health checks - Dental Nursing
• Dental teams could detect undiagnosed diabetes in more than one million people with new care pathway - Nature
• Research to spot signs of type 2 diabetes from dentist appointments - Diabetes UK
• Dental teams could detect diabetes via new pathway - Scottish Dental Magazine
• Dental teams could help detect undiagnosed diabetes in patients - Dental Tribune
• Dental Teams Detect Early Signs of Diabetes - Elearn College
• Model for early diabetes detection in dental practice - ZM Online
• Promoting Oral Health - CDC
• Diabetes cases experts discover shocking risk factor doctors have missed - Daily Mail

INDICATE 2 Study Reaches Major Recruitment Milestones

The INDICATE 2 Diabetes and Oral Health study has passed key targets since recruitment began. Obex Dental Group were the first practice to sign up to the study in May 2024, and the first patient was recruited by Claregate Dental in December 2024.

Participant numbers have climbed rapidly: 1,000 by July 2025, 2,000 by October 2025, 3,000 by January 2026, and 4,000 by April 2026. So far, 42 dental practices have contributed, with 4,000 patient assessments completed and 2,650 saliva samples collected.

These achievements mark strong national engagement as the study explores how dental settings can support early detection of diabetes risk.

• First practice recruited – Obex Dental Group 21/5/24
• First patient recruited – Claregate Dental 10 December 2024
• 1000 patients July 2025,
  2000 patients Oct 2025,
  3000 patients: Jan 2026,
  4000 patients: April 2026
• Number of primary care practices who have recruited patients to the study 42
• Number of saliva samples collected 2650 [March 2026]
• First INDICATE-2 practice-based-research-network conference March 2026: The Birmingham INDICATE 2 conference brought together 65 delegates from 31 study sites, the University of Birmingham, the study funder Haleon, and Siemens who provide the diabetes point of care test. It offered a valuable chance for study teams to connect, share progress, and learn from one another in a collaborative setting.
  
  Roundtable discussions and presentations highlighted the importance of understanding the relationship between oral and general health, as well as the role of saliva collection within the study. The day created meaningful exchanges of experience and ideas, strengthening momentum across the network as INDICATE 2 continues to advance.

Quotes by patients:

• Great to get it carried out at the dentist and great that it is checked before you have symptoms and made aware of the level you are at.
• As my result was high now will get tested at my GP so great to know so I can change lifestyle etc
• Doctor surgery's are so busy these days, so I think dental surgery's are a great alternative. They have clean and hygienic premises and already have patient relationships, so they are a great solution.
• More relaxed with people I'd met before, very friendly and everything clearly explained.
• helped me understand the broader mechanics of mouth health and medical health - as previously thought they were separate. Now understand that I can cross pollinate - now consider dental to be more healing and less traumatic.
• If it had not been offered to me I would never have known I had diabetes and low kidney function.

Quote by OHP:

“Patients are also genuinely appreciative of the result and are really supportive of being able to double up on health care outcomes in the one appointment. The study is definitely on to something and I am enthusiastic about advocating for screening to be available more widely in a dental setting.” Mark Fowler Woodside Dental

1. Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, Graziani F, Hobbs FDR, Huck O, Hummers E, Jepsen S, Kravtchenko O, Madianos P, Molina A, Ungan M, Vilaseca J, Windak A, Vinker S. Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe. Eur J Gen Pract. 2024 Dec;30(1):2320120. doi: 10.1080/13814788.2024.2320120. Epub 2024 Mar 21. PMID: 38511739; PMCID: PMC10962307.

2. Commissioning standard: dental care for people with diabetes

3. Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, Herrera D, Jepsen S, Lione L, Madianos P, Mathur M, Montanya E, Shapira L, Tonetti M, Vegh D. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. Diabetes Res Clin Pract. 2018 Mar;137:231-241. doi: 10.1016/j.diabres.2017.12.001. Epub 2017 Dec 5. PMID: 29208508.

4. Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub4. Accessed 02 April 2026. 

5. Botelho J, Singh S, Varenne B et al.Oral health and diabetes: a systematic review and meta-analysisThe Lancet Public Health, 2026; 0

If your blood sugar levels are high or poorly controlled then this can have an impact on the health of your gums. Some signs that you may have poor gum health include:

• gums which bleed on cleaning or eating
• bad breath (Halitosis)
• gaps appearing between the teeth, or a change in the position of the teeth
• loose/wobbly teeth

There is some evidence that patients without diabetes who have periodontitis, show an increase in their blood sugar levels over a 5 year period when compared to those patients without periodontitis.

There is some evidence that through stabilising periodontitis and improving the health of your gums it can have a positive effect on your diabetes control. There have been studies showing a reduction in blood sugar at 3, 6 and 12 months following successful treatment of gum disease.

Gum disease refers to a group of diseases that affect the gums and surrounding tissues. Where only the gums are affected we term the condition gingivitis. The more severe form known as periodontitis results in inflammation of the gums but also affects the underlying bone and connective tissue.

Approximately half the population will experience some level of gum disease at some point in their lives. 10 in 100 people are likely to have the severe form of gum disease which may lead to tooth loss.

Periodontitis is a complex disease.

• The disease is caused by the bacteria that are naturally found in the mouth and the saliva.
• These bacteria attach to the tooth surface and form small colonies and group together in a community known as a bacterial biofilm.
• In its early stages this appears as a soft creamy white sticky plaque on the teeth. In this form it can be effectively brushed away with good home-care oral hygiene regimes (brushing and cleaning between the teeth).
• If left on the teeth the soft plaque eventually (over a period of 12 hours) hardens and develops into calculus (tartar) on the tooth surface. This cannot be effectively removed through at-home cleaning practices. If left to build up it can cause irritation and inflammation of the gums.
• All of us have bacteria in our mouths but not all of us will necessarily develop periodontitis. This is because our bodies' immune (defence) system respond differently to this build-up and composition of bacteria. Some people will be naturally more susceptible to periodontitis than others. There are a variety of factors that may increase your risk of developing periodontitis, including
  • Oral hygiene practices - lower levels of plaque reduce risk therefore it is important to maintain excellent oral hygiene throuhg brushing the teeth twice a day using a fluoridated tooth paste. Cleaning between the teeth using the appropriate size interdental brushes twice per day. Seeing a dental care professional regularly to support and maintain optimal oral hygiene.
  • Smoking - significantly increases risk of periodontitis, makes treating and managing periodontitis more complex. The outcomes of clinical treatment in patients who smoke is less favourable than in patients who are non-smokers.
  • Family history - parents or siblings who have lost teeth at an early age may suggest a genetic disposition to periodontitis
  • Poorly controlled diabetes - high blood sugar levels and poorly controlled diabetes increases the risk of periodontitis and makes management of periodontitis more complex.

The signs of gum disease include:

• bad breath (Halitosis)
• bleeding gums (this may be spontaneous, or on eating or brushing teeth)
• metallic taste in the mouth
• change in the appearance of teeth - teeth may appear longer due to the gum shrinking back (recession), this may also result in sensitivity to hot/cold things. The sensitivity usually only lasts a few seconds in the presence of stimulus.
• change in the position of teeth
• developing gaps/spaces between the teeth
• wobbly/loose teeth
• multiple abscesses (infections) within the gums close to the teeth.

Please note:

Periodontitis is often painless. Therefore you may not experience any pain with this condition.

Smoking can mask some of the signs of periodontitis (i.e. smokers often don't have bleeding gums) therefore it is important that you see a dental care team regularly to thoroughly check for clinical signs of gum disease.

Through modification of risk factors you can reduce your risk of developing gum disease and prevent its occurrence. The best way to do this is to:

• maintain excellent oral hygiene practices and minimising the amount of bacterial plaque biofilm on the teeth
• stop smoking
• reduce stress levels
• optimise a healthy lifestyle - with a diet rich in antioxidants and maintaining a healthy weight
• Ensuring good diabetic control.

Yes, a recent commissioning standard in the UK was published that advised patients diagnosed with diabetes should be signposted to a dental care professional. This will allow the dental team to create a personalised care plan which will include assessing and monitoring your gum health. This will allow disease prevention measures to be instigated and timely intervention if required.

Yes, there are effective treatments available for gum disease. These can be provided by your dental healthcare team.

Inflammation of the gum tissues can be reduced from optimising home care and cleaning regimes. The dental care team can advise on the best cleaning methods both with regards to brushing the teeth, but also importantly how we can effectively clearn between the teeth.

Depending on the extent of the "gum disease" there are several treatment options available. The most common treatment is a process known as PMPR - Professional Mechanical Plaque Removal. This process involves the dental teams using instruments to remove the plaque and calculus from the tooth surface, both above and below the gum line.

To effectively undertake the cleaning below the gum line local anaesthesia is administered. This involves a small injection to numb the area. The numbness is temporary and lasts for the duration of the treatment ensuring you are comfortable throughout the procedure.

The treatment of periodontal disease in people with diabetes, who have good control of blood sugar, can be just as successful as in patients who do not have diabetes. Improving blood sugar control can improve the outcome of periodontal treatment in people with diabetes. Also there is evidence that treatment of periodontal disease can result in improvement in blood sugar control in people with poorly controlled diabetes and reduce the risk of the other complications of diabetes.

You can participate in the INDICATE Study if you are a patient at one of these practices.

• The Perio Link, gum disease and diabetes connection
• The links between periodontitis and diabetes
• EFP videos