RESEARCH ARTICLE


https://doi.org/10.5005/jp-journals-10005-2419
International Journal of Clinical Pediatric Dentistry
Volume 15 | Issue 4 | Year 2022

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


Deepika Patidar1, Suma Sogi2, Dinesh Chand Patidar3

1Department of Pediatric and Preventive Dentistry, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India

2Department of Pediatric & Preventive Dentistry, Maharishi Markandeshwar (Deemed to be University), Maharishi Markandeshwar College of Dental Sciences and Research, Ambala, Haryana, India

3Oral & Maxillofacial Surgeon, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India

Corresponding Author: Dinesh Chand Patidar, Oral & Maxillofacial Surgeon, College of Dental Science and Hospital, Rau, Indore, Madhya Pradesh, India, e-mail: drdineshpatidar30@gmail.com

ABSTRACT

Aim: To evaluate the oral health status of children with special healthcare needs (CSHCN) having either systemic illness or any disabilities.

Materials and methods: A retrospective analysis of oral health status was done from Jan 2013 to Dec 2018 on 58 CSHCN (both genders) up to 16 years of age. The oral health status of patients was assessed with the decayed, missing, and filled teeth (DMFT/dmft) indices and simplified oral hygiene index (OHI-S) by using the World Health Organization (WHO) 2013 oral health survey criteria.

Results: Fair oral hygiene was dominantly present (62%) among all the subjects. Association between oral hygiene status and systemic illness/disability was done using the Chi-squared 2) test and was found statistically nonsignificant. The overall mean DMFT/dmft found was 4.16. The highest mean DMFT/dmft score was recorded in nephrotic syndrome patients (16.0%), while the least score was seen among cleft anomalies (1.89%). Comparison between mean DMFT/dmft scores among various systemic illnesses/disabilities were done using Kruskal–Wallis one-way analysis of variance (Kruskal–Wallis ANOVA) test and found statistically significant (p-value 0.048).

Conclusion: The majority of the CSHCN fall under fair oral hygiene status. A high caries prevalence and statistically significant value were demonstrated between mean DMFT/dmft scores of various systemic illnesses/disabilities.

Clinical significance: Present study aids in understanding the needs of the community, identifying high-risk groups, planning the required treatment and prevention strategies, and thus monitoring and improving the oral health status of children with special healthcare needs.

How to cite this article: Patidar D, Sogi S, Patidar DC. Oral Health Status of Children with Special Healthcare Need: A Retrospective Analysis. Int J Clin Pediatr Dent 2022;15(4):433-437.

Source of support: Nil

Conflict of interest: None

Keywords: Dental caries, Oral health status, Special healthcare needs.

INTRODUCTION

Children with special healthcare needs are defined as “children with any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, healthcare intervention, and/or use of specialized services or programs.”1 According to the National Sample Survey Organisation, 18.49 million individuals with disabilities comprise about 1.8% of the total population in India. Nearly 6–10% of children in India are born disabled, and probably, children constitute one-third of the total disabled population.2

Oral health is an inseparable part of general health and well-being. The importance of good dental health is often not recognized nor explained to children or their caregivers. Children with special healthcare needs might be at a higher risk for oral diseases during their life owing to their actual disability, or any other medical, economic/social causes. Moreover, their parents/caregivers find it difficult to perform routine oral hygiene practices. The primary focus of attention of parents or caregivers is usually directed toward the medical treatment of these children.3

Many conditions such as mental retardation, developmental or physical disabilities, cerebral palsy, craniofacial abnormalities, and epilepsy can influence a child’s oral health. Children with special healthcare needs generally have an increased prevalence of poor oral hygiene, compromised gingival/periodontal health, and a higher prevalence of dental caries. Staying at home and pampering with cariogenic snacks and other unhealthy dietary habits might render them at higher risk for dental caries. Moreover, the importance of dental care for these chronically ill children has often been ignored and neglected by health planners. These children may not realize the importance and responsibility of preventive oral hygiene.4,5 Special healthcare children present unique challenges for both pedodontists and general dental practitioners. The present study was conducted with the aim to evaluate the oral health status of CSHCN having either systemic illness or any disabilities.

MATERIALS AND METHODS

This retrospective study was carried out in the Department of Pediatric & Preventive Dentistry, M.M.C.D.S.R, Mullana, from January 2013 to December 2018. Ethical approval was taken from the Institutional Research Committee and Ethical Committee of M.M. Deemed to be University, Mullana. Children with special healthcare needs (both male and female) having either systemic illness or any disabilities reported to the department outpatient department up to 16 years of age were included in the study.

Required data was collected from the departmental records. The oral health status of patients was assessed along with general information like name, age, and gender by using WHO 2013 oral health survey criteria.6 Dental caries were recorded by using dmft and DMFT index for primary and permanent dentition, respectively. In cases of mixed dentition, both indices were combined to assess the extent of dental caries. The oral hygiene status of the children was assessed according to the criteria used in OHI-S proposed by Green and Vermillion. In addition to this, other oral pathologies of dental origin and miscellaneous findings were also recorded. Data collected were analyzed statistically.

Statistical Analysis

The data were tabulated and analyzed in Microsoft Office Excel worksheet (version 2007) and Statistical Package for Social Sciences version 19.0. Pearson’s χ2 was used to determine the association between systemic illness/disabilities and oral health status, and the mean DMFT/dmft scores were compared by using Kruskal–Wallis ANOVA test. The result was observed as statistically significant when the p-value < 0.05.

RESULT

A total of 58 CSHCN from one month to 16 years (mean age 8.71 ± 4.1), comprising 35 (60.3%) males and 23 (39.7%) females, were analyzed retrospectively for the study. Table 1 summarizes the distribution of subjects and their frequency. Among them, the most frequently observed systemic illness/disability in the study was cleft anomalies (32.8%), followed by mental retardation (19%), epileptic (10.3%), and the least observed were endocrine and renal (nephrotic syndrome) disorder (1.7%).

Table 1: Distribution of subjects according to the presence of systemic illness/disability
Systemic illness/disability Frequency Percent
Mental disorders 11 19
Cerebral and Bell’s palsy 4 6.9
Malignancy 3 5.2
Syndromic patients 5 8.6
CVS disorders 2 3.4
Epilepsy 6 10.3
Cleft patients 19 32.8
Physically challenged 2 3.4
Hematological disorders 2 3.4
TB meningitis 2 3.4
Endocrine disorders 1 1.7
Nephrotic syndrome 1 1.7
Total 58 100.0

CVS, Cardiovascular

Under oral hygiene status, poor oral hygiene was predominantly found in all patients with malignancies, while in other systemic illnesses/disabilities, fair oral hygiene was observed more often in 36 (62.0%) patients. Good oral hygiene status was rarely seen among these patients. Comparatively, physically challenged patients and patients with tubercular meningitis (TB meningitis) showed good oral hygiene with no poor oral hygiene status in them. Association between oral hygiene status and systemic illness/disability was performed using χ2 and was found to be statistically nonsignificant (p-value of 0.318) (Table 2 and Fig. 1).

Table 2: Association between oral hygiene and systemic illness/disability
Systemic illness/disability Oral hygiene (OHI) Total Chi-square p-value
Good Fair Poor
Mental disorders 0 7 4 11 24.563 0.318#
Cerebral and Bell’s palsy 0 3 1 4
Malignancy 0 0 3 3
Syndromic patients 0 3 2 5
CVS disorders 0 2 0 2
Epilepsy 1 3 2 6
Cleft patients 4 13 2 19
Physically challenged 1 1 0 2
Hematological disorders 0 1 1 2
TB meningitis 1 1 0 2
Endocrine disorders 0 1 0 1
Nephrotic syndrome 0 1 0 1
Total 7 36 15 58

#denotes nonsignificant

Fig. 1: Association between oral hygiene status and systemic illness/disability

While analyzing DMFT/dmft score among these selected patients, the overall mean DMFT/dmft was found to be 4.16 (Table 3). The highest mean DMFT/dmft score was recorded in nephrotic syndrome patients (16.0%), followed by patients with endocrine disorder (8.0%), syndromes (7.2%), and mental disorders (5.27%), while least score was seen among cleft anomalies (1.89%). Comparison between mean DMFT/dmft scores among various systemic illness/disability was done using Kruskal–Wallis ANOVA test and found statistically significant with a p-value of 0.048. A detailed description of mean DMFT/dmft with systemic illness/disability is given in Table 3 and Figure 2.

Table 3: Comparison of mean DMFT/dmft with systemic illness/disability
Systemic illness/disability N Mean Standard deviation p-value
Mental disorder 11 5.27 4.71 0.048*
Cerebral and Bell’s palsy 4 5.00 5.23
Malignancy 3 2.67 2.31
Syndromic patients 5 7.20 5.26
CVS disorders 2 4.00 2.83
Epilepsy 6 5.00 4.10
Cleft patients 19 1.89 2.96
Physically challenged 2 2.50 2.12
Hematological disorders 2 3.50 2.12
TB meningitis 2 4.50 2.12
Endocrine disorders 1 8.00 .
Nephrotic syndrome 1 16.00 .
Overall mean dmft/DMFT 58 4.16 4.234

CVS, cardiovascular;*Statistically significant using Kruskal–Wallis ANOVA

Fig. 2: Comparison of mean DMFT/dmft with systemic illness/disability

Only 29.2% CSHCNs were seen with various oral pathologies of dental origin. Among them, the majority (12.1%) of the cleft anomalies cases were having abnormal tooth eruption. 6.9% of total patients have shown periapical abscess; however, developmental anomalies, extraoral swelling, and presence of sinus tract were found in 1% of cases each (Table 4).

Table 4: Distribution of subjects according to the presence of other oral findings
Oral pathologies (Total N = 58) Absent (N) % Present (N) %
Periapical abscess 54 93.1 4 6.9
Sinus tract 56 96.6 2 3.4
Abnormal tooth eruption 51 87.9 7 12.1
Developmental anomalies 56 96.6 2 3.4
Extraoral swelling/space infections 56 96.6 2 3.4
Miscellaneous findings (Total N = 58)
Constricted maxillary arch 53 91.37 5 8.62
Anterior crossbite 55 94.8 3 5.1
Posterior crossbite 57 98.2 1 1.7
Tooth fracture 53 91.37 5 8.6
Premaxilla prominence 57 98.2 1 1.7

The other miscellaneous findings were present in only 24.1% of total patients. Among them, the constricted maxillary arch was noted in the majority (13.7%), followed by tooth fracture (8.6%) and anterior crossbite (5.2%). However, posterior crossbite, and premaxillary prominence was found in 1% of cases each (Table 4).

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.

CONCLUSION

In spite of advances in oral health, oral diseases continue to be a primary health problem among CSHCNs. In this study majority of the CSHCN were observed under fair oral hygiene status. However, a high caries prevalence and statistically significant value was demonstrated between mean DMFT/dmft scores of various systemic illnesses/disabilities. Attention should be given to organize a complete dental healthcare program for these children.

Clinical significance

Children with special healthcare need have a significantly higher burden of oral diseases because of the lack of oral health knowledge, access to care, and preventive measures. The collection of epidemiological data aids in understanding the requirements of the community, identifying high-risk groups, planning the required treatment, and preventive approach, and thus monitoring and improving the oral health status of special healthcare needs children over a period of several years.

Limitations of the study

Limitations included less number of participants reported at that time period. Gender and age association with oral hygiene status and dental caries was not included.

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