Table of Contents    
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 179-182  

Comparison between oral health status of institutionalised and home stay disabled children in western Maharashtra region


1 Department of Pediatric and Preventive Dentistry, School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
2 Department of Peadiatric Preventive Dentistry, School of Dental Sciences, KIMSDU, Karad, Maharashtra, India

Date of Submission26-Jan-2020
Date of Decision27-Apr-2020
Date of Acceptance20-May-2020
Date of Web Publication22-Jul-2020

Correspondence Address:
Pallavi Sharad Suryarao
Department of Pediatric and Preventive Dentistry, School of Dental Sciences, KIMSDU, Karad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsbm.JNSBM_27_20

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   Abstract 


Background: Parents and caregivers of differently-abled children while focusing on the primary medical issues may not pay adequate attention to their dental care. In this study, we assessed and compared the oral health status of differently-abled children (aged 7–17 years) from structured institutionalized versus home care conditions in the Western Maharashtra region, India. Materials and Methodology: The study consisted of 100 differently-abled children (aged 7–17 years), each under structured institutionalized or home care conditions. For each child, decayed, missing, and filled teeth (DMFT) and decayed, extracted, or filled deciduous teeth (deft) index and oral hygiene status were assessed. Results: Differently-abled children under structured institutionalized care showed lower caries experience in both primary and permanent teeth as compared to differently-abled children who were under home care conditions. Conclusions: The DMFT/deft score was less in Group B compared to Group A. The overall oral hygiene was poor in both groups. Educating the parents and primary caregivers on improving the dental care of differently-abled children is necessary.

Keywords: caries, disabled children, homestay, institutionalized, oral hygiene


How to cite this article:
Suryarao PS, Gaonkar NN, Hariyani PV, Wable D, Shashikiran N D. Comparison between oral health status of institutionalised and home stay disabled children in western Maharashtra region. J Nat Sc Biol Med 2020;11:179-82

How to cite this URL:
Suryarao PS, Gaonkar NN, Hariyani PV, Wable D, Shashikiran N D. Comparison between oral health status of institutionalised and home stay disabled children in western Maharashtra region. J Nat Sc Biol Med [serial online] 2020 [cited 2020 Aug 12];11:179-82. Available from: http://www.jnsbm.org/text.asp?2020/11/2/179/290490




   Introduction Top


The International Classification of Functioning, Disability, and Health defines disability as an umbrella term for impairments, activity limitations, and participation restrictions.[1] Many people with disabilities do not have equal access to healthcare, education, and employment opportunities and do not receive the disability-related services that they require, and hence, experience exclusion from everyday life activities.[2] The disabled population in India as per the 2011 census is 26.8 million population, which is 2.17% of the total population. Among the disabled population, 56% are males and 44% are females.[3]

Differently-abled children may have more marked oral pathologies due to several factors such as their actual disability, medical, economic and social reasons, self-mutilating behaviors (excessive tooth grinding), cariogenic effect of medicines with high sugar content, or inability of their parents/caregivers to carry out proper regular oral hygiene measures.[4] These children and their families constantly experience barriers to the enjoyment of their basic human rights and to their inclusion in society, more because of the environment they live in rather than the result of impairment. The additional burden placed on families with children having disabilities deepens their economic conditions, which may further perpetuate discriminatory attitudes toward them.[4]

Differently-abled children from structured institutionalized versus home care conditions are likely to experience different daily personal care provided to them.[5] Very few studies have compared the occurrence of dental diseases between two different cohorts of children. The present study was undertaken with the aim to asses and to compare the oral health status of differently-abled children (aged 7–17 years) from structured institutionalized versus home care conditions in the Western Maharashtra region, India.


   Materials and Methodology Top


The present study was conducted by the Department of Pedodontics and Preventive dentistry, Krishna Institute of Medical Sciences, Karad, India, in association with special schools in Western Maharashtra, India. Ethical clearance was obtained from the ethical committee of Krishna Institute of Medical Sciences, Karad, India, and the permission was obtained from heads of the special care institutions, which were run by private bodies and parents before the study were scheduled. Informed consent and verbal assent were obtained from both the guardians and parents before the clinical examination. Children present on the day of examination were included in the study. Those who were not willing to participate or unwell were excluded from the study.

This cross-sectional study was conducted on 100 home staying (attending special school) mentally differently-abled children (Group A) and 100 institutionalized mentally differently-abled children (Group B). Children belonging to Group A were those who resided at home with their families attending special schools, whereas Group B children were those who resided within the premises of the institution, which includes their special schooling within premises. These institutions are run by nongovernment organizations and charitable trusts. The minimum age requirement for admitting these children into the institution was 7–17 years old as per the rules laid by the institution. A total of 200 differently-abled children in this age group participated in the study.

Case history records were made, in which previous day sugar exposure was recorded with the help of diet chart, presence or absence of dental pain, and utilization of dental services. The interview was followed by the clinical examination of children. Clinical examination was carried out using mouth mirror and explorer under natural light. The sufficient number of presterilized instruments was carried to the institutions on the day of examination to avoid interruption during the examination. The examination was carried out by a single examiner with a recording assistant. During the examination, children were seated in a chair with the examiner standing in front and the trained assistant standing in close vicinity to the examiner to record the findings. Oral hygiene status and dental caries in permanent and primary dentition were recorded using decayed, missing, and filled teeth (DMFT) index[6] for permanent teeth and decayed, extracted, or filled deciduous teeth (deft) index[7] for primary teeth.

The data obtained were tabulated and analyzed using Mann–Whitney U-test and Chi-square test. All the statistical tests were carried out using SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM.


   Results Top


One hundred home care (Group A) and 100 institutionalized (Group B) differently-abled children aged 7–17 years were examined in institutions and those who attending special schools each. The mean age of both groups was 11 years. Differently-abled children aged <10 years were significantly under home care conditions [Table 1]. Whereas children aged over 11 years were predominantly under institutionalized care [Table 1].
Table 1: Age group-wise distribution of homestay (Group A) and institutionalized (Group B) differently abled children

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Chi-square test was done to check the association between DMFT/deft score groups and the location of differently-abled children. The children in Group B had significantly lower DMFT/deft scores than children in Group A [Table 2]. Although the DMFT/deft score was less in Group B, the overall oral hygiene was poor in both groups. Furthermore, there was no history of regular dental checkup or preventive treatment measures for differently-abled children from both groups. Mann–Whitney U-test was done to compare the mean DMFT/deft score of Group A and Group B [Table 2]. It was found that the mean DMFT/deft score of Group A children (3.02) was significantly higher than the mean DMFT/deft score of Group B children (0.82).
Table 2: Comparison of Decayed, Missing, and Filled Teeth/decayed missing filled teeth score for homestay (Group A) and institutionalized (Group B) differently abled children

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   Discussion Top


Most of the children were multihandicapped and physically handicapped in Group B as compared to Group A. This was because residential institutes cater mainly to the physical and multihandicap children who are often admitted to the institutions due to the nature of care required. The oral disease represents a major health problem among individuals with disabilities.[8],[9] The prevalence and severity of oral disease among this group is higher when compared to the general population. Poor periodontal health and lack of oral hygiene are observed in children with disabilities.[10] These results may be related to the lack of development of fine motor skills and dexterity, which leads to consequent difficulties in toothbrushing. Oral health is impacted by the following: limited understanding on the importance of oral health management,[11] difficulties in communicating oral health needs, and[12] anticonvulsant medications that impact on gum health[13] and other medications taken for the related health problems (commonly used atypical antipsychotics) may cause dry mouth which promotes caries incidences[14] and a fear of oral health procedures.[15]

The results of this study showed a high proportion of dental caries among Group A (home staying) children as compared to Group B (institutionalized children). The high DMFT score could be because of poor utilization of dental services for children on the part of the parents or negligence toward oral hygiene maintenance by parents or due to snacking in between meals to pacify them. Another possible reason for higher DMFT in Group A could be easy accessibility to snacks at home as opposed to Group B. The institutes follow a fixed time and type of meals, despite this oral hygiene was not satisfactory in Group B, suggesting negligence in carrying out oral hygiene measure as a routine practice. The findings of this study clearly demonstrate the picture of the dental caries status of the differently-abled children in Western Maharashtra, India, which is well below the global standard set by the World Health Organization (DMFT of 12–15-year-old children to be below 3 per child). Although the dental care services are available, due to a lack of knowledge and awareness in the society, the practice of going to the dentist for preventive care or the utilization of the available dental services is not considered. Our observations are consistent with previous reports[16] identifying highly unmet treatment needs seen regardless of the status of institutionalization.

Transportation difficulty is faced by families of many differently-abled children, which may perhaps be one barrier in accessing preventive dental care services.[17] Besides, this lack of supervision of the toothbrushing technique together with limited motor skills and assistance from guardians, may further contribute to the poor oral hygiene status of differently-abled children.[18] Hence, training and oral health educations for the professionals to handle differently-abled individuals would be highly helpful. Furthermore, different treatment needs of the children should be considered based on the nature of disability the children suffer from. Although the provision of oral health education and their frequency is on the rise, caregivers and parents of differently-abled children should be specifically trained to educate them regarding the prevention, etiology, and treatment of dental caries.[19],[20]


   Conclusions Top


Poor oral hygiene and lack of access to dental care are evident in children with special health-care needs. Parents and caregivers of the differently-abled children should be trained by the public health dentistry departments, as they play a vital role in delivering dental care to these children. Pedodontists can play a vital role in dental health education by conducting specific dental camps in targeted schools and societies for wider reach and impact.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. URL. Available from: https://www.who.int/news-room/fact-sheets/det ail/disability-and-health. [Last accessed on 2020 Jan 10].  Back to cited text no. 1
    
2.
World Report on Disability, World Health Organization. URL. Available from: https://www.who.int/disabilities/wo rld_report/2011/report. [Last accessed on 2020 Jan 10].  Back to cited text no. 2
    
3.
Census of India: Government of India; 2011. Available from: http://censusindia.gov.in/Census_And_Yo u/disabled_populati on.aspx. [Last updated on 2020 Jan 10].  Back to cited text no. 3
    
4.
Purohit BM, Singh A. Oral health status of 12-year-old children with disabilities and controls in Southern India. WHO South East Asia J Public Health 2012;1:330-8.  Back to cited text no. 4
    
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6.
Henry K, Carroll E, Palmer, John WK. Studies on dental caries. Public Health Rep 1938;53:751-65.  Back to cited text no. 6
    
7.
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8.
Aytaç S, DokuzEylül J. Increasing importance of rehabilitation of the disabled child. UnivSoc Sci 2000;2:21-35.  Back to cited text no. 8
    
9.
Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent 2010;4:361-6.  Back to cited text no. 9
    
10.
Shyama M, Al-Mutawa SA, Morris RE, Sugathan T, Honkala E. Dental caries experience of disabled children and young adults in Kuwait. Community Dent Health 2001;18:181-6.  Back to cited text no. 10
    
11.
Lindemann R, Zaschel-Grob D, Opp S, Lewis MA, Lewis C. Oral health status of adults from a California regional center for developmental disabilities. Spec Care Dentist 2001;21:9-14.  Back to cited text no. 11
    
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Faulks D, Hennequin M. Evaluation of a long-term oral health program by carers of children and adults with intellectual disabilities. Spec Care Dentist 2000;20:199-208.  Back to cited text no. 12
    
13.
Marshall RI, Bartold PM. A clinical review of drug-induced gingival overgrowths. Aust Dent J 1999;44:219-32.  Back to cited text no. 13
    
14.
Tripathi KD. Drugs used in mental illness: Antipsychotic and Antimanic drugs. In: Tripathi KD, editor. Essentials of Medical Pharmacology. 7th ed. New Delhi (India): JAYPEE Brother Medical Publishers Pvt Ltd.; 2013. p. 443.  Back to cited text no. 14
    
15.
Gordon SM, Dionne RA, Snyder J. Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs. Spec Care Dentist 1998;18:88-92.  Back to cited text no. 15
    
16.
Bhatia R, Namrata MR. The oral health status and treatment needs of institutionalized and non-institutionalized disabled children in Navi Mumbai, India. Int J Contemp Med Res 2016;3:1041-5.  Back to cited text no. 16
    
17.
Bhaskar BV, Janakiram C, Joseph J. Access to dental care among differently-abled children in Kochi. J Indian Assoc Public Health Dent 2016;14:29-34.  Back to cited text no. 17
  [Full text]  
18.
Prasad M, Patthi B, Singla A, Gupta R, Niraj LK, Ali I. Special care with special child-oral health status of differently abled children attending special schools in Delhi: A cross-sectional study. J Indian Assoc Public Health Dent 2018;16:137-43.  Back to cited text no. 18
  [Full text]  
19.
Khanal S, Acharya J. Dental caries status and oral health practice among 12-15 year old children in Jorpati, Kathmandu. Nepal Med Coll J 2014;16:84-7.  Back to cited text no. 19
    
20.
Lewis C, Robertson AS, Phelps S. Unmet dental care needs among children with special health care needs: implications for the medical home. Pediatrics 2005;116:e426-31.  Back to cited text no. 20
    



 
 
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  [Table 1], [Table 2]



 

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