|Year : 2018 | Volume
| Issue : 2 | Page : 137-143
Special care with special child-oral health status of differently abled children attending special schools in Delhi: A cross-sectional study
Monika Prasad, Basavaraj Patthi, Ashish Singla, Ritu Gupta, Lav Kumar Niraj, Irfan Ali
Department of Public Health Dentistry, Divya Jyoti College of Dental Sciences and Research, Ghaziabad, Uttar Pradesh, India
|Date of Submission||10-Oct-2017|
|Date of Acceptance||20-Mar-2018|
|Date of Web Publication||24-May-2018|
Dr. Monika Prasad
Department of Public Health Dentistry, Divya Jyoti College of Dental Science and Research, Niwari Road, Modinagar, Ghaziabad - 201 204, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Oral health is an essential component of overall health. Oral health maintenance is more complex for the physically challenged children; the essential problem is lack of cooperation and coordination because of their physical or mental inability. Thus, physically challenged children are considered as a high-risk group for having dental problems. Aim: The aim of this study is to assess dental caries experience, oral hygiene status, periodontal status, and prevalence of malocclusion among differently abled children attending special schools in Delhi. Materials and Methods: A total of 1060 (610 males and 450 females), differently abled children were included in the study. The children were grouped into visually impaired, hearing and speech impaired, and orthopedic physically challenged only. Clinical examination was recorded using Dentition Status and Treatment Need Index and periodontal status recommended by the World Health Organization (WHO), 2013 and examination for malocclusion was made according to the Dental Aesthetic Index as described by the WHO Oral Health Survey 1997. The Simplified Oral Hygiene Index introduced by John C Greene and Jack R Vermillion in 1964 was used to assess the oral hygiene status. Results: Out of 1060 physically challenged children, 56.4% (598) had dental caries with the mean index or decayed, missing, and filled teeth (DMFT) being 1.10 (standard deviation ±1.26). It was observed that prevalence of dental caries was high in visually impaired group (63.2%) and least in hearing and speech impaired group (51.7%). The overall oral hygiene status recorded was good in 58.5%, fair in 40.8%, and poor in 0.7% of the study population. Conclusion: The cumulative neglect of oral health was seen among the physically challenged children. Children with visual impairment had much more poorer oral health when compared to the hearing and speech impairment and orthopedically physically challenged group. An improved accessibility to dental services as well as dental health education is necessary to ensure that optimum dental care should reach this special group.
Keywords: Dental caries, gingivitis, oral health, physically challenged children, prevalence
|How to cite this article:|
Prasad M, Patthi B, Singla A, Gupta R, Niraj LK, Ali I. Special care with special child-oral health status of differently abled children attending special schools in Delhi: A cross-sectional study. J Indian Assoc Public Health Dent 2018;16:137-43
|How to cite this URL:|
Prasad M, Patthi B, Singla A, Gupta R, Niraj LK, Ali I. Special care with special child-oral health status of differently abled children attending special schools in Delhi: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2023 Jun 8];16:137-43. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2018/16/2/137/233063
| Introduction|| |
It has been established that the children in a population were the main concern in the drafting of any health program. Each and every child has the right to get love and affection from the parents and society, but it is seen that the physically challenged children are neglected by their own parents, relatives as well as society.
There are about 650 million people who are affected with the disability which is rising with the population rise and the aging process. It was reported by the United Nations Development Program in 2006 that approximately 80% of people having disabilities reside in developing countries. The National Sample Survey Organization in 2002 in India reports that there are 18.49 million people affected with disabilities which comprises about 1.8% of the total population.,
Disability has seldom been related to a physiological deficit. 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. Physically challenged children have been classified as physically, mentally, or socially challenged. In 1995, the Government of India under the “Persons with Disabilities Act” described “handicapped” as a person with one or more of the following disabilities: impaired vision, leprosy-cured, hearing impaired, orthopedic disability, mental retardation, and mental illness. In general, a child who is physically or mentally handicapped neither is accepted by the society nor avail the social fulfillments.
Although individuals who are physically challenged are entitled to the same standards of health and care as the general population, these children and their families are constantly kept away from their basic human rights and to their inclusion in society, more because of the environment they live in rather than the result of impairment.,
Oral health is an important part of overall health and plays a vital role in each individual's well-being and quality of life by influencing physical and mental well-being, appearance, and interpersonal relations in a positive way. As one's esthetics and communications is influenced by oral hygiene, it has a strong biological, psychological, and social projections. Oral disease is a major health problem for children with disabilities, who have a higher prevalence and severity of oral disease when compared to the general population. High rates of dental caries, teeth lost earlier, periodontal problems, prolonged retention of primary teeth, misaligned or supernumerary teeth, and malocclusion are all regarded as determinants of poor oral health in children with disabilities. Poor oral health has a negative impact on nutrition, digestion, the ability to chew food, facial shape, and speech. Poor oral health is considered to be an extra burden, whereas good oral health is regarded to improve general health, dignity and self-esteem, social integration, and quality of life.
Oral health improvement in a population begins with the collection of epidemiological data, which helps to understand the needs of the community, to plan treatment, and prevention strategies and monitor the development of situation over a period of several years. Thus, it is important to know the status of oral health of differently abled children to recommend effective preventive measures. Hence, the present study was conducted with the aim to assess the dental caries experience, oral hygiene status, periodontal status, and prevalence of malocclusion among differently abled children attending special schools of Delhi.
| Materials and Methods|| |
A descriptive cross-sectional study was carried out to assess the dental caries experience, oral hygiene status, periodontal status, and prevalence of malocclusion among differently abled children attending special schools over a period of 3 months from May to July 2017 among differently abled children in Delhi. Ethical approval was obtained from the Ethical Institutional Review committee (DJD/IEC/2015/A-037). The written informed consent was obtained from the Head of the institution as well as from the parents of all the study participants after duly explaining the purpose and methodology of the study.
The sample size for the present study was calculated based on the data obtained from census, 2011 for disability in Delhi. According to the census, the total physically challenged children for the visually impaired is 4170, for the hearing and speech impaired children is 8684 and for the orthopedically physically challenged is 7084. For the present study, the sample size was determined at 95% confidence interval and the prevalence of dental caries was 59% from one of the previous study conducted in Delhi and Gurgaon along with the margin of error was kept at 3%. Sample size was calculated and then, the proportionate sampling was done. The estimated sample size for the study based on the prevalence of dental caries was calculated to be 982 among physically challenged children and thus, and it was rounded off to minimum of 1060 so that after proportionate sampling, 220 participants of visually impaired, 460 children of hearing and speech impaired, and 380 children of orthopedically physically challenged were examined.
Sample size was calculated using the formula
n = z2 × p × q × N/e2 (N − 1)+z2pq
Where, “n” is the number of participants required
z = confidence level at 95% (standard value of 1.96)
P = 59% (prevalence of dental caries) = 0.59
q = 1 − p = 41% = 0.41
e = margin of error at 3% (standard value of 0.03)
N = Total population = 4170 + 8684 + 7084 = 19,938
The addresses of the institutionalized physically challenged students were obtained from the Department of Social Welfare at Delhi Gate, Delhi. For the study purpose, Delhi was arbitrarily divided into four zones, namely, north, south, east, west, and central zones. Ten schools were randomly selected through stratified random cluster sampling method such that two schools from each zone were included in the study. All children above 12 years who were present on that day were examined. The age group of children available in all the institution ranged from 12 to 19 years. Those children who had given informed consent were examined and those who are differently abled were examined. Those who were intellectually physically challenged and those with any difficulty to carry out examination were excluded from the study.
Training and calibration
A pilot study was conducted in comparable age groups to check the feasibility of the study and to calculate the sample size. The training and calibration was done on the 25 participants who were examined by the validator and subsequently by the investigator. By comparing the results of the two examinations the diagnostic variability based on kappa coefficient came out to be 87% (0.87) which is in the acceptability range of 85%–95% as recommended by the World Health Organization (WHO) Basic Oral Health Survey 2013.
A structured pretested modified oral health assessment form based on the WHO Basic Oral Health Survey 2013 and 1997, was used to collect the data. The pro forma had three components-sociodemographic data such as age, gender, type of handicap, diet, questionnaire-related to oral hygiene habits, sugar exposure, and oral health seeking behavior and clinical examination was recorded using Dentition Status and Treatment Needs recommended by the WHO, 2013; Oral Hygiene Index-Simplified (OHI-S) introduced by Greene and Vermillion in 1964, periodontal status was recorded the presence of bleeding and pockets as described by the WHO (2013) and examination for malocclusion was made according to the Dental Aesthetic Index (DAI) as described by the WHO oral health survey (1997).
Type III examination was carried out by the investigator himself and recorded by a trained recorder throughout the study.
Clinical findings of the children were reported to the class teachers at the end of the day of the examination. Reference slips were forwarded to the parents or guardians of the students through their class teachers, for information and necessary action. School children requiring treatment were referred to Dental College.
The resulting data were entered into statistical software (Statistical Package for the Social Sciences version 15; SPSS Chicago, IL, USA) and were analyzed by applying the descriptive statistics, Chi-square test, and ANOVA. The significance level was set at P < 0.05.
| Results|| |
A total of 1060 children comprised the sample and according to proportionate sampling, 220 (20.7%) were visually impaired, 460 (43.4%) were hearing and speech impaired and 380 (35.9%) were orthopedic physically challenged only and among all, 57.5% were boys. The sociodemographic characteristic of the study participantsis shown in [Table 1]. The assessment of oral health care according to their type of disability revealed that all the study participants used toothpaste for brushing their teeth and 202 (19.1%) of the study participants required assistance for tooth cleaning [Table 2]. A statistically significant difference was found among the groups based on the type of diet and sweet score interpretations [Table 3]. A statistically significant difference was found among the three groups, and the visually impaired groups had the highest mean decayed, missing, and filled teeth (DMFT) and least was found for hearing and speech impaired group. Among the 1060 children, 598 (56.4%) of the study participants had caries. The visually impaired population had the highest number of caries (63.2%) followed by orthopedically physically challenged (58.2%) and hearing impaired (51.7%), and the difference was statistically significant [Table 4]. The visually impaired population was having the highest number of the population who had high OHI-S score followed by hearing and speech impaired and orthopedically physically challenged population, and the difference was statistically significant [Table 5]. The visually impaired population had the highest number of the population who had gingival bleeding followed by hearing and speech impaired and orthopedically physically challenged. In the presence of pockets, the visually impaired population had the highest number of the population who have pockets followed by hearing and speech impaired and orthopedically physically challenged [Table 6].
|Table 4: Distribution of the study participants according to mean decayed, missing, and filled teeth scores based on the type of disability|
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|Table 5: Distribution of the study participants according to mean Debris Index simplified, Calculus Index simplified, Oral Hygiene Index simplified, and oral hygiene interpretation based on the type of disability|
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|Table 6: Distribution of the study participants according to the presence of gingival bleeding and presence of pockets|
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According to the severity of malocclusion, it was seen that 918 (86.6%) had no abnormality or minor malocclusion and 142 (13.4%) had definite malocclusion. None of the children had severe or very severe malocclusion [Table 7]. The mean DAI score of the study participants is revealed in [Table 8]. According to the type of malocclusion, it was revealed that 172 (16.4%) had crowding, spacing, diastema, or anterior maxillary or mandibular irregularity [Table 9].
|Table 7: Distribution of the study participants according to the severity of malocclusion|
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|Table 8: Distribution of study subjects according to mean Dental Aesthetic Index score|
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|Table 9: Distribution of the study participants according to types of malocclusion|
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| Discussion|| |
The physically challenged population comprises a substantial section of the community, and it is estimated that there are about 500 million people with disabilities worldwide and they are on the increase in proportion to the general population.
Dental caries is a speedily rising oral health problem amongst the children of India. According to the National Oral Health Survey conducted in 2003–2004, caries prevalence in India was 51.9, 53.8 and 63.1% at ages 5, 12, and 15 years, and mean DMF values were 2, 1.8, and 2.3 respectively. As per the WHO oral health report (2003), mean DMF among 12-years children in Indian population was in the range of 1.2–2.6. The mean DMFT of the study group was 1.11 ± 1.26 which is lower than the mentioned above reports. Low caries prevalence can be accounted for well-balanced diet, with supervised intake of refined carbohydrates in many institutions. The visually impaired group (1.13 ± 1.23) had the highest decayed component followed by hearing and speech impaired group (0.88 ± 1.19), and the lowest decayed component was for orthopedically handicapped group (0.77 ± 1.11). This is consistent with the findings of the study conducted by Jain et al. in Udaipur, Mehta et al. in Delhi, India and Singh et al. in Rajasthan, India.,, The findings of the mean DMFT was much lower when compared to the study conducted by Sanjay et al. in India and Al-Qahtani and Wyne in Saudi Arab., The findings are in contrast to the study conducted by Avasthi et al. in Delhi.
The present study revealed that the mean oral hygiene index score was 1.21 ± 0.58 among the three groups. The mean OHI-S score for visually impaired (1.70 ± 0.63) was higher followed by hearing and speech impaired (1.15 ± 0.43) and lowest was for orthopedically physically challenged group (0.99 ± 0.56). This finding is in agreement with the study conducted by Reddy et al. in Madhya Pradesh, India. It may be due to the facts that there is no supervision for the tooth brushing technique and other factors such as motor skills and assistance from guardians is overlooked which might influence oral hygiene status of both groups.
In this study, 64.9% of the total study sample had gingival bleeding. Majority of the visually impaired children (89.5%) had gingival bleeding followed by hearing and speech impaired group (60.7%), and the lowest percentage of children with gingival bleeding was from the orthopedically physically challenged group (55.8%), and the difference was statistically significant (P < 0.001). The findings are in agreement with the study conducted by Avasthi et al., Mehta et al. in Delhi but in contrast to the study conducted by Jain et al. in Udaipur, India.,, This may be possibly because visually impaired children cannot see the way of tooth brushing, which is still believed to have a greater influence on the maintenance of the oral hygiene.
Out of the total study participants, 86.6% had no abnormality or minor malocclusion, and 13.4% had definite malocclusion, and the difference was not statistically significant (P > 0.05). The mean score of the DAI was 20.49 ± 3.80. Majority of orthopedically physically challenged children (14.7%) had malocclusion followed by hearing and speech impaired children (13%), and least number of children were from visually impaired children (11.8%). The prevalence malocclusion was lower among these group can be explained by the fact that these children has a lesser amount of dento-alveolar discrepancies and lesser prevalence of deleterious oral habits.
The findings are in accordance with the study conducted by Siddibhavi in Belgaum; Dinesh et al. in Mangaloreans which is lower when compared to the study conducted by Purohit (2010) in Karnataka, Avasthi et al. in Delhi.,,, However, contradictory findings were seen by Nayak et al. in Dharwad, India.
The higher levels of dental disease in these physically challenged children seem to be due to poor use of dental services and there is a need of dental awareness among the caretakers of these type of children. Better accessibility of dental services as well as oral health education is mandatory to make certain that optimum dental health should be in reach of these less fortunate children.
It is suggested that: school dental health programs should be undertaken in these institutions:
- School dental health education – The students as well as the caretakers should be taught regarding dental health and training of teachers, parents, and caretakers regarding maintenance of oral hygiene through proper brushing techniques, use of fluoride tooth paste, and mouth washes should be done
- School dental health services like periodic check-up for early diagnosis and prompt treatment should be done
- School health environment including availability of fluoride in drinking water or supplements if fluoride concentration is low in water should be made.
| Conclusion|| |
From the results, it can be concluded that the overall oral health status was poor in these children. Moreover, children with visual impairment have much more poorer oral health when compared to the hearing and speech impairment and orthopedically physically challenged group. The mean DMFT, the poor gingival condition was significantly higher among visually impaired individuals. Society should take care of its dependent or neglected part as this determines its development and evolution. Children with special needs should earn special attention in the area of oral health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J, et al.
Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J 1982;32:281-91.
Tak M, Nagarajappa R, Sharda A, Asawa K, Tak A, Jalihal S, et al.
Comparative assessment of oral hygiene and periodontal status among children who have poliomyelitis at Udaipur city, Rajasthan, India. Med Oral Patol Oral Cir Bucal 2012;17:e969-76.
Bernier JC. Parental adjustment to a disabled child: A family-system perspective, families in society. Fam Soc 1990;71:589-96.
Park K. Park's Textbook of Preventive and Social Medicine. 19th
ed. Jabalpur: Banarasi Das Bhanot Publishers; 2007.
Shivakumar M. Dental care delivery to the institutionalized handicapped children. J Indian Assoc Public Health Dent 2002;3:6-7.
Ohmori I, Awaya S, Ishikawa F. Dental care for severely handicapped children. Int Dent J 1981;31:177-84.
Fiske J, Hyland K. Parkinson's disease and oral care. Dent Update 2000;27:58-65.
Purohit BM, Acharya S, Bhat M. Oral health status and treatment needs of children attending special schools in South India: A comparative study. Spec Care Dentist 2010;30:235-41.
Avasthi K, Bansal K, Mittal M, Marwaha M. Oral health status of sensory impaired children in Delhi and Gurgaon. Int J Dent Clin 2011;3:21-3.
World Health Organization. Oral Health Surveys-Basic Methods. 5th
ed. Geneva: WHO Press; 2013.
World Health Organization. Oral Health Surveys-Basic Methods. 4th
ed. Geneva: WHO Press; 1997.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Sanjay V, Shetty SM, Shetty RG, Managoli NA, Gugawad SC, Hitesh D, et al.
Dental health status among sensory impaired and blind institutionalized children aged 6 to 20 years. J Int Oral Health 2014;6:55-8.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century – the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Jain M, Bharadwaj SP, Kaira LS, Bharadwaj SP, Chopra D, Prabu D, et al.
Oral health status and treatment need among institutionalised hearing-impaired and blind children and young adults in Udaipur, India. A comparative study. Oral Health Dent Manag 2013;12:41-9.
Mehta A, Gupta R, Mansoob S, Mansoori S. Assessment of oral health status of children with special needs in Delhi, India. Rev Bras Odontol 2015;12:239-46.
Singh A, Kumar A, Berwal V, Kaur M. Comparative study of oral hygiene status in blind and deaf children of Rajasthan. J Adv Med Dent Sci 2014;2:26-31.
Al-Qahtani Z, Wyne AH. Caries experience and oral hygiene status of blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia. Odontostomatol Trop 2004;27:37-40.
Reddy VK, Chaurasia K, Bhambal A, Moon N, Reddy EK. A comparison of oral hygiene status and dental caries experience among institutionalized visually impaired and hearing impaired children of age between 7 and 17 years in central India. J Indian Soc Pedod Prev Dent 2013;31:141-5.
] [Full text]
Siddibhavi MB. Oral health status of handicapped children attending various special schools in Belgaum city Karnataka. Webmedcentral Epidemiol 2012;3:WMC003061.
Dinesh RB, Arnitha HM, Munshi AK. Malocclusion and orthodontic treatment need of handicapped individuals in South Canara, India. Int Dent J 2003;53:13-8.
Nayak PP, Prasad K, Bhat YM. Orthodontic treatment need among special health care needs school children in Dharwad, India: A comparative study. J Orthod Sci 2015;4:47-51.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]