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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1709-1712  

Assessment of oral health status with visually impaired children in Patna City, Bihar


1 Department of Prosthodontics, Crown, Bridge and Implantology, Patna Dental College and Hospital, Patna, Bihar, India
2 Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar, India
3 Prosthodontics, Crown and Bridge, Private Practitioner at Dental Clinic, Patna, Bihar, India
4 Department of Dentistry, Patna Medical College and Hospital, Patna, Bihar, India

Date of Submission10-May-2021
Date of Acceptance15-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Kumari Kavita
Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_381_21

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   Abstract 


Aim: Children with a visually impairment often face various challenges in their day-to-day skills. Oral hygiene maintenance is one major task for them. Such child has difficulty to live current normal life and demands of permission or healthy life. The present study aims to assess the oral health in children with visually impaired using oral health status assessment tool in Patna city. Methodology: A cross-sectional institutional survey was implicated among visually impaired children who attend special school in Patna city. A total of 180 visually impaired children were selected as per the inclusion criteria. Participant's parents gave written consent for the study. The oral hygiene practices of visually impaired children were recorded by teachers. Oral health assessment tool (OHAT) findings were recorded by the principal investigator. Results: Sixty-seven percent of children had gingival inflammation and 59.8% had normal tongue. 55.2% of children had 1–3 decayed or broken teeth and 16.1% had unhealthy natural teeth. 78.7% of children had change in oral hygiene. Conclusion: Oral health status of visually impaired child was very poor and gingivitis was also seen according to usage of oral hygiene assessment tool(OHAT). The sentence should be chaged as Oral health status of visually impaired child was very poor and gingivitis was also seen according to usage of oral hygiene assessment tool (OHAT).

Keywords: Care giver, oral health, visually impairment


How to cite this article:
Anand S, Kavita K, Pandey A, Verma S, Singh R, Singh R. Assessment of oral health status with visually impaired children in Patna City, Bihar. J Pharm Bioall Sci 2021;13, Suppl S2:1709-12

How to cite this URL:
Anand S, Kavita K, Pandey A, Verma S, Singh R, Singh R. Assessment of oral health status with visually impaired children in Patna City, Bihar. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 16];13, Suppl S2:1709-12. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1709/330117




   Introduction Top


In the life of human beings, functions such as esthetics, mastication, phonetics, communication, and emotional expressions are all performed through oral cavity. Safe guarding the oral health in childhood is vital or else poor oral health will lead to various dental diseases such as caries and gum diseases, which adversely affects the overall health.[1]

Handicapped person is one “who over an appreciable period is prevented by his/her physical or mental conditions from full participation in the normal activities of their age groups including those of a social, recreational, educational and vocational nature.” Usually, handicapped individuals start their life with good oral health with strong teeth and gums, but their eating habit, diet, drugs used, physical limitations, no proper cleaning habits, and attitudes of parents and health providers contribute to poor oral health of the handicapped.[2]

Visually impaired children regularly face challenges in their day-to-day life. Maintenance of proper oral hygiene is tough in visual impaired children when compared with their normal sighted peers. Conventional methods for teaching oral hygiene involves more of use of visual perception and also disclosing agents to show plaque which can be removed by tooth brushing and often re disclosing periodically to monitor their improvement of oral hygiene status. These methods are not beneficial for visually impaired children as they learn a skill better by feeling and hearing it.[3]

The visually impaired people have poor oral hygiene as they cannot visualize plaque formation and cannot see signs of caries development such as discoloration which indicates the disease process.[4] A normal child gets enough attention and care from parents and the society, whereas the underprivileged groups such as mentally handicapped, physically handicapped, and socially handicapped are not properly cared for by their own kith and kin as well as the society.[5]

Dental diseases are quite common in children and should be prevented. Good oral hygiene helps in proper mastication, appearance, digestion, speech, and health, but it is more important for handicapped children as some of them use mouth as a functional limb to manipulate a chair and to manipulate bite stick.[5] Handicapped children cannot maintain proper oral hygiene and dental health as they are physically handicapped. Of late, studies concerning the dental health of visually impaired children are less compared to that of oral health of normal children.[6],[7]

Screening of special children's oral health and monitoring their oral health needs by aid of an oral health assessment tool (OHAT) can increase the care giver interest in dental aspects of the child and this leads to timely evaluations of oral hygiene and helps in providing right treatment to the special children. This also helps to activate a need for dentists visit to assist the children in individualized oral hygiene care planning to overcome their dental needs.[7]

Since these handicaps live in special schools, knowing their problems regarding dental diseases, it will be easy to plan dental care for such groups in school campus. There is no such scientific study available (searched in EBSCO and PUBMED dated till February 29, 2020) for the special group of visual impairment in Patna district using OHAT.

Thus, in this study, the evaluation of the oral hygiene status is checked in visually impaired children attending various special schools of Patna city. Thus, the OHAT gives the dental needs of special child and accordingly prevention and treatment of disease.

Null hypothesis

The assessment of oral health status will not differ using OHAT in children with visually impaired of Patna city, Bihar.


   Methodology Top


A cross-sectional institutional survey was conducted to assess the oral hygiene status among the visually impaired children attending special school in Patna city.

A total number of 180 visually impaired children were selected as per the inclusion criteria. Prior written permission and consent were obtained from the participant's parents. The children involved and caregiver were informed the purpose of study before starting the study. The respective class teachers were used as coordinators for the study for visually impaired children and general information regarding name, age, and oral hygiene practices were recorded. The oral examination was done for all the participants. Oral hygiene assessment tool (OHAT) was used to assess the oral hygiene status. OHAT was recorded by the principal investigator.


   Results Top


A cross-sectional institutional survey was conducted to assess the oral hygiene status among the visually impaired children attending special school in Patna city. A total number of 180 visual impaired children were selected as per the inclusion criteria.

[Table 1] shows that out of 180 visually impaired children, the mean age of children was 12.05 ± 2.59. The range is from 7 to 20 years. Out of 180 visually impaired children, the mean SD was 3.75 ± 2.10, which is ranges from 0 to 11 as per the OHAT. [Table 2] shows that in relation to lips, out of 180 screened visually impaired children, 94 (52.2%) had healthy lips that is smooth, pink, and moist; 84 (46.7%) had change in lips showing dry lips, chapped, or little redness at corners; and 2 (1.1%) had unhealthy lips that is swelling in the lip or lump and also white/red/ulcerated patch and bleeding/ulcerated at corners.
Table 1: Age and oral health assessment tool score distribution

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Table 2: Oral health assessment tool used in visually impaired children

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In relation to tongue, out of 180 screened visually impaired children, 162 (90.0%) had healthy tongue that is normal, moist, roughness, and pink and 18 (10.0%) had change in tongue that is patchy, fissured, red, and coated.

In relation to gums, out of 180 screened visually impaired children, 66 (36.7%) had healthy gums that is pink, moist, smooth, no bleeding; 98 (54.4%) showed gums with dry/rough, red and swollen, shiny, rough with one ulcer/sore spot under dentures; and 16 (8.9%) had unhealthy which were bleeding gums with ulcers, white/red patches, generalized redness, or some ulcers under dentures.

In relation to saliva, out of 180 screened visually impaired children, 106 (58.9%) had healthy free-flowing saliva, which is watery and moist tissues; 72 (40%) had change in saliva that is dry, sticky tissues, and little saliva; and 2 (1.1%) had unhealthy saliva that is very thick with tissues parched and red, very little/no saliva present.

In relation to natural teeth, out of 180 screened visually impaired children, 54 (30%) had healthy natural teeth without any decay or fractured tooth/roots. 101 (56.1%) children had change in natural teeth that is 1–3 carious or broken teeth/roots or teeth showing attrition, and 25 (13.9%) had unhealthy natural teeth showing 4 decayed teeth with broken tooth or roots and teeth which were worn out.

In relation to denture, out of 180 screened visually impaired children, no significant finding for any child wore a denture.

In relation to oral cleanliness, out of 180 screened visually impaired children, 25 (13.9%) had healthy oral hygiene, showing clean mouth with no food particles or tartar in mouth or on dentures; 146 (81.1%) had change in oral hygiene showing food particles/tartar/plaque in one or two regions of the mouth or on small area of dentures or bad breath; and 9 (5%) had unhealthy oral hygiene in which most areas of mouth were covered with food particles/tartar/plaque and also on most of dentures and had severe halitosis (bad breath).

In relation to dental pain, out of 180 screened visually impaired children, 133 (73.9%) had no pain such as no behavioral, verbal, or physical signs of dental pain; 46 (25.6%) had change in pain that is verbal and/or behavioral signs of pain such as pulling at face, chewing lips, not eating, aggression; and 1 (0.6%) had facial swelling, large ulcers, and verbal and/or behavioral signs such as pulling at face.


   Discussion Top


It is estimated that there are about 500 million people with disabilities worldwide[8] and are on the increase in proportion to the general population.[9] The American Health Association defines a child with disability as a child who for various reasons cannot fully make use of all his or her physical, mental, and social abilities.[10] Patients with disabilities deserve special consideration and have been previously ignored or even hidden away in institutions.[11]

Society in general and parents in particular show all the love and affection to a normal child whereas the disadvantaged children such as physically handicapped, mentally handicapped, and socially handicapped are neglected by their own nearest and dearest ones as well as society.[12] This negligence adversely affects the psychological as well as oral status. The oral health status of handicapped children in India has been topic of less discussion and thus only few studies have been conducted till now.[7] Therefore, the current study deals with nature and severity of dental problems among visually impaired child and measures to be taken for the same.

The World Health Organization defines blindness as a “visual acuity of <3/60 m or corresponding visual field loss in the better eye with the best possible correction,” so a blind person could see a distance of 3 m, and a nonvisually impaired person could see 60 m. Visual impairment relates to a person's eyesight, which cannot be corrected to normal vision. Visual disability can be of two types, namely low vision (partially blind) and absolutely nil vision (totally blind). A study completed by Chang and Shih found that visually impaired children were less knowledgeable about their oral care.[12]

Kayser-Jones who developed the brief oral health status examination (BOHSE) tool recommended that replication of the study in multiple sites is recommended.[13] Thus, rather than directly recommending the BOHSE, a modified version of the BOHSE, termed OHAT, was used in this study. This enabled the simplification of the assessment tool but also maintained the integrity, validity, and reliability of the original BOHSE. It was important to ensure that the OHAT was able to be used by all staff ranging from personal care attendants to teachers.[7],[14]

This study was conducted over a longer time period and participants had more time to become familiar with the OHAT before reliability was evaluated. The participants reported difficulties with other oral assessment tool studies.[7],[15] Hence, in this study, we have asked OHAT for the assessment in visually impaired children.

In this study, according to OHAT, out of 180 visually impaired children, 52.2% had healthy lips that is smooth, pink, and moist; 46.7% dry, chapped, or red lips at corners; 1.1% had unhealthy lips which is swelling or lump, white/red/ulcerated patch; bleeding/ulcerated at corners. In relation to tongue; 90.0% had healthy pink tongue with normal, moist, roughness; and 10% had patchy, fissured, red, coated tongue. In relation to gums, 36.7% had healthy gums pink, moist, and smooth with no bleeding; 54.4% had dry, shiny, rough, red, swollen, one ulcer in gum region; and 8.9% had swollen, bleeding gums, ulcers, white/red patches.

Socioeconomic status and caries prevalence have shown inverse relationship and it is seen that children with immigrant backgrounds have three times higher caries rates than nonimmigrants.[16],[17] In this study, according to OHAT, 30% had healthy natural teeth with no decay or broken teeth/roots; 56.1% natural teeth with 1–3 decay or broken teeth/roots or teeth very worn down; and 13.9% had 4 or more decayed or broken teeth/roots, or fewer than teeth, or very worn down teeth.

Future research and training initiatives with OHAT tools should concentrate on improvement in the categories of saliva, oral cleanliness, and dental pain as similar issues have arisen in the use of oral assessment screening tools in other acute and rehabilitative care settings.[7],[18]

Fortunately, in this study, we assess and check the status of saliva, oral cleanliness, and dental pain, and 58.9% had healthy free-flowing saliva which is watery and moist tissues; 40% had dry, sticky tissues, little saliva; 1.1% had saliva very thick; 13.3% had healthy oral hygiene that is clean, no food particles or tartar in mouth; 80.1% had change in oral hygiene that is food particles/tartar/plaque in 1–2 areas of the mouth or bad breath; and 9.0% had severe halitosis (bad breath). While 73.9% noticed no behavioral, verbal, or physical signs of dental pain, 25.6% showed verbal and/or behavioral signs of pain such as pulling at face, chewing lips, not eating, aggression respectively, and 1 (0.6%) had facial swelling.

The frequency of brushing and decreased dental caries shares a weak relationship because it is difficult to distinguish whether the effect is actually a measure of fluoride application or mechanical plaque removal by brushing.[19] The dental home or regular periodic care by the same practitioner is included in many caries risk assessment models because of its known benefit for dental health.[20]


   Conclusion Top


It can be concluded that visually impaired individuals have moderate-to-low grade of oral hygiene status. The treatment needs among the blind individuals were very high and unmet.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Backer Dirks O, Houwink B, Kwant GW. The results of 6 1/2 years of artificial fluoridation of drinking water in the Netherlands. The Tiel-Culemborg experiment. Arch Oral Biol 1961;5:284-300.  Back to cited text no. 16
    
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Singh KA, Spencer AJ. Relative effects of pre- and post-eruption water fluoride on caries experience by surface type of permanent first molars. Community Dent Oral Epidemiol 2004;32:435-46.  Back to cited text no. 17
    
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Berkey DB, Ettinger RL, Meskin LH. Oral health care variables affecting the institutionalized and homebound individual: A review and analysis of the literature 1970–1989. Monograph Series, No. 3. Iowa Geriatric Education Center, 1990.  Back to cited text no. 18
    
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Reisine ST, Psoter W. Socioeconomic status and selected behavioural determinants and risk factor for dental caries. J Dent Educ 2001;65:1009-16.  Back to cited text no. 19
    
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    Tables

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