|Year : 2013 | Volume
| Issue : 3 | Page : 141-145
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
Venugopal K Reddy1, Kshitij Chaurasia1, Ajay Bhambal1, Ninad Moon2, Eshwar K Reddy3
1 Department of Public Health Dentistry, People’s College of Dental Sciences & Research Centre, People’s University, Bhanpur, Bhopal, Madhya Pradesh, India
2 Department of Periodontics, RKDF dental college, Bhopal, Madhya Pradesh, India
3 SIMS college of Physiotherapy, Guntur, Andhra Pradesh, India
|Date of Web Publication||11-Sep-2013|
Venugopal K Reddy
Department of Public Health Dentistry, People’s College of Dental Sciences & Research Centre, People’s University, Karond-Bhanpur Bypass Road, Bhopal-462 037, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The aim of this study is to compare the oral hygiene status and dental caries experience among institutionalized visually impaired and hearing impaired children of age between 7 and 17 years in Bhopal city of Madhya Pradesh located in Central India. Materials and Methods: A total of 95 hearing impaired and 48 visually impaired children of age between 7 and 17 years were recruited from special care institutions (one institution of hearing impaired and two institutions of visually impaired) in Bhopal city. Information related to different study variables was obtained from both groups. Oral hygiene index simplified (OHI[S]), decayed,extracted, filled teeth (deft and DECAYED, MISSING, FILLED TETTH (DMFT)) indices were used to record the oral hygiene status and dental caries experience. Results: Mean OHI(S) score for hearing impaired was 1.15 ± 0.72 while it was 1.51 ± 0.93 for visually impaired children (P < 0.05). Mean DMFT score was 1.4 ± 1.95 and 0.94 ± 1.45 among hearing impaired and visually impaired respectively. The hearing impaired had a mean deft score of 0.47 ± 1.01 and in visually impaired it was 0.19 ± 0.79 and the difference was statistically significant (P < 0.05). Conclusion: Oral hygiene status of hearing impaired children was better than visually impaired and the difference was statistically significant. There was no significant difference between both groups with respect to DMFT. The hearing impaired children had significantly higher deft than visually impaired.
Keywords: Dental caries experience, hearing impaired, institutionalized, oral hygiene status, visually impaired
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2013 [cited 2019 Oct 14];31:141-5. Available from: http://www.jisppd.com/text.asp?2013/31/3/141/117963
| Introduction|| |
Disability is an umbrella term that includes problem in body function or structure, difficulty encountered by an individual in executing a task or action or problem experienced by an individual in involvement in life situations. It is a complex phenomenon reflecting an interaction between features of a person's body and features of the society in which he or she lives.  About 15% of the world's population lives with some form of disability of which 2-4% experience significant difficulties in functioning.  Disability is more complex among children. Visual impairment and hearing impairment constitutes a significant proportion among all disabled children. Visual impairment refers to a condition where a person suffers from any of the following conditions: Total absence of sight or visual acuity not exceeding 6/60 or 20/200 in the better eye even with correction lenses or limitation of the field of vision subtending an angle of 20° or worse. Hearing impairment has been defined as loss of 60 dB or more in the better ear in the conventional range of frequencies. According to a recent report, globally 19 million children are visually impaired out of which 1.4 million are irreversibly blind. The prevalence ranges from 0.3/1000 children aged 0-15 years in affluent countries to 1.5/1000 children in very poor communities. , According to Titiyal et al., there were probably 280,000-320,000 visually impaired children in India.  On the other hand, according to a study report in the year 2000, the prevalence of hearing impairment in children was 0.05-0.23% in developed countries and 0.2-0.42% in developing countries.  In India, 0.4% children are hearing impaired. 
These children are usually dependent on parents or guardians for carrying out daily activities including oral care.  Studies performed by Anaise in Israel,  Shaw et al. in UK  and Purohit et al. in South India  found poor oral health attributes among special care children. Shaw et al.  in 1986 and Rao et al.  in 2005 reported poor oral hygiene status among special care children. A Study report of Purohit et al. in 2010 in South India  showed a dental caries prevalence of 89.1% in special care children. They had significantly higher DMFT and deft than their healthy counterparts. These study reports clearly indicates that children with disabilities remain as a highly neglected group of the human society with very high unmet needs requiring special attention. Therefore, they are a special challenge to dental public health.
There were studies ,, reported in the literature comparing the dental health of special care children with normal children. However, only limited studies have been done comparing dental health of different kinds of special care children. Comparing oral health attributes between different groups of special care children would be helpful in obtaining baseline data to understand oral health needs of these children and accordingly recommending appropriate preventive measures. Therefore, the present study was undertaken with an aim to compare the oral hygiene status and dental caries experience among institutionalized visually impaired and hearing impaired children of age between 7 and 17 years in Bhopal city of Madhya Pradesh located in Central India.
| Materials and Methods|| |
A cross-sectional study was conducted among institutionalized visually impaired and hearing impaired children in Bhopal city during August 2011, for a period of 3 months. All these institutions were run by the state government. The minimum age requirement for admitting the special care children into these institutions was that children should have been 7 years old. All the special care institutions in Bhopal city boarding the special care children were invited to participate in the study. Out of these, one institution of hearing impaired and two institutions of visually impaired children were finally agreed to participate in the study. A total of 143 special care children of age between 7 and 17 years participated in the study, of whom 95 were hearing impaired and 48 were visually impaired.
Ethical clearance was obtained from the institutional ethical committee and permission was obtained from heads of the special care institutions before the study was scheduled. Informed consent and verbal assent were obtained from both the guardians and children respectively prior to the interview and clinical examination of children. Children present on the day of examination were included in the study. Those who were not willing to participate or unwell were excluded.
A close-ended questionnaire was designed to record information on oral hygiene practices, previous day sugar exposure, tobacco related habits, presence or absence of dental pain and utilization of dental services. The responses for the close ended questionnaire were recorded with the help of guardians of both groups. The interview was followed by the clinical examination of children by the calibrated examiner. Cohen's Kappa coefficient for assessment of dental caries was 0.84, indicating good intra examiner reliability.
Type III clinical examination was carried out using mouth mirror and explorer under good illumination by a single examiner. Sufficient number of presterilized instruments was carried to the institutions on the day of examination to avoid interruption during the examination. Examination was carried out by a single examiner with recording assistant. During the examination, children were seated in a chair with examiner standing in front and the trained assistant standing in close vicinity to the examiner to record the findings. The examination was done under adequate natural illumination. Oral hygiene status was recorded using Greene and vermillion's oral hygiene index simplified (OHI[S])  and dental caries in permanent and primary dentition was recorded using Klein, Palmer and Knutson's DMFT index  and DMFT index proposed by Gruebbel.  After the examination, children in need of dental treatment were referred to the dental college for rendering specialty care.
Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 (SPSS Inc. 233 South Wacker Drive, 11 th Floor, Chicago, II,60606-6412). Chi-square analysis was used to explore the association between explanatory variables and oral health. Mann-Whitney U test was used to compare the categorical variables between visually impaired and hearing impaired children. Statistical significance was fixed at P ≤ 0.05.
| Results|| |
In the present study, 143 special care children in the age group of 7-17 years were examined. They were sub-divided to two age groups, i.e., 7-12 years and 13-17 years. Most of them belonged to the later age group. Majority of the children were males. No significant differences (P > 0.05) were noted between the two groups for age and gender [Table 1]. Furthermore, there were no significant differences (P > 0.05) between the two groups for tooth brushing habits, last day sugar exposure, tobacco related habits, dental pain and utilization of dental services. Most of these children were brushing regularly once a day using toothpaste without any supervision and none of them had ever visited a Dentist [Table 2].
Mean OHI(S) score was found to be 1.15 ± 0.72 (mean debris index (simplified) [DI(S)] score = 0.7 ± 0.38 and mean calculus index (simplified) [CI(S)] score = 0.45 ± 0.51) for hearing impaired children while it was 1.51 ± 0.93 (mean DI(S) score = 0.86 ± 0.46 and mean CI(S) score = 0.65 ± 0.7) for visually impaired. Statistically, there was no significant difference (P > 0.05) between the two special groups for mean debris and calculus scores. However, mean OHI(S) score was found to be significantly different (P < 0.05) between both groups with the hearing impaired having better oral hygiene than visually impaired children [Table 3].
|Table 3: Mean scores of study subjects for OHIS(S), DMFT and deft indices|
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Mean DMFT score was found to be 1.4 ± 1.95 among hearing impaired and 0.94 ± 1.45 among visually impaired. However, the difference was not statistically significant (P > 0.05). Hearing impaired children had a mean DMFT score of 0.47 ± 1.01 and in visually impaired it was 0.19 ± 0.79 and the difference was statistically significant (P > 0.05) with the hearing impaired having higher DMFT than the visually impaired.
| Discussion|| |
In the present study, 143 institutionalized disabled subjects (95 hearing impaired and 48 visually impaired) of age between 7 and 17 years were examined. They were treated as children according to the child's definition given by United Nations Children's Fund,  which states that any individual up to 18 years of age should be designated as a child. These institutionalized children were designated disabled according to criteria given by "Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995,"  which defines blindness as a condition where a person suffers from total absence of sight or visual acuity not exceeding 6/60 or 20/200 in the better eye even with correction lenses or limitation of the field of vision subtending an angle of 20° or worse. Deafness has been defined as loss of 60 dB or more in the better ear in the conventional range of frequencies.
The demographic information related to both groups reveals that there was no significant difference between both groups with respect to age and gender composition. There was also no significant differences between both groups regarding their brushing habits, last day sugar exposure, tobacco related habits and utilization of dental care and thus did not influenced the study results. The assessment of oral hygiene status, which was based on Greene and Vermillion's categorization of OHI(S) scores  (Good: 0.0-1.2; Fair: 1.3-3.0; Poor: 3.1-6.0) revealed that the oral hygiene status of the hearing impaired children was found to be significantly better than visually impaired (P < 0.05). This may be perhaps due to the fact that hearing impaired children can visualize the act of tooth brushing, which is still one of the most common means of maintaining oral hygiene especially, in developing countries like India. As the act of tooth brushing was not supervised, the role of other factors like technique of tooth brushing, motor skills and obtaining the help from guardians was ignored which might have an impact on oral hygiene status of both groups. This finding was in agreement with the study reports of Shaw et al. in Birmingham, in which hearing impaired were having better oral hygiene than other handicapped groups.  In an another study done by Altun et al. comparing different handicapped groups, poor oral hygiene status was found among subjects with mental retardation than other handicapped groups. 
The assessment of dental caries experience among these groups revealed certain interesting facts. There was no significant difference between both groups with respect to mean DMFT. This is likely because both groups were institutionalized and thus should have exposed to similar dietary patterns including the sugar consumption. Our study finding is in agreement with study carried out by Shaw et al.  and Altun et al.,  in which mean DMFT was not significantly different between different handicapped groups. But our finding is not in agreement with the study report of Jain et al.  in India who reported a significantly higher mean DMFT in hearing impaired group. On the other hand, mean DMFT was significantly higher among hearing impaired children as compared with visually impaired children. This may be perhaps due to the exposure of hearing impaired to a different living environment that includes various factors such as socio-economic status, peer influence, Illiteracy, lack of awareness towards oral health among the parents, which might have encouraged the frequent consumption of refined sugars resulting in a higher DMFT before their admission to the special care institutions. Our finding is in agreement with the study results of Al-Qahtani and Wyne in March 2004 at Riyadh, Saudi Arabia who reported a higher mean DMFT score in hearing impaired. 
Many children of both groups were also suffering from dental pain, which was untreated and none of them had any filled tooth until the date of examination as they neither visited a Dentist nor a qualified dental surgeon is been appointed by the authorities to take care of their dental problems. This implies that both groups were completely deprived of dental care with very high unmet needs. These findings are in agreement with the study reports of Jain et al. in India and Brown in Saudi Arabia revealing a high need for dental care among handicapped children. , Thus, these underserved children need a special attention by the Dentist community.
The only limitation of the present study was that no data was recorded about the level of mental capacity and motor skills of the study subjects as it was beyond the scope of this research. Further, studies are recommended in this direction in order to achieve more definite conclusions.
| Conclusions|| |
The oral hygiene status of the hearing impaired children was better than visually impaired children and the difference was statistically significant. The mean DMFT was not significantly different between both handicapped groups. The mean DMFT was significantly higher among the hearing impaired subjects than among visually impaired.
- Oral health education must be given to these special groups according to their handicapped status. Guardians of these handicapped groups should be trained by the public health dentistry departments of dental colleges in basic oral health on a periodic basis as they play a vital role in delivering oral health education, assistance in dental care to these special groups and in making appropriate referrals.
- There should be separate wards in pedodontics department of the dental colleges in order to take care of oral health needs of these special groups.
| Acknowledgments|| |
We would like to thank all the staff and children of the special care institutions in Bhopal city for rendering their valuable support during the study.
| References|| |
|1.||World Health Organization. Disabilities. Available from: http://www.who.int/topics/disabilities/en/. [Last accessed on 2011 Oct 22]. |
|2.||World Health Organization. World report on disability. Available from: http://www.who.int/disabilities/world_report/2011/report/en/index.html. [Last accessed on 2012 Feb 10]. |
|3.||World Health Organization. Visual impairment and blindness. Available from: http://www.who.int/mediacentre/factsheets/fs282/en/index.html. [Last accessed on 2012 Feb 10]. |
|4.||World Health Organization. Vision 2020 the right to sight. Global initiative for the elimination of avoidable blindness: Action plan, 2006-2011. Available from: http://www.who.int/blindness/Vision2020_report.pdf. [Last accessed on 2012 Feb 8]. |
|5.||Titiyal JS, Pal N, Murthy GV, Gupta SK, Tandon R, Vajpayee RB, et al. Causes and temporal trends of blindness and severe visual impairment in children in schools for the blind in North India. Br J Ophthalmol 2003;87:941-5. |
|6.||Mathers C, Smith A, Concha M. Global burden of hearing loss in the year, 2000. Available from: http://www.who.int/healthinfo/statistics/bod_hearingloss.pdf. [Last accessed on 2012 Feb 14]. |
|7.||Jain M, Mathur A, Kumar S, Dagli RJ, Duraiswamy P, Kulkarni S. Dentition status and treatment needs among children with impaired hearing attending a special school for the deaf and mute in Udaipur, India. J Oral Sci 2008;50:161-5. |
|8.||Rao D, Amitha H, Munshi AK. Oral hygiene status of disabled children and adolescents attending special schools of South Canara, India. Hong Kong Dent J 2005;2:107-13. |
|9.||Anaise JZ. Periodontal disease and oral hygiene in a group of blind and sighted Israeli teenagers 14-17 years of age. Community Dent Oral Epidemiol 1979;7:353-6. |
|10.||Shaw L, Maclaurin ET, Foster TD. Dental study of handicapped children attending special schools in Birmingham, UK. Community Dent Oral Epidemiol 1986;14:24-7. |
|11.||Purohit BM, Acharya S, Bhat M. Oral health status and treatment needs of children attending special schools in South India: A comparative study. Spec Care Dentist 2010;30:235-41. |
|12.||Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13. |
|13.||Klein H, Palmer CE, Knutson JW. Dental status and dental needs of elementary school children. Public Health Rep 1938;53:751-65. |
|14.||Gruebbel ÀÎ. A measurement of dental caries prevalence and treatment service for deciduous teeth. J Dent Res 1944;23:163-8. |
|15.||UNICEF. Convention on the rights of the child. Available from: http://www.unicef.org/crc/. [Last accessed on 2012 Feb 11]. |
|16.||The persons with disabilities (equal opportunities, protection of rights and full participation) Act, 1995. Ministry of Social Justice and Empowerment. Government of India. Available from: http://socialjustice.nic.in/pwdact1995.php?pageid=3. [Accessed on 11]. |
|17.||Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent 2010;4:361-6. |
|18.||Al-Qahtani Z, Wyne AH. Caries experience and oral hygiene status of blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia. Odontostomatol Trop 2004;27:37-40. |
|19.||Brown A. Caries prevalence and treatment needs of healthy and medically compromised children at a tertiary care institution in Saudi Arabia. East Mediterr Health J 2009;15:378-86. |
[Table 1], [Table 2], [Table 3]