Background: This audit aims to determine if children and young people with type I diabetes mellitus (TIDM) under the care of The Royal Alexandra Children’s Hospital (RACH) are registered with a dentist and receive enhanced oral health prevention.NHS England’s “Core20PLUS5” highlighted diabetes and oral health as specific areas with healthcare inequalities that require accelerated improvement. People with TIDM are at higher risk of dental and oral diseases. Additionally, active periodontal disease has been associated with elevated HbA1c levels, which increases the risk of medical complications. It is, therefore, essential for children and young people to understand the importance of maintaining good oral hygiene and to have access to a dentist for the provision of enhanced oral health prevention and rapid dental treatment.Gold standard: All paediatric patients with TIDM should receive oral health promotion (OHP) from Children and Young Person’s (CYP) diabetes team, be registered with a dentist, attend for 3-6 monthly dental check-ups, and have topical fluoride applied.Standards were set in accordance with: NICE guideline Diabetes (type 1 and type 2) in children and young people: diagnosis and management (2023), NICE guideline Dental checks: intervals between oral health reviews (2004); Public Health England Delivering better oral health: an evidence-based tool kit for prevention (2021).Method: A piloted questionnaire was completed by 50 consecutive participants and their families attending CYP diabetes outpatient clinics at RACH from May 2024 to August 2024. Data collected included participants’ demographics, comorbidities, frequency and pattern of hypos, whether OHP was provided by CYP diabetes team, if participants were registered with a dentist, interval of dental recalls, and if topical fluoride was applied by a dental professional.Results: Participants ages ranged from 2-15 years old. 28% had comorbidities, including asthma, hypothyroidism, coeliac disease, and autism with pathological demand avoidance, which can be a barrier to achieving good oral hygiene.The greatest proportion of participants (36%) had hypos 4-6 times per week. Common times for hypos to arise were between mealtimes, during the night, and after exercise, which could increase the risk of dental caries. 14% of participants had received OHP from CYP diabetes team. 86% of participants were seeing a dentist, of which 12% were seen 3-monthly and 51% 6-monthly. With regards to preventive interventions, 37% reported never having had topical fluoride applied.Following these findings, an action plan was implemented to address shortfalls in the set gold standards:1- Results were disseminated to dental and CYP diabetes teams.2- A dental care pathway was created in consultation with stakeholders.3- Oral health education session was delivered to CYP diabetes team, and an oral health champion was identified.4- In collaboration, CYP diabetes and dental teams developed a diabetes-specific oral health patient information leaflet and posters.Conclusion: This audit highlights the importance of developing a dental care pathway, universal diabetes-specific OHP, and establishing local dental networks to improve access, oral health awareness, and mouthcare for children and young people with diabetes.A re-audit is planned to assess the effectiveness of the implemented action plan.
