|Year : 2022 | Volume
| Issue : 1 | Page : 60-67
Assessment of Oral Health and Treatment Needs in Population with Visual Impairment
Abarna Jawahar, G Maragathavalli
Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
|Date of Submission||26-Aug-2021|
|Date of Decision||18-Oct-2021|
|Date of Acceptance||15-Dec-2021|
|Date of Web Publication||25-Mar-2022|
Dr. G Maragathavalli
Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai - 600 077, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Visually impaired individuals when compared to healthy have poor oral health status as they cannot visualize the plaque deposits on the tooth surface, leading to poor understanding of the importance of oral hygiene which results in development of dental caries as well as inflammatory disease of the periodontium and loss of tooth structure. Aim: The study aims to assess the oral health and treatment needs of patients with visual impairment using WHO Oral Health Assessment form for adults 2013. Materials and Methods: A cross-sectional study was conducted on 207 visually impaired patients who visited the special care dentistry department, a unit of Oral Medicine and Radiology in a private dental college & hospital and a private blind institute. WHO Oral Health Assessment form was filled after oral examination was done using Type III clinical examination. Statistical Analysis: Descriptive analysis was used to describe the frequencies and percentages. Chi-square test was used to determine statistical significance. Results and Conclusion: Dental caries were present in 129 (62.3%) study participants. Oral mucosal lesion was prevalent in 14% of the study population. 146 (71%) participants required prompt dental treatment such as scaling, restorations, extractions, 58 (28%) participants required immediate dental treatment due to presence of pain or infection of dental origin such as advanced dental caries, periapical abscess and OPMD. Only 3 (1%) participants out of 207 did not require any dental treatment. The findings of the study suggest that the dental treatment needs are high and unmet in the visually impaired population.
Keywords: Dental treatment needs, intervention urgency, oral health assessment, visually impaired
|How to cite this article:|
Jawahar A, Maragathavalli G. Assessment of Oral Health and Treatment Needs in Population with Visual Impairment. J Indian Acad Oral Med Radiol 2022;34:60-7
|How to cite this URL:|
Jawahar A, Maragathavalli G. Assessment of Oral Health and Treatment Needs in Population with Visual Impairment. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 May 27];34:60-7. Available from: https://www.jiaomr.in/text.asp?2022/34/1/60/340744
| Introduction|| |
Oral health is a vital component of overall health which contributes to each individual's wellbeing and quality of life by positively affecting physical and mental healthiness. Good oral health is essential for proper mastication, digestion, appearance and speech. It is often associated with happiness and good general health.,
According to WHO, blindness is defined as a person having a “visual acuity of less than 3/60 m or corresponding visual field loss in the better eye with the best possible correction” meaning that whilst a blind could see 3 m, a normal person without any visual impairment could see 60 mm. WHO estimates suggest that across the world about 35 million people are blind and among them over 4 million are from India.
Visual impairment can affect the oral health through physical, social or information barriers related to the impairment, medical conditions of the attendant or lack of information in a customized format. Other obstacles include lack of transport and services, inadequate resources or financial considerations, lack of social awareness or lack of education and training of caretaker or service provider.,
Literature suggests that visually impaired individuals have poor oral health status when compared to healthy individuals. Individuals with visual impairment cannot visualize the plaque deposits on the tooth surface, hence leading to poor understanding of the importance of oral hygiene which results in development of dental caries as well as inflammatory disease of the periodontium and loss of tooth structure,
Therefore, this study was designed to assess the dental treatment needs and prevalence of oral mucosal lesion in patients with visual impairment using the WHO Oral Health assessment form for adults, 2013.
| Materials and Methods|| |
This study was approved by the Research and Ethics Committee, Scientific Review Board (SRB/SDMDS11/18/OMRD/02) on November 22, 2018 in accordance with the Declaration of Helsinki. The duration of the study spanned over 24 months from December 2018 to December 2020 at the Special Care Dentistry, Unit of Oral Medicine and Radiology department in a private dental college in Chennai and in a private blind institute.
Sample size (n) was calculated to be 207 using formula by keeping power of 99%. Patients with Unique Disability ID for blindness only were included. As the study was conducted in a private dental hospital and blind institute, patients with varying degree of blindness participated. Since an ophthalmologist testing and assessment is required for categorization as complete or partial vision impairment patients with both complete and partial visual impairment were included. Patients with loss of vision since birth or acquired during various stages of life were also included. Patients with physical impairment, mental impairment, sensory impairments such as hearing and speech impairment were excluded. The Informed consent form was read aloud to the patients before the beginning of the research. After obtaining the consent from the patient, a thumb impression was obtained. In patients who were able to sign a consent form, a signed consent was obtained.
The patient's interview, clinical examination and data collection was performed by a single observer. WHO Oral Health Assessment form for adults 2013 and Oral Health Questionnaire for adults 2013 were recorded for each patient. The clinical examination for patients who visited the Special Care Dentistry department was done in a dental chair using a mouth mirror, explorer and CPI probe under artificial light. Patients who were screened in the blind institute underwent clinical examination in the institute's medical room with the aid of a mouth mirror, explorer and CPI probe under adequate natural light (Type III).
The WHO Oral Health Questionnaire for Adults 2013 was filled for each patient by reading out the questions aloud to the patient and the options for each were provided, following which their response was recorded.
Data gathered from the assessment were entered in a Microsoft Excel workbook and statistical analysis was done by using Statistical Package of Social Science (SPSS 21). Chisquare test was used to determine statistically significant association for the responses given by visually impaired patients. P < 0.05 was considered statistically significant.
| Results|| |
A total of 207 participants were included in the study out of which 133 (64.3%) were males and 74 (35.7%) were females [Graph 1]. The age of the study participants ranged from 21 to 80 years with the majority of participants belonging to the age group of 41-60 years [Table 1].
The prevalence of decayed, missing and filled teeth in our study population was 62.3%, 60.3% and 9.7% respectively. The prevalence of gingival bleeding, periodontal pocket and attachment loss was 94.69%, 81.16% and 58.9% respectively in our study population [Graph 2].
Dental trauma was present in 62 (30%) participants of which enamel fracture was present in 29, enamel and dentin fracture in 14 and pulpal involvement in 12 [Graph 3].
Oral mucosal lesion was prevalent in 29 (14%) participants of the study population [Graph 4] [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14]. Leukoplakia and angular cheilitis were the most frequently seen oral mucosal lesions present in each 7 (3.38%) participants respectively. Oral submucous fibrosis was present in 5 (2.41%) participants and tobacco pouch keratosis was seen in 2 (0.96%) participants. Traumatic ulcers were seen in 4 (1.93%) participants and aphthous ulcers in 2 (0.96%) participants. Thermal burn and depapillation of the tongue were present in 2 (0.96%) participants each [Graph 5].
Normal anatomical variants which are of no pathological significance such as Fordyce's granules and Linea alba buccalis were observed in 31 (14.97%) and 9 (4.34%) participants respectively in the study population.
Males had higher prevalence of oral mucosal lesions comparatively than females [Graph 6] [Table 2] and buccal mucosa was the most commonly affected site in the oral cavity with 18 (48.65%) lesions [Graph 7]. On analyzing the chi square association between site and oral mucosal lesion distribution a statistically significant association exists between site and oral mucosal lesions [Graph 8].
|Table 2: Gender distribution of study participants with oral mucosal lesion|
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On analyzing the intervention urgency, prompt dental treatment was needed in 146 (70.53%) participants, immediate dental treatment in 58 (28.02%) participants and no dental treatment needed in 3 (1.45%) participants respectively [Graph 9].
| Discussion|| |
Oral health is a major concern for individuals with disability and poor oral health is a factor of comorbidity when associated with systemic disease. The dental treatment has been reported to be the greatest unattended health need of the visually impaired and with this view point, the present study was conducted to assess the oral health and treatment needs of the visually impaired population.
High prevalence of gingival bleeding and periodontal pocket reflects the poor oral hygiene status. It may be attributed to the inability to see and remove plaque, low physical abilities and consequent difficulties in tooth brushing. Motivating individuals with visual impairments to have good oral hygiene is a major challenge for dentists as conventional techniques used to show the dental plaque may not be applicable. The visually impaired have poor oral hygiene and are significantly worse than in an equivalent sighted one. The results were consistent with the previous studies.,,,
The evaluation of dental traumatic status revealed the prevalence of anterior teeth fracture in 30% of the study population, mostly due to accidents or falls. This finding is in accordance with the study conducted by Reddy et al. who reported 31.2% of visually impaired children sustained trauma.
When questioned about habits, 34 (16.43%) participants had a positive tobacco habit history. 24 (71%) participants had tobacco chewing habit while 9 (27%) participants had tobacco smoking habit and 1 (2%) participant had both tobacco chewing and smoking habits. 30 (88%) participants were using tobacco several times a week while 2 participants were using tobacco once a week and several times in a month respectively. An average of 8 years duration of tobacco habit was present in our study participants.
When asked further about the development of the tobacco habit, the majority had started chewing tobacco to keep themselves awake while commuting in buses and trains. Studies have reported that smokeless tobacco is used by many people to avoid sleep and improve concentration during work, as it contains certain psychoactive substances.,, This could be the major attributable reason for the development of tobacco habits among the study participants.
The oral mucosal lesions observed in our study ranged from the presence of trauma related lesions such as traumatic ulcer, epulis fissuratum, thermal burns to oral potentially malignant disorders such as leukoplakia, erythroleukoplakia, OSMF and tobacco pouch keratosis. Fordyce's granules and linea alba buccalis which are of no pathological significance were also observed in our study.
Trauma related oral mucosal lesions such as traumatic ulcers, thermal burns and epulis fissuratum were reported in our study. These lesions usually heal spontaneously but sometimes trauma causing agents needs to be removed as it can lead to further development of chronic ulcers. These findings suggest that trauma related oral mucosal lesions requiring interventions are present in visually impaired population which they might not be aware of due to their impairment. Hence the dentist should be aware that visually impaired individuals are more prone to develop trauma related oral mucosal lesions comparatively and hence thorough examination of the oral cavity has to be done.
Oral Potentially Malignant Disorders (OPMDs) such as leukoplakia, erythroleukoplakia, OSMF and tobacco pouch keratosis have been reported in our study. This could be attributed to the tobacco habit history in 16% of our study population. Many Oral Squamous Cell Carcinomas develop from OPMDs, hence early diagnosis and timely treatment can help prevent malignant transformation in these oral lesions.,
The prevalence of oral mucosal lesions in our study population was 14%. The prevalence of oral mucosal lesions in the normal sighted population ranged from 11%-64% which suggests that the visually impaired are equally susceptible to develop oral mucosal lesions and hence require subsequent dental treatment.,, Despite the considerable prevalence of oral mucosal lesions and their subsequent morbidity in the involved patients, there is no large scaled population-based study regarding prevalence and pattern of the lesion in visually impaired population till now.
Regarding the distribution of mucosal lesions in the oral cavity, different sites in the oral cavity show predilection for different types of lesions. The buccal mucosa (48.65%) was the most commonly affected site followed by lips (18.92%) in our study population. In the present study OPMDs was the most common lesions prevalent in the buccal mucosa. This finding is in accordance with other studies which have reported buccal mucosa to be the most commonly affected site in the oral cavity.,
The high dental treatment needs of the visually impaired may be due to multiple factors such as lack of motivation, low priority given to dental care in the society, lack of facilities for regular dental health check-up and poor socioeconomic status.
| Limitations and Future Perspectives|| |
Although our study focused on the visually impaired population, it did not differentiate among the partially and completely visually impaired. Therefore, the oral health status and prevalence of oral mucosal lesions could not be correlated among the partially and completely visually impaired individuals. Our data has provided baseline information about epidemiologic aspects of oral health status that can be valuable in organized national programs targeting oral health and hygiene in the visually impaired population. In future, similar studies with larger sample size could be done with prime focus on correlating the findings of oral health status in regard to population with partial and complete visual impairment respectively.
| Conclusion|| |
Visually impaired population have high rate of dental caries and poor oral hygiene status. Oral mucosal lesions were prevalent in 14% of the study population. The prevalence of oral mucosal lesions in visually impaired population do not appear to differ significantly when compared to normal sighted population suggesting that visually impaired population are equally susceptible in developing oral mucosal lesions. 71% of the participants required prompt dental treatment such as scaling, restorations, extractions and replacement of missing teeth and 28% required immediate dental treatment due to presence of pain or infection of dental origin such as advanced dental caries, periapical abscess and oral potentially malignant conditions. Only 1% did not require any intervention which clearly reflects that dental treatment needs of the visually impaired population are unattended. The visually impaired population due to their impairment experience several barriers in receiving dental care and their dental treatment needs are high and unmet.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 8], [Figure 7], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14]
[Table 1], [Table 2]