|Year : 2021 | Volume
| Issue : 2 | Page : 236-242
|Oral health status and treatment needs of children with sensory deficits in Chennai, India–A cross-sectional study
P Vishnu1, R Mahesh2, PD Madan Kumar3, N Sharna4
1 Department of Community and Preventive Dentistry, Karpaga Vinayaka Dental College, Chennai, India
2 Department of Pediatric Dentistry, Saveetha Dental College & Hospitals, Saveetha University, Chennai, India
3 Department of Community and Preventive Dentistry, Ragas Dental College, Chennai, India
4 Department of Pediatric, Dentistry, Jawaharlal Nehru Institute of Dental Sciences, Manipur, India
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|Date of Submission||22-Nov-2018|
|Date of Decision||06-Sep-2019|
|Date of Acceptance||22-Nov-2020|
|Date of Web Publication||22-Nov-2021|
| Abstract|| |
Purpose: The negligence of oral health combined with barriers in accessing adequate oral care is more commonly encountered in children with sensory deficits. In a developing country like India, there is a severe lacuna in data regarding the oral health status and treatment needs in this group of population. The purpose of this study is to assess the oral health status and treatment needs of children with sensory deficits, using WHO criteria of Basic Oral Health Survey Methods, 1997. Materials and Methods: A descriptive cross-sectional study was conducted using the WHO criteria (Basic Oral Health Survey, 1997); questionnaire data regarding the demographic profile, oral hygiene status, degree of sensory impairment were recorded and tabulated. The Chi-square test was used to determine whether there existed a significant difference in the oral health status. The confidence interval was set at 95% and alpha error was assumed at 0.05. Results: Among the 742 sensory deficit children examined, 371 children are visually impaired and 371 are hearing impaired. Gingival bleeding and poor oral hygiene is diagnosed in more than 70% of the visually impaired children. The prevalence of trauma is estimated to be 8% in children, who are visually impaired. In the hearing impairment group, gingival bleeding because of inadequate oral hygiene is seen in 58% of the population examined. There is no statistically significant difference in the dental caries status between visually impaired and hearing impaired children (P > 0.05). There is also no statistically significant difference in the restorative treatment need and trauma status between visually impaired and hearing impaired children (P > 0.05). Conclusion: The present study shows a high prevalence of gingival diseases and dental caries in the special health care group children. The study signifies a wide spread presence of unmet treatment needs among children in this study population.
Keywords: Dental caries, oral hygiene status, sensory deficits
|How to cite this article:|
Vishnu P, Mahesh R, Madan Kumar P D, Sharna N. Oral health status and treatment needs of children with sensory deficits in Chennai, India–A cross-sectional study. Indian J Dent Res 2021;32:236-42
|How to cite this URL:|
Vishnu P, Mahesh R, Madan Kumar P D, Sharna N. Oral health status and treatment needs of children with sensory deficits in Chennai, India–A cross-sectional study. Indian J Dent Res [serial online] 2021 [cited 2021 Dec 8];32:236-42. Available from: https://www.ijdr.in/text.asp?2021/32/2/236/330865
| Introduction|| |
Sensory deficits include children with visual impairment, hearing impairment, mental disabilities, and speech difficulties. Children with sensory deficits pose a special challenge to dental professionals, primarily because of issues with proper communication and they are at an increased risk of developing oral diseases because of poor access to dental care facilities. According to the census report of 2011, India constitutes about 2.68 crore persons with sensory deficits. Dental infection and early loss of teeth are more prevalent especially in this group of children because of lack of adequate knowledge on oral health care and negligence in maintaining appropriate dental care.
According to International Classification of Impairments, Disabilities and Handicaps (ICIDH), impairment is defined as any loss or abnormality of psychological, physiological, or anatomical structure or function, disability as any restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a person.
The WHO definition of blindness specifies visual acuity less than 20/400 or remaining visual field less than 10° in the better seeing eye. Visual acuity of 20/70 to 20/400 (inclusive) is considered moderate visual impairment or low vision. Visual impairment can have deleterious effects on physical, neurological, cognitive, and emotional development. The individual's ability to cope with everyday tasks of personal hygiene, including oral hygiene becomes critical. These children are primarily dependent on parents/care givers for maintenance of oral hygiene and are not in a position to detect and recognize early oral disease and may be unable to take immediate actions unless informed of the situation.
Hearing impairment is another form of sensory impairment with four degrees of hearing loss designated: Mild (26–40dB), moderate (41–70dB), severe (70dB), and profound (above 90 dB)., Hearing impairment can primarily influence communication skills of these children, which can have a devastating effect. These children are at increased risk of developing dental problems because of their inability to be educated and communicated from the dental professionals. In most of the situations, communication between the dental health care professionals is benefited by the use of sign languages. There is a lack of awareness among dental health professionals and the paucity in communication aids could also be a major reason for the barrier in delivering health care to special need children. Although a number of studies have been carried out to assess the oral health of children in general, there have been relatively few investigations of the oral conditions of sensory deficits children in India., Detailed information pertaining to the oral health condition of such special children is limited. One of the prime reasons for inadequate delivery of the dental care for the sensory deficit children is because of lack of awareness, resources, and skilled manpower.
The amount of difficulties and complications are proportional to their types and extent of disability. Oral health of these subjects is affected because of difficulties in maintaining oral hygiene and in seeking dental treatment. They generally have low expectations from the health care professional and face immense difficulties in accessing health care facility when the need arises. In the western countries, there are several guidelines for day to day oral health care and facilities for oral health services for the disabled. However, there are no such guidelines for prevention and treatment of oral problems for persons with disabilities in India.
In order to obtain a detailed and systematic data, an effort has been made in the present study to assess the oral health status of sensory deficit children attending special schools in Chennai city, India and to develop a database to facilitate planning and implementation of oral health care programmes for them.
| Materials and Methods|| |
A descriptive cross-sectional study was conducted to assess oral health status and treatment needs of 5, 12, and 15 years old sensory deficits children attending special schools in Chennai city, India.
Ethical clearance was obtained from the Institutional Review Board of Ragas Dental College and Hospital. Furthermore, permission was also obtained from the office of State Commissioner for the disabled children and also from the school higher officials.
Children with hearing loss greater than 25 dB.
Children with visual acuity less than 20/400 and or remaining visual field less than 10° in the better Seeing Eye.
Children with IQ score under 70.
Physically handicapped children, particularly one that limits mobility.
Children who exhibit signs of psychiatric problems.
Study sample data collection and sampling method
Before the actual field examinations, the investigator administered the survey proforma of WHO Oral Health Surveys—Basic Methods (1997) for a total of 10 visually challenged and hearing impaired children in the Department of Public Health Dentistry, Private Dental School to calibrate the examination procedure.
A pilot study was carried out in Government school for 30 visually challenged and 30 hearing impaired children who were not part of the main study to determine the feasibility of the study, examination of each subject and applicability of WHO Oral Health Surveys—Basic Methods (1997).
The sample proportion for the present study was Pa = 0.20 calculated from the pilot study. Assuming the population proportion as P0 = 0.25, power 90% and allowing alpha error of 5% the sample size was calculated as 742 using nMaster—software package.
The field examinations were carried out by a single examiner and 10% of the study subjects were re-examined to assess the intra-examiner reproducibility which was assessed using kappa statistics and it was found to be adequate (Kappa value = 0.86).
The study subjects were derived from the eight sensory deficits schools in Chennai, among which three schools were for visually challenged children and the rest five schools were for children with hearing impairment. Among 742 subjects, 371 subjects were selected from visually challenged school and the rest 371 subjects were selected from the hearing impairment school. Among 371 subjects for visually challenged, 123 to 124 children were selected from each school, out of the three visually challenged schools. In each school 41 to 42 children each of 5, 12, and 15 years old were selected using stratified random sampling method, so that the total sample collected for each school will be 123 to 124. Among 371 subjects included in hearing impaired, 74 to 75 children each were selected from each school, out of the five hearing impaired schools. In each school, 24 to 25 children each of 5, 12, and 15 years old were selected using stratified random sampling method, so that the total sample collected for each school will be 74 to 75. [Figure 1] depicts the method of sample selection.
Calibrated single qualified examiner carried out the entire survey with a help of a recording staff. All the subjects who fulfilled the inclusion criteria were examined. Clinical examination was conducted in school premises under natural light and the children were made to sit on a stool in upright position. The scribe recording the data were seated on the left side of the patient close to the examiner, so that the scribe was able to hear the examiner instructions and codes and also the examiner was able to see the data being recorded.
The data was recorded and computed in SPSS (Statistical package for social sciences, version 20.0, Chicago, IL). The Chi-square test was used to determine whether there existed a significant difference in the oral health status of visually challenged and hearing impaired school children. The confidence interval was set at 95% and alpha error was assumed at 0.05.
| Results|| |
The present study was conducted in Chennai during April 2016 to March 2017 among 5, 12, and 15 years old sensory deficits (visually impaired and hearing impaired) children attending special schools.
Census 2001 had revealed that over 21 million people in India are suffering from one or the other kind of disability. This is equivalent to 2.1% of the population. Among the total disabled in the country, 12.6 million are males and 9.3 million are females. Tamil Nadu constitute around 1.6 million people with some form of disability. Tamil Nadu is the only state, which has a higher number of disabled females than males. Tamil Nadu was among the few states where the population of the differently abled was less than 1.75% of the total population. Chennai, formerly known as Madras, is located on the Coromandel Coast of the Bay of Bengal. It is the metropolitan capital of Tamil Nadu with a population of 4,646,732. It is estimated to have around 90,064 people with various forms of disability.
A descriptive cross-sectional study was conducted to assess the oral health status and treatment needs for children with sensory deficits attending special schools in Chennai City. A total of 742 school going children with sensory deficits of aged 5, 12, and 15 years were selected for the study.
Among 742 children, 371 with hearing impairment and 371 with visually challenged were examined. Three Grades (Grades IV, III, and II) of hearing impairment and two Grades (Grades I and II) of visually challenged were examined. [Table 1] Grade I (26–40dB) were not included in the study since there were not adequate sample in the study population.
|Table 1: Distribution of study population based on age group and grades of sensory impairments|
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Among the hearing impaired children, 74 (76.3%) in 5 years old group, 86 (62.8%) in 12 years old group, and 57 (41.6%) in 15 years old group showed presence of gingival bleeding. In the visually impaired children, 82 (84.5%) in 5 years old group, 124 (86.1%) in 12 years old group, and 86 (66.2%) in 15 years old group showed presence of gingival bleeding on probing. The CPI Scores recorded among 371 hearing impaired children indicated that there was no statistically significant difference in the CPI scores among 5, 12, and 15 year old children. On comparing the CPI scores among visually challenged children, there was a significant difference in CPI scores in 12 year (P value = 0.002) and 15-year-old children (P value = 0.001). In addition, there was a significant difference in the CPI score among visually impaired and hearing impaired children (P value = 0.000). The gingival health was found to be healthy in hearing impaired children as compared to visually challenged children [Table 2].
With regards to dental caries status among hearing impaired children, Grade IV children had more dental caries as compared to grade III and II children. In grade IV hearing impaired group, 28 (28.9%) in 5 years old group, 39 (28.5%) in 12 years old group, 30 (21.9%) in 15 years old group showed presence of decayed tooth. Similarly, Grade II visually challenged children 97 (42.1%) presented with a higher percentage of dental caries compared to Grade I visually challenged children 59 (41.8%). Though it was not statistically significant, Grade IV hearing impaired children and grade II visually impaired children had more missing teeth. There was no statistically significant difference in the restorative need between visually impaired and hearing impaired children. Overall, there was no statistically significant difference in the dental caries status between visually impaired and hearing impaired children (P > 0.05) [Table 3].
|Table 3: Comparison of the study population based on Dental caries status|
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Considering the different form of treatment needed among the hearing impaired children, Grade IV hearing impaired children required more number of one surface restoration, two surface restoration and pulp therapy as compared to other two grades of children. With regards to visually impaired children, there was a significant difference in two surface filling between Grade I and II, where 12 year old grade II visually impaired children required more number of 2 surface filling as compared to 12-year-old grade I children (P = 0.011). Similarly, 12-year-old grade II children required more pulp therapy treatment as compared to grade I children (P value = 0.005). Overall, there was no significant difference in the treatment needs (one surface filling, two surface filling, and pulp therapy) between visually impaired and hearing impaired children [Table 4], [Table 5], [Table 6].
|Table 4: Comparison of the study population who required one surface restorations|
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Regarding Trauma status among hearing impaired children, 12-year and 15-year-old Grade III and IV children presented with more traumatized teeth, but it was not statistically significant. There was a statistically significant difference in the trauma status between grade I and II 12-year-old visually impaired children (P = 0.012). In general, there was no significant difference in the trauma status between visually impaired and hearing impaired children (P > 0.05) [Table 7].
| Discussion|| |
The present study was conducted in Chennai during April 2016 to May 2017 among 5, 12, and 15 years old sensory deficits (visually impaired and hearing impaired) children attending special schools. A total of 742 children (371 visually impaired and 371 hearing impaired) attending special schools were included in the study. WHO Oral Health assessment proforma was used to assess the oral health status and treatment needs of the study population. This standard form for oral health assessment is designed for collection of all the information needed for planning oral care services and thorough monitoring and re-planning of existing oral care services.
In the present study, it is evident that the visually impaired children had a compromised gingival health (P < 0.05) as compared to hearing impaired children. Nandhini S et al. conducted a study to evaluate oral hygiene status of visually impaired children and the author had stated that majority of children (71%) had gingivitis. This result is in concordance with the present study, where most of the visually impaired children had compromised gingival health, especially children in 12 years and 15 years age group. This was probably because of lack of proper plaque removal technique, as visually impaired children cannot visualize the plaque deposit on tooth surface. Visually impaired students needs a regular dental visit, education, and motivation regarding oral health hygiene measures, as it has an impact on oral health as well overall health. Sandeep V et al. conducted a study in 6–16 year old hearing impaired children in Bhimavaram, India, and the author concluded that around 80% of children exhibited gingival inflammation and bleeding. This result is in accordance with the present study, where grade III and IV hearing impaired children presented with gingival bleeding and calculus deposits. Lack of sign language and shortage or absences of aids for communication could be one of the main reasons for the development of poor gingival health in hearing impaired children.
In our study, the dmft/DMFT status of hearing impaired children was considerably low than the visually impaired children. This result is similar to the study conducted by Ajami AB et al., the author found that the mean dmft/DMFT for children with hearing impairment was lower than that of the children with visual impairment. The author also added that the dental caries prevalence in visually impaired children was higher than hearing impaired subjects. The low prevalence of caries in hearing impaired subject suggested that hearing impaired children had higher ability to learn oral hygiene compared to visually impaired children. Al-Qahtani Z et al. had reported that the caries prevalence in hearing impaired children was higher than the visually impaired children, especially 11–12 year old children. This result is in contrast to the results of the current study. Meaningful comparison of caries prevalence rates cannot be made from these studies as there are wide variations in age distribution of the sample selected in each study and the sample size.
In the present study, only 1.3% of children had filled teeth, which was an alarming situation. This may be attributed to the negligence of the parent and school authorities in obtaining dental treatment for these disabled children. This was similar to studies conducted by Prashant GM, Rao DB, Aruna CN. The authors had disclosed that less than 1% of visually impaired and hearing impaired children had restored teeth.,,
In the present study, majority of visually impaired children required one or two surface restoration and pulp therapy as compared to hearing impaired children. This result is similar to the findings of Ajami AB et al., where the number of complex restoration needed was higher in visually impaired children than the hearing impaired children. But eloquent comparison was not possible because of variation in sample size.
Prevalence of traumatic injuries was more in grade II visually impaired children as compared to Grade I visually impaired and hearing impaired children (P < 0.05). A similar result was provided by a study done by Tagelsir A et al. on 11–13 year old visually impaired children and the findings suggested that 19% of visually impaired experienced traumatic dental injuries.
The main disadvantage of the study is considering only children who have reported to special schools in Chennai. The study data belongs to a group of children in a particular region and can't be generalized to the entire population. Treatment of children with special needs still remains as a greater challenge for the dental professional. The present study provides a clear evidence of unmet dental needs among most of the children with sensory deficits. The dental schools/Hospitals should have a direct affiliation with various resident and non-resident special schools/home to deliver appropriate oral health care.
| Conclusion|| |
The present study showed a high prevalence of periodontal diseases and dental caries among the sensory deficits school children in Chennai city. The study signifies an unmet back log of treatment needs among this study population. Necessary initiative should be taken by dental health care professional to deliver appropriate oral health care to these children.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. R Mahesh
Reader, Department of Pediatric Dentistry, Saveetha Dental College, Saveetha University, Chennai
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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