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 Table of Contents  
ORIGINAL RESEARCH
Year : 2017  |  Volume : 9  |  Issue : 5  |  Page : 197-201

Oral health status and dental treatment needs of sensory-impaired children of Satara District, India


1 Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India
2 Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, India

Date of Web Publication20-Oct-2017

Correspondence Address:
K M Shivakumar
School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad - 415 110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_158_17

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  Abstract 

Background: The physiological deficit can often lead to disability and one of the major population groups of disabled children includes the children with hearing impairment. In India, people with disability may be with one or more of its kind which is equal to 2.1% of the population of the country. Aims: The aim of this study was to assess the oral hygiene status, dental caries levels, and periodontal status among the sensory-impaired children. Materials and Methods: A cross-sectional survey was conducted among 150 disabled children aged 5–22 years attending a school for the sensory impaired children of Satara district, India. The subjects were examined using Type III clinical examination. Oral hygiene status by oral hygiene index-simplified (OHI-S), decayed, missing, and filled teeth/surface (DMFT/S) index, periodontal status by community periodontal index, and dentition status and treatment needs were assessed. ANOVA and Chi-square test were used and P < 0.05 was considered statistically significant. Results: The highest component of DMFT/dmft was the decayed component, with a mean of 2.71 ± 1.92. The P < 0.05 was statistically significant. The Calculus Index-Simplified and OHI-S index showed a significant difference between males and females of the study population (P < 0.05, S). Of 150 subjects examined, 72.6% subjects needed one surface filling, while 21.3% needed two surface fillings, 15.3% needed pit and fissure sealant application, 10% needed pulp care, and 6% needed tooth extraction. Conclusion: There is an alarming situation for dental diseases among special children. Hence, it is recommended to encourage their parents and school teachers to promote and improve their dental health.

Keywords: Community periodontal index, deaf and mute, disability, decayed, missing, and filled teeth surface Index, dmft/dmfs,oral hygiene index-simplified


How to cite this article:
Shivakumar K M, Patil S, Kadashetti V. Oral health status and dental treatment needs of sensory-impaired children of Satara District, India. J Int Oral Health 2017;9:197-201

How to cite this URL:
Shivakumar K M, Patil S, Kadashetti V. Oral health status and dental treatment needs of sensory-impaired children of Satara District, India. J Int Oral Health [serial online] 2017 [cited 2019 Nov 21];9:197-201. Available from: http://www.jioh.org/text.asp?2017/9/5/197/216950


  Introduction Top


The physiological deficit can often described as a disability, and accurately, it is described as persons who had an impairment causing an adverse effect upon their ability to perform routine activities typical for the person's stage of development.[1],[2] The disabled people forms a considerable section of the community and estimated that there are about 500 million people with disabilities worldwide.[3],[4] The hearing impaired forms one of the major groups of disabled children in the world.

Nearly one in 600 neonates has congenital hearing loss.[3],[5] As per the report given by WHO in 1980, the hearing impairment causes in India were infections suffering from bacterial meningitis, mumps and measles, and ignorance. There are three levels of prevention of hearing impairment; primary, secondary, and tertiary. Measurement of hearing loss can be made using various techniques such as otoacoustic emission measurement.[3] The primary target of any nation is to improve the health and social functioning of deprived people. Hearing disorders affect general behavior and impair the level of social functioning. Because of ignorance, fear, stigma, misconception, and negative attitudes, these groups are neglected.[3],[6],[7],[8],[9],[10] Disability affects a larger population in all ages and social classes.[1],[11],[12] As per the WHO, an estimated 650 million people live with disabilities worldwide [1],[12] and census 2001 has revealed that over 21 million people in India are suffered from any one kind of disability which is equal to 2.1% of the country's population.[13] India in 2002, 0.4% of 1065.40 million children (Census 2002) suffered from hearing impairment as per the National Sample Survey Organization.[3]

In London, the judiciary says, “fit for the future” recommended that the oral health of disabled children should be brought up to the level of that provided for normal children.[14] Children and adolescents with disabilities appear to have poorer oral health than their normal counterpart.[15],[16] Disabled individuals receive less general care as well as dental care than the normal children.[17] Dental caries is one of the most prevalent diseases among mentally challenged children worldwide and dental treatment is the greatest unattended dental health need of these disabled people.[18] The reasons that can contribute to the care of disabled children may be inadequate call systems, practical difficulties during treatment sessions, socioeconomic status and underestimation of treatment needs, communication problems, and poor cooperation.[19],[20],[21],[22],[23],[24],[25]

In India, the problem of disabled children is a serious issue. The children with such disability consisted of a unique population needing special attention.[3] Disabled individuals' dental health may be influenced by age, severity of impairment, and their living conditions. This group of individuals may not also understand and assume responsibility or cooperate with preventive dental health practices. Very young and those who are living in various institutional homes are mainly dependent on parents, siblings, or caregivers for general care including maintenance of oral hygiene. Most of the caretakers do not have the required knowledge to recognize the importance of oral hygiene and proper diet to these disabled. The children who are residing at home are pampered with cariogenic diet and other unhealthy eating habits and are more susceptible to dental caries. Studies have reported an increased level of dental caries in these sensory impaired children.[26],[27]

Hence, the present study was designed to collect the primary data and to determine the oral hygiene status, dental caries levels, and periodontal status among the sensory impaired children's of Satara district in western Maharashtra, India.


  Materials and Methods Top


A cross-sectional survey was conducted among 150 children aged 5–18 years attending a school for the sensory impaired children of Satara district, India. List of special schools in Satara district was obtained. Two special schools were selected using simple random sampling procedure for the study. Permissions from the concerned schools were obtained by the higher authorities. An ethical approval KIMSDU/IEC/2013 was obtained from the Institutional Ethics Committee of the Institution dated December 6, 2013. Informed consent was obtained from all the study subjects or caretakers or from their parents. Sensory-impaired children attending special schools were all included for the study. The study was conducted over a period of 1 year from June 2014 to July 2015.

The children having systemic diseases, under medication or uncooperative and those parents/caretakers do not provide consent for oral examination were excluded out of the study. Twenty-four subjects were aged 5–8 years, 46 were aged 9–12 years, 55 were 13–18 years, and 25 were aged ≥19–22 years. The subjects were examined using a mouth mirror and community periodontal index (CPI) probe as per the WHO criteria for diagnosis of dental caries. Required instruments were autoclaved; assessment was done by Type III clinical examination procedure. The school teachers were asked to assist during communication. Two examiners, who were calibrated before the study for interexaminer variability, and their reliability was 92.1%. The parameters such as oral hygiene status (oral hygiene index-simplified [OHI-S]), decayed, missing, and filled teeth/surface (DMFT/S) index, periodontal status using CPI and dentition status, and treatment needs were assessed. The WHO oral health assessment form (1997) was used to record dental findings. Children in need of emergency treatment were referred to dental hospital.

Descriptive statistics was used to assess all the parameters. ANOVA and Chi-square test were applied using the SPSS software package (version 20.0, Inc., and Chicago, IL, USA). P < 0.05 was considered statistically significant. Hearing loss with 4° were designated: mild (26–40 db), moderate (41–70 db), severe (71–90 db), and profound (>90 db).


  Results Top


[Table 1] showed the mean level of caries prevalence (DT/dt, MT/mt, FT/ft, and DMFT/dmft) for the different age groups with standard deviation. Mean DMFT/dmft was 0.51 ± 0.80 for the 5–8 age group, 1.73 ± 1.69 for the 9–12 age group, 2.79 ± 1.98 for the 13–18 age group, and 4.53 ± 2.39 for the ≥19–22 age group, clearly stating an increase in caries prevalence with age. Adults had a greater number of decayed teeth. The largest component of DMFT/dmft was the D component, with a mean of 2.71 ± 1.92. The P < 0.05 was statistically significant. The M and F components had very low mean values of 0.24 ± 0.83and 0.11 ± 0.95, respectively. For comparison of means, one-way ANOVA was used. The highest mean DMFS/dmfs (7.15 ± 3.71) was noted for ≥19–22 age groups. In the younger age groups (13–18 and ≥19–22), decayed surfaces showed high values of 2.99 ± 2.21 and 4.29 ± 2.75, respectively. Missing surfaces and filled surfaces did not account for a major proportion in any of the age groups except the ≥19–22 age groups. Statistically significant differences have been observed in the DMFS index also (P < 0.001, HS).
Table 1: Agewise distribution of decayed, missing, and filled teeth and decayed, missing, and filled teeth surface index sensory-impaired children

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[Table 2] shows the distribution of OHI-S and Silness and Loe plaque index (PI). The Calculus Index-Simplified (CI-S) and OHI-S index showed a significant difference between males and females of the study population (P < 0.05, S). The mean values of PI show more in males (0.89 ± 1.55) when compared with females (0.67 ± 1.23). However, there were no statistical significant differences between males and females for PI.
Table 2: Distribution of oral hygiene index.simplified and plaque index in sensory.impaired children

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[Table 3] shows the periodontal status by recording CPI and loss of attachment (LoA). Mean value for females showed 0.49 ± 0.33 which is more than males (0.39 ± 0.28) and there was no statistically significant difference between males and females. In LoA, males showed more mean values (0.29 ± 0.15) when compared to females (0.20 ± 0.08) and there was a statistically significant difference between males and females for LoA.
Table 3: Community periodontal index and level of loss of attachment of study population

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[Table 4] depicted the treatment needs for the various age groups as per the WHO criteria. Of 150 subjects examined, one surface filling was needed by 72.6% subjects, while 21.3% needed two surface fillings, 15.3% needed pit and fissure sealant application, 10% needed pulp care, and 6% needed tooth extraction. The number of disabled children requiring crowns and veneers was low, but it was very significant.
Table 4: Dentition status and treatment needs of the study population

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  Discussion Top


In our study, the major finding was that there is high prevalence of dental caries among disabled subjects with hearing difficulties. The older the age groups, the proportion of increased risk of oral diseases. The mean DMFT and the mean number of decayed teeth in the 9–12 years age group were 1.73 ± 1.69 and 1.68 ± 1.43, respectively, which are higher than the corresponding number for the general population because of ignorance and poor oral hygiene habits as per the study conducted by National Oral health survey and fluoride mapping by the Dental council of India.[28] Dental caries prevalence in the 9–12 and 13–18 years age groups were 91.2% and 86.8%, respectively, being high proportion than the general population, likely because of ignorance on the part of school teachers and parents, whereas the corresponding number for the general population were 39.1% and 33.1% for 12 and 15 years age groups, respectively.[28] Shaw et al.[26] conducted a study in Birmingham, UK, and found a mean DMFT score of 1.76 in 5–15-year-old disabled children. In our study, the figure was 2.89 for 5–22 age group children with hearing impairment, may be due to lack of parental care were ignorant about dental health. Shyama et al.[29] conducted a study to demonstrate a higher prevalence of caries, 86%, with a mean DMFT score of 5.0 in subjects aged 3–29 years with hearing impairment probably could be the changes in lifestyle and dietary habits. In our study, the prevalence of untreated tooth decay was 81.2% and the mean DMFT was 2.89 ± 1.91, probably due to poor oral hygiene habits and barriers health education.

A study conducted by Rao et al.[30] in Mangalore and Alvarez-Arenal et al.[31] in Spain showed a higher caries prevalence with a mean DMFT of 2.48 and 3.30, respectively. The results of our study were in consistent with scores of 2.89 which emphasized the need to find preventive as well curative treatment to enhance and improve dental care, particularly with the special children. Our study results show that the mean OHI-S score among deaf and mute children was found to be 1.51 ± 0.85; that among males and females was 1.69 ± 0.83 and 1.41 ± 0.59, respectively. The OHI-S score among males was higher when compared to females, and the difference was statistically significant (P < 0.05). These findings are in consistent with the other studies conducted by Jain et al.[3] and Kumar et al.[32] In our study, the mean Loe and Silness PI score was 0.79 ± 1.32. The mean Loe and Silness PI score among male deaf and mute children was found to be 0.89 ± 1.55, and that among female deaf and mute children (0.67 ± 1.23). However, there were no statistically significant differences has been observed among the study population. These results were in consistent with the studies conducted by Rawlani et al.[33] in Warora.

Our study results show that the prevalence of periodontal disease among deaf and mute children was 49.7% (male: 49.1%, female: 50.3%). Almost similar kind of results were observed in studies conducted by Rai and Jain [34] and the study conducted by Gherunpong et al.[35] The mean score for the CPI Index was 0.53 ± 0.41, with no significant difference between male and female (P > 0.05). The score for male was 0.39 ± 0.28, and that for female was 0.49 ± 0.33. These results are in accordance with the studies conducted by Rawlani et al.[33] in Warora. The loss of gingival attachment among deaf and mute children 0.32 ± 0.19 (male children 0.29 ± 0.15) has higher LoA when compared to females (0.20 ± 0.08). However, there was no statistically significant difference observed among males and female children.

A study conducted by Alvarez-Arenal et al.[31] in Spain, the schoolchildren showed fillings with one and two surfaces were required; 58.39% of subjects required one surface filling and 27.02% required two surface filling. In our study, 72.6% of subjects needed one surface filling and 21.3% needed two surfaces filling. Filling with one or two surfaces was more widely spread followed by other treatment needs in parallel with a previous study conducted by Mandal et al.[36] The results of our study showed that there is an alarming situation for dental diseases among these sensory impaired children. Hence, efforts must be made to promote the parents and their teachers of these to promote and improve their oral health. Oral health education should be provided to school teachers and parents, to improve dental health of this special population. Caregivers should be educated about dental development of their children, dental disease processes, the role of diet in initiation of caries, and oral hygiene measures that are appropriate for children.


  Conclusion Top


The present findings demonstrated an increased caries prevalence, poor oral hygiene, increased risk of periodontal diseases, and extensive unmet needs for dental treatment indicating that these children were neglected and less treatment priority is offered to these children. In fact this is a highly alarming situation which needs immediate attention. Hence, it is recommended that intervention program is much needed for these groups of subjects involving voluntary health agencies. Effort must be taken to encourage and promote the parents of these children to improve their oral health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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