Prevalence of Oral Health Status and Needs in Institutionlized Physically Challenged Children.

BACKGROUND: Oral hygiene has significant effect on the overall health of an individual as it has vital role in human life, so it is necessary to protect oral hygiene of all children since childhood.
OBJECTIVES: The objectives were to evaluate and compare the prevalence of dental caries and oral hygiene status in institutionalized physically challenged children of Bihar. MATERIALS AND
METHODOLOGY: A total of 700 (400 male and 300 female) children were included in the study that were physically handicapped and were institutionalized in various special schools. In this study, complete oral examination was done and was recorded by using Oral Hygiene Status-Simplified given by Greene and Vermillion, 1964, and all statistical analyses were done by using SPSS software. For statistical analysis, Chi-square test and ANOVA were used.
RESULTS: Out of 700 children, 48.8% (342) had dental caries with mean Decayed, Missing, and Filled Teeth (DMFT) index of 0.86 (standard deviation [SD] ±1.37) and mean dmft index of 0.36 (SD ± 0.98). In this study, orthopedic, blind, deaf and dumb, and compound students were examined. It was observed that the dental caries prevalence was high in the blind group (71%) compared to that of the deaf and dumb group (40.2%), while oral hygiene status was observed as good in 42.2%, fair in 46.9%, and poor in 10.9% of children.
CONCLUSION: Every dental professional should be aware of his/her responsibilities and provide both comprehensive and incremental dental care to improve the overall oral hygiene condition of physically handicapped children. Copyright:

INTRODUCTION

Oral hygiene has significant effect on the overall health of an individual as it has a vital role in human life.[1] In India, there are various communities in which special children have fundamental rights than any other normal individual.[2] However, the quality of their life is adjusted according to their capabilities.[2] Many handicapped children have normal teeth and gums during the initial stage of their life. However, their diet, eating habits, medications, parental and health providers' attitude, and lack of cleaning habits lead to poor oral hygiene in them. Good oral hygiene is very essential for proper mastication digestion, speech, and health of handicapped children as many use their mouth and teeth to compensate the challenged organ.[345]

It is necessary to protect the oral hygiene of all children since childhood. Several studies emphasize the dental health of normal children, but there are less studies regarding the dental health of handicapped children who actually require more special care and attention.[6]

The aim and objective of this study was to evaluate the prevalence of dental caries and oral hygiene status in physically handicapped children attending various special schools.

MATERIALS AND METHODOLOGY

An epidemiological survey was conducted among 700 children (400 males and 300 females) to evaluate the prevalence of dental caries and oral hygiene status among 6–15-year-old physically handicapped children attending special schools in the city. Ethical clearance was obtained from institutionalized review board. For this study, a survey pro forma was prepared according to WHO oral health assessment form,[7] and OHI was recorded by using OHI-S index.[8]

Prior to the study, the purpose and significance of the study was informed and explained to the children. For deaf and dumb students, help of the class teacher was taken and information to these students was conveyed through sign languages with the help of the teacher.

In this study, different physically handicapped children were divided into the following categories: orthopedic, blind, deaf and dumb, and compound handicap groups.

Dental caries examination was recorded by a Community Periodontal Index probe and a plane mouth mirror; oral hygiene index was recorded by using an explorer and a plane mouth mirror and for light, natural sunlight was used; and the children were made to sit in such a way to obtain maximum illumination.

By the end of the day, clinical findings were reported to the class teacher and a reference slip was forwarded to the parents or guardian through their class teacher so that they can get the maximum benefit of the treatment.

Statistical analysis

After data collection, descriptive statistics was used to determine significant difference in mean Decayed, Missing, and Filled Teeth (DMFT)/dmft between different handicapped groups. Data were analyzed using SPSS software 21.0 Armonk (2012), and significance of all the statistical tests was predetermined at P ≤ 0.05.

RESULTS

The study population consisted of 700 schoolchildren, out of which 400 (60%) were male and 300 (40%) were female. Overall, when caries prevalence was compared between vegetarian and mixed diet, the difference was not statistically significant (χ2 = 1.50, P = 0.31, not significant). Table 1 represents the distribution of DMFT components among the handicap groups. Table 2 shows the distribution of dmft components among the handicap groups. The total number of dmft components was 233, out of which 231 were decayed, 2 were missing, and no teeth were filed. The mean dmft was 0.32 (standard deviation [SD] ±0.98). Table 3 depicts the sex-wise distribution of oral hygiene status among the handicap groups. Table 4 mentions the caries prevalence among the study population according to oral hygiene status in the handicap groups. When the overall caries prevalence was compared with oral hygiene status, the difference was not statistically significant (χ2 = 1.50, P = 0.47).

Table 1

Distribution of Decayed, Missing, and Filled tooth components among the handicap groups

Handicap groups	Decayed	Missing	Filled	DMFT	Mean DMFT±SD
Orthopedic	238	0	1	239	0.81±1.27
Blind	138	5	2	145	1.48±1.61
Deaf and dumb	176	2	5	183	0.66±1.30
Compound	51	0	1	52	1.20±1.58
Total	603	7	10	619	0.86±1.37

ANOVA F=10.15, P<0.01 significant. DMFT: Decayed, Missing, and Filled teeth, SD: Standard deviation

Table 2

Distribution of decayed, missing, and filled teeth components among the handicap groups

Handicap groups	Decayed	Missing	Filled	dmft	Mean dmft±SD
Orthopedic	80	0	0	80	0.27±0.90
Blind	33	2	0	35	0.36±1.04
Deaf and dumb	105	0	0	105	0.38±1.06
Compound	13	0	0	13	0.32±1.05
Total	231	2	0	233	0.32±0.98

ANOVA F=0.60, P=0.62 (P>0.05) (NS). NS: Not significant, dmft: Decayed, missing, and filled teeth, SD: Standard deviation

Table 3

Sex-wise distribution of oral hygiene status

Handicap groups	Good (%)			Fair (%)			Poor (%)
	Males	Females	Total	Males	Females	Total	Males	Females	Total
Orthopedic: 291 (41.6)	81 (62.3)	49 (37.7)	130 (44.7)	93 (66.4)	47 (33.6)	140 (48.1)	17 (81.0)	4 (19.0)	21 (7.2)
Blind: 97 (13.8)	4 (13.3)	26 (86.7)	30 (30.9)	16 (29.1)	39 (70.9)	55 (56.7)	6 (50.0)	6 (50.0)	12 (12.4)
Deaf and dumb: 267 (38.2)	83 (63.4)	48 (36.6)	131 (49.0)	82 (73.9)	29 (26.1)	111 (41.6)	15 (60.0)	10 (40.0)	25 (9.4)
Compound: 44 (6.3)	7 (63.6)	4 (36.4)	11 (25.0)	23 (79.3)	6 (20.7)	29 (65.9)	3 (75.0)	1 (25.0)	4 (9.1)
Total: 699 (100)	175 (57.9)	127 (42.1)	302 (43.2)	214 (63.9)	121 (36.1)	335 (47.9)	41 (66.1)	21 (33.7)	62 (8.9)

Oral hygiene status among the handicap groups, χ2=22.1, P<0.1 significant, Oral hygiene status among males versus females, χ2=2.97, P=0.23 (NS). *1 case was excluded due to index teeth was not present in younger children

Table 4

Oral hygiene status and caries prevalence among the handicap groups

Handicap groups	Good (%)	Caries affected (%)	Fair (%)	Caries affected (%)	Poor (%)	Caries affected (%)
Orthopedic	130 (44.7)	67 (51.5)	140 (48.1)	69 (49.3)	21 (7.2)	6 (28.6)
Blind	30 (30.9)	22 (73.3)	55 (56.7)	41 (74.5)	12 (12.4)	9 (75.0)
Deaf and dumb	131 (49.0)	63 (48.1)	111 (41.6)	39 (35.1)	25 (9.4)	11 (44.0)
Compound	11 (25.0)	5 (45.5)	29 (65.9)	18 (62.1)	4 (9.1)	1 (25.0)
Total	302 (43.2)	157 (52.0)	335 (47.9)	167 (49.9)	62 (8.9)	27 (43.5)

Overall, χ2=1.50, P=0.47 (NS). NS: Not significant

DISCUSSION

The handicapped are often one of the ignorant groups in our society and due to which they are deprived of many social benefits in the society. Therefore, the prevalence of dental caries and oral hygiene status in special children has drawn the attention of many researchers.[78]

The study population consists of 700 handicapped children attending special schools, out of which, 48.8% (342) had dental caries with a mean DMFT of 0.86 (SD ± 1.37) and dmft of 0.32 (SD ± 0.98). Yee and Mc Donald in 2002 found similar results.[9]

In our study, we found that the caries prevalence was higher in male handicapped children (49.25% (197)) than their female counterparts (48.66% (146)). The difference was statistically significant (P < 0.05).

Present study shows treatment required in permanent dentition was one surface filling and two or more surface fillings was highest while in deciduous dentition one surface filling, two or more surface fillings and extraction was required more. Yee R, Mc Donald N. in 2002 and Constance B Greeley also found similar results.[910]

This study shows fair to good oral hygiene status. The poor score of few children may be because of their extent of disability. Shaw et al. in 1986 showed similar findings.[11] The high caries activity leads to difficulty in maintaining oral hygiene, poor muscular co-ordination, and muscle weakness, interfering with routine oral hygiene practices.[12]

The present study showed some unexpected observation in contrast to the general belief. A dental caries prevalence of 52% was observed in children with good oral hygiene, 49.9% caries prevalence was observed in children with fair oral hygiene, and 43.5% prevalence was observed among children with poor oral hygiene. The differences between oral hygiene status and caries prevalence were not statistically significant, χ2 = 1.50, P = 0.47. Some other factors such as fluoride, environment, genetics, and diet in the study population were known to affect oral hygiene.

CONCLUSION

Every dentist and health-care professional should be aware of their responsibility and play a vital role in improving the dental health of handicapped children. The idea has been proposed to several chief dental officers to arrange dentists or dental auxiliaries who can visit these special institutionalized schools on a regular basis for providing oral hygiene instructions to parents, staff, and children. Regular follow-up for these children is sufficient to help them maintain good oral hygiene. In addition to that, chemical plaque control measures should be emphasized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.