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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 20
| Issue : 4 | Page : 352-355 |
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Assessment of effect of health song on oral hygiene status among visually impaired children
J John Smith1, Jithesh Jain2, SR Ananda2, Bhakti Jadduram Sadhu2
1 Department of Public Health Dentistry, Vivekanandha Dental College for Women, Tiruchengode, Tamil Nadu, India
2 Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
| Date of Submission | 02-Jul-2021 |
| Date of Decision | 25-Mar-2022 |
| Date of Acceptance | 27-Aug-2022 |
| Date of Web Publication | 19-Dec-2022 |
Correspondence Address:
J John Smith
Plot No: 18, Nggos Colony, Gorimedu, Salem - 636 008, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaphd.jiaphd_121_21
Background: The visually impaired depend much on sound, speech, and touch, and therefore, promotion of oral hygiene maintenance through a health song can improve their oral hygiene practices. Aim and Objectives: To assess the effectiveness of oral health song on oral hygiene status among visually impaired children at baseline and after oral health education (OHE) at different time intervals. Materials and Methods: A study was carried out in Government Blind School, Salem, with prior permission. Out of 63 students, 57 students were taken to the study based on the inclusion and exclusion criteria. Seven students were lost to follow-up during the second visit and 9 students during the last visit. During the first visit, a health talk about brushing techniques was given without using any audiovisual aids, and oral health song which is of 2 min duration was taught to the students. Each of the students was given a tooth cast model and was taught how to brush. The oral hygiene status was assessed at baseline and 15th and 45th day using visible plaque index (VPI) and gingival bleeding index (GBI). Statistical analysis was done using IBM SPSS Statistics 25. The Bonferroni test was to compare the VPI and GBI scores between the baseline, 15 days, and 45 days, and P < 0.05 was considered statistically significant. Results: VPI and GBI scores were found to be statistically significant at different intervals (P < 0.001). The VPI anterior and posterior percentage (P < 0.001) and GBI anterior and posterior percentage (P < 0.001) at different intervals were found to be statistically highly significant. Conclusion: A song with music can increase interest and helps them retain information easily, which was found to be effective in the present study.
Keywords: Oral health song, oral hygiene, visual impairment
How to cite this article:
Smith J J, Jain J, Ananda S R, Sadhu BJ. Assessment of effect of health song on oral hygiene status among visually impaired children. J Indian Assoc Public Health Dent 2022;20:352-5 |
| Introduction | |  |
According to the WHO statistics, there are 19 million children with vision impairment.[1] Compared with the other children, they have poor oral hygiene because of inadequate plaque removal as these children cannot visualize the plaque on the teeth surfaces.[2] Visually impaired children are challenged in learning everyday skills, with maintaining proper oral hygiene being one of the major things. Therefore, proper health education using various aids can help in adopting a healthier lifestyle, positive attitude, and good oral health behavior in maintaining oral hygiene.[3],[4],[5] Braille texts are the common method of education; however, advancements in technology created facilities to store Braille characters and read text aloud on computers, and these are found to be useful in assisting these children in their studies. Although Braille displays have already been developed, these technologies are still not widely used because of high cost and lack of awareness among the users. The use of sound as an educational tool can be more effective and economic compared to others. Sound being one of the methods of health education uses various cassette players and other recording machines for different purposes. It can be used to record lectures, books, and study materials and to submit their assignments in audio formats. The use of music and natural tooth models or typhodonts can be effective in educating these children as they depend much on sound, speech, and touch.[6],[7] Because visually impaired population has poorer oral hygiene, primordial prevention for the schoolchildren can lead to change in their attitude and practices, thereby improving their dental health. A paucity of studies in educating these children using oral health song and models led the present study to assess the effectiveness of oral health song on oral hygiene status among visually impaired children.
| Materials and Methods | | |
The present study is a nonrandomized clinical trial. There are a total of 20 blind schools in Tamil Nadu out of which only one school is present in Salem district which was included in the study. There were a total of 63 students aged 7–16 years present in an institutionalized Government Blind School, Salem. A convenient sampling method was used. All the students who fulfilled the inclusion and exclusion criteria were included in the study. Inclusion criteria include subjects who are blind by birth and those who are both partially blind and completely blind. Exclusion criteria included subjects with other disabilities such as deaf and dumb and mental and physical disabilities and also subjects who are under medication for systemic diseases. Ethical clearance was obtained from the institutional review board of Coorg Institute of Dental Sciences, Virajpet (IRB no. IRB/CIDS/90/2017). Permission was taken from the head of the school before the study. Informed consent for all students was obtained from the parents/caretaker before the commencement of the study.
During the first visit, all the 57 students included in the study were given a health talk about brushing techniques without using audiovisual aids. Then, a newly composed oral health song which is of 2 min duration was played and the song was taught to the students. The song was in the Tamil language which included brushing techniques, the way the subjects should clean their tongue and rinse their mouth regularly. Each of the students was given a tooth cast model which was poured into Orthokal (Type III dental stone). The students were made to feel the tooth surface and the gingiva. Gingiva was made of wax enabling the students to appreciate the difference between the tooth and the gingiva. The students were given the cast model and a toothbrush and were asked to move the toothbrush around the teeth in the model according to the song played. The song was also taught separately for better understanding of the lyrics. Content of the song was analyzed by experts in the field of public health dentistry, and before the start of the study, the song was pilot tested using 10 subjects who met the inclusion criteria and were not participants of the present study. Cronbach's alpha value was found to be 0.817.
Baseline data were collected before the start of the study. Type III clinical examination was done using a mouth mirror and no. 23 explorer under artificial light. Oral hygiene status was assessed using visible plaque index (VPI) and gingival bleeding index (GBI) by Ainamo and Bay (1975).[8] A single calibrated examiner examined all the students. VPI was scored as “+” or “−” based on the presence or absence of visible plaque. Similarly, for GBI, it was marked as “+” or “−” based on the presence or absence of gingival bleeding, respectively.
The health song was played every day by the school using a public address system when the students gather for assembly till the end of the study. During the 2nd visit, which was 15 days later, 7 students were lost to follow-up (4 students discontinued schooling, 3 students were absent). The oral hygiene status of the remaining 50 children was assessed again. During the last visit which was 1 month after the second visit, 9 students were lost to follow-up (5 students discontinued schooling, 4 students were absent). Therefore, a total of 41 students were re-examined to assess their oral hygiene status. Data were collected, coded, and fed into the IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, N.Y., USA) for analysis. Descriptive and inferential statistics were calculated. Descriptive statistics included frequency distribution and percentage. Inferential statistics includes adjustment for multiple comparisons using the Bonferroni test to compare the VPI and GBI scores between the baseline, 15 days, and 45 days, and P < 0.05 was considered statistically significant.
| Results | | |
A nonrandomized clinical trial was conducted among 41 visually impaired students, and the mean age of the students was 12.63 ± 2.51 years. Out of the 41 students, 27 (62.8%) were males and 14 (32.65) were females and 6 (14%) were partially blind and 35 (81.4%) were completely blind. Comparison of VPI and GBI at different intervals, baseline, 15 days, and 45 days, showed high statistical significance of P < 0.001 [Table 1]. Pair-wise comparison of VPI and GBI between three intervals was found to have high statistical significance of P < 0.001 [Table 2]. Comparison of VPI and GBI anterior percentage and posterior percentage at different intervals among study subjects showed high statistical significance with a P < 0.001 [Table 3] and [Table 4]. | Table 1: Comparison of visible plaque index full-mouth percentage at different intervals among study subjects
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 | Table 2: Pair-wise comparisons of visible plaque index and gingival bleeding index full-mouth percentage at different intervals among study subjects
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 | Table 3: Comparison of visible plaque index and gingival bleeding index anterior percentage at different intervals among study subjects
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 | Table 4: Comparison of visible plaque index and gingival bleeding index posterior percentage at different intervals among study subjects
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| Discussion | | |
The present study was a nonrandomized clinical trial conducted on 57 visually impaired children at Government Blind School, Salem, to assess the effectiveness of oral health song on oral hygiene status. The visually impaired children frequently have poor oral hygiene compared to their sighted counterparts as they cannot visualize and remove the plaque which further has the potential to cause periodontal diseases and dental caries. Although various health education methods such as Braille text and verbal methods are available to educate this population,[9],[10],[11] the present study used oral health song to educate the subjects.
In the present study, teeth cast models were used as a part of a tactile method to educate the children about the tooth and surrounding structures. The methodology adopted in the current study is in accordance with a study conducted by Chowdary et al.[12] where they evaluated the impact of verbal, Braille text, and tactile oral hygiene awareness instructions on oral health status among visually impaired children. The present methodology is also in accordance with the study conducted by Gautam et al.[13] where they assessed the improvement in oral hygiene by using audio aids and Braille and tactile models in visually impaired children of Bhopal city. These studies show that the combination of audio aids, Braille, and tactile models is an effective way to provide oral health education (OHE) and improve oral health status of visually impaired children.
In the present study, plaque scores were assessed using VPI at baseline, 15th day, and 45th day. Plaque scores, when compared at these intervals, yielded statistically significant results with a P < 0.001. This finding is in accordance with results of the study conducted by So AW et al.,[14] where there was significant decrease in the mean full-mouth VPI (pre-OHE: 31.8%, post-OHE: 18.2%, P < 0.001). The present study also compared VPI anterior and posterior percentage at different intervals (baseline, 15th day, and 45th day), and it was found to be statistically significant with a P < 0.001. This is in accordance to the study conducted by So AW et al.,[14] where VPI score, when compared between pre-oral hygiene index (OHI) and post-OHI, was found to be statistically significant with a P < 0.001 at both anterior and posterior region.
In the present study, GBI full-mouth percentage at different intervals was found to be statistically highly significant with a P < 0.001. This is in accordance with the study conducted by So AW et al.,[14] where there was a decrease in mean full-mouth GBI was observed (pre-OHE: 47.7%, post-OHE: 42.8%); however, it was not statistically significant. In the present study, GBI anterior and posterior percentage at different intervals was found to be statistically significant with a P < 0.001. This is in accordance with the results of the study conducted by So AW et al.,[14] where the GBI anterior and posterior percentage showed reduction in the plaque scores, but it was not statistically significant.
OHE through oral health song was found to be effective in the present study which used VPI and GBI for oral hygiene assessment. This is in accordance with the study conducted by Shetty et al.[15] among visually impaired children in which music was used in a song format to teach tooth brushing. This method used a modified gingival index, the Turesky-Gilmore-Glickman modification of the Quigley Hein plaque index, and Streptococcus mutans colony count for the assessment of oral health status, and it showed a very high drop from the preOHE level to the end of both the periods of reinforcement (2 weeks and 1 month) and nonreinforcement (2 months).
In the present study, the oral health song was taught to the student's line by line and was asked to repeat after each line and they were made to listen to the song every day. The method adopted in the present study was found to be effective in improving oral hygiene status. This is in accordance with the study conducted by Yoshida et al.,[16] where they evaluated the effectiveness of educational media using traditional folk songs (lam) for people in Lao. Lam singing is the use of a flexible melody based on the words in the text. This method was found to be useful in memorizing and communicating information in AIDS prevention.
Although oral health song can be used as an effective tool in improving the oral hygiene status among visually impaired children, combined approaches were also found to be effective as mentioned by Chowdary et al.,[12] where they found that combination of verbal, Braille text, and tactile mode of oral health can improve the oral health status of these children. Radio and frequency modulation (FM) can play a major role in these children as they depend more on noise. Government can take initiatives to give OHE by using radio and FM which can be very effective tools in OHE.
The course of the present study was for a shorter period of time due to which effectiveness of the intervention could not be evaluated to the full extent. Further Studies of longer duration should be carried out to obtain a vivid understanding of the effectiveness of these health education measures.
| Conclusion | | |
The present study has shown improvement in oral hygiene status by using oral health song as an effective health education tool. A song with music can increase the interest of children in education and also it helps them to retain the information easily. A combined approach of all three, i.e., sound, speech, and touch, can be still more effective over a longer period.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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