4. Discussion
In a sample of adolescents with type 1 diabetes being
treated at a pediatric diabetes specialty clinic, we found high
utilization of professional preventive dental care services,
and over 90% of these adolescents had received preventive
dental care instructions from a dental professional on
how to floss and brush their teeth. In contrast, though,
there was low knowledge about risk factors for periodontal
disease. Most notably, less than half of the adolescents were
aware that periodontal disease is associated with diabetes
and only one-quarter knew that periodontal disease can
start in childhood with bleeding gums. Despite being a
group of youth at high risk for developing periodontal
disease, the average toothbrushing frequency was just 9.5
times per week and nearly 42% of these adolescents did
not floss. These adolescents reported that taking care of
their gums was less important than taking care of their
teeth and both had lower priority than taking care of
their medical health. If confirmed, our findings suggest
several opportunities for improving clinical dental practice
in the area of health education, intervention planning, and
medical-dental professional collaboration to improve the