|Year : 2020 | Volume
| Issue : 1 | Page : 46-51
Comparison of dental health, treatment needs in visually impaired and normal healthy school-going children of 6–14-year age group
Sunil Kumar, Rishi Tyagi, Namita Kalra, Amit Khatri, Deepak Khandelwal, Dhiraj Kumar
Department of Paedodontics and Preventive Dentistry, University College of Medical Sciences (University of Delhi) and GTB Hospital, New Delhi, India
|Date of Submission||09-May-2019|
|Date of Decision||26-Aug-2019|
|Date of Acceptance||01-Sep-2019|
|Date of Web Publication||05-Feb-2020|
Dr. Sunil Kumar
Department of Paedodontics and Preventive Dentistry, University College of Medical Sciences (University of Delhi) and GTB Hospital, New Delhi - 110 095
Source of Support: None, Conflict of Interest: None
Introduction: This research aimed to evaluate and compare the oral health status and treatment required for visually impaired children and normal healthy school-going children in New Delhi and to investigate the factors that influence oral health.
Subjects and Methods: The study was conducted in 420 children who were equally divided into visually impaired children and normal healthy children. Oral health status was recorded, which includes dental caries, plaque, debris, and gingival status in both groups. The Chi-square test was used, and statistical significance was fixed at (P < 0.05).
Results: The total caries experience (Decayed, Missing, and Filled Surface + decayed, missing, filled surface) was found to be more in normal healthy children 2.72 than the visually impaired children 2.22 and it was found to be statistically significant (P < 0.05). Oral hygiene simplified index of normal healthy children and visually impaired children were 0.74 and 1.33, respectively, and found to be statistically significant (P < 0.05). The gingival index of normal healthy children was 0.10 found to be greater than visually impaired children 0.08. Visually impaired children required more treatment needs than normal healthy children.
Conclusions: Visual impairment can actively limit these children maintaining good oral hygiene, and hence, it is important to create awareness, proper oral health guidance, and periodically screening to avoid complicated treatment needs in these children.
Keywords: Dental caries, normal healthy children, oral hygiene status, treatment needs, visually impaired children
|How to cite this article:|
Kumar S, Tyagi R, Kalra N, Khatri A, Khandelwal D, Kumar D. Comparison of dental health, treatment needs in visually impaired and normal healthy school-going children of 6–14-year age group. Saudi J Oral Sci 2020;7:46-51
|How to cite this URL:|
Kumar S, Tyagi R, Kalra N, Khatri A, Khandelwal D, Kumar D. Comparison of dental health, treatment needs in visually impaired and normal healthy school-going children of 6–14-year age group. Saudi J Oral Sci [serial online] 2020 [cited 2020 Jun 6];7:46-51. Available from: http://www.saudijos.org/text.asp?2020/7/1/46/269031
| Introduction|| |
Visual impairment can be defined as any chronic visual impairment that impairs day-to-day operations and cannot be corrected by normal eyeglasses or contact lenses. Globally, roughly 1.3 billion individuals are estimated to live with some types of vision impairment. Concerning distance vision, 188.5 million individuals have a mild vision impairment, 217 million have moderate-to-serious vision impairment and 36 million are blind. About close-view, 826 million people experience a near-vision impairment. Globally, uncorrected refractive errors and cataracts constitute the leading causes of vision impairment. About 80% of global visual impairment is considered avoidable.
Globally, uncorrected refractive errors, cataract, macular degeneration related to age, glaucoma, diabetic retinopathy, corneal opacity, and trachoma can lead to impaired visual activity. The causes of vision impairment among children vary widely between countries. For example, congenital cataracts are a major cause in low-income countries, for instance, whereas premature retinopathy is more common in high-income countries.
The component of systemic health is important in oral health. Oral disease in disabled children can be difficult to diagnose, and treatment compliance is poor. Furthermore, the lack of coordination between hands, inadequate parental supervision, and lack of input by peers can reduce the focus on oral health.
However, few studies have examined oral health in children with visual impairment, mainly in the poorest regions of Asia and Africa. Recent research has shown that the prevalence of caries for primary and permanent teeth the average oral hygiene index-Simplified was 15% and 46% (OHI-S), respectively, 2.43 ± 1.03 in different age groups in visually impaired children. In another study, mean OHI (S) score for visually impaired children was 1.51 ± 0.93 and mean Decayed, Missing, and Filled Teeth (DMFT) score was 0.94 ± 1.4 in the 7–17-year age group. In a recent study performed in China, the overall caries prevalence was 78.64%, and the mean caries count was 2.43 ± 2.75. The prevalence of caries was 65.22% in primary dentition and 71.84% in permanent dentition, respectively. Gingival bleeding rates were 44.66%, and dental calculus was 67.96%.
About 12 million blind people were estimated to be living in India in 1990, about 15% of the world's blind population at that time. The main causes of blindness were listed as cataract, uncorrected refractive errors, corneal opacities, and glaucoma. With the increasing availability of ophthalmological services, this mountain of mostly treatable blindness is being vigorously attacked. However, a significant number of patients either refuse treatment or do not attain normal or near-normal vision following treatment. These patients constitute the visually impaired population. The rehabilitation of visually impaired people in India has been comparatively ignored. This obvious absence of concern is justified by (1) the overwhelming demand for cataract surgery, (2) the absence of postdoctoral rehabilitating education in the field of low vision, (3) the belief that low vision rehabilitation takes time and is usually ineffective, (4) the very bad availability of low vision aids at local level, and (5) the complexity and cost for the import of low vision aids at foreign level.
In a study done in Chandigarh, the overall, 58%, 37%, and 5% of the visually impaired group had good, fair, and poor oral hygiene status, respectively. For sighted children, 65%, 32%, and 3%, respectively, having a good, fair, and poor oral hygiene status.
The present study aimed to examine the oral condition and treatment needs of children with visual impairments and normal healthy children, registered in the institution for visually impaired children and public–private schools for normal healthy children of New Delhi.
| Subjects and Methods|| |
A cross-sectional study was conducted to compare the oral health status and treatment needs in visually impaired and normal healthy children attending the various blind institution and other schools in Delhi, India. A total of 420 children were taken in this study, including 210 each, visually impaired and normal healthy children. The age group of children was the 6–14 year. Inclusion criteria were children belonging to the age group of 6–14 years attending residential schools for visually impaired children and residential schools for healthy children and exclusion criteria for the visually impaired children were children with any illness other than blindness and for the normal healthy children were children with any illness. Oral examinations and questionnaires were administered after written informed consent was obtained from the parents and teachers. A detailed history was taken including Name, Age/Sex, CR No., Address, Telephone No., Date and Place of Birth, Class, Parent's Name, and Personal data about dental status included: Toothbrushing frequency, use of fluoride toothpaste or mouthwash, frequency of sugar intake in-between meal, and mouth breathing habit.
This study was approved by the Ethics Committee of the University College of Medical Sciences, University of Delhi.
On the 1st day, written consent/assent was obtained from parents and child and along with that information about the study was given to their parents. The next day, the basic information and personal history were recorded, and children's medical history was taken from parents. A total of 420 children were examined during the study period.
Caries status was measured by Decayed, Missing, and Filled Surface index for permanent teeth and decayed, missing, filled surface index for deciduous teeth given by the WHO, Oral Health Surveys, Basic Method (2013).
Oral hygiene index-Simplified
The oral hygiene status of participants was assessed using OHI-S index given by Greene and Vermillion.
Subjects were examined for gingivitis using probe, mouth mirror, under daylight condition and measured using the gingival index (GI) given by “Loe and Silness.”
Standardization of examiner
A thorough standardization was done. The examiner was standardized in interpreting and recording dental caries (WHO, 2013), OHI-S (Greene and Vermillion, 1964) and GI (Loe and Silness, 1963). A questionnaire was used to collect data on general characteristics (registered residence, gender, and ethnicity), oral health-related behaviors, use of fluoride-containing toothpaste, dietary habits, healthcare-seeking behaviors, and knowledge and attitudes about oral healthcare.
The intra-oral examination of children was carried out by the sole examiner in the school premises with the help of the mouth mirror and community periodontal index (CPI)-probe. The treatment needs for every child were evaluated and ascertained after discussion with one of the dental supervisor or co-supervisors.
During the examination, the child was made to sit on a chair in front of the examiner in broad daylight. Gauze pads were used to clean and dry teeth surfaces before the examination. Intra- and inter-examiner reproducibility was assessed with the help of kappa statistics. To minimize the intra-examiner variability, the first 30 children who were observed on the 1st day, were re-examined before examining the new batch of children.
Statistical analysis used
Statistical analysis was performed using the Statistical Package for the Social Sciences version 25.0 (IBM Inc., Armonk, NY, USA). A Chi-square analysis was used to explore the relationship between explanatory variables and oral health. The Mann–Whitney U-test has been used to compare the categorical variables between visually impaired children and normal healthy children. Statistical significance was fixed at (P ≤ 0.05).
| Results|| |
Total participants were 420, including 210 each visually impaired and normal healthy children from 6 to 14 years of age [Table 1]. Total males and females were 292 (69.5%) and 128 (30.5%), respectively [Table 2].
The overall mean caries experience in normal healthy and visually impaired children was found to be 2.72 and 2.22 and statistically significant (P< 0.05). The caries experience of primary teeth in normal healthy and visually impaired children was found to be 2.23 and 0.47, and finding was statistically highly significant (P< 0.05). The caries experience of permanent teeth in normal healthy and visually impaired children was found to be 0.51 and 1.75 and finding was statistically highly significant (P< 0.05) [Table 3].
Oral hygiene simplified index
OHI-S of normal healthy and visually impaired children were 0.74 and 1.33, respectively [Table 3] and found to be statistically significant (P< 0.05).
Gingival status of normal healthy and visually impaired children was 0.10 and 0.08, respectively and found to be statistically significant (P< 0.05) [Table 3].
Normal healthy children required 29% one surface filling, 25.2% two surface filling, 11.5% crowns, 3% pulp care and 2.4% extractions of 210, whereas visually impaired children required 40.5% one surface filling, 21% two surface filling, and 12% crowns. None of the visually impaired children required pulp care and extraction out of 210 [Table 4]. 175 (83.3%) visually impaired children required oral prophylaxis, whereas 88 (41.9%) normal healthy children required oral prophylaxis [Table 5].
| Discussion|| |
The present study is a cross-sectional study conducted on normal healthy and visually impaired children to compare the experience of dental caries, oral hygiene status, and treatment needs among normal healthy children and visually impaired children.
The overall caries experience in normal healthy children was found to be marginally higher than visually impaired children namely 2.72 and 2.22, respectively. The main factor to improve the oral health of children with disabilities is most likely to be the awareness of their families of the importance of oral health. In contrast to our findings, the study done by Solanki et al. in dental caries, the overall prevalence in visually impaired children was higher than normal healthy children, respectively.
Caries experience in primary teeth was found to be less in visually impaired children 0.47 then normal healthy children 2.23, it could be because sugar consumption was restricted to their meal only and proper brushing techniques were being taught to them in the institution by professional. On the other hand, normal healthy children have no such restrictions and training. The maximum caries was present in the 6–8-year age group (normal healthy and visually impaired children) and the minimum was present in the 13–14-year age group. As the age progress, the child shifts from primary dentition to mixed dentition and finally into the permanent dentition, in this process, the primary teeth get exfoliated with the age, and hence, it could be the reason, that we have observed maximum caries experience in primary teeth in the 6–8-year age group. Findings obtained in the present study were lower than the study done by Reddy and Sharma the mean deft was 0.17 and 0.47 in visually impaired and normal children, respectively. A study was done by Tagelsir et al. and Prashanth et al. mean 1.9 (decayed, missing, and filled teeth) and 2 (decayed, missing, filled) in visually impaired children, which was higher than the present study.
In the present study, the caries experience in permanent teeth was found to be higher in visually impaired children, i.e., 1.75 then normal healthy children, i.e., 0.51, as in the present study we have seen that children of age around 14 years, visually impaired children get promoted from blind institution to other schools and colleges for further education, when these children get shifted from blind institution to other schools and colleges, then it is become difficult for them to follow the same protocol/routine further. In a study by Naveen and Reddy mean DMFT for blind children was 1.2, which was lower than the present study. In another study by Reddy and Sharma the mean DMFT was 0.87 in normal children, i.e., higher than the present study.
The oral hygiene status was found to be better in normal healthy than visually impaired children, but the prevalence of gingivitis was marginally higher in normal healthy children 0.10 than visually impaired children 0.08. The OHI-S was 0.74 and 1.33 in normal healthy and visually impaired children and found to be statistically significant. A study conducted by Chang and Shih. found that students with visual impairments were less aware of their oral care. The maximum OHI-S was recorded in 6–8-year age groups in our study this could be explained by the recent entry into the institution of members of the 6–8-year group. The deposition of the calculus in older groups is lowered as these students received dental inspections and preliminary dental treatment in previous years from a nearby dental hospital through mobile dental van.
According to Prashanth et al. and Priyadarshini et al., mean OHI was lower 0.58 and 1.21 than the present study while studies done by Kumar et al. and Rao et al. they found the higher mean OHI-S score, i.e., 2.72 and 2.04 then this study. This can be due to plaque removal from teeth which can only be managed if a person has the ability to manipulate a toothbrush and understands the purposes of this activity, It becomes evident that many people with disabilities will find it more difficult to maintain their oral hygiene than ordinary individuals, as blind people do not have the vision to understand or master oral hygiene techniques.
Studies have shown that oral hygiene can be substantially enhanced through increased daily brushing instructions by dental professionals, the development of self-help workshops, efficient training for dental personals or a mixture of these methods.
The gingival health status was determined using the GI. The gingival score was 0.10 in normal healthy, while 0.08 in visually impaired children. The finding was found to be statistically highly significant. In a study done by Jain et al., oral hygiene of visually impaired people was more coherent than those of the visually impaired as children living with visual impairments have an institutional setup, in which caretakers enforce compulsory oral hygiene practices, they are regularly brushed with the brush and toothpaste daily. Meanwhile, sighted students have been living in family units, and probably do not undergo the same type of enforced routine; therefore, they do not brush or use dental aids day.
The maximum gingival score was found in the 13–14-year age group and the minimum was in 6–8-year age group in both groups. A study done by Nandini and Avasthi et al., the prevalence of gingivitis was found to be 10.67% and 71.53% in visually impaired children.
The treatment needs in both groups who had dental caries were also evaluated. One surface filling was needed in 29% and 40.5% in normal healthy and visually impaired children. Our findings were comparable with the study done by Suresan et al. they found that 47% visually impaired children needed one surface filling and Jain et al. found 62.7% one surface filling in visually impaired children which were higher than our findings. This indicates that a maximum of the carious teeth required conservative treatment and that treatment strategy should also be directed toward conservative management, as against performing a more number of extractions for these individuals, as reported by Dicks. According to Rashad Al-Alousi one surface filling was required in 25.9% in the nonblind group and <7% pulp therapy was required. The two surface filling was required in 25.2% and 21% in normal healthy and visually impaired children. The requirement of the crown was almost equal in both the groups, i.e., 11.5% and 12%. The pulp therapy and extraction required in normal healthy children were 3% and 2.4%, while no pulp therapy and extraction was needed in visually impaired children. Several factors might exist to explain why so many treatments need for dental caries among these subjects. Lack of understanding of excellent oral hygiene practices among the officials involved, lack of motivation, low dental priority in society, lack of preliminary and regular oral health control and timely therapy, the parents or guardians' bad socioeconomic status, and therapy price may be the factors behind accumulated therapy requirements.
The finding of this study showed that the dental caries prevalence and gingival disease were less in visually impaired children than normal healthy children, but the OHI-S index was found to be greater in visually impaired children. The upcoming research should concentrate on enhancing oral health education for children with disabilities, educating parents with disabilities on oral healthcare, and use of preventive measures like a fluoride application, fluoride dentifrice, sugar substitute like xylitol, sealant application. These are some preventive measures that could be taken to prevent further complicated treatment and help in reducing dental disability.
| Conclusion|| |
In conclusion, visually impaired children are at greater risk of poor oral hygiene and have restricted access to oral care than normal healthy children. Blindness could limit such children from actively maintaining the great oral hygiene, thus it's necessary to create awareness, correct oral health guidance and periodically screening to avoid complicated treatment need in these children. In the forthcoming research, efforts should concentrate on improving oral health education for these children, educating the parents of disabled children concerning oral care, and use of preventive measures like a fluoride application, fluoride dentifrice, sugar substitute like xylitol, sealant application. These are some preventive measures that might be taken to stop further complicated treatment needs and facilitate in reducing dental incapacity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bourne RR, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al.
Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: A systematic review and meta-analysis. Lancet Glob Health 2017;5:e888-97.
Fricke TR, Tahhan N, Resnikoff S, Papas E, Burnett A, Ho SM, et al.
Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: Systematic review, meta-analysis, and modelling. Ophthalmology 2018;125:1492-9.
Liu L, Zhang Y, Wu W, He M, Lu Z, Zhang K, et al.
Oral health status among visually impaired schoolchildren in Northeast China. BMC Oral Health 2019;19:63.
Suresan V, Das D, Jnaneswar A, Jha K, Kumar G, Subramaniam GB. Assessment of dental caries, oral hygiene status, traumatic dental injuries and provision of basic oral health care among visually impaired children of Eastern Odisha. J Indian Soc Pedod Prev Dent 2017;35:284-90.
] [Full text]
Reddy VK, Chaurasia K, Bhambal A, Moon N, Reddy EK. A comparison of oral hygiene status and dental caries experience among institutionalized visually impaired and hearing impaired children of age between 7 and 17 years in central India. J Indian Soc Pedod Prev Dent 2013;31:141-5.
] [Full text]
Bhattacharjee J, Devadethan, Sharma RS, Saini NK, Datta KK. Methods for estimating prevalence and incidence of senile cataract blindness in a district. Indian J Ophthalmol 1996;44:207-11.
] [Full text]
Malik S. Blindness scenario in South East Asia: Overview. In: Kalevar V, editor. Proceedings of the All India Ophthalmological Society Conference. New Delhi: All India Ophthalmological Society; 1993. p. 591-2.
Herse P, Gothwal VK. Survey of visual impairment in an Indian tertiary eye hospital. Indian J Ophthalmol 1997;45:189-93.
] [Full text]
Kulasekharan P, Vidyavati M. Blind school children: An integrated survey. In: Kalevar V, editor. Proceedings of the All India Ophthalmological Society Conference. New Delhi: All India Ophthalmological Society; 1988. p. 411-4.
Desai NC, Desai R, Iyer KK, Sharma R. Low vision therapy: Indian perspective. In: Kalevar V, editor. Proceedings of the All India Ophthalmological Society Conference. New Delhi: All India Ophthalmological Society; 1991. p. 614-5.
Jain A, Gupta J, Aggarwal V, Goyal C. To evaluate the comparative status of oral health practices, oral hygiene and periodontal status amongst visually impaired and sighted students. Spec Care Dentist 2013;33:78-84.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Loe H, Silness J. Periodontal disease in pregnancy. I. prevalence and severity. Acta Odontol Scand 1963;21:533-51.
Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E, et al.
Oral health status of disabled individuals attending special schools. Eur J Dent 2010;4:361-6.
Solanki J, Gupta S, Arora G, Bhateja S. Prevalence of dental caries and oral hygiene status among blind school children and normal children, Jodhpur city – A comparative study. J Adv Oral Res 2013;4:2-6.
Reddy K, Sharma A. Prevalence of oral health status in visually impaired children. J Indian Soc Pedod Prev Dent 2011;29:25-7.
] [Full text]
Tagelsir A, Khogli AE, Nurelhuda NM. Oral health of visually impaired schoolchildren in Khartoum state, Sudan. BMC Oral Health 2013;13:33.
Prashanth ST, Bhatnagar S, Das UM, Gopu H. Oral health knowledge, practice, oral hygiene status, and dental caries prevalence among visually impaired children in Bangalore. J Indian Soc Pedod Prev Dent 2011;29:102-5.
] [Full text]
Naveen N, Reddy CV. A study to assess the oral health status of institutionalized blind children in Mysore city, Karnataka. J Orofac Sci 2010;2:12-5. [Full text]
Chang CH, Shih YH. Knowledge of dental health and oral hygiene practices of taiwanese visually impaired and sighted students. J Vis Impair Blind 2004;98:1-27.
Bekiroglu N, Acar N, Kargul B. Caries experience and oral hygiene status of a group of visually impaired children in Istanbul, Turkey. Oral Health Prev Dent 2012;10:75-80.
Priyadarshini P, Pushpanjali K, Sagarkar A, Bhoomika, Shenoy S. Assessment of oral health status among visually impaired children. J Dent Orofac Res 2015;11:3-6.
Kumar S, Konde S, Raj S, Agarwal M. Effect of oral health education and fluoridated dentifrices on the oral health status of visually impaired children. Contemp Clin Dent 2012;3:398-401.
] [Full text]
Rao D, Amitha H, Munshi A. Oral hygiene status of disabled children and adolescents attending special schools of South Canara, India. Hong Kong Dent J 2005;2:107-13.
Mann J, Wolnerman JS, Lavie G, Carlin Y, Garfunkel AA. Periodontal treatment needs and oral hygiene for institutionalized individuals with handicapping conditions. Spec Care Dentist 1984;4:173-6.
Nakre PD, Harikiran AG. Effectiveness of oral health education programs: A systematic review. J Int Soc Prev Community Dent 2013;3:103-15.
Nandini NS. New insights into improving the oral health of visually impaired children. J Indian Soc Pedod Prev Dent 2003;21:142-3.
] [Full text]
Avasthi K, Bansal K, Mittal M, Marwaha M. Oral health status of sensory impaired children in Delhi and Gurgaon. Int J Dent Clin 2011;3:21-3.
Jain M, Bharadwaj SP, Kaira LS, Bharadwaj SP, Chopra D, Prabu D. Oral health status and treatment need among institutionalised hearing-impaired and blind children and young adults in Udaipur, India. A comparative study. Oral Health Dent Manag 2013;12:41-9.
Dicks JL. Outpatient dental services for individuals with mental illness: A program description. Spec Care Dentist 1995;15:239-42.
Rashad Al-Alousi JM. Oral health status and treatment needs among blind children in Iraq. MDJ 2009;6:313-24.
Parkar SM, Patel N, Patel N, Zinzuwadia H. Dental health status of visually impaired individuals attending the special school for the blind in Ahmedabad city, India. Indian J Oral Sci 2014;5:73-7. [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]