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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2018  |  Volume : 36  |  Issue : 1  |  Page : 33-37

Impact of oral health-related behaviors on dental caries among children with special health-care needs in Goa: A cross-sectional study

Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India

Date of Web Publication28-Mar-2018

Correspondence Address:
Dr. Akshatha Gadiyar
Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, Goa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISPPD.JISPPD_214_17

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Background: Children with special health-care needs (CSHCNs) have high unmet dental needs and are at increased risk of poor oral health. The aim of the present study was to evaluate the relationship between oral health behavior and dental caries experience among CSHCN. Materials and Methods: The cross-sectional study sample comprised of 223 CSHCNs from special educational schools in Goa. A self-administered parental questionnaire was used to collect data on sociodemographic characteristics and oral health behavior variables. Type III clinical examination for dental caries was done using the World Health Organization criteria. Statistical analysis was done using SPSS version 19.0. Results: The mean age of the study sample was 13.85 ± 7.2 years. Seventy-two percent of the study sample had never visited a dentist. Majority of the study participants (57.4%) brushed their teeth once daily. The caries prevalence was 68.6%. The mean decayed, missing, and filled teeth index for permanent dentition and primary dentition of the study participants was 2.83 ± 3.23 and 0.35 ± 1.00, respectively. Dental caries was significantly associated with frequency of brushing and dental visits. Conclusion: The caries experience was high among children with special needs in Goa. There is a significant association between oral health behavior and dental caries experience. Oral health promotion may lead to reduction in dental caries level, thus reducing the emotional, physical, and financial drain on their caregivers.

Keywords: Child, dental care, dental caries, oral health

How to cite this article:
Gadiyar A, Gaunkar R, Kamat AK, Tiwari A, Kumar A. Impact of oral health-related behaviors on dental caries among children with special health-care needs in Goa: A cross-sectional study. J Indian Soc Pedod Prev Dent 2018;36:33-7

How to cite this URL:
Gadiyar A, Gaunkar R, Kamat AK, Tiwari A, Kumar A. Impact of oral health-related behaviors on dental caries among children with special health-care needs in Goa: A cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2022 Sep 26];36:33-7. Available from: http://www.jisppd.com/text.asp?2018/36/1/33/228743

   Introduction Top

The Maternal and Child Health Bureau defines children with special health-care needs (CSHCNs) as those “who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services of a type or amount beyond that required by children generally.”[1] CSHCNs face a lot of challenges to perform their daily care activities, thus making them partially or completely dependent on their caretakers.[2]

Oral health plays an important role in the overall health and well-being of children.[3] Optimal oral health is achieved through a combination of positive behaviors including preventive dental visits, toothbrushing with fluoride toothpaste, and eating a healthy diet low in fermentable carbohydrates.[4]

It has been reported that dental care is the leading unmet health-care need among CSHCN.[5] They are at increased risk to poor oral health. Their oral health-care needs are said to be highly underserved due to health-care neglect of caretakers, communication barriers as well as the socioeconomic status.[6]

Oral health problems are common with dental caries and gingivitis being the biggest concerns as their prevalence is higher as compared to the general population. These patients' inability to keep adequate oral hygiene is enough to explain the high incidence of these problems along with other issues such as mouth breathing, cariogenic diet, and side effect of medications.[7]

Oral health status is significantly related to oral health behavior. A person's oral health behavior and oral habits, including toothbrushing, use of dental floss, and regular dental visits, influence oral health.[8] Thus, behavior modification may have a positive effect and produce improvement in oral health.

To promote oral health, it is important to understand the oral health behavior and its influencing factors. There is a paucity of literature regarding dental caries and oral health behavior among special children in Goa. Hence, the aim of the study was to evaluate the relationship between oral health behavior and dental caries experience among children with special needs.

   Materials and Methods Top

The present cross-sectional study was carried out from August 2016 to December 2016 in Goa.

Study population

The target population of the study was the CSHCN in Goa.

Sampling method and sample size estimation

A list of all the special schools was compiled. There are two districts in Goa. Out of the total schools, a representative sample of six special educational schools (three from each district) was randomly chosen for the study. Based on the pilot study, the prevalence of dental caries was found to be 65%. The sample size estimated was 216, and a total of 223 children were included for the final study.

Data collection

Ethical clearance was obtained from the institutional review board. Permission to conduct the study was obtained from the principal of each school. All the caregivers were fully informed of the study purpose, and informed consent was obtained from them. The caregiver for the purpose of the study was the individual who was in charge of the child on a day-to-day basis.

The study included participants who were present on the day of examination and whose caregiver gave informed consent. Children who were uncooperative were excluded from the study.

Data collection was done using specially designed questionnaire which consisted of two parts. The first part comprised of sociodemographic background and child's oral health-related behaviors. The second part included clinical examination for dental caries. A pilot study was carried out on a sample of 20 participants to check the feasibility of the questionnaire and to check if any modification was required for the pro forma. The questionnaire included 15-item closed-ended questions. The data were collected through individual face-to-face interviews with the children's caregivers.

Demographic and socioeconomic factors

The sociodemographic data comprised of age, gender, and family type. Oral health-related behaviors assessed frequency of sugar intake, toothbrushing frequency, oral hygiene aids used, visit to the dentist, and barriers to dental service utilization.

Clinical examination

Clinical assessment for dental caries was carried out using the World Health Organization criteria 1997.[9] Caries experience was evaluated using decayed, missing, and filled teeth (dmft) index (for primary dentition) and DMFT index (for permanent dentition). The mean number of teeth that were decayed, missing (as a result of decay by extraction), and filled (because of decay) was calculated. Type III clinical examination was carried out with the aid of mouth mirror and CPI probe, under adequate natural light. The two examiners were trained in the department of public health dentistry before the start of the study. The inter-examiner variability was tested, and the weighted kappa statistic was 0.80.

Following this, oral health education was given to all the study participants and correct brushing techniques were taught. Those who required dental treatment were referred to dental college for needful.

Statistical analysis

The data obtained from the questionnaire were compiled and analysed using SPSS Version 19.0 (Armonk, NY:IBM Corp). Statistical significance was set at P < 0.05. Descriptive statistics were computed and Chi-square test was used to test the association between dental caries and oral health variables.

   Results Top

The study sample comprised of 223 special schoolchildren with a mean age of 13.85 ± 7.2 years. Nearly 66.4% of the study participants were males. The frequency distribution of the sociodemographic variables is as shown in [Table 1].
Table 1: Data regarding the sociodemographic variables

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The study reveals that majority of the study participants (57.4%) brushed their teeth once daily. Sugar consumption was nil in most of the study participants (60.1%). About 69.5% used toothbrush as oral hygiene aid while 24.7% did not use any oral hygiene aids. Brushing was assisted for maximum study participants (91.5%). Only 11.4% were aware about the use of powered toothbrush. About 71.7% of the study sample had never visited a dentist [Table 2]. The most common barriers faced by the caregivers in utilizing dental care was uncooperative child and other complications.[Table 3].
Table 2: Distribution of study participants according to oral health variables

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Table 3: Barriers faced by caregivers in utilizing dental care

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The caries prevalence was 68.6%. The mean DMFT of the study participants was 2.83 ± 3.23 and mean dmft was 0.35 ± 1.00. There was a statistically significant association between presence of caries and frequency of brushing as well as dental visit (P< 0.05) [Table 4].
Table 4: Association between oral health variables and presence of dental caries

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   Discussion Top

The study presented an overview and information regarding the oral health-related variables and practices among special schoolchildren in Goa. To the best of our knowledge, this study represents the first of its kind in Goa.

Evidence suggests that children with special needs have a higher prevalence of oral diseases and higher unmet oral needs as compared to general population.[10],[11]

Good oral health practices consist of self-care habits such as oral hygiene, restriction of sugar consumption, utilization of dental services, oral health education, and preventive measures.[12]

Maintaining good oral hygiene is essential for good oral health status. The present study shows that majority of the study participants used toothbrush and toothpaste as oral hygiene aids. These findings were similar to the study conducted by Bekiroglu et al.[13] However, there was a lack of knowledge about the use of powered toothbrush. Majority of the study participants (57.45%) brushed their teeth once daily while 42.6% brushed twice a day suggesting that there is a need for promoting awareness about the effective use of oral hygiene aids as well as brushing techniques.

Previous studies have suggested that a predominant percentage of special children had never visited the dentist. The present study reported that 71.7% of the study participants had never visited a dentist. This was in line with studies conducted by Ahmad et al.[14] This could be due to felt stigma among the parents and fear of discrimination. The various barriers for access to dental care were uncooperative child, medical complications, financial problems as well as transport problems.

The caries prevalence was 68.6% which is in close agreement with Prashanth GM et al.[15] However, it was higher when compared to a study conducted by Suma et al.[16]

The mean DMFT was 2.8 which is comparable to Gizani et al.[17] who concluded the mean DMFT to be 2.7. High prevalence of dental caries has been reported in previous studies.[18],[19]

The increased caries experience may be related to the physical disabilities which could be a barrier to oral care,[20] improper oral hygiene practices followed.

Toothbrushing and routine visits to dentists are caries preventive measures.[21] The present study shows that participants who brushed more than once daily and who visited dentist had less caries compared to who did not (P< 0.05) which is in agreement to study conducted by Zifeng Lui et al.[22]

Behaviors conducted regularly, often on a daily basis turns into habits, and habits performed daily have been shown to be resistant to changes.[23] Establishing favorable oral health behavior early in life has the potential to prevent children from painful dental treatment. The present study shows that there is a strong need to strengthen the knowledge about oral health among the caregivers to improve the capacity to address the oral health needs of special children. Oral health promotional activities must be undertaken to improve the oral health of these children. A supportive environment and comprehensive oral health educational programs for caregivers as well as teachers would go a long way in improving the oral hygiene of the children with special needs.

   Conclusion Top

The caries prevalence among the study participants was high (68.6%). The mean DMFT was 2.83 ± 3.23 and mean dmft was 0.35 ± 1.00. Oral health variables such as brushing frequency and routine dental visit were caries protective factors.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck PW, et al. Anew definition of children with special health care needs. Pediatrics 1998;102:137-40.  Back to cited text no. 1
Siklos S, Kerns KA. Assessing the diagnostic experiences of a small sample of parents of children with autism spectrum disorders. Res Dev Disabil 2007;28:9-22.  Back to cited text no. 2
US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institute of Health; 2000.  Back to cited text no. 3
American Academy of Pediatric Dentistry, Council on Clinical Affairs. Guideline on Infant Oral Health Care, Revised 2014. Available from: http://www.aapd.org/media/policies_guidelines/G_InfantOralHealthCare.pdf. [Last accessed on 2017 Nov 21].  Back to cited text no. 4
Lewis C, Robertson AS, Phelps S. Unmet dental care needs among children with special health care needs: Implications for the medical home. Pediatrics 2005;116:e426-31.  Back to cited text no. 5
Nowak AJ, editor. Dental care for the handicapped patient – Past, present, future. In: Dentistry for the Handicapped Patient. 1st ed. St. Louis, MO: C.V. Mosby; 1976. p. 3-20.  Back to cited text no. 6
Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci 2011;19:212-7.  Back to cited text no. 7
Hsu KJ, Yen YY, Lan SJ, Wu YM, Lee HE. Impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults. Oral Health Prev Dent 2013;11:121-30.  Back to cited text no. 8
World Health Organisation. Oral Health Surveys: Basic Methods. 4th ed. Geneva: World Health Organisation; 1997.  Back to cited text no. 9
Beange HP. Caring for a vulnerable population: Who will take responsibility for those getting a raw deal from the health care system? Med J Aust 1996;164:159-60.  Back to cited text no. 10
The Faculty of Dental Surgery of the Royal College of Surgeons of England and the British Society for Disability and Oral Health. Clinical Guidelines and Integrated Care Pathways for the Oral Health of People with Learning Disabilities. London: Royal College of Surgeons of England; 2001.  Back to cited text no. 11
Honkala E. Oral health promotion with children and adolescents. In: Schou L, Blinkhorn A, editors. Oral Health Promotion. New York: Oxford University Press; 1993. p. 169-87.  Back to cited text no. 12
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.  Back to cited text no. 13
Ahmad 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 Hyg 2009;1:22-6.  Back to cited text no. 14
Prashanth GM, Chandu GN, Shafiulla MD. Dental caries experience among 6-18 years old blind children of residential school, Bangalore, Karnataka. J Indian Assoc Public Health Dent 2005;6:18-21.  Back to cited text no. 15
Suma G, Das UM, Akshatha BS. Dentition status and oral health practice among hearing and speech-impaired children: A cross-sectional study. Int J Clin Pediatr Dent 2011;4:105-8.  Back to cited text no. 16
Gizani S, Declerck D, Vinckier F, Martens L, Marks L, Goffin G,et al. Oral health condition of 12-year-old handicapped children in Flanders (Belgium). Community Dent Oral Epidemiol 1997;25:352-7.  Back to cited text no. 17
Rao DB, Hegde AM, Munshi AK. Caries prevalence amongst handicapped children of south Canara district, Karnataka. J Indian Soc Pedod Prev Dent 2001;19:67-73.  Back to cited text no. 18
Suresan V, Das D, Jnaneswar A, Jha K, Kumar G, Subramaniam GB,et al. 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.  Back to cited text no. 19
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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.  Back to cited text no. 20
Levin KA, Nicholls N, Macdonald S, Dundas R, Douglas GV. Geographic and socioeconomic variations in adolescent toothbrushing: A multilevel cross-sectional study of 15 year olds in Scotland. J Public Health (Oxf) 2015;37:107-15.  Back to cited text no. 21
Liu Z, Yu D, Luo W, Yang J, Lu J, Gao S,et al. Impact of oral health behaviors on dental caries in children with intellectual disabilities in Guangzhou, China. Int J Environ Res Public Health 2014;11:11015-27.  Back to cited text no. 22
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  [Table 1], [Table 2], [Table 3], [Table 4]


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