EVALUATE THE EFFECTIVENESS OF REPEATED ORAL HEALTH EDUCATION PROGRAMME ON ORAL HEALTH KNOWLEDGE AND HYGIENE OF VISUALLY IMPAIRED INDIVIDUALS
SYNOPSIS
3/21/2012
Introduction
In dentistry, a key health promotion tool used is oral hygiene instruction. Oral hygiene instruction is especially important for prevention and treatment of oral conditions in children as it provides basis for good oral health throughout life. An oral hygiene instruction normally includes the use of visual aids such as disclosing tablets and models. Unfortunately, none of these measures are beneficial to visually impaired children who depend much more on feeling and hearing to learn. This led to the thinking about what techniques are used when educating visually impaired persons about their oral care as vision is the primary sense for learning and consequently the sense on which most educational programmes are based. The main factor of differentiation between normal patients and blind ones is the difficulty in removing plaque. [1]
Blindness is the condition of lacking visual perception due to physiological or neurological factors. Various scales have been developed to describe the extent of vision loss and define blindness.[2]
Blindness is defined by the World Health Organization as vision in a person’s best eye of less than 20/500 or a visual field of less than 10 degrees. [3]
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Visually impaired children daily face challenges for bearing their everyday skills. Maintenance of proper oral hygiene is one among them. The visually impaired people are at a greater risk to develop caries, since they are unable to see the early signs of caries such as discoloration which indicates the disease process. The difficulty in removing bacterial plaque being the main factor for development of caries, continual motivation to the correct oral hygiene procedures is fundamental in order to keep a good oral hygiene in blind patients. [4]
“Death is no more than passing from one room into another. But there’s a difference for me, you know. Because in that other room I shall be able to see.” ― Helen Keller
“Love looks not with the eyes, but with the mind,
And therefore is winged Cupid painted blind.” ― William Shakespeare, A Midsummer Night’s Dream
‘Little research has been conducted on teaching oral hygiene skills to persons with visual impairments’ and ‘studies in the dental literature on teaching oral hygiene skills to persons with visual impairments were rare. [5] Oral hygiene of the blind population is significantly worse than in an equivalent sighted one. [6] Students with visual impairments were less knowledgeable about their oral care. [7]
LITERATURE REVIEW
Visually impaired children tend to have more accidents than other children during the early years while they are acquiring motor skills. Trauma to the anterior teeth has been reported to occur with greater than average frequency in visually impaired children. Such children are also more likely to have gingival inflammation because of their inability to see and remove plaque. Other abnormalities occur with same frequency as in the general population. [8]
There was a greater prevalence of dental caries, poorer oral hygiene, and higher incidence of trauma in visually impaired children, so we can play a key role not only in diagnosing the oral health conditions of such children but also treat and to maintain oral health thereby contributing to the general well being of the individuals.[9]
AIM AND OBJECTIVES
The aim of this study was to evaluate the effectiveness of repeated oral health education programme on oral health knowledge and hygiene of visually impaired individuals.
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The objectives of this study include:
* To contribute towards improvement in oral health knowledge and oral hygiene in visually impaired individuals.
* Children knowledge concerning oral hygiene and their oral hygiene habits were recorded.
* If any oral health intervention were to be carried out, this data highlights the aspects of oral health promotion and services that need to be improved.
MATERIALS AND METHODS
* SAMPLE
The participants were children at the _________, an organization in Karachi, Pakistan that looks after the blind individuals. All participants had some form of visual impairment and did not have any other disabilities or impairments such as loss of limbs, impaired speech or hearing. _________ children (aged ___-___) were included in the sampling frame and participated in this longitudinal study involving a face-to-face interview, an oral examination and assessment of visual impairment.
* FACE-TO-FACE INTERVIEW
The interview was conducted by a group of 20 undergraduate dental students of DIKIOHS (DUHS) who had been briefed prior to the data collection. It was done using a pre-tested, structured questionnaire form to collect the following: personal information, oral hygiene habits, dental service utilization and dental knowledge. The section on oral hygiene practices included questions related to method, frequency, duration and type of tooth bushing done.
* DENTAL EXAMINATION
The status of oral debris and calculus provides an indication of oral hygiene status when assessed using Simplified-Oral Hygiene Index [OHI-S].[10] The data for debris and calculus will be obtained by visual detection and by running the probe along the gingival margin.
OHI-S Index (Simplified Oral Hygiene Index) [11, 12]
DESCRIPTION
Stedman’s Medical Dictionary states the an OHI-S is “an index that measures the current oral hygiene status based on the amount of debris and calculus occurring on six representative tooth surfaces in the mouth; often used in field surveys of periodontal disease”. This index has very distinct differences between the OHI index and the OHI-S. The differences are with the number of tooth surfaces scored, which is 6 instead of 12; the way in which the teeth are selected; and the scores. This index incorporates both the Debris Index and Calculus Index.
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Fundamentals of Clinical Dentistry: Intro to Indices and Charting Specific Objectives: 1) Define the purpose of dental indices, such as DMF-T, DMF-S, Gingival Inflammation Index and Plaque Index. Dental indices are important tools used in examinations to provide a numeric score that quantifies the magnitude of the disease measured. DMF-T: The number of teeth that are decayed, missing, or filled, ...
The six teeth that are selected for this index consist of four posterior teeth which is the first completely erupted tooth distal to the second premolar. The buccal surfaces are scored on the maxilla and the lingual surfaces are scored on the mandible. The last two teeth selected and scored are the labial surfaces of the maxillary right central incisor (#8) and mandibular left central incisor (#24), but if one of these teeth is missing then #9 & #25 would be used for the index.
Scores | Criteria |
0 | No debris or stain present |
1 | Soft debris covering not more than one third of the tooth surface, or presence of extrinsic stains without other debris regardless of surface area covered |
2 | Soft debris covering more than one third, but not more than two thirds, of the exposed tooth surface. |
3 | Soft debris covering more than two thirds of the exposed tooth surface. |
SCORES FOR CLASSIFYING DEBRIS:
SCORES FOR CLASSIFYING CALCULUS:
Scores | Criteria |
0 | No calculus present |
1 | Supragingival calculus covering not more than third of the exposed tooth surface. |
2 | Supragingival calculus covering more than one third but not more than two thirds of the exposed tooth surface or the presence of individual flecks of subgingival calculus around the cervical portion of the tooth or both. |
3 | Supragingival calculus covering more than two third of the exposed tooth surface or a continuous heavy band of subgingival calculus around the cervical portion of the tooth or both. |
Using the simplified oral hygiene index (OHI-S) by Greene and Vermillion 21, which was chosen because it was depicted as a sensitive, simple method for assessing group or individual oral hygiene quantitatively.[13] The OHI-S was developed for the study of variations in gingival inflammation in relation to the degree of intellectual sub normality in children, but has proven useful as an epidemiological tool for evaluating oral health programs in both the general population and disabled groups.[14][15][16]
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The teeth were then recorded for the Plaque and Calculus Index with the appropriate scores.
CALCULATIONS:
* Plaque Index = [(The buccal-scores) + (The lingual-scores)] / 6
* Calculus Index = [(The buccal-scores) + (The lingual-scores)] / 6
* OHI-S Index = Plaque Index + Calculus Index
SUGGESTED RANGE OF SCORES:
* Debris Index & Calculus Index
Rating | Scores |
Excellent | 0 |
Good | 0.1-0.6 |
Fair | 0.7-1.8 |
Poor | 1.9-3.0 |
* OHI-S
Rating | Scores |
Excellent | 0 |
Good | 0.1-1.2 |
Fair | 1.3-3.0 |
Poor | 3.1-6.0 |
Presence of plaque and dental calculus are indications of oral hygiene status.
The dental examination was carried out in _____by ____ examiners who took turns to examine. Prior to the data collection period, these examiners underwent a standardization session for OHI-S index and were calibrated with a _____ who acted as the gold standard. However, during the actual data collection, it was not possible to carry out a duplicate examination on the study respondents due to time constraint.
* Assessment of visual acuity
Visual impairment was assessed by the optometry team using distant visual acuity (VA) measurement. VA is an indication of the clarity or clearness of one’s vision and often measured according to the size of letters viewed on a chart. VA is expressed relative to 20/20 if using “foot” as a unit of measurement, or 6/6 if using the metre. In this study LogMAR or Minimal Angle of Resolution charts are used to measure distant VA. Subjects were asked to stand 3m away from the charts to measure habitual VA. To obtain distant VA for the right eye, the left eye was covered, and vice versa. For participants who had difficulty seeing the topmost line, (1.0LogMAR) charts, they were asked to move forward for a specified distance of 2m and 1m. If they were still not able to see the line, they were then assessed whether they were able to count number of fingers shown from a distance of 50m (CF), able to distinguish whether a hand is moving or not (HM) or able to perceive presence of light. Not being able to perceive light will be interpreted as total blindness.
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* Data processing and analysis
The data collected were to be entered and analyzed using______. Responses to most of the questionnaire items were reported as percentages. The oral debris and calculus scores were calculated as the percentage of sites with plaque or calculus over the total number of sites charted. Mean percentages for different regions – anterior/posterior, upper/lower, buccal/lingual – were reported separately. As for visual acuity assessment, the vision is determined using the reading from the better eye and reported as percentages of participants at a particular level of visual impairment.
References
[1] www.royalblind.org/school/
[2] International Council of Ophthalmology. “International Standards: Visual Standards — Aspects and Ranges of Vision Loss with Emphasis on Population Surveys.” April 2002.
[3] Maberley, DA; Hollands, H, Chuo, J, Tam, G, Konkal, J, Roesch, M, Veselinovic, A, Witzigmann, M, Bassett, K (2006 Mar).
“The prevalence of low vision and blindness in Canada.”. Eye (London, England) 20 (3): 341–6. PMID 15905873
[4] Al Sarheed M, Bedi R, Alkhatib MN, Hunt NP. Dentists attitude and practices towards provision of orthodontic treatment for children with visual and hearing impairments. Spec Care Dentist 2006;26:30-6
[5] C. S. Chang, Y.Shih. Teaching Oral Hygiene Skills to Elementary Students with Visual Impairments. Journal of Visual Impairment and Blindness.2005;99;1
[6] D.O’Donnell, M.A.Crosswaite. Dental Health Education for the Visually Impaired Child. The Journal of the Royal Society for the Promotion of Health.1990;110;60
[7] C. S. Chang, Y.Shih. Knowledge of Dental Health and Oral Hygiene Practices of Taiwanese Visually Impaired and Sighted Students. Journal of Visual Impairment and Blindness.2004;98;
[8] Dental problems of children with disabilities: Mc Donald, Avery, Dean, Dentistry for the child and adolescent, 8th ed. Mosby Elsvier publication; 2004. P. 550-1.
[9] Prevalence of oral health status in visually impaired children. By Reddy K, Sharma A. (Department of Pedodontics and Preventive Dentistry, College of Dental Surgery, Saveetha University, Chennai, Tamil Nadu, India. J Indian Soc Pedod Prev Dent. 2011 Jan-Mar;29(1):25-7.
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