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ISSN 0975 -8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011 :3(2): 21-23

INTERNATIONALJOURNAL OFDENTAL CLINICS VOLUME3ISSUE2APRIL -JUNE2011 21

Oral health status of sensory impaired children in Delhi and GurgaonKanika Avasthi, Kalpana Bansal, Meenu Mittal , Mohita Marwaha

Abstract

Background: Sensory impairments can compromise an individuals efficiency to maintenance of

oral health care. A ims: To evaluate the prevalence of dental caries, gingivitis, malocclusion and traumaticinjury to upper anterior teeth in sensory impaired children. Materials and Methods: A total of 614 children

with varying sensory impairments (blindnes s, deafness/ muteness) within the age group of 5-16 years

attending special schools in Delhi and Gurgaon were inc luded. Results: The prevalence of dental caries

was more in the deaf/mute children at 72.43% while in the blind it was 59.68%, gingivitis was more in the

blind at 71.53%, than the deaf/mute at 49.65%. The prevalence o f malocclus ion was 58% in the deaf/mute,

while in the blind it was 30.69% and for trauma it was almost doubles in the blind (44.28%) when

compared with the deaf (24.48%). Conclusion: The prevalence of dental diseases especially dental caries

and gingivitis is as high as that seen in the normal children (60-70%) and that there is a need for

administration of proper and profess ional dental treatment in these children.

Key Words: Blind; Deaf; Gingivitis ; Dental Caries; Prevalence; Oral Health

Received on: 13/08/2010 Accepted on: 13/11/2010

IntroductionThe 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.(1) As

per cens us 2001, there are about 21 million

people with disability in Ind ia.(2) It is believed

that the number of handicapped individuals is

increasing in proportion to the general

population. Oral health is a vita l co mponent of

overall health, which contributes to each

individuals wellbeing and quality of life by

pos itively affecting phys ical and mental

healthiness, appearance and interpersonal

relations.(3) Individuals with special needs have

greater limitations in oral hygiene performance

due to their potential motor, sensory and

intellectual disabilities and are thus, prone to

poor oral health.(4) Several reports have been

documented in literature regarding the dental

status in disabled children. (1, 2, 5, 6) The present

study was planned to determine the prevalence of

dental caries, gingivitis, malocclusion and

traumatic injury to upper anterior teeth in

sensory impaired children.

Material and Methods

A total of 614 children, within the age

group of 5-16 years attending special schools inDelhi and Gurgaon were included. The inclusion

criteria for the s tudy were: a) children with either

one of the following sensory impairments,blindness , deafness and inability to speak, b)

children between the age group of 5-16 years of

age and c) children free from any other form of

mental handicap. The Research protocol of the

study was approved by the Institutional Reviews

Committee. The schools randomly selected,

centered towards education and rehabilitation of

sensory impaired children. Out of the entire

sample, 350(Group A) were blind subjects and,

264(Group B) were deaf. Prior to the

examination of children a written formal

permiss ion was taken from parents and the

administrative authorities of the selected schools.

Demographic information regarding the age,

school and the residential address was collected

from the s chools itself.

The children were examined in the

school using natural day light and sterilized

instruments with participants seated on an

ordinary chair. The findings were recorded on a

specially designed oral health assessment form.

For assessment of caries the DMFT index was

used in the permanent teeth while for the pr imary

teeth the def index was used. The g ingival

health was assessed using the gingival index. For

determining malocclusion 4 sub categories were

selected, these were a) spacing, b) crowding, c)

cross bite and d) increased over jet and f) any

other. For anterior tooth trauma the presence or

absence of the trauma was noted as given in the

oral health asses sment form.

After the examination a dental healtheducation class was held for the students,

teachers and the care givers so that the children

could be educated with regards to maintainingtheir oral health and hygiene. The data was

recorded in excel table using patient names and

identification numbers and statistical analysis

was done.

ORIGINAL RESEARCH ARTICLE

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0.00%

20.00%

40.00%

60.00%

80.00%

Blind

Deaf/mute

Results

The total sample comprised of 614

subjects. Out of which 57% (350) were blind,while 42.99% (264) were deaf with an age range

of 5-16 years. The mean deft / DMFT in the

blind population was found to be 2.40, while that

in the deaf group was slightly more at 3.18.

Caries prevalence in group A (blind)

was found to be less at 59.68% when comparedwith that of the group B (deaf) at 72.43%. The

prevalence of gingivitis was more in the blind

population with, 71.53 % (250 children of the

total 350) of group A showing varying degrees

of gingivitis. In the deaf/mute population

however, the prevalence of gingivitis was

slightly lower at 49.65% (131 children of thetotal 264 in this group). Overall prevalence of

trauma was more in group A (blind) at 44.28%

(155 of 350) as compared with that of group

B(deaf/mute) at 24.48% ( 65 of 264). Overall

prevalence of malocclusion was more in the deafchildren at 57.98% (153 of the total of 264) as

compared with that of blind children at 30.69%

(107 of the total 350) Graph1.

Graph 1:Oral Health status of both GroupsWhen the sub- categories of malocclusion

were studied it was found that in group A(blind)

32.57% had crowding/spacing, 2.28% had cross

bite, 15.7% had over jet >2mm , while 6.85%

were categorized as any other. Similarly, group

B(deaf/mute) had 37.5%, 6.43%,15.53% and

4.16% in respective categories.

Discussion

Good health is a fundamental goal for

people and the societies in which they live.(7)

Sir William Osler has stressed the significance of

oral health as the mirror of general health. (8)

People with physical and intellectual disabilities

(PID) form a sub-group the special needs

population.(5) They have limited ability to be

advocates of their health and little is known

about their oral health, also they experience

substantially higher levels of oral disease and

have ext ra barriers to accessing dental care.(9) In

our study we found the mean DMFT in the blind

to be 2.40 while that in the deaf/mute to be 3.18.

Gupta et al reported that the mean

DMFT of 4.85 in the blind while that in the

deaf/mute to be around 4.02. (10)This differencecould be attributed to the fact that in our s tudy all

the blind children were hostellers thus, their

dietary consumptions were restricted and under

check, while the deaf/mute population sample

comprised of both day scholar students and

hostellers, resulting in unsupervised eatinghabits. For the assessment of dental caries we

used the decayed, missing, and filled teeth

(DMFT) inde x as it is one of the most commonly

used index in various epidemiological studies to

measure the degree of caries experience of

subjects with primary as well as permanent

dentition15. In our study the prevalence of dentalcaries was higher in the deaf/mute at 72.43%

whereas that in the blind was 59.68%.

The status of gingival health was

determined us ing the gingival index. In our study

we found a relatively high prevalence of poorgingival health in the blind at 71.53% as

compared with the deaf at 49.65%. Poorer oral

hygiene and gingival health in the studied

children are consistent with the findings of other

studies also, which can be attributed to

environmental, systemic and local factors.(11,

12) The majority of the study population had

moderate to mild gingivitis. There were no

subjects with poor score. This may be attributed

to their institutionalization in special schools and

being under d irect supervision of the teachers of

the institutions.

In our study we found the prevalence oftraumatic injuries to teeth in the blind to be

nearly twice as that found in the deaf ch ildren. In

the blind children we found a prevalence of

44.28%, and in the deaf it was , 24.48%. Children

who are blind are at greatest risk for traumatic

injury due to their compromised vision. This

difference could however be attributed to a size

of the sample and variation in the area where the

study was carried out. Hearing impaired children

had more opportunities to play and move around

as compared to non- s ighted peers.(13)

In our study we found that amongst the

blind children 32.57% had crowding/spacing,2.28% had cross bite, 15.7% had over jet >2mm ,

while 6.85% were categorized as any other.

Similarly, in deaf/mute children the prevalence

was 37.5%, 6.43%, 15.53% and 4.16% in

respective categories. This could be because

deaf/mute appear to have a less flexible tongue

during speech production than do hearing

subjects24. This difference could disrupt tongue

function just as abnormal habits would. With

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changes in the tongue, cheek, and lip muscle

functions, the overall effect is a significant

narrowing of the maxillary arch, similar to thatof open mouth syndrome or mouth breathing

subjects. (14)

Conclusion

In conclusion a) the prevalence of

dental caries was more in the deaf/mute children

as compared the blind, b) Prevalence ofgingivitis was more in the blind than the

deaf/mute, c) The prevalence of malocclusion

was more in the deaf/mute, as compared with the

blind, d) Preva lence of t rauma was almost twice

in the blind when compared with the deaf, e) It

can be concluded that the prevalence of dental

diseases especially dental caries and gingivitis isas high as that seen in the normal children (60-

70%) and that there is a need for administration

of proper and professional dental treatment in

these children.

Recommendations Children requiring special care are a priority

group indicated for use of fissure sealants, such aprogram should be designed such in all the

children, the permanent molars should be sealed

soon as they erupt.

Regular school-based programs of tooth brushingshould be implemented and reinforced in all these

groups with disabilities.

Supervised programs of fluoride supplementationshould be reinforced in these schools, and the use

of topical fluoride varnishes should berecommended.

There is a clear need to involve the dentalprofession more actively in dietary counselingand provision of preventive oral health care andtreatment.

Authors Affiliations: 1. Dr. Kanika Avasthi, BDS,

Post Graduate Student, 2. Dr. Kalpana Bansal, MDS,

Professor and Head, 3. Dr. Meenu Mittal, MDS,Professor 4.Dr.Mohita M arwaha, MDS, Senior

Lecturer, Department of Pedodontics and Preventive

Dentistry, SGT Dental College, Hospital and Research

Institute, Haryana, India.

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11. Tesini DA. An annotated review of the literatureof dental caries and periodontal disease inmentally retarded individuals. Special Care in

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12. Ajami BA, Shabzendedar M, Rezay YA, AsgaryM. Dental Treatment Needs of Children with

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13. AlSarheed M, Bedi R, Hunt N. Traumatisedpermanent t eeth in 1116 year old Saudi Arabian

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14. Gross A, Kellum G, Franz D, Michas K, WalkerM, Foster M, et al. A longitudinal evaluation of

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Address for Correspondence

Dr. Kalpana Bansal, MDS,

Professor and Head,

Department of Pedodontics and Preventive Dentistry ,SGT Dental College and Hospital,

New Delhi, India.

Ph: +91.11.26262700

E mail:[email protected]

Source of Support: Nil, Conflict of Interest: None Declared

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