|Year : 2012 | Volume
| Issue : 2 | Page : 127-132
Inter-relationship of intelligence-quotient and self-concept with dental caries amongst socially handicapped orphan children
PKS Virk1, RL Jain2, A Pathak3, U Sharma4, JS Rajput5
1 Department of Pedodontics, Bhojia Dental College and Hospital, Nalagarh, Distt. Solan, Himachal Pradesh, India
2 Department of Pedodontics, Guru Nanak Dev Dental College, Sunam, India
3 Department of Pedodontics, Government Dental College and Hospital, Patiala, Panjab, India
4 Department of Pedodontics, Dr. HSJ Institute of Dental Sciences and Hospital, Panjab University, Sector 25, Chandigarh, Panjab, India
5 Department of Pedodontics, Teerthankara Mahaveer Dental College, Moradabad, Uttar Pradesh, India
|Date of Web Publication||23-Aug-2012|
35-B, Udham Singh Nagar, Civil Lines, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context : India has been the focus of many health surveys among normal, physically, and mentally handicapped children. However, the data, concerning oral health conditions of socially handicapped children living in orphanages, are scanty. Aims: To study the effect of parental inadequacy, environmental deprivation, and emotional disturbances on dental caries through intelligence quotient (IQ) and self-concept in orphan children and also to co-relate dental caries with different levels of IQ and self-concept. Settings and Design: The study was carried out amongst socially handicapped children living in orphanages. Patients and Methods: 100 children in the age group of 10-14 years from orphanages were selected. Malin's Intelligence Scale for Indian Children (MISIC) was used to assess the intelligence quotient; self-concept questionnaire to assess self-concept of the child and recording of dental caries status of children was done as per WHO Index (1997). StatisticaL Analysis Used : To assess the relationship of dental caries with IQ, student's unpaired t-test was used and; to find the relationship between self-concept and dental caries, Karl-Pearson's coefficient of co-relation was applied. Results: the children in orphanages had a lower IQ and high caries experience but had an above average self-concept. There was also no co-relation between dental caries and self-concept. Conclusions: Orphan children, being socially handicapped, are at an increased risk for dental caries due to a lower IQ level, parental deprivation, and institutionalization. Moreover, lack of co-relation between dental caries and self-concept could be explained by the fact that dental caries is a lifelong process whereas different dimensions of self-concept are in a state of constant flux.
Keywords: Dental caries, institutionalization, intelligence-quotient, self-concept, social handicap
|How to cite this article:|
Virk P, Jain R L, Pathak A, Sharma U, Rajput J S. Inter-relationship of intelligence-quotient and self-concept with dental caries amongst socially handicapped orphan children. J Indian Soc Pedod Prev Dent 2012;30:127-32
|How to cite this URL:|
Virk P, Jain R L, Pathak A, Sharma U, Rajput J S. Inter-relationship of intelligence-quotient and self-concept with dental caries amongst socially handicapped orphan children. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Dec 11];30:127-32. Available from: http://www.jisppd.com/text.asp?2012/30/2/127/99986
| Introduction|| |
Socially handicapped children are those children whose healthy personality development and full unfolding of potentialities are hampered by certain elements in their social environment such as parental inadequacy, environmental deprivation, and emotional disturbances.  The pattern of orphanage living is different from family living as the latter provides physical security, food, and shelter but is devoid of psychological security. These children form a population at risk with reference to abnormal psychosocial development. 
Each child possesses a unique constellation of traits and one of these traits is intelligence, which can be measured as intelligence quotient (IQ). The intellectual level of an individual reflects both his own genetic potential as well as his experiential inputs.  The adverse psychological conditions therefore, impair intellectual development. Self-concept is described as an individual way of looking at oneself and is the ultimate goal of personality development. It is formed through one's environment and is influenced by others' as well as one's own behavior.  There is an effect on intelligence and self-concept amongst the institutionalized orphans due to an early psychological problem, relative monotony, and homogeneity of environment. 
The modern concept of dental caries involves the interaction between genetic and environmental factors in which biological, social, behavioral, and psychological components are expressed in a highly complex and interactive manner.  There are very few specific studies describing the status of dental caries in orphan children living under institutionalized care in India. , Since these children are socially deprived, they form a perfect group to study the influence of intelligence and self-concept on dental caries. A number of studies conducted to find the relationship of dental caries with different Intelligence Quotients show conflicting data. ,, Besides, no study was conducted in institutionalized orphan children. Low caries prevalence in orphanages has been reported  and attributed to a combination of the following environmental factors - regimentation of living conditions; sheltered life at the institution accompanied by freedom from emotional tension and adequacy of diet  but the psychological aspects of these children have not been explored.
This study explores the psychological aspects of institutionalized orphan children and the possible relationship of dental caries with both IQ and self-concept in these children.
| Patients and Methods|| |
A total of 100 children in age group of 10-14 years from various Indian orphanages were selected. A sequence of recording for IQ, self-concept, and dental caries was followed. Malin's Intelligence Scale for Indian Children (MISIC) was used to assess the IQ. This is an Indian adaptation of Wechsler's Intelligence Scale for Children (WISC) and embraces all the advantages of the original scale along with several improvements.  This scale is used to assess both the verbal and performance IQ of the child.
In this study, four verbal IQ subtests were used, that is, information test, general comprehension test, arithmetic test, and digit span test. The two performance IQ subtests used were the picture completion test and block design test. The raw scores were converted into the test quotient of each subtest. Full scale IQ was obtained by adding both verbal and performance test results and dividing for the average. Self-concept questionnaire by R. K. Saraswat was used to assess the self-concept of the child.  This test provides six dimensions of self-concept, namely physical, social, temperamental, educational, moral, and intellectual. The inventory contains a total of 48 items; each item is provided with five alternatives. The responses were obtained on the test booklet itself. This questionnaire gives the score for a particular dimension of self-concept as well as the total self-concept score. The summated score of all items provides the total self-concept of the individual. A high score on this inventory indicates a high self-concept whereas a low score shows low self-concept. Surface-wise recording of dental caries was done as per WHO Index (1997) on a modified Unilever Dental Chart using a mouth mirror and ordinary dental probe. 
To assess the relationship of dental caries with IQ, student's unpaired t-test was used and; to find the relationship between self-concept and dental caries, Karl-Pearson's coefficient of co-relation was applied.
Standardization of investigator
The investigator was trained by a clinical psychologist in proper administration, scoring, and interpretation of the intelligence test and self-concept scale and calibrated for assessment of these tests by repeated sessions. Similarly, the same investigator was calibrated for recording dental caries before the start of study.
| Results|| |
According to Wechsler Bellevue Classification of Intelligence (W-BI), children were divided into three groups, namely group I or average, group II or dull normal, and group III or borderline [Table 1]. In this study, the IQ range of orphan children was 72-109 with a mean of 88.75 ± 8.41 using MISIC. However, the mean IQ scores in males and females did not differ.
A total of 94% of children were affected by dental caries out of which the males and females were 93.1% and 95.23%, respectively. It was also observed that the dental caries experience was least in children with borderline IQ (84.61%) and maximum in children with dull normal IQ (95.83%) and was closely followed by children with average IQ (94.87%). DMFT (decayed, missing, and filled teeth) + deft (decayed, extracted due to caries, filled teeth) score was highest (5.15 ± 2.54) in children with average IQ, followed by children with dull normal IQ with a DMFT + deft score of 4.68 ± 2.08. The lowest DMFT + deft score (3.84 ± 2.11) was seen in children with borderline IQ.
The mean DMFS (decayed, missing, and filled surfaces) + defs (decayed, missing, and filled surfaces) was highest in children with average IQ (7.82 ± 4.23) followed by dull normal IQ children (6.97 ± 4.14) and lowest was found in borderline IQ (5.46 ± 3.57) [Figure 1]. The result of intergroup comparison of all scores was statistically nonsignificant. The mean DMFT + deft and DMFS + defs of the orphans was 4.76 ± 2.29 and 7.11 ± 4.14 respectively. The Decayed (D + d) component (98.11%) took predominance over Missing (M + m) component (1.24%) and filled (F + f) component (0.65%) [Figure 2].
|Figure 1: Bar diagram showing DMFT+ deft and DMFS+ defs in different Intelligence Quotient groups|
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It was also noted that dental caries was more in mandibular teeth (59.67%) than in the maxillary teeth (40.33%) [Figure 3]. The first permanent molar was the most frequently involved tooth by caries [Figure 4]. Amongst a total of 711 surfaces of the teeth, the most commonly involved carious surface was the occlusal, 423 (59.5%) followed by the buccal/lingual surfaces, 227 (31.9%) and the least commonly involved were the mesial/distal surfaces, 61 (8.6%) [Figure 5]. The relationship of dental caries with IQ showed that there was a trend toward an increased dental caries activity with an increase in IQ although it did not reach a statistically significant level.
|Figure 3: Distribution of carious teeth in maxillary and mandibular arch|
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Children living in orphanages had an above average self-concept in all its individual dimensions [Figure 6], [Table 2]. The mean total self-concept score was 176.75 ± 21.37 with a range of 132-218. The relationship between various dimensions of self-concept and dental caries was obtained by applying the correlation coefficient (r value). There was no significant correlation between dental caries and self-concept score in all its dimensions, namely physical, social, temperamental, educational, moral, intellectual, as well as total self-concept [Table 3].
|Figure 6: Bar diagram showing scores of different self-concept dimensions|
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|Table 3: Relationship between dental caries (DMFT + deft and DMFS + defs) and different dimensions of self-concept|
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| Discussion|| |
In this study, intelligence score tends to cluster around the mean and a lower level of intelligence continuum that is in accordance with a number of studies. Kafiluddin  found that intelligence was determined not only by genetic, but also influenced by environmental factors. Vaz et al.  stated that most common group amongst the institutionalized orphans was in the IQ range of 80-90 in which 47.31% children were placed and hence, is in agreement with present study. The result could be explained on the basis of residence in orphanages that is characterized in extreme as it lacks in sensory stimulation and environmental deprivation. Singh  summed up the reason behind low performance on intelligence tests as nonexposure to reading material, lack of interaction, prohibitive atmosphere, absence of care, and above all a feeling of being an orphan. The factors related to a varied outcome in intellectual functioning are the result of an individualized stimulation provided, the age at the time of institutionalization, difference in vulnerability to institutional deprivation, and duration of institutionalization.
There was an above average mean score in all the individual self-concept dimensions as well as total self-concept. The results are contrary to a generally accepted opinion that orphan children had a poor self-concept. However, these results are in accordance with the study conducted by Parthasarathy and Swaminathan  who stated that orphan children had a higher self-concept. This could be interpreted as an expression of defensiveness to combat stress arising out of conflict that might be encountered when they leave the institute that protects or prevents them from the hardships of realistic and competitive world. Secondly, due to institutional environment with limited exposure to reality, orphan children form their own self-concept and compare themselves with other orphans in forming a conception about them. Also they did not blame themselves for their social deprivation or misfortunes.
The results of present study showed that there was no significant correlation of dental caries with various dimensions of self-concept as well as total self-concept. There are no studies reported in the literature relating caries with self-concept. However, Kallestel et al.  associated self-esteem, an indicator of self-concept, with oral health behavior and concluded that poor health behavior was related to low self esteem. Manhold and Rosenberg  supported the psychosomatic hypothesis that personality maladjustment was associated with dental decay. Barry and Dutkovic  stated that Manhold, in his various studies on association of psychological factors with dental decay needed large samples of homogenous subjects before he could obtain a stable and significant result and inventories could be easily distorted due to any bias on the part of subject. Ozaki et al.  stated that the relationship between the increase of dental caries and personality characteristics showed a tendency toward a low degree of direct correlation. The lack of relationship between dental caries and self-concept can be explained as these two are nonidentical variables. Area of self-concept is not very well defined; it is in a state of constant flux and can improve or deteriorate with time whereas dental caries score represents a lifelong process that will not respond in a similar manner. More importantly, children have a tendency to answer questions on self-concept in a socially desirable way.
This study also showed that orphan children living in orphanages had more caries as compared to normal children. Bruckner and Hill  stated that normal noninstitutionalized children with higher IQ had fewer teeth and/or surfaces of the teeth involved by caries. Steinberg and Zimmermann  stated that institutionalized subnormal person with a lower IQ(20- 49) had significantly lower caries score than the group of subjects with a higher IQ (≥50) and when graphed from lowest IQ to highest IQ, the caries score formed a bell-shaped curve with persons of an average IQ having the highest caries score. But in a study conducted by Shanker et al.  IQ had a direct relationship with dental caries, that is, with increase in IQ there was an increase in dental caries. In this study, trends followed the above studies; highest caries score was seen in those with an average IQ and an increase in IQ was associated with an increase in caries score, though it did not reach a statistically significant level. It could not be ascertained whether the graph will be bell shaped or a straight line curve since there was a lack of an above average group IQ (≥110) in this study [Figure 7].
|Figure 7: Line diagram comparing the results of IQ with dental caries scores of different studies with the present study|
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The results of this study are not in accordance with a generally accepted opinion that institutionalized children tend to be less susceptible to caries attack. There are number of factors pertaining to variance of the result of present study with other studies. The children of this study had a variable period of institutionalization and were not brought up in such institutions from infancy. Past caries experience, before the children were institutionalized, could be the reason for high dental caries scores of these children. Taanenbaum and Miller  reported that caries attack rate was less in children staying in the institution for a longer period. An interesting observation of this study was that children were allowed to visit their relatives and homes during school vacations. During this period, not only was their pattern of living disturbed, but also important changes in their daily diet may have occurred. Suher  proposed this reason to explain high caries attack rate in institutionalized children. As far as restriction of refined sugar intake was concerned, the people felt sympathetic toward the plight of these children and pampered them with sweets and snacks at the orphanages on social occasions.
The orphan children also had more psychological problems. Adamowicz and Burkiewicz  stated that amongst the children subjected to sociopathies, the so-called social orphan, state of the teeth was worse. Jones et al.  reported that dental decay in children was positively and significantly associated with deprivation. Siddiqui  reported that in most of the orphanages of India, there was no health facility available and there was a total absence of health education. Manati and Saraswati  further stated that most of the institutions were overcrowded; underfunded; there was lack of trained staff and were not equipped to meet the developmental needs of children. Therefore, the difference in caries could have been due to lack of awareness, motivation, and accessibility to health care combined with prohibitive cost of dental health care.
| Acknowledgement|| |
The authors duly acknowledge the management of the orphanages for extending their full support and the participants for their co-operation that helped in the completion of this study.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3]
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