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Year : 2020  |  Volume : 18  |  Issue : 1  |  Page : 31-34

Influence of intellectual disabilities on oral health among children attending special schools in Goa:A cross-sectional study

1 Department of Public Health Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
2 Unit of Public Health Dentistry, PGIMER, Chandigarh, India

Date of Submission29-Aug-2019
Date of Decision03-Jan-2020
Date of Acceptance21-Jan-2020
Date of Web Publication2-Mar-2020

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

DOI: 10.4103/jiaphd.jiaphd_97_19

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Background: The severity of oral health problems in intellectually disabled population is worse than in general population, and they tend to have more untreated dental problems. Aim: The aim of this study was to assess the influence of intellectual disability on oral health among 127 children. Materials and Methods: A self-administered parental questionnaire was used to collect data on sociodemographic characteristics and oral health behavior variables. Type III clinical examination was done using Decayed, Missing, and Filled Teeth (DMFT)/decayed, missing, and filled teeth (dmft) index, plaque index, and gingival index. Data collected were statistically analyzed using SPSS (version 19.0, IBM Corp., Armonk, NY, USA). Mann–Whitney test and Kruskal–Wallis test were used. Results: The mean age of the study participants was 11.71 ± 2.03 years. The mean DMFT and dmft of study participants were 2.55 ± 2.99 and 1.54 ± 2.66, respectively. There was no statistically significant difference in DMFT scores between mild, moderate, and severe disability levels (P = 0.28). The mean plaque score and gingival score were 11.71 ± 2.03 and 0.78 ± 0.56, respectively, and there was no statistically significant difference in plaque scores (P = 0.11) and gingival scores (P = 0.10) between mild, moderate, and severe disability levels. Conclusion: Children with intellectual disabilities presented with poor oral health conditions. There was a trend of increase in DMFT and plaque scores with the level of the disability although there was no statistically significant difference.

Keywords: Dental caries, dental plaque, India, intellectual disability, oral health

How to cite this article:
Gadiyar A, Gaunkar R, Kamat A, Kumar A. Influence of intellectual disabilities on oral health among children attending special schools in Goa:A cross-sectional study. J Indian Assoc Public Health Dent 2020;18:31-4

How to cite this URL:
Gadiyar A, Gaunkar R, Kamat A, Kumar A. Influence of intellectual disabilities on oral health among children attending special schools in Goa:A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2022 Aug 11];18:31-4. Available from: https://www.jiaphd.org/text.asp?2020/18/1/31/279829

  Introduction Top

Oral health is an integral part of general health and well-being. Good oral health enables individuals to communicate effectively, to eat and enjoy a variety of foods, and is important for overall quality of life, self-esteem, and social confidence.[1]

The term disability refers to an individual functioning, mental illness, including physical, sensory, cognitive, and intellectual impairment, and various types of chronic diseases.[2] As per Census 2011, in India, out of the 121 crore population, about 2.68 crore persons are “differently abled” which is 2.21% of the total population.[3]

Intellectual disability (ID) is a developmental condition characterized by significant deficits in both intellectual functioning and adaptive behavior including conceptual, social, and practical skills.[4]

Three elements are common for people with ID: a significant impairment of intelligence; a resultant significant reduction in adaptive behavior/social functioning; and the development of the condition before the age of 18, which persists throughout life.[5]

About 80% of intellectually disabled individuals are estimated to reside in developing countries.[6] Oral health problems are a great concern in these individuals. They may be attributed to various causes such as inability to maintain oral hygiene, cariogenic diet, side effect of medications, lack of resources, poor organizational support, and lack of knowledgeable professionals.[7],[8]

Oral health care is one of the greatest unmet health needs of disabled individuals, but these needs are nonetheless grossly underestimated by caregivers.[9] Furthermore, oral health-care delivery is challenging for people with ID because they may have physical impairments and may also exhibit uncooperative behavior.[10]

A systematic review of 27 studies concluded that people with disabilities have worse oral hygiene and higher plaque levels, more severe gingivitis and periodontitis, and more untreated dental disease.[11]

There is a paucity of literature focusing on the impact of ID on oral health in Goa. Hence, the present study was conducted to evaluate the oral health of children with various levels of intellectual disabilities.

  Materials and Methods Top

The present cross-sectional study was conducted from July to November 2017.

The study was reviewed and approved by the institutional review board. Permission to conduct the study was obtained from the school authorities. Informed consent was obtained from the parents. All individuals with ID and age between 6 and 16 years were included in the study. Children who had detrimental systemic diseases an extremely uncooperative were excluded from the study.

The clinical diagnosis of ID level was obtained from their medical records in school describing as mild, moderate, severe, and profound, according to the International Classification of Diseases-10. Every child with a disability had been examined and assessed by the designated and qualified hospital. The results of the assessment were registered in the school's medical records.

Sampling method and sample size estimation

Based on the pilot study, the prevalence of dental caries among children with intellectual disabilities was found to be 71% using the formula: 4 pq/d2. The final sample size estimated was 127 individuals.

Sociodemographic data

A self-administered parental questionnaire comprising 10 questions was used to collect data on sociodemographic characteristics and oral health behavior variables. Reliability of the questionnaire was assessed, and the Cronbach's alpha value was 0.8. Content validity was done, and the content validity index score obtained was 0.9. Oral health behavior variables included were toothbrushing frequency, visit to the dentist, and brushing assistance.

Clinical examination

Type III clinical examination was carried out with the aid of mouth mirror and community periodontal index probe, under adequate natural light. 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. Level of dental caries, gingivitis scores, and plaque scores were recorded.

Clinical assessment for dental caries was carried out using the World Health Organization criteria 1997.[12] Caries experience was evaluated using decayed, missing, and filled teeth (dmft) index (for primary dentition) and Decayed, Missing, and Filled Teeth (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.

Gingivitis was scored using Löe and Silness Gingival Index[13] and plaque scores using Silness and Löe Plaque Index,[14] and the mean score was calculated.

Oral health education was given to all the study participants, and correct brushing techniques were taught. Toothbrushing was taught in steps by task analysis method. Those who required dental treatment were referred to dental college for needful.

Statistical analysis

The data obtained were compiled and analyzed using SPSS (version 19.0, IBM Corp., Armonk, NY, USA). Statistical significance was set at P < 0.05. Mann–Whitney test and Kruskal–Wallis test were used.

  Results Top

The study sample comprised 127 children with ID. The mean age of the study sample was 11.71 ± 2.03 years. Majority of the study participants (67.7%) were male. There was a difference in the distribution of participants according to the type of disability where 60% belonged to mild, 25.2% belonged to moderate, and 14.2% belonged to severe type of ID [Table 1].
Table 1: Distribution of study participants according to sociodemographic characteristics

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Majority (57.5%) of the study participants brushed once daily. About 64.1% of the study participants had never visited a dentist. Brushing was assisted for 90.6% of the participants [Table 2].
Table 2: Distribution of study participants according to oral health variables

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Dental caries prevalence was 63.8%. The mean DMFT of the study participants was 2.55 ± 2.99. Participants with severe ID had the highest mean DMFT which was 5.66 ± 4.26 followed by moderate and mild ID who had DMFT of 2.15 ± 2.67 and 1.98 ± 2.27, respectively [Table 3].
Table 3: Mean Decayed, Missing, and Filled Teeth and decayed, missing, and filled teeth according to different intellectual disability level

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Plaque and gingivitis scores

The mean plaque and gingival scores were 1.16 ± 0.58 and 0.88 ± 0.74, respectively, with no statistically significant difference between genders. The mean plaque score in severe level was 1.61 ± 1.03, moderate level was 1.06 ± 0.61, and mild level of ID was 1.16 ± 0.58, which was not statistically significant [Table 4].
Table 4: Mean plaque and gingival scores according to different intellectual disability levels

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There was no statistically significant difference in DMFT and dmft scores between males and females (P = 0.49) [Table 5].
Table 5: Comparison of mean plaque index, gingival index, Decayed, Missing, and Filled Teeth, and decayed, missing, and filled teeth scores according to gender

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  Discussion Top

The present cross-sectional study gives an overview of the caries status and gingival health of the children with different levels of intellectual disabilities.

The study demonstrated that the DMFT was 2.55 and the mean dmft was 1.54 among children with intellectual disabilities, which was higher than previous studies.[15],[16] There was no statistically significant difference between gender and DMFT. These findings were similar to a study conducted by Jain et al.[17] The present study supported previous results showing that oral health status in patients with disabilities was poorer compared with that of the general population.[18],[19] The increased risk of caries experience in children with Intellectual disability might be related to complications that could lower their physical abilities and be barriers to adequate oral care.

Toothbrushing is an effective method for the mechanical removal of bacterial biofilm.[20]

Majority of the study participants reported that they brushed once daily and brushing was assisted by caregivers. This is in accordance with a study conducted by Liu et al.[15]

This suggests that there is a need for oral health promotion to improve the oral hygiene.

The mean DMFT of participants with mild, moderate, and severe disability was 1.98, 2.15, and 5.66, respectively. This was in agreement with previous studies[21.22] suggesting that treatment need increases with the level of disability.

People with ID have a higher prevalence and greater severity of periodontal disease than the general population.[23],[24],[25]

The mean plaque score of the study participants was 1.10 which was in line with a study conducted by Ameer et al.[26] However, there was no statistical significance in the plaque scores between males and females, which is in agreement with previous studies.[27]

Martens et al.[28] reported that manual dexterity was better in patients with mild ID compared to severe ID. In the present study, the plaque and gingival score levels showed an increasing trend with the severity of the ID which confirmed the previous findings.

The present study showed that children with severe ID had poor oral hygiene and gingival health. This is consistent with studies conducted by Al-Sufyani et al.[29] The main reason for gingival/periodontal problems in disabled individuals is the lack of proper oral hygiene and inadequacy of the plaque removal. This suggests that there is a need for more assistance from caretakers with their oral health care.

Parents and teachers should be trained and educated by dental professionals regarding the oral hygiene measures to enable them to implement effective preventive regimes. Early oral health-care interventions and preventive measures are important to improve the oral health of children with intellectual disabilities.

The limitations of the study include small sample size, cross-sectional design, and lack of control group.

  Conclusion Top

Children with intellectual disabilities presented with poor oral health conditions. There was a trend of increasing DMFT with the level of disability. The gingival health was most affected in children with severe level of disabilities.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-V. 5th ed. Washington (DC): American Psychiatric Association; 2013. p. 31.  Back to cited text no. 4
World Health Organization. Atlas: Global Resources for Persons with Intellectual Disabilities, 2007. Key Findings Relevant for Low- and Middle-Income Countries. World Health Organization; 2007.  Back to cited text no. 5
Matson JL, Shoemaker ME. Psychopathology and intellectual disability. Curr Opin Psychiatry 2011;24:367-71.  Back to cited text no. 6
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Loe H, Silness J. Periodontal disease in pregnancy. I. prevalence and severity. Acta Odontol Scand 1963;21:533-51.  Back to cited text no. 13
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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. 15
Chand BR, Kulkarni S, Swamy NK, Bafna Y. Dentition status, treatment needs and risk predictors for dental caries among institutionalised disabled individuals in central India. J Clin Diagn Res 2014;8:ZC56-9.  Back to cited text no. 16
Jain M, Mathur A, Sawla L, Choudhary G, Kabra K, Duraiswamy P, et al. Oral health status of mentally disabled subjects in India. J Oral Sci 2009;51:333-40.  Back to cited text no. 17
Chang J, Lee JH, Son HH, Kim HY. Caries risk profile of Korean dental patients with severe intellectual disabilities. Spec Care Dentist 2014;34:201-7.  Back to cited text no. 18
Oliveira JS, Prado Júnior RR, de Sousa Lima KR, de Oliveira Amaral H, Moita Neto JM, Mendes RF. Intellectual disability and impact on oral health: A paired study. Spec Care Dentist 2013;33:262-8.  Back to cited text no. 19
Li W, Yu D, Gao S, Lin J, Chen Z, Zhao W. Role of Candida albicans-secreted aspartyl proteinases (Saps) in severe early childhood caries. Int J Mol Sci 2014;15:10766-79.  Back to cited text no. 20
Huang ST, Hurng S, Liu HY, Chen CC, Hu WC, Tai Y, et al. The oral health status and treatment needs of institutionalized children with cerebral palsy in Taiwan. J Dent Sci 2010;5:75-89.  Back to cited text no. 21
Gondim LA, Andrade MC, Maciel SS, Ferreira MA. Epidemiological profile of dental conditions and treatment needs of the disabled in the city of Caruaru PE Brazil. RGO 2008;56:393-7.  Back to cited text no. 22
El Khatib AA, El Tekeya MM, El Tantawi MA, Omar T. Oral health status and behaviours of children with autism spectrum disorder: A case-control study. Int J Paediatr Dent 2014;24:314-23.  Back to cited text no. 23
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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. 25
Ameer N, Palaparthi R, Neerudu M, Palakuru SK, Singam HR, Durvasula S. Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India. J Indian Soc Periodontol 2012;16:421-5.  Back to cited text no. 26
[PUBMED]  [Full text]  
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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