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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 2  |  Page : 139-142

Assessment of oral health status in orphanage inmates of north-eastern part of Rajasthan: A descriptive cross-sectional study


1 Department of Public Health Dentistry, Postgraduate Research Institute, Saraswati Dhanwantari Dental College and Hospital, Parbhani, Maharashtra, India
2 Department of Public Health Dentistry, Triveni Institute of Dental Sciences, Hospital and Research Centre, Bilaspur, Chhattisgarh, India
3 Department of Public Health Dentistry, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India
4 Department of Public Health Dentistry, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India

Date of Submission07-Oct-2019
Date of Decision03-Apr-2020
Date of Acceptance08-May-2020
Date of Web Publication24-Jun-2020

Correspondence Address:
Dr. Hunny Sharma
MD 264, Phase 4, Near AIIMS Residential Complex, Kabir Nagar, Raipur - 492 099, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_104_19

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  Abstract 


Background: A child is dependent on their parents for care and affection, but, unfortunately, millions of children have to live without parents. Health problems of orphan children can be compromised and directly depend on the living conditions of the institution. Aim: To assess the oral health status in orphanage inmates of north-eastern part of Rajasthan. Materials and Methods: A cross-sectional survey among 1005 orphan children was conducted. The Oral Health Assessment Form for Children, 2013, was used to assess the oral health status of the study participants. IBM SPSS software vs 24 for windows (New York, USA) was used for statistical analysis. To estimate frequency and percentage, descriptive statistics were performed, while the need of inferential statistics necessitated the use of Chi-square test. A P < 0.05 was considered statistically significant. Results: The prevalence of dental caries in primary and permanent dentition was found to be 13.83% and 20.70%, respectively. Comparatively higher prevalence of dental caries was observed in female inmates. Bleeding on probing was detected in 225 (22.39%) participants. While, assessment of fluorotic lesions showed 0.80% with questionable fluorosis, followed by 2.89% with very mild, 2.69% with mild, and 0.40% with moderate fluorosis. Enamel erosion was found in 2.39% of the participants. Abscess was the only oral mucosal lesion found in sulci of 15 (1.49%) study participants. Conclusion: Our study findings showed that there is very limited accessibility and availability of any oral health care for orphanage residents. Children living in Rajasthan orphanages are suffering from dental caries that need to be urgently treated. There was no proof of any dedicated oral health-care services for these orphaned children.

Keywords: Children, dental caries, oral health, oral health status, orphanage, tooth loss


How to cite this article:
Soni A, Sharma H, Motghare V, Verma S. Assessment of oral health status in orphanage inmates of north-eastern part of Rajasthan: A descriptive cross-sectional study. J Indian Assoc Public Health Dent 2020;18:139-42

How to cite this URL:
Soni A, Sharma H, Motghare V, Verma S. Assessment of oral health status in orphanage inmates of north-eastern part of Rajasthan: A descriptive cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Oct 28];18:139-42. Available from: https://www.jiaphd.org/text.asp?2020/18/2/139/287625




  Introduction Top


For care and affection, a child is dependent on their parents, but, unfortunately, millions of children have to live without parents. Orphan child health issues can be complex and rely directly on the institution's living conditions.[1] An orphanage is a residential facility in which an orphaned child lives, whose parents either are no longer there or are unable to care for him/her.[2]

An orphan child is neglected and separated from the outside world, and needs special physical, mental, and social attention in order to become a gallant citizen.[3] Unfortunately, children living in an orphanage may suffer from nutritional deficiency that may lead to malnutrition, anemia, and delays in growth and are vulnerable to the burden of oral disease associated with economically disadvantaged communities.[4]

Children's behaviors and attitudes are shaped and established over their lives by the complex interaction of social, cultural, economic, and ethnic factors. This complex mechanism affects their awareness about health and disease prevention, including oral infections.[5] However, owing to the expensive nature of oral and dental services, orphaned children who are socially or economically marginalized are denied access to oral health care because of inaccessibility and un-affordability, rendering them more vulnerable to oro-dental diseases.[6]

Due to poverty, armed conflict, human immunodeficiency virus/acquired immunodeficiency syndrome, and other causes, there are approximately 14 million orphans living in the world today, and this amounts to 2% of the world population. Moreover, over the past decade, it is estimated that nearly one million children have been split from their families due to military conflicts among countries. The total number of socially deprived children in India was estimated at 23,246,000 in 2010, accounting for 6.8% of the total child population in India.[7],[8]

The World Health Organization (WHO) advises the preparation and implementation of dental services on the basis of the literature collected through surveys on oral health and disease prevention and promotion, which will help track improvements in oral health rates and patterns.[9] Specific studies identify the oral health status of orphaned inmates living at Rajasthan's institutionalized care centers. The present study was, therefore, undertaken to determine the oral health status in orphaned inmates from the north-eastern region of Rajasthan.


  Materials and Methods Top


The present descriptive cross-sectional study was conducted to assess oral health status in orphanage inmates of north-eastern part of Rajasthan. The study was carried out over a period of 6 months from February 2014 to July 2014, and the study protocol reviewed by the Institutional Review Board was approved via letter number (RDCH/155/2012). A permission was also sought from the Director and Joint Secretary, Child Empowerment Department, Jaipur, to conduct the study throughout the orphanages of the Jaipur district in Rajasthan.

Before the beginning of the study, a list of 22 public and private orphanages was obtained from the Director and Joint Secretary, Child Empowerment Department, Jaipur, Rajasthan. Out of 22 orphanages, a total of 16 provided permission for the conduction of the study.

Because it would have not been ethical to leave any orphan child to be excluded from the assessment of his/her treatment needs, hence a convenient sampling technique was utilized to include all the study participants into the study. A total of 1005 children aged 3–18 years who were staying in these orphanages were included in the study.

The Oral Health Assessment Form for Children, 2013, was used to assess the oral health status of the study participants.[10] A pilot survey was conducted among 25 children randomly selected from two orphanages, and the information gathered was utilized for proper planning and execution of the main study and to know the practical difficulties while conducting the study. The data gathered included demographic details such as name, age, and location of the orphanages with clinical information such as dentition status, periodontal status, and information status regarding dental erosion, trauma, and fluorosis. The data gathered from these 25 children were also included in the main study.

Pre-sterilized instruments were adequately packed and carried to the institute in sufficient numbers to avoid the interruption during the examination. Although for safety purposes, a chemical method (Korsolex) of sterilization diluted by adding one part to nine parts of potable water was kept. Before the start of the study, the examiner was standardized and calibrated in the institution, by practicing on ten children with a wide range of disease conditions. It was done to ensure uniform interpretations, understanding, and application of the codes and criteria for the various diseases and health to be observed and recorded. The intra-examiner reliability was assessed using Kappa statistics, which was 89% for detecting caries and 87% for the Community Periodontal Index (CPI). A recording clerk also trained for recording data on the Oral Health Assessment Form for Children, 2013. The study was conducted at a fixed time of the day, i.e., 10 a.m.–3 p.m., and a maximum of 25–30 children were examined each day in order to avoid examiner's fatigue.

The examiner visited the residential institutes on the predetermined dates according to the schedule with a trained recorder. Clinical examinations were carried out at the outside of the institute's corridor with the aid of a mouth mirror and CPI probe as described in WHO, Oral Health Surveys (Basic Method, 5th edition).[11]

Statistical analysis

Continuous variables were summarized as mean and standard deviation, whereas nominal/categorical variables as proportions (%). Unpaired t-test was used for the comparison of continuous variables between the groups, while the Chi-square test was used for nominal/categorical variables. P ≤ 0.05 was taken as statistically significant. IBM SPSS software vs 24 for windows (New York, USA) was used for all statistical calculations.


  Results Top


The total study population was 1005, comprising 658 (65.37%) males and 347 (34.53%) females in 3–18 years' age group. The age distribution of the population was as follows: 13.93% were in 3–6 years, with a majority, i.e., 46.17% in 7–12 years and 39.90% in 13–18 years' age group. Participants residing in urban, peri-urban, and rural areas were 852 (84.78%), 78 (7.76%), and 75 (7.46%), respectively [Table 1].
Table 1: Distribution of the study participants according to age and gender

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Assessing the gingival status revealed that 780 (77.61%) of the study participants had healthy gums while bleeding on probing was detected in 225 (22.39%) [Table 2].
Table 2: Periodontal disease status among the study participants

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Majority of the participants (937 [93.23%]) had no fluorosis, while only 8 (0.80%) participants had questionable fluorosis, followed by 29 (2.89%) with very mild, 27 (2.69%) with mild, and 4 (0.40%) with moderate fluorosis [Table 3].
Table 3: Prevalence of the study enamel fluorosis among the study participants

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The prevalence of dental caries was found to be 13.83% and 20.70% in primary and permanent teeth, respectively. Only 1.19% of participants had the dental filling in permanent teeth and 3.98% of the participants had the fractured crown. According to gender, the prevalence of dental caries in primary teeth was found to be 84 (12.77%) and 55 (15.85%) male and females, respectively, while in permanent teeth, it was 134 (20.36%) and 74 (21.33%), respectively. According to gender, fractured teeth were observed in 25 (3.80%) males and 15 (4.32%) females [Table 4] and [Table 5].
Table 4: Prevalence of dental caries in primary teeth among the study participants

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Table 5: Prevalence of dental caries in permanent teeth by gender among the study participants

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The prevalence of filled teeth with decay was found to be in two (0.20%) participants of the orphanage. Gender wise, filled teeth without decay was observed in three (0.46%) and nine (1.19%) males and females, respectively. Missing teeth as a result of caries and missing teeth due to other reasons were found to be 3 (0.30%) for both the parameters. No pit-and-fissure sealant application was observed in any orphanage children. Veneer or laminate was given to only one (0.10%) female participant. Unerupted teeth were found among five (0.50%) male participants. Fractured teeth were found in forty (3.98%) orphan children.

While examining for the evidence of dental erosion, enamel erosion was found in 24 (2.39%) participants, while dentinal erosion or erosion involving pulp was not evident in any of the participants. Abscess was the only oral mucosal lesion found in the sulci of 15 (1.49%) study participants.

Accessing the collected data showed that a total of 630 referrals were made to dentists, out of which 212 (33.65) belonged to the government sector and 418 (66.35) belonged to the private sector [Table 6].
Table 6: Distribution of referral according to the type of institute

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  Discussion Top


In the present study, the prevalence of dental fluorosis was found contrary to the study conducted by Sharma et al., which reported dental fluorosis to be found in 2.3% of the study participants, while our study indicates a wide array of fluorotic lesion of various degree among the study participants, which may be a result of water from borewell and wells located in institutes itself, which was consumed by the participants.[10] Although most of the participants stayed in orphanages from a very young age, the findings of fluorosis can not be considered as a result of their stay in orphanages, as all the participants came from different parts of Rajasthan in India. The findings of the periodontal condition were similar to those of the study done by Vijaya et al., who reported bleeding on probing in 21.2% of participants.[12]

In the present study, the prevalence of dental caries was seen in 3.83% and 20.70% of deciduous and permanent teeth, respectively. The observation found in agreement with the study conducted by Sharma et al.[10] The prevalence of dental caries was higher in females in both primary (15.85%) and permanent (21.33%) dentition. The previous literature also gives evidence of female gender experiencing more carious activity than male gender. Higher caries prevalence among females might be due to different salivary composition and flow rate, hormonal fluctuations, dietary habits, genetic variations, and particular social roles in pervious real family.[10],[13] As a result, the longer exposure of girls' teeth to the cariogenic oral environment, coupled with less attention to the oral health status of girls compared to boys in the orphanage, may have resulted in higher levels of decayed teeth and lower levels of filled teeth in the current study population. In the present study, none of the participants had a prosthesis in either of their jaws.

Abscess was the only oral mucosal lesion found in the sulci of 15 (1.49%) study participants, which might be due to dental caries, but needs further radiographic diagnosis.

A surprising finding was obtained when data regarding referral dentist were assessed; the collected data showed that although more than half, i.e., 62.69% children with treatment needs were referred to dentist, very less were actually provided or availed the treatment, which is evident from the significantly less number of filled teeth and other treatments such as missing teeth due to extraction and veneers, the reason for which remains unknown.

Avenues of future research and recommendations

Further studies covering the wider geographical region and the larger sample size are recommended in this area of research to explore the oral health status and treatment needs and reflect the real-time scenario of this marginalized population; a special attention should also be made regarding the number of children being referred to dentist and children actually being provided or availing the treatment. Oral health status needs to be improved in orphan inmates. Oral health problems cannot be resolved by the dentists alone. Thus, the active inclusion of the caretakers, community leaders, voluntary members, and primary health-care workers should be done for the prevention of oral diseases. Special programs should be formulated and conducted at these institutions to improve oral hygiene and instill positive oral health behavior among these inmates.


  Conclusion Top


The findings of the current study will help in providing some insight into the oral health status of the participants residing in orphanages of Jaipur district, Rajasthan. The results of our study indicate a very poor accessibility and availability of any oral health care for the inmates residing in orphanages. Our study findings showed that there is very limited accessibility and availability of any oral health care for orphanage residents. Children living in Rajasthan orphanages are suffering from dental caries that need to be urgently treated. There was no proof of any dedicated oral health-care services for these orphaned children. This information can be utilized in designing the oral health promotion program implementing both preventive and curative strategies for the same. Special programs should be formulated and conducted at these institutions to improve the oral hygiene and instill positive oral health behavior among these inmates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khan S. Oral health status and treatment needs among children and adolescents in orphanages of Bhopal Madhya Pradesh: A cross-sectional study. J Appl Dent Med Sci 2017;3:160-71.  Back to cited text no. 1
    
2.
Dozier M, Zeanah CH, Wallin AR, Shauffer C. Institutional care for young children: review of literature and policy implications. Soc Issues Policy Rev 2012;6:1-25.  Back to cited text no. 2
    
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Sinha A, Kaur K, Singh K, Puri MS, Anandani C, Kaur J. Dental caries status among orphans and parented children in north India: A comparative study. J Adv Med Dent Scie Res 2017;5:54-7.  Back to cited text no. 3
    
4.
Shukla B, Shukla D. Study to assess physical health status of children in selected orphanage in Salem Chennai – India. IARS' Int Res J 2011;1:1-8.  Back to cited text no. 4
    
5.
Freitas-Fernandes LB, Novaes AB Jr., Feitosa AC, Novaes AB. Effectiveness of an oral hygiene program for Brazilian orphans. Braz Dent J 2002;13:44-8.  Back to cited text no. 5
    
6.
Sogi GM, Baskar DJ. Dental caries and oral hygiene status of schoolchildren in Davangere related to their socio-economic levels. An epidemiological study. J Indian Soc Pedod Prev Dent 2002;20:152-7.  Back to cited text no. 6
[PUBMED]    
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Shah AF, Tangade P, Ravishankar TL, Tirth A, Pal S, Batra M. Dental caries status of institutionalized orphan children from Jammu and Kashmir, India. Int J Clin Pediatr Dent 2016;9:364-71.  Back to cited text no. 7
    
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Wagt de A, Connolly M. Orphans and the impact of HIV/AIDS in sub-Saharan Africa. Food Nutr Agric 2004;34:1-9.  Back to cited text no. 8
    
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Naidu R, Prevatt I, Simeon D. The oral health and treatment needs of schoolchildren in Trinidad and Tobago: Findings of a national survey. Int J Paediatr Dent 2006;16:412-8.  Back to cited text no. 9
    
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Sharma A, Gaur A, Pareek S, Raja VD, Sanadhya S, Sharma AB. Oral health status and treatment needs among orphanage children of Jaipur City. Scholars J Applied Med Sci 2014;2:1776-80.  Back to cited text no. 10
    
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Oral Health Surveys: Basic Methods. 5th ed. World Health Organization; 2013. Available from: https://www.who.int/oral_health/publicat ions/9789241548649/en/. [Last accessed on 2018 Jul 06].  Back to cited text no. 11
    
12.
Vijaya V, Kumar DA, Kshitish DK, Nadkerny PV, Agrawal A. Periodontal status among children and adolescents' in orphanages of Bilaspur district, Chattisgarh, India. J Res Adv Dent 2014;3:125-33.  Back to cited text no. 12
    
13.
Ferraro M, Vieira AR. Explaining gender differences in caries: A multifactorial approach to a multifactorial disease. Int J Dent 2010;2010:649643. https://doi.org/10.1155/2010/649643.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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