|Year : 2014 | Volume
| Issue : 2 | Page : 78-81
Dentition status and treatment needs among institutionalized hearing and speech impaired children in Himachal Pradesh in India: A cross-sectional study
Vinay K Bhardwaj1, Shailee Fotedar1, Kapil R Sharma2, Rajeshwar P Luthra3, Pravesh Jhingta4, Deepak Sharma4
1 Department of Public Health Dentistry, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Pediatric and Preventive Dentistry, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
3 Department of Prosthodontics, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
4 Department of Periodontology, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
|Date of Web Publication||7-May-2014|
Vinay K Bhardwaj
Department of Public Health Dentistry, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: The oral health of the disabled may be neglected because of the disability condition, demanding diseases or limited access to oral health care. It has been reported that dental treatment is the greatest unattended health need of the disabled. Aim: Present study was conducted to assess the prevalence of dental caries and treatment needs among hearing and speech impaired children in Shimla city, Himachal Pradesh. Materials and Methods: 202 institutionalised subjects aged 5-22 years attending special school were examined. Data was recorded using modified WHO survey 1997 proforma. Dentition status and treatment needs using DMFT, DMFS, dmft, dmfs were recorded. The data was analysed using the software version 15 (SPSS Inc. Chicago). ANOVA, chi-square test and multiple regressions were applied appropriately. Results: Among study subjects, largest component of DMFT was the D component, with a mean of 1.47. Highest mean DMFS was recorded for the age group 18-22 years. Missing surfaces and filled surfaces did not account for a major proportion. Mean dmft and dmfs scores were 1.04 and 1.73, respectively. Out of 202 subjects examined, 182 (90.1%) required treatment. One surface restoration was the most common treatment required followed by two surface restorations, pit and fissure sealants and pulp care. Conclusion: High prevalence of dental caries among special children is a highly alarming situation and needs immediate attention. Filled teeth are very less, which reflects the provision, and availing of dental care is almost negligible. Awareness should be created among parents and teachers by oral health educators about the importance of oral health and regular dental checkup.
Keywords: Dental caries, disabled, hearing impaired, special children, speech impaired
|How to cite this article:|
Bhardwaj VK, Fotedar S, Sharma KR, Luthra RP, Jhingta P, Sharma D. Dentition status and treatment needs among institutionalized hearing and speech impaired children in Himachal Pradesh in India: A cross-sectional study. SRM J Res Dent Sci 2014;5:78-81
|How to cite this URL:|
Bhardwaj VK, Fotedar S, Sharma KR, Luthra RP, Jhingta P, Sharma D. Dentition status and treatment needs among institutionalized hearing and speech impaired children in Himachal Pradesh in India: A cross-sectional study. SRM J Res Dent Sci [serial online] 2014 [cited 2022 May 21];5:78-81. Available from: https://www.srmjrds.in/text.asp?2014/5/2/78/132075
| Introduction|| |
It has been established that the children in a population are a priority group in planning any health program. A normal child gets the benefits of love and care from parents and society whereas the unprivileged children such as physically and mentally challenged are neglected by their own kith and kin as well as society.  Children and adolescents with disability appear to have poorer health than their non-disabled counterparts. Oral health is an important aspect for all children, and is all the more important for children with special needs. Because oral hygiene affects one's esthetics and communication, it has strong biological, psychological and social projections.  The disabled form a substantial section of the community and it is estimated that there are 500 million people with disabilities worldwide.  Children with hearing impairment constitute one of major population groups of disabled children. About one in 600 neonates has congenital hearing loss.  According to the National Sample Survey Organisation, India, in 2002, 0.4% of 1065.40 million children (Census 2002) suffered from hearing impairment. WHO report in 1980 states that the main causes of hearing impairment in India were infections such as bacterial meningitis, mumps and measles and the neglect or ignorance about their management. Further complications could lead to hearing loss. It is believed that number of handicapped individuals is increasing in proportion to the general population.  Dental care is the most common unmet health care need of disabled children.  Studies have shown that all the common dental disorders affecting the normal population are to be seen in handicapped individuals also in whom they occur more often with greater severity and at an younger age. ,,, No data is available in the state of Himachal Pradesh as far as oro-dental health of this special group of children is concerned. Hence this study has been taken up to assess the dentition status and treatment needs among institutionalized hearing and speech-impaired children in the state of Himachal Pradesh in India.
| Materials and methods|| |
This cross-sectional study was conducted in the state of Himachal Pradesh in December 2011 among 202 subjects in a school for special children with hearing and speech impairment at Dhalli Shimla. Subjects were aged 5-22 years. The study was cleared by the institutional ethical committee of Government Dental College and Hospital. Permission was taken from the Principal of the concerned school. Verbal consent was taken from the caregivers. All the special children who were present on the day of clinical examination, willing to participate in the study and were not suffering from severe systemic diseases were included. In this study, observations were recorded on simplified WHO oral health assessment proforma 1997.  Special designed WHO proforma was used to record dentition status and treatment needs along with DMFT, DMFS, dmft and dmfs index. The proforma utilized also revealed the general information about name, age, gender, dietary habits and oral hygiene practices and socioeconomic status of the parents. Type III examination as recommended by the American Dental Association,  which includes inspection using a mirror and probe under good illumination, was conducted in the school premises.
To ensure the reliability and validity of the results, the examiner was first calibrated against an experienced examiner, obtaining a 0.85 Kappa index and a percentage agreement of 99.4% for 'D' and 'd' component. The data was analysed using the software statistical package for social sciences version 15 (SPSS Inc. Chicago). ANOVA, chi-square test and multiple regressions were applied appropriately. Multiple regression analysis was used for multiple comparisons where the dependent variables comprised of DMFT, dmft, DMFS, dmfs and independent variables such as age, level of education, and socioeconomic status.
| Results|| |
Study subjects were divided into four age groups i.e. 5-8, 9-12, 13-17, 18-22 years. Mean DMFT was 0.61 for the age group 5-8 years, 1.85 for the age group 9-12, 2.79 for the age group 13-17 and 4.48 for the age group 18-22. The largest component of DMFT was the D component, with a mean of 1.47. For comparison of means, one-way ANOVA was used, which is used to compare the means of three or more groups [Table 1].
Highest mean DMFS was recorded for the age group 18-22 years. In the younger age group of 13-17 and 9-12, decayed surfaces showed values of 2.81 and 1.84, respectively. Missing surfaces and filled surfaces did not account for a major proportion in any of the age groups except the 18-22 years age group having a value of 2.72 [Table 2]. Highest mean dmft and dmfs were recorded for the youngest age group. This value decreased as the age advances. Mean dmft and dmfs scores were 1.04 and 1.73, respectively [Table 3]. DMFT, dmft, DMFS, dmfs were the dependent variables used in multiple regression analysis. The independent demographical variables were age, level of education, socioeconomic status. Degree of hearing loss was an independent health-related variable. DMFT showed a close association with age. Values for DMFT, dmft, DMFS, dmfs were 31.5, 26.3, 41.4 and 21.6, respectively, in which age being a constant predictor. DMFT did not show any variation in the level of education and socioeconomic status [Table 4]. Out of 202 subjects examined, the most required treatment need was one-surface restoration followed by two-surface restorations, pit and fissure sealants and pulp care [Table 5].
| Discussion|| |
Intention of the present study was to assess the dentition status and treatment needs among hearing and speech-impaired institutionalized children. Prevalence of dental caries was related to age, the older subjects were having more permanent teeth at risk and a higher incidence of caries. More deciduous teeth were at risk of dental decay among the younger age group than the older age group. Mean DMFT and mean number of decayed teeth in the 9-12 year age group were 1.85 and 1.79, respectively. This was higher than the results of the study conducted on general population i.e. 0.9 and 0.79. The reasons could be ignorance, poor oral hygiene habits and not availing the available oro-dental care facilities. 
Mean DMFT among the study population was 2.43, which was higher than the study conducted by Shyama et al. in Kuwait,  amongst 3562 intellectually disabled children in which it was 1.76. Almost similar results were revealed in a study conducted in India in Rajasthan.  Difference in results as compared with the study conducted abroad may be because of ignorance of school teachers and parents regarding the provision of comprehensive oro-dental care. Rao et al. in 2001 conducted a study at Mangalore among a similar population and revealed a mean DMFT of 2.38.  The corresponding figure in our study was 2.43, which was similar to the study conducted in Bangalore by Suma et al.  These findings propose the need to emphasize preventive care in these disabled children.
In the multiple regression analysis, DMFT has shown variation with respect to age factor only, whereas it was unaffected with respect to the education and socioeconomic status. Study conducted in similar population has revealed identical results.  One-surface and two-surface restorations were the most commonly required treatment needs, followed by the other treatment needs. Similar results were found in a study conducted by Mandal et al. 
Present study shows filled component 'F' in the 0.15, which is very less as compared to the study conducted in Kuwait  and Spain.  Maybe the provision of preventive and curative care for special children is more advanced and comprehensive in those countries where these studies were conducted than in our country.
| Conclusion|| |
Dentition status of the special children is such that dental caries is highly prevalent among the study population and the number of filled teeth is very less which reflects the negligible provision of dental care. This study also shows extensive unmet needs. So, this highly alarming situation needs immediate attention. Sincere efforts may be put in to encourage the parents and school teachers to promote and improve oro-dental health. Parents and caretaker should be educated about dental diseases process, role of diet in the initiation of dental caries and oral hygiene that are appropriate for the children. It is prudent suggestion that a greater degree of awareness should be created among parents and teachers by dentist and health educators. School authorities should organize dental check-up camps in these special schools in collaboration with dental college administration and non-governmental organizations. They should follow up students affected by dental diseases and persuade them to avail dental treatment. Further studies to find out the cause of a high prevalence of dental caries among this group in the state of Himachal Pradesh should be carried out in future.
I thank all the special children, parents, guardians and caregivers who agreed to take part in this study. I also thank administration of the school, dental college administration and statistician for their unconditional support.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]