|Year : 2011 | Volume
| Issue : 2 | Page : 102-105
Oral health knowledge, practice, oral hygiene status, and dental caries prevalence among visually impaired children in Bangalore
ST Prashanth1, Sudhanshu Bhatnagar2, Usha Mohan Das3, H Gopu4
1 Department of Pedodontics and Preventive Dentistry, V. S. Dental College and Hospital, Bangalore, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Jodhpur Dental College General Hospital, Jodhpur, Rajasthan, India
3 Formerly Dean,VSDC, Bangalore, India
4 Department of Pedodontics and Preventive Dentistry, Azeezia College of Dental Sciences and Research, Meyanoor, Kollam, Kerala, India
|Date of Web Publication||9-Sep-2011|
S T Prashanth
Department of Pedodontics & Preventive Dentistry, V S Dental College & Hospital, K R Road, V V Puram, Bangalore
| Abstract|| |
Introduction: Visually impaired children daily face challenges for bearing their everyday skills. Maintenance of proper oral hygiene is one among them. Aim: The aim of the study was to assess the oral health knowledge, practice, oral hygiene status, and dental caries prevalence among visually impaired children in Bangalore. Materials and Methods: A total of 85 children were asked verbally a questionnaire regarding the frequency of brushing, cleaning tools, use of dentifrice, knowledge about the role of sugar in producing dental decay, and frequency of visit to the dentist. All children were screened and DMF and def scores were recorded and oral hygiene status were assessed by Green and Vermillion index. Results: Green and Vermillion index. Kruskal Wallis Chi square test was performed and no statistically significant results were obtained with DMF and def scores as well as OHI scores across different ages in the range of 8 to 13 years. A highly statistically significant result was obtained with dental caries prevalence and oral hygiene status of visually impaired children. Conclusions: The present study shows not much worsening of oral health status in the study population. A little extra care by the parent or caretaker regarding oral hygiene can give drastic results in reduction of dental caries.
Keywords: Dental caries, oral hygiene, visually impaired
|How to cite this article:|
Prashanth S T, 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
|How to cite this URL:|
Prashanth S T, 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 [serial online] 2011 [cited 2014 Apr 23];29:102-5. Available from: http://www.jisppd.com/text.asp?2011/29/2/102/84680
| Introduction|| |
Visually impaired children daily face challenges for bearing their everyday skills. Maintenance of proper oral hygiene is one among them. There are two types of visual disability, namely low vision (partially blind) and absolutely nil vision (totally blind).  The World Health Organization in May 2009 estimated that globally about 314 million people are visually impaired, and 45 million of them are blind. When compared with their normal sighted peers, visually impaired children have a poorer oral hygiene.Conventional methods for teaching oral hygiene involves use of visual perception, using disclosing agents to visualize the plaque and tooth brushing to remove it, and re-disclosing periodically to monitor their improvement of oral hygiene status. Unfortunately, none of these measures are beneficial to visually impaired children who depend much more on feeling and hearing to learn. The main factor of differentiation between normal patients and blind ones is the difficulty in removing plaque.  The visually impaired people are at a greater risk to develop caries, since they are unable to see the early signs of caries such as discoloration which indicates the disease process. The difficulty in removing bacterial plaque being the main factor for development of caries, continual motivation to the correct oral hygiene procedures is fundamental in order to keep a good oral hygiene in blind patients.  Chemical plaque control is advised in visually impaired for effective plaque control. There is utmost need of individual training in oral care and plaque control in order to reduce the prevalence of dental caries among visually impaired children.  The aim of the study was to assess the oral health knowledge, practice, oral hygiene status, and the prevalence of dental caries among visually impaired children in a residential school in Bangalore.
| Aim of the Study|| |
To assess the oral health knowledge practice, oral hygiene status, and dental caries prevalence among visually impaired children in a residential school in Bangalore.
| Materials and Methods|| |
A total of 85 children from a residential blind school in Bangalore were selected for the study. General questionnaires regarding oral health practices were included.
- How often do you brush your teeth?
- What do you use to brush your teeth?
- What do you along with the tooth brush?
- Do you know the role of sugar in producing dental decay?
- How often do you visit the dentist?
A routine dental check up was done by the single examiner following the verbal interrogation of the questionnaire by the examiner.
DMF index and def index were scored in each patient and Green and Vermillion index was used to score the oral hygiene status of the patient. The data collected were subjected to statistical analysis and results were arrived.
| Results|| |
A total of 85 blind school children were subjected to the study, wherein 51 (60%) children were boys and 34 (40%) children were girls.
An age group in the range of 8 to 13 years children were included in the study, wherein 16% were 8-year-old boys (n = 8), 15% were 8-year-old girls (n = 5), 22% children were 9-year-old boys (n = 11), and 26% children were 9-year-old girls (n = 9). The majority were 10-year-old children, where 31% (n = 16) were boys and 21% were girls (n = 7). 11-year-old group of children belonged to the second majority, where 25% (n = 13) were boys and 24% (n = 8) were girls. The least population belonged to the group of 12-year-old children, where in 2% (n = 1) were boys and 6% (n = 2) were girls. Finally, 13-year-old children screened were 4% boys (n = 2) and 9% girls (n = 3) [Figure 1].
The questionnaire was analyzed according to their responses. 37.65% children responded that they brushed twice a day (n = 32), whereas 62.35% children answered that they brushed their teeth only once in the morning (n = 53). 98.82% (n = 84) of children used toothbrush to brush their teeth and only one child [Figure 2] (1.18%) used finger to clean their teeth [Figure 3].
100% of the children responded that they used tooth paste along with the cleaning tool. Regarding the knowledge of the role of sugar in producing dental caries, 51.76% (n = 44) of the children responded that they are aware that sugar plays a role in producing dental caries, whereas 48.23% (n = 41) of children responded otherwise [Figure 4].
While conducting the examination regarding dental caries, and assessing the DMF and def index, it was observed that the mean DMF score was found to be 0.6, and mean def score to be 2, and the mean OHI score being 0.58.
91.76% of children had good oral hygiene, whereas 5.88% of children had fair oral hygiene, and only 2.35% of children had a poor oral hygiene status. Among these, 92% of boys and 91% of girls had a good oral hygiene status, whereas 6% boys and 6% girls had fair oral hygiene, and just 2% boys and 3% girls had a poor oral hygiene status [Figure 5].
Test of significance used was Kruskal-Wallis Chi-Square test for identifying the significance of DMF index and def index among different ages in the study group. We observed that there is no statistically significant difference in the DMF scores recorded in children of different ages ranging from 8 to 13 years (P>0.05), and the same was observed with recorded def index and OHI scores recorded [Table 1],[Table 2],[Table 3].
| Discussion|| |
Blindness is defined by WHO as having a "visual acuity of less than 3/60m or corresponding visual field loss in the better eye with the best possible correction," meaning that whilst a blind person could see a distance of 3 m, a non-visually impaired person could see 60 m. Visual impairment relates to a person's eyesight which cannot be corrected to normal vision. A study completed by Chang and Shih found that students with visual impairments were less knowledgeable about their oral care.  In the present study, in contrast to the former, the study population had better knowledge regarding dental healthcare. Majority of them knew the basic preventive aspects regarding oral health. It was also found in a study by Nandini that 37% of participants were affected by dental caries and 71% by gingivitis,  whereas in our study, we found that 34.1% of children had dental caries. This study showed that only 8% of the blind children had poor oral hygiene. 69.4% of children had dental caries in deciduous dentition and 35.2% of children had dental caries in permanent dentition. In a study conducted by Ahmad et al., most of the blind students examined were having poor oral hygiene. Total 80 visually impaired students were examined, of which 44 (55%) were having poor oral hygiene and among them 22.7% were having dental caries.  29% of blind students were having fair oral hygiene and among them 57% developed dental caries which was highest which was in contrast to our study that showed that majority of the children had good oral hygiene. In this study of 85 visually impaired students, there was not any significant relationship between dental caries and oral hygiene practice with type of cleaning tools namely: toothbrush, finger, use of dentifrices (paste, powder), frequency of cleaning (morning and evening, morning only) and neither it was significantly related with knowledge about impact of sugar consumption on dental caries nor with visit to dentist (occasionally, never). But the prevalence of dental caries had highly significant relation with the oral hygiene status of visually impaired students. It was also observed statistically that oral hygiene status was not significantly related with time of cleaning, tools used for cleaning mouth, and dentifrices used. The students with good oral hygiene were free from dental caries. In a study, it was observed that highest rate of dental caries belonged to mentally retarded students, while the lowest rate was found among blind (Bhavsar and Sco, 1995).  Furthermore, this was proved by Goreeleg et al. who did not find any significant relationship between dental decay and blindness among 120 blind students. 
| Conclusions|| |
If dental health awareness can be instituted to the parents, including brushing techniques and diet counseling at a very early age, the incidence of dental caries can be kept to minimum, and can reduce the probability of complicated dental treatment needs. However, an effective dental health education method has not been well instituted for visually impaired children; more studies have to be carried out regarding an education mode that can be best perceived by visually impaired children. The present study shows not much worsening of oral health status in the study population. A little extra care by the parent or caretaker regarding oral hygiene can give drastic results in reduction of dental caries and gingival diseases.
| Acknowledgement|| |
We extend our kind gratitude to the Principal of Rakum School for the Blind, Sri Acharya Rakum for his constant support and without his permission, the study would have been an impossible task. We also extend our gratitude to Dr Ambika, Post graduate student, Department of Pedodontics and Preventive Dentistry, V S Dental College and Hospital, Bangalore, and Dr Parth and Dr Nischitha, Interns in the same institution for their contribution for the study.
| References|| |
|1.||Zainal M, Ismail SM, Ropilah AR, Elias H, Arumugam G, Alias D, et al. Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey. Br J Ophthalmol 2002;86:951-6. |
|2.||Al Sarheed M, Bedi R, Alkhatib MN, Hunt NP. Dentists attitude and practices towards provision of orthodontic treatment for children with visual and hearing impairments. Spec Care Dentist 2006;26:30-6. |
|3.||Yalcinkaya SE, Atalay T. Improvement of oral hygiene knowledge in a group of visually impaired students. Oral Health Prev Dent 2006;4:243-53. |
|4.||Ahmed MS, Jindal MK, Khan S, Hashmi SH. Oral health knowledge, practice, oral hygiene status and dental caries prevalence among visually impaired students in residential institute of Aligarh. J Dent Oral Hygiene 2009;1:22-6. |
|5.||Chang CS, Shih Y. Knowledge of dental health and oral hygiene practices of taiwanese visually impaired and sighted students. J Visual Impairment Blindness 2004;98: 1-27 |
|6.||Nandini NS. New insights into improving the oral health of visually impaired children. J Indian Soc Pedod Prev Dent 2003;21:142-3. |
|7.||Bhavsar JP, Damle SG. Dental caries and oral hygiene amongst 12- 14 year old handicapped children of Bombay, India. J Indian Soc Pedod Prev Dent 1996;14:1-3. |
|8.||Goreeleg CB, Goldstein PA, Forrester DJ. Oral manifestation in a group of blind students. Am Soc Dent Child J 1976;43:39-41. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]