|Year : 2017 | Volume
| Issue : 3 | Page : 203-208
Assessment of dental caries and periodontal status in institutionalized hearing impaired children in Khordha District of Odisha
Avinash Jnaneswar1, Goutham Bala Subramaniya1, Jayashree Pathi2, Kunal Jha1, Vinay Suresan1, Gunjan Kumar1
1 Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India
2 Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
|Date of Web Publication||31-Jul-2017|
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, Campus-5, KIIT University, Patia, Bhubaneswar - 751 024, Odisha
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Over 5% of the world's population has disabling hearing loss. The oral health of the disabled may be disused for the reason of the disabling condition, a challenging disease or the limited access to oral health care. Objectives: The objectives of the study were to assess the prevalence of dental caries and periodontal status of institutionalized hearing impaired (HI) children in Khordha district of Odisha. Materials and Methods: A descriptive cross-sectional study on the HI children was conducted in Khordha district, Odisha. Type III examination procedure was conducted to assess the oral health status of the children. Statistical analysis was performed by Chi-square test and Student's t-test, and the significance level was fixed at P < 0.05. Results: The final population consisted of 540 HI children out of which 262 (48.5%) were male and 278 (51.5%) were female, 285 (52.8%) children had severe hearing loss and 227 (42.0%) had profound hearing loss. Bleeding on probing was found in 72 (13.3%) female children as compared to 57 (10.6%) male children. While 131 (24.3%) female children had calculus, 124 (23.0%) male children had the same condition. Total caries prevalence was 19.3%. Statistically highly significant difference was found for mean decayed teeth (DT), missing teeth decayed, missing filled teeth (FT) (P < 0.001), while for mean FT there was no statistically significant difference according to age groups. Statistically highly significant difference was found for mean DT, extracted teeth and decayed, extracted, filled teeth (P < 0.001). Conclusion: An improved accessibility to dental services as well as dental health education is necessary to ensure the optimum dental health within the reach of these less fortunate children.
Keywords: Dental caries, hearing impaired, institutionalized, periodontal status
|How to cite this article:|
Jnaneswar A, Subramaniya GB, Pathi J, Jha K, Suresan V, Kumar G. Assessment of dental caries and periodontal status in institutionalized hearing impaired children in Khordha District of Odisha. J Indian Soc Pedod Prev Dent 2017;35:203-8
|How to cite this URL:|
Jnaneswar A, Subramaniya GB, Pathi J, Jha K, Suresan V, Kumar G. Assessment of dental caries and periodontal status in institutionalized hearing impaired children in Khordha District of Odisha. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2019 Nov 21];35:203-8. Available from: http://www.jisppd.com/text.asp?2017/35/3/203/211836
| Introduction|| |
Over 5% of the world's population - 360 million people - has disabling hearing loss (328 million adults and 32 million children). Disabling hearing loss refers to hearing loss >40 decibels (dBs) in the better hearing ear for adults and a hearing loss >30 dB in the better hearing ear in children.
The approach toward oral health, oral hygiene, and dental attendance and the virtual significance placed on esthetically acceptable and functionally adequate dentitions must be viewed within the framework of illness, disability, socioeconomic status, and stresses imposed on daily living for the individual, family and caretakers., The disabling conditions when coalesce with these kind of additional pressures can make oral health attain a low priority. There arises thus a requirement of change in the attitude and practice for parents/caretakers to include oral health as part of routine care of the children from an early age in life.
The oral health of the disabled may be disused for the reason of the disabling condition, a challenging disease or the limited access to oral health care. Unsurprisingly, it has been reported that “a dental treatment is the greatest unattended health need of the disabled.”
Numerous studies have been done on the general population, but there have been relatively fewer studies on oral health status of the institutionalized hearing impaired (HI) children who actually require special care and attention. In addition, very few or no studies for this population are available in Khordha district, Odisha.
Consequently, an attempt was made in this study to assess the prevalence of dental caries and periodontal status of institutionalized HI children in Khordha district of Odisha.
| Materials and Methods|| |
A descriptive cross-sectional study on the HI children was conducted in Khordha district, Odisha. The study population who were present on the day of examination was considered and the age ranged from 5 to 15 years. All the students were institutionalized, with low socioeconomic status, and poor background, and they were under the guidance of caretakers. Children affected with mental retardation, physically and mentally challenged, with orthopedic defects, cerebral palsy and who were medically compromised were excluded from the study and Children, who were absent on the day of examination, did not cooperate and, who were systemically ill, were also excluded from the study. The study was conducted after due permission was obtained from the Directorate for Welfare of Persons with Disabilities, Khordha, Odisha. The study was approved by the Institutional Ethical Committee of Kalinga Institute of Medical Sciences, KIMS, KIIT University, and clearance was obtained with the reference number KIMS/KIIT/IEC/050/2014. Before the start of the study, informed consent was taken from the heads of the institutes, as the children were not in a position to understand the consent form.
A preliminary test was conducted on 25 HI children in March 2016. The study was conducted to assess the validity and accuracy of the pro forma and the reliability of the examiner and to know the practical and communication difficulties while examining oral cavity of this group of children. The intraexaminer reliability of the examiner was assessed using the Weighted Kappa statistics, which was 90% for decayed filled teeth (dft), 91% for decayed, missing filled teeth (DMFT) while for community periodontal index (CPI) it was 83%.
There were seven institutionalized HI schools in Khordha district. All the children present in these seven schools were included in the study, thus making it a universal sample design. The WHO Oral Health Assessment form (1997) was used for the study.
A survey was systematically scheduled to cover all the institutes according to the convenience of the institutional authorities. The survey period extended from March to July 2016. Although a detailed schedule plan was prepared meticulously well in advance by informing and obtaining consent from authorities, few adjustment and changes were called for while working it out practically.
The examiner visited the residential institutes on the predetermined dates as according to the schedule with a trained recorder, where the recorder recorded the general information and the clinical examination finding as dictated by the examiner. The recording assistant was allowed to sit close enough to the examiner so that instructions and codes could be easily heard and the examiner could see that findings were recorded correctly. The school teachers or the heads of the institutions were used as interpreters for communication with the HI children.
Clinical examinations were carried out at the institute's verandah or classroom with the aid of a mouth mirror, explorer and CPI probe under adequate natural light (Type III examination). Before examination, each tooth was wiped with sterile cotton roll to get a dry surface for proper evaluation. Children were seated on a chair and oral cavity was examined. The chair was placed in front of a well-lit window, but not in direct sunlight, with the subject facing the window or toward the direction of light. No artificial dental illumination was used.
Examiner wore disposable mouth masks and gloves during examination. For instruments, chemical method of disinfection was followed using Korsolex diluted by adding 1–9 parts of potable water.
To ensure uniform interpretation, understanding and application by the examiner, of the codes and criteria for the various diseases and conditions to be observed and recorded in the pro forma used, the examiner was previously calibrated and trained in the department by the head of the department. The recorder in the study was also previously trained in the department. Duplicate examination was conducted for 5% of the sample at the beginning and again on successive days using the same diagnostic criteria to ensure the reliability of the examiner.
Statistical analysis was performed by Chi-square test and Student's t-test, and the significance level was fixed at P < 0.05.
| Results|| |
[Table 1] shows the demographic distribution of the children. The final population consisted of 540 HI children out of which 262 (48.5%) were male and 278 (51.5%) were female, 285 (52.8%) children had severe hearing loss and 227 (42.0%) had profound hearing loss. The age group distribution had 337 (62.4%) children in the 5–10 years group while 203 (37.6%) were in the 11–15 years group. Most of the children were from urban location, i.e., 424 (78.5%). Statistically significant difference was not found in the distribution of children according to age groups, gender, location, and degree of hearing loss.
|Table 1: Demographic distribution of the hearing impaired children according to age groups, gender, location and degree of hearing loss|
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[Table 2] shows the gingival condition of the children. Out of the 540 children, bleeding on probing was found in 72 (13.3%) female children as compared to 57 (10.6%) male children. While 131 (24.3%) female children had calculus, 124 (23.0%) male children had the same condition.
|Table 2: Distribution of periodontal status according to the gender among hearing impaired children|
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[Table 3] shows the overall DMFT the mean dental caries experience among the study children in both the age groups. The mean decayed teeth (DT) was 0.22 ± 0.56 in 5–10-year-old children and 0.39 ± 0.88 in 11–15-year-old children. Mean missing and filled teeth (FT) were very less, i.e., 0.02 ± 0.17 and 0.06 ± 0.29, respectively. Total caries prevalence was 19.3%. It was 11.1% in 5–10-year-old children and 8.1% in 11–15-year-old children. Statistically significant difference was not found in the prevalence of dental caries according to age. However, the mean DMFT was 0.37 ± 0.88 in 11–15-year-old children which were higher than the 5–10-year-old children. Furthermore, statistically highly significant difference was found for mean missing teeth (MT) and DMFT (P < 0.001), while for mean FT, there was no statistically significant difference according to age groups.
|Table 3: Mean dental caries experience (decayed teeth, missing teeth, filled teeth and decayed missing filled teeth) according to age groups|
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[Table 4] shows the mean dental caries experience according to gender. Mean DT was 0.32 ± 0.66 in female children and 0.25 ± 0.63 in male children, and the mean DMFT was 0.30 ± 0.75 in males and 0.43 ± 0.98 in females. There was a statistically significant difference for the mean MT according to gender (P = 0.05).
|Table 4: Mean dental caries experience (decayed teeth, missing teeth, filled teeth and decayed missing filled teeth) according to gender|
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[Table 5] shows the mean dental caries experience in primary dentition according to the age groups. Mean DT was 0.18 ± 0.53 in 5–10-year-old children and only 0.01 ± 0.15 in 11–15-year-old children. Mean MT was very less, i.e., 0.03 ± 0.20. Mean FT was 0.00. Mean decayed, extracted, filled teeth (DEFT) was 0.15 ± 0.56 in 5–10-year-old children which were higher when compared to 11–15-year-old children. Statistically highly significant difference was found for mean DT, extracted teeth and DEFT (P < 0.001).
|Table 5: Mean dental caries experience (decayed teeth, missing teeth, filled teeth and decayed missing filled teeth) in primary dentition according to the age groups|
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| Discussion|| |
This cross-sectional descriptive type of study was undertaken to organize preventive and promotive oral health programs for the institutionalized HI children of Khordha district. Before the start of the research, the prevalence of dental caries and periodontal disease was assumed to be high among the study children. However, the prevalence of dental caries was found to be within the acceptable limit.
Historically, in a country like India where more preference is given to the male child in all walks of life, it was surprising to see more female children in the institutes. The demographic information related to both groups revealed that there was no significant difference between both groups with respect to age, gender composition, and location and thus did not influence the study results.
The removal of plaque from teeth is a skill that can be mastered only when the individual has the dexterity to manipulate a toothbrush and an understanding of the objectives of this activity. It is obvious that many disabled individuals will find the maintenance of their own oral hygiene much more difficult than normal individuals. Since the HI cannot understand and respond to the instructions given to them, they are unable to comprehend and master the technique of oral hygiene practices. This study showed a poor gingival health of the HI children with 71.1% prevalence of periodontal problems. This may be attributed to the individual's attention, quality of care given by parents, caretakers, and community oral health programmers.
Out of 540 study children, 156 (28.9%) were healthy, 129 (23.9%) had bleeding on probing, and 255 (47.2%) had calculus. These findings put forward the need to emphasize preventive care in these children. A study done by Suma et al. showed 35% of the children with bleeding gums or calculus, which was less as compared to this study.
At the same time, the majority of the children in this study using a toothbrush were unaware of proper brushing techniques. Other oral hygiene aids, such as dental floss, interdental cleaning aids, and mouthwashes, are not widely available and thus were rarely used in these schools. Studies have shown that oral hygiene can be improved significantly by providing intensified daily brushing by dental personnel, by the development of self-help workshops, by providing effective staff training, or by a combination of all these approaches.,
This study showed that overall mean DMFT for HI was 0.37 ± 0.88 and it also showed that mean dft was 0.15 ± 0.56. Mean DMFT among the study population was less than the study conducted by Bhardwaj, et al. in which it was found to be 2.43. Caries prevalence in a study done by Suma et al. was 42% and demonstrated a higher prevalence in the age group of 11–15 years. In a study conducted by Rao, et al. at Mangalore, Karnataka, the mean DMFT was found to be 2.48 ± 2.02 in HI and 5.92 in visually impaired children, which is higher compared to this study. In addition, the mean DEFT was 2.6 ± 3.37 for HI and 0 for visually impaired children, which is also higher compared to this study.
A partial explanation for low caries prevalence in this population as compared with other study populations may be that in many of these institutional settings in Bhubaneswar, residents received a well-balanced diet, with supervised intake of refined carbohydrates which stays monitored by the school authorities. The acceptable DMFT score as per the WHO guideline in year 2000 was 3.00. Hence, the DMFT index reported in this study was within the acceptable limits.
Nevertheless, the overall decayed component comprised the majority of the DMFT scores which highlights the severity of caries experience in this population. This can be correlated to the consumption of liquid and sticky forms of carbohydrates in between meals by the study population and their improper oral hygiene practices.
The mean DT in the HI was found to be 0.29 ± 0.70. The results were higher than the study done by Shaw, et al. which showed mean DT as 0.18 in HI. Difference in results as compared with the study conducted abroad may be because of ignorance of school teachers and parents regarding the provision of comprehensive oro-dental care. However, in a study done by Shyama, et al., the mean DT in deaf and dumb was 4.3. This variation in the mean DT scores in these studies may be due to the reason that these studies were done in different countries with different cross-cultural variation in living standards, dietary habits and genetic predisposition.
The female study population showed a higher overall mean decayed component (0.43 ± 0.98) than the males (0.30 ± 0.75). This could be probably because females are considered to be having frequent snacking habit while males usually stay more interested in socializing and spending time with their peers. Besides, the female population was proportionately higher than the males which could also be one of the reasons of higher DT in females. Similar findings were seen in a study done by Rawlani et al. However, contradictory results were seen in a study done by GS et al. and Gardens et al.
The mean MT in the present study was 0.04 ± 0.22 and 0.01 ± 0.08 in females and males, respectively, which had a significant difference. An almost similar finding was seen in a study done by Gardens, et al. where the mean MT was 0.04 ± 0.31. The higher mean MT in the females can be correlated to the significantly higher mean DT in this group. After interacting with the school authorities during the study, it was observed that a more conservative form of dental treatment could have resulted in a more reduced mean MT in this population.
The mean FT in our study was 0.06 ± 0.29, which was higher than the study done by Gardens, et al. where the mean FT was 0.01 ± 0.09. However, this finding is very less as compared to the results seen in a study done by Vichayanrat and Kositpumivate  where the mean FT was 1.95 ± 2.30 and to studies done in Kuwait  and Spain. To some extent, the provision of preventive and curative care for special children is more advanced and comprehensive in those countries where these studies were conducted than in our country.
In this study, no attempt was made to evaluate the level of motor skills of the children and also the social and behavioral factors which are associated with oral health as it was beyond the scope of this research. Further studies are recommended in this direction to achieve more definite conclusions.
The academic curriculum does not train a dental practitioner to treat these children. Hence, there is a need to sensitize the dental profession and the dental students to the special problems posed by these disabled children and to impart suitable training, when any dental health programs for the rehabilitation of these unfortunate children is to be attempted.
| Conclusion|| |
The oral health status of these individuals continues to be largely dependent on the ability of the dental services to provide treatment up to at least the same level as for normal children. The findings in this study spotlight the lack of dental treatment for this group. There is an urgent need to plan properly to meet the unmet needs of these children as it was observed that only a little care has been provided for these institutions pertaining to oral care. An improved accessibility to dental services as well as dental health education is necessary to ensure the optimum dental health within the reach of these less fortunate children.
The authors would like to thank all the participants who consented to be a part of this study. Many thanks to Dr. Tshewang Lhendup, Intern posted in the department, for his help during data collection and Shri Bibhuti Bhusan Patnaik, Director, Department of Persons with Disabilities, for making the course of this research smooth by granting the requisite permits and clearances in a timely manner.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]