Oral Health Status of Children with Special Healthcare Need: A Retrospective Analysis

DISCUSSION

Esthetic and communication skills are affected by oral health, and it has important biological, psychological, and social developments as well. Special children, too, deserve the same prospects for good oral health and hygiene as other normal groups. Unfortunately, due to their clinical state and lack of awareness of oral hygiene, dental diseases are often left untreated, leading to undesirable consequences and further higher demand for dental care in their life. A higher prevalence and severity of dental diseases were examined by several researchers in disabled persons around India and the world. Yet, only limited research has been conducted to evaluate the dental health of children with different special healthcare needs.⁷

Dental caries is a major oral health problem among the children of India. In India, according to a national oral health survey carried out in 2003–2004, for children at the ages of 5, 12, and 15 years, caries prevalence and mean decay-missing-filled (DMF) values were noted as 51.9, 53.8, and 63.1%, and 2, 1.8, and 2.3, respectively. As per the WHO oral health report (2003), the mean DMF value among 12-year children in the Indian population was in the range of 1.2–2.6.⁸ Children with special healthcare needs might be at higher risk for dental caries, owing to poor muscular coordination and muscular weakness that could hinder their regular oral hygiene practices. Moreover, frequent intake of sugary sweetened food items, long-standing use of medications such as sweetened syrups, and less frequent brushing may be important determinants of caries risk for these children.^5,9

The present study was done on 58 CSHCN, up to 16 years of age, with a mean age of 8.74 years. Males were noted in the majority, representing 60.3% of the total selected children, which is in agreement with several other researchers.^3,5,7,9 Most frequently, CSHCN were seen with cleft anomalies followed by mental retardation and epileptic, while the least observed were under endocrine and renal (nephrotic syndrome) disorder. However, Purohit et al.⁹ found 105 (39.6%) mentally challenged children in the majority in a study conducted on 265 special healthcare children, whereas Çetingüç et al.³ observed maximum children (25.7%) with hematological disorders in their study.

Oral hygiene is essential for the prevention of oral diseases. Although various studies and systematic reviews have observed poor oral hygiene, especially in children having intellectual disabilities, as compared to the general population.^7,10,11 In the present study, fair oral hygiene status was dominantly present among all other systemic illnesses/disabilities, similar to a study done by Saravanakumar et al.¹² with 51.4% fair oral hygiene status among special needs children. On the contrary, Oredugba et al.⁵ found a higher portion (43.6%) of special healthcare needs children showing good oral hygiene while 31.5% and 22.2% showing fair and poor oral hygiene respectively in their study.

On the other hand, children with malignancies like squamous cell carcinoma, leukemia, and ameloblastoma have shown poor oral hygiene in this study, while physically challenged children and those with TB meningitis had better oral health status with good oral hygiene as compared to other disabilities in the present study. Shukla et al. also noted similar results in their study.¹³ In another study done by Mehta et al.⁷ on 414 special needs children, the best gingival condition was found in physically challenged children while the worse condition was noted among intellectually disabled ones.

In the present study, the overall mean DMFT/dmft score was 4.16, which was in accordance with the study done by Hsiao et al.¹⁴ on school children with disabilities in Kaohsiung County with a mean value of 4.0. The national oral health survey (2002–2003) reported a lower mean DMFT value (1.87) compared to the present study.¹⁵ In the National Health Insurance Survey 2004, the mean value of decayed extracted due to caries filled teeth (deft)/DMFT index for 3–12-year-old special children was noted as 3.25.¹⁶ Additionally, Oredugba et al.⁵ also noted lower mean dmft and DMFT values of 0.7 ± 1.77 and 0.4 ± 1.44, respectively than our study. Although Chen et al.¹⁷ observed a higher mean deft/DMFT score of 12.47 for 3-14 years old special children than the present study. The difference in the results from various studies might be because of different age groups, the severity of a disability, parental socioeconomic, and education status.^18,19 In the present study higher mean DMFT/dmft score was observed in children with nephrotic syndrome followed by patients with an endocrine disorder, syndromes, mental disorders, epilepsy, cerebral and Bell’s palsy, TB meningitis, CVS, hematological disorders and physically challenged patient. Conversely least score was seen among cleft anomalies (Table 2). In contrast to the current study, Mehta et al.⁷ found a higher DMF value of 3.71 in intellectually disabled children than in other groups, and Saravanakumar et al.¹² too found high caries prevalence in mentally challenged children, followed by cerebral palsy, epilepsy, and physically challenged patients.

Only a few CSHCN had shown oral pathologies of dental origin in the present study, out of which abnormal tooth eruption was observed more frequently as compared to other pathologies. Among other findings, the constricted maxillary arch was noticed more, followed by tooth fracture. Both abnormal tooth eruption and constricted maxillary arch were reported mostly in cleft anomalies cases of the present study, which was in contrast to the study done by Mehta et al.⁷ in which trauma (34.4%) followed by the delayed eruption (24%) was seen in higher proportions in CSHCN.