| Abstract|| |
Background: Children with hearing impairment (CHI) have special accessibility issues to meet their health care needs. Their oral health status is deprived and has wide ranging treatment needs to attend.
Aim: The aim of this study was to evaluate the oral health status and treatment needs of CHI attending a special school in Bhimavaram Town, India.
Study Design: The study design was a descriptive cross-sectional study.
Materials and Methods: This study was conducted in November 2012 at SVS special school for deaf, Bhimavaram, India. This study involved 180 CHI of both genders, aged 6-16 years, divided into Group-I (6-8 years), Group-II (9-12 years), and Group-III (13-16 years). Oral health status and treatment needs were recorded using methods and standards recommended by the WHO for Oral Health Surveys, 1997. Dental caries prevalence (decayed, missing, and filled teeth [DMFT/dmft]), gingivitis levels (Lφe, Silness Gingival Index), plaque levels (Silness, Lφe Plaque index), and treatment needs were the parameters recorded and analyzed.
Statistical Analysis: Z-test for proportion, one-way analysis of variance, and Chi-square test were used to analyze the data.
Results: Prevalence of dental caries in the sample was found to be 65% with a mean level of caries prevalence (DMFT) of 1.6 ± 1.3 in Group-I, 1.9 ± 1.2 in Group-II, and 2.2 ± 1.2 in Group-III. About 91.7% of the total children examined needs treatment. The mean plaque and gingivitis scores of the sample were 1.70 ± 0.61 and 1.59 ± 0.58, respectively.
Conclusion: These findings imply the overwhelming situation of CHI in oral health perspective. Hence, prevention-based educational and motivational programs should be targeted to this vital group to achieve adequate oral hygiene levels.
Keywords: Gingival index, hearing impairment, oral health education, plaque index, visual instruction
|How to cite this article:|
Sandeep V, Kumar M, Vinay C, Chandrasekhar R, Jyostna P. Oral health status and treatment needs of hearing impaired children attending a special school in Bhimavaram, India. Indian J Dent Res 2016;27:73-7
Special child is the one, who for various reasons, cannot fully make use of all his/her physical, mental, and social abilities or do things that other child of his/her age can do. Globally, there is an estimated 150 million children with disabilities, most of who live in an inaccessible health care arena.  They suffer high risk in oral health perspective.  Their dental needs are said to be highly underserved due to health care neglect (care takers or parents), communication barriers, socioeconomic status, etc. , Children with hearing impairment (CHI) are one important group deprived of good oral health due to communication barriers. ,
|How to cite this URL:|
Sandeep V, Kumar M, Vinay C, Chandrasekhar R, Jyostna P. Oral health status and treatment needs of hearing impaired children attending a special school in Bhimavaram, India. Indian J Dent Res [serial online] 2016 [cited 2019 Oct 21];27:73-7. Available from: http://www.ijdr.in/text.asp?2016/27/1/73/179835
Deafness refers to the complete loss of ability to hear from one or both ears. However, CHI is a broad term used to describe any degree of hearing loss in children varying from mild (15-30 dB) to profound impairment (>95 dB). Hearing impairment (HI) affects many children worldwide. In the UK, there are 23,000-25,000 children (aged 0-15 years) who are permanently deaf and many more hard of hearing  (statistics 1997). In India, about 0.4% of 1065.40 million children are hearing impaired and every child in 1000 live births suffers from HI , (NSSO 2002). In Turkey (2007 and 2008), only 6268 CHI were enrolled in special education schools that account for only 5.4% of the total deaf and mute.  HI delays speech and linguistic outcome, reduces cognitive skills, and as a whole hinders their academic progress in school affecting the overall development and maturation of child. ,
Various cross-sectional studies on CHI reported poor oral health status with extensive treatment needs. All these studies were conducted on a small sample, with wide variations in age distribution and reviewed concomitantly with other special children ,,, (children with visual impairment, physical and mental disability, etc.). Recently, very few studies reported a descriptive evaluation of their dental needs in an isolated approach. ,,, Any motivation to improve oral health should be efficient and appropriate to the target groups. , This is only possible when the needs of the target groups are identified precisely. Hence, the purpose of the present study was to evaluate the prevalence of dental caries, plaque scores, gingivitis scores, and treatment needs of CHI and have a short review on their caries experience and treatment needs.
| Materials and methods|| |
This descriptive cross-sectional study was approved by the Institutional Ethical Review Board for research activities (IERB/VDC-117/2012). Prior written consent was obtained from the school authorities and parents. All the parents were informed regarding the study protocol during their monthly visit to the school and consent was obtained.
This descriptive comprehensive survey was done on CHI, aged 6-16 years (average age 10.83 ± 2.9 years) of both genders attending a special school for deaf and mute in Bhimavaram Town, Andhra Pradesh, India. The study sample was, therefore, neither representative of hearing impaired children of the town nor the district and nation. Out of 192 children in the school, five were absent on the day of examination and seven were excluded based on the inclusion criteria, yielding a total sample of 180. Inclusion criteria are children with good general health (American Society of Anesthesiology I-II). Exclusion criteria are children with other systemic diseases and uncooperative children unable to cope up with the examination procedure. Demographic distribution of the sample is presented in [Table 1].
All the children were examined during school hours using a mouth mirror, CPI probe under artificial illumination of a head lamp in accordance with the WHO survey recommendations.  Level of dental caries, gingivitis scores, plaque scores, and treatment needs were recorded on a simplified WHO oral health assessment form. Examinations were carried out by two examiners calibrated for interexaminer variability and reliability (kappa value-0.71). A trained dental assistant was used to record the data.
Assessment of dental caries (decayed, missing, and filled teeth)
A tooth was considered to be decayed when there was lesion in the pit/fissure/smooth surface, undermined enamel, temporary filling with caries, and softened floor. A tooth was classified as missing if it was extracted due to caries. A tooth was classified as filled if it had a restoration for a carious lesion. Exfoliated teeth in the primary and mixed dentition, unerupted, and those extracted for other reasons apart from caries were not included. Previous treatment records of the children were obtained from the institution to exclude the bias of noncarious extraction and filling. No radiographic examination was performed during the examination.
Assessment of plaque and gingivitis scores
Gingivitis scores using Löe, Silness Gingival Index  and plaque scores using Silness, Löe Plaque Index  were obtained from the gingival third of buccal and lingual surfaces on both mesial and distal sites (four measurements) and average score was calculated. All the teeth were examined and average score was calculated.
The Statistical Package for Social Sciences (SPSS) was used for data analysis (SPSS Inc., version 14.0, Chicago, IL, USA). Z- and Chi-square tests were used to compare the prevalence of caries and treatment needs. Analysis of variance (ANOVA) was used to compare caries levels (decayed, missing, and filled teeth [DMFT/dmft]) between the groups. For all the tests, P ≤ 0.05 was set for statistical significance and P ≤ 0.001 represents a highly significant relation.
| Results|| |
Statistical analysis revealed variations between different age groups. Hence, most of the results were described pertaining to age group.
Plaque and gingivitis scores
The mean plaque and gingivitis scores of the total sample were found to be 1.70 ± 0.61 and 1.59 ± 0.58, respectively, with no gender and age variations. Eighty-one percent of the total sample had moderate to abundant deposits of plaque and 78% of the sample exhibited moderate to severe gingival inflammation [Table 2] and [Table 3].
Prevalence of dental caries
The total prevalence of dental caries in the present sample was found to be 65% with a prevalence rate of 66.0% in Group-I, 79.2% in Group-II, and 46.6% being the least in Group-III. Statistically significant differences were found when Group-III was compared with Group-I (P = 0.04) and II (P < 0.001). Caries prevalence was 61.3% in boys and 69% in girls with no significant difference between them (P = 0.28) [Table 4].
The mean level of caries prevalence (DMFT) for different age groups was found to be 1.6 ± 1.3 in Group-I, 1.9 ± 1.2 in Group-II, and 2.2 ± 1.2 in Group-III. One-way ANOVA showed a statistically significant difference between the groups (P = 0.04). The largest component was found to be decayed (D) with a mean total prevalence of 1.8 ± 1.2. When dmft was compared, mean dmft was 2.8 ± 2.2 in Group-I, 2.1 ± 1.5 in Group-II, and 1.1 ± 1.3 in Group-III with "d" being the largest component [Table 5].
The total number of children who needed one or the other treatment was 91.7% with 86% of the total boys and 79% of the total girls needing treatment. No significant gender (P = 0.69) or age (P = 0.99) variations were observed [Table 6].
The number of children requiring individual treatment need was compared between different age groups, children in need of sealant placement were more in Group-I, children needing two surface fillings were more in Group-II, and children needing extraction were more in Group-III [Table 7].
| Discussion|| |
Dental treatment is the greatest unmet health need of the handicapped child.  This statement by Nowak was substantiated by various studies done globally on special children. ,, Similarly, in the present study, the overall dental caries prevalence of the sample was 65% with a drastic portion of the sample (91.7%) needing one or the other treatment. This distressing condition can be ascribed to communication barriers faced by these children in various parts of the world.
Recently, another study done by Wei et al. on 229 senior high school deaf students comparing 196 healthy adolescence reported a caries prevalence rate of 55.9%.  Many other studies done solely on CHI reported wide variations in caries prevalence rates. Suma reported a prevalence rate of 42% with decayed component of the index being the highest.  Al-Qahtani and Wyne reported a prevalence of 91% and 95% in 6-7 and 11-12-year-old CHI, respectively.  Shyama et al. reported a prevalence rate of 84.6% with 86% of the caries lesions still untreated.  Rao et al. reported a prevalence rate of 65.1%.  Meaningful comparison of caries prevalence rates cannot be made from these studies as there are wide variations in age distribution of the sample selected in each study; however, all these studies signify the devastating situation of CHI concerning oral health.
A similar study done by Jain et al. in India reported mean DMFT of 0.5 in 5-8 years CHI, 1.76 in 9-12 years, and 2.95 in 13-17 years.  In our study, it was 1.6, 1.9, and 2.2, respectively. In both the studies, DMFT scores increased with increase in age. The largest component was the decayed component in both the studies. This resemblance may be due to comparable health care delivery systems in both the regions (India).
The results of the present study depict that 81% of the total sample have moderate to abundant deposits of plaque. Similarly, 78% of the total sample have moderate to severe gingivitis scores. This implies that oral hygiene performance in these children is someway compromised.
Treatment needs evaluated by Jain et al.  on CHI reported concomitant findings with the present study. He noted 75.9% of the children needing one surface filling compared to 71.7% in our study. Children requiring extractions were 16.5% in our study, but Jain et al. noted only 5.5%. The fewer rates can be attributed to the health care access of the children in cities such as Udaipur compared to remote area like ours.
The possible limitation of the present study is the lack of control group. The present sample was from a special school funded and run by Tirumala Tirupati Devasthanam (Andhra Pradesh, India), which is a government organization having its own disciplines regarding diet (strict vegetarian), commodities, etc., There was no other school in the locality which can provide comparable diet patterns and other confounding variables. Henceforth, this study was restricted to give descriptive data of these children only.
| Conclusion|| |
The present findings of the study show that CHI have poor oral health and extensive treatment needs. A caries prevalence rate of 65% was noted and large portion (91.7%) of the sample requires treatment. Hence, it is suggested that oral health educational programs should be tailored to this important group to improve their oral health status.
The cooperation rendered by the school authorities of SV School of Deaf, Bhimavaram, West Godavari, Andhra Pradesh, India, is deeply appreciated by the authors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brown JP, Schodel DR. A review of controlled surveys of dental disease in handicapped persons. ASDC J Dent Child 1976;43:313-20.
Nowak AJ, editor. Dental care for the handicapped patient - Past, present, future. In: Dentistry for the Handicapped Patient. 1 st
ed. St. Louis, MO: CV Mosby; 1976. p. 3-20.
Jain M, Mathur A, Kumar S, Dagli RJ, Duraiswamy P, Kulkarni S. Dentition status and treatment needs among children with impaired hearing attending a special school for the deaf and mute in Udaipur, India. J Oral Sci 2008;50:161-5.
Stiefel DJ. Dental care considerations for disabled adults. Spec Care Dentist 2002;22 3 Suppl:26S-39S.
Alsmark SS, García J, Martínez MR, López NE. How to improve communication with deaf children in the dental clinic. Med Oral Patol Oral Cir Bucal 2007;12:E576-81.
Champion J, Holt R. Dental care for children and young people who have a hearing impairment. Br Dent J 2000;189:155-9.
Joint Committee on Infant Hearing; American Academy of Audiology; American Academy of Pediatrics; American Speech-Language-Hearing Association; Directors of Speech and Hearing Programs in State Health and Welfare Agencies. Year 2000 position statement: Principles and guidelines for early hearing detection and intervention programs. Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics, American Speech-Language-Hearing Association, and Directors of Speech and Hearing Programs in State Health and Welfare Agencies. Pediatrics 2000;106:798-817.
Ciger S, Akan S. Occlusal characteristics of deaf-mute individuals in the Turkish population. Eur J Dent 2010;4:128-36.
Davis A, Hind S. The impact of hearing impairment: A global health problem. Int J Pediatr Otorhinolaryngol 1999;49 Suppl 1:51-4.
Simon EN, Matee MI, Scheutz F. Oral health status of handicapped primary school pupils in Dares Salaam, Tanzania. East Afr Med J 2008;85:113-7.
Al-Qahtani Z, Wyne AH. Caries experience and oral hygiene status of blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia. Odontostomatol Trop 2004;27:37-40.
Rao DB, Hegde AM, Munshi AK. Caries prevalence amongst handicapped children of South Canara District, Karnataka. J Indian Soc Pedod Prev Dent 2001;19:67-73.
Wei H, Wang YL, Cong XN, Tang WQ, Wei PM. Survey and analysis of dental caries in students at a deaf-mute high school. Res Dev Disabil 2012;33:1279-86.
Kumar S, Dagli RJ, Mathur A, Jain M, Duraiswamy P, Kulkarni S. Oral hygiene status in relation to sociodemographic factors of children and adults who are hearing impaired, attending a special school. Spec Care Dentist 2008;28:258-64.
Suma G, Das UM, Akshatha BS. Dentition status and oral health practice among hearing and speech-impaired children: A cross-sectional study. Int J Clin Pediatr Dent 2011;4:105-8.
Ramseier CA, Leiggener I, Lang NP, Bagramian RA, Inglehart MR. Short-term effects of hygiene education for preschool (Kindergarten) children: A clinical study. Oral Health Prev Dent 2007;5:19-24.
Axelsson P. Mechanical plaque control. In: Lang N, Karring T, editors. Proceedings of the 1 st
European Workshop on Periodontics, 1993. London: Quintessence; 1994. p. 219-43.
WHO. Oral Health Surveys, Basic Methods. 4 th
ed. Geneva: WHO; 1997.
Loe H, Silness J. Periodontal disease in pregnancy. I. prevalence and severity. Acta Odontol Scand 1963;21:533-51.
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121-35.
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.
Department of Pediatric Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]