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MDJ
Oral Health Status and Treatment Needs among
Blind Children in Iraq
Dr. Jinan Mohammed Rashad Al-Alousi, B.D.S., M.Sc.
Abstract
Dental caries is a significant public health problem for a large segment of society.
Blind people have been described as those who encounter more visual barriers to the
receipt of dental care than other people. They may have greater problems accessing
dental care or may be at increased risk from dental disease or its treatment.
The present study was conducted to assess the caries prevalence, traumatic
injuries, levels of oral hygiene and treatment need, in a group of 58 blind children
aged (6-15) years. The results were compared with a control group of 58 age and sex
matched normal children. The data were collected using the methods and standards
recommended by the WHO for oral health survey, 1997.
A highly significant difference between study and controls concerning DMFT and
dmft, dental caries was higher among normal students compared to blind one. Where
as traumatized teeth were higher among blind compared to normal students with a
significant difference, a highly significant difference was seen on comparing between
blind and normal students concerning plaque and gingival index, while a significant
difference was seen for calculus index, one surface filling was needed by 25.9% of 58
control subjects, while only 5.2% of study group needed this type of treatment, less
than 7% of the control group required pulp treatment, while 25.9% needed pulp care
in the study group.
The findings of this study demonstrate that blind subjects have a low prevalence of
dental caries, poor oral hygiene, and extensive unmet need for dental treatment. This
highly alarming situation requires immediate attention.
Key words: Blind, Caries prevalence, Treatment need.
Introduction
The World Health Organization
(WHO) defined Health as a state of
complete physical, mental, and social
well-being, rather than solely the
absence of disease (1). Oral health has
been defined as the standard of health
of the oral and related tissues which
enables an individual to eat, speak and
socialize without active disease,
discomfort and embarrassment and
which contributes to general wellbeing. Oral health has strong
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Results
Table (1) shows the distribution of
control and study groups according to
age in years and gender. The study
group consisted of 58 blind students
(30 males, 28 females) with an age
range of (6-15) years, in addition to
control group matching in age and
gender.
Mean
values
and
standard
deviations of DMFT for the study
group are shown in Table (2). The
decayed component contributed to
major part in DMFT values, there was
an increase in values of (D) fraction
with age, similar results was revealed
for the DMFT values, for both (D)
component and DMFT differences
were statistically significant between
different age groups (D; F value=
3,179, DMFT; F value= 8,726, df=2,
P< 0.05). Concerning the (M), and (F)
components, the results revealed a nonsignificant difference between different
age groups (P> 0.05). Comparing
between components of DMFT of the
same age group, a significant
difference was found between D and F
fractions at age of 6-9 (P< 0.05). At
age 10-13, a highly significant
difference was seen between D and F
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age, about 9.1% had injuries at age (69), while 40% of adolescents over (13)
years old had traumatic injuries, a non
significant difference was found
among male between different age
groups, similar results was revealed for
female between different age groups
(P> 0.05). Table (9) illustrates the
number and percentage of subjects
with traumatic injuries in the control
group, increases in the values was seen
with age, a non significant difference
was found among male and among
female between different age group(P>
0.05).
Comparing between study and
control groups concerning traumatic
injuries Table (10), a significant
difference was seen (t-test=2.047, df
=114, P< 0.05), it seems that the values
of traumatic injuries was higher among
study group as compared to the
control.
Table (11 and 12) illustrate plaque,
gingival and calculus indices for the
study and control groups respectively.
Statistically, for study group a nonsignificant difference was found
between different age groups. The
differences between male and female
were not significant. Similar results
were revealed concerning the control
group.
Table (13) shows a comparison
between study and control groups at
different age groups regarding oral
hygiene indices, a highly significant
differences were found concerning
plaque, and gingival indices (PlI; ttest= 51.377, GI; t-test=35.856,
df=114, P <0.001), the values of
plaque and gingival indices were
higher among study group compared to
the control. For calculus index, a
significant difference was seen
between study and control group
between different age groups (ttest=3.397, df =114, P< 0.05), calculus
among study group was higher than
that of the control group. The treatment
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Discussion
Sample size and proportion of the
blind subjects was not representative as
the total population of the blind
children and young adults in Iraq were
not examined. This is the first
comprehensive oral health survey of
the blind population in Iraq; this survey
reinforces and adds information
pertaining to differences in prevalence
of disease between blind and normal
children. In the present study,
differences in the prevalence of the
dental conditions assessed among blind
and normal were significant. An
evaluation of the DMFT and dmft
scores revealed that the study group
had a much lower mean DMFT and
dmft components than the control
group did. The lowest caries
experience observed in the blind group
in the present study coincides with that
found in other studies (17, 18). The
reasons put forward for this difference
in caries increment may be various,
ranging from biochemical differences
in salivary buffering to differences in
living environment, dietary and
hygiene habits, different proportions of
salivary components and possible
differences in chemical composition of
the saliva compared to normal children
(18, 19)
, however, further studies are
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318
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implemented
children.
for
these
high-risk
References
1- Peter S. Essentials of preventive and
community Dentistry. 2nd ed. New Delhi.
2004; p. 459-463.
2- Gift H and Atchison K. Oral health,
health, and health- related quality of life.
Medical care 1995; 33(11): NS57-NS77
Supplement.
3- Fiske J, Davis D, Frances C, Gelbier S.
The emotional effects of tooth loss in
edentulous people. Br. Dent J 1998; 184:
90-93.
4- Locker D. The burden of oral disorders in
populations of older adults. Community
Dent Health 1992; 9: 1-5.
5- Titiyal S, Murthy G, Gupta S, Tandon R,
Vajpayee R. Causes and temporal trends
of blindness and severe visual impairment
in children in schools for the blind in
North India. Br. J. Ophthalmol. 2003; 87:
941-945.
6- Nunn J. Childhood disability. In: Pediatric
Dentistry. (ed. Welbury RR), Oxford
University Press, 1999; pp. 375-394.
7- Gilbert C, Foster A, Thylefors B.
Childhood blindness-a new form for
recording causes of visual loss in children.
Bull World Health Organ 1993; 71: 485
89.
8- Thylefors B, Negrel A, Pararajasegaram
R. Available data on blindness.
Ophthalmic Epidemiol 1995; 2: 539.
9- Menacker S, Batshaw M. Vision: our
window to the world. In: Children with
disabilities. 4th ed. (ed. Batshaw ML), Paul
Brookes publishing company, USA. 2000;
pp. 211-239.
10- Schembri A, Fiske J. The implications of
visual impairment in an elderly population
in recognizing oral disease and
maintaining oral health. Spec Care Dent
2001; 21: 222-226.
11- Chang C. and Shih Y. Knowledge of
Dental Health and Oral Hygiene Practices
of Taiwanese Visually Impaired and
Sighted Students. Journal of Visual
Impairment and Blindness. 2004; 98:5.
12- World Health Organization. Oral Health
Surveys: Basic methods. IV edition.
Geneva; 1997.
13- Sillness J, Le H. Periodontal disease in
pregnancy. II. Correlation between oral
hygiene and periodontal condition. Acta
Odont Scand 1964; 22: 121-135.
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10-13
<13
Total
Sex
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
Study group
No.
%
11
9.48
10
8.63
21
18.11
14
12.07
12
10.34
26
22.41
5
4.31
6
5.17
11
9.48
30
25.86
28
24.14
58
50.00
Control group
No.
%
11
9.48
10
8.63
21
18.11
14
12.07
12
10.34
26
22.41
5
4.31
6
5.17
11
9.48
30
25.86
28
24.14
58
50.00
Total
No.
22
20
42
28
24
52
10
12
22
60
56
116
%
18.96
17.26
36.22
24.14
20.68
44.82
8.62
10.34
18.96
51.72
48.28
100.00
Table (2): Caries- experience of permanent teeth (DMFT) among study group by age
and gender.
Age
(year)
6-9
10-13
<13
Total
Sex
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male and female
D
Mean
0.90
1.10
1.00
1.50
2.00
1.73
1.80
2.33
2.09
1.53
M
SD
1.38
1.10
1.22
1.16
1.28
1.22
1.16
1.28
1.51
1.33
Mean
0.36
1.00
0.62
0.71
0.58
0.56
0.80
1.66
1.27
0.76
320
F
SD
0.92
1.05
1.20
1.14
0.98
1.06
0.84
1.63
1.35
1.17
Mean
0.00
0.30
0.14
0.07
0.16
0.11
0.20
0.17
0.18
0.14
SD
0.00
0.48
0.36
0.27
0.39
0.33
0.45
0.41
0.40
0.35
DMFT
Mean
SD
1.27
1.49
2.10
1.29
1.66
1.43
2.28
1.14
2.75
0.87
2.50
1.03
2.80
0.84
4.16
1.17
3.54
1.21
2.40
1.38
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Table (3): Caries- experience of permanent teeth (DMFT) among control group by
age and gender.
Age
(year)
Sex
6-9
10-13
<13
Total
M
Mean
SD
Mean
SD
Male
1.18
1.25
0.09
Female
Total
Male
Female
Total
Male
Female
Total
Male and female
1.40
1.28
2.21
2.08
2.15
3.80
3.66
3.72
2.14
1.17
1.19
1.12
1.31
1.19
1.87
0.82
1.10
1.43
0.10
0.10
0.14
0.25
0.19
0.20
0.16
0.18
0.16
DMFT
Mean
SD
Mean
SD
0.30
1.18
1.33
2.45
1.81
0.32
0.30
0.36
0.45
0.40
0.45
0.41
0.40
0.37
1.60
1.38
0.79
1.50
1.12
1.40
1.50
1.45
1.28
1.26
1.28
1.12
0.90
1.07
1.34
0.84
1.04
1.14
3.10
2.76
3.14
3.83
3.46
5.40
5.33
5.36
3.57
0.57
1.37
0.86
1.47
1.21
0.55
0.52
0.50
1.49
Table (4): Statistical differences in DMFT between study and control groups.
Study
DMFT
DT
MT
FT
Control
t = 4.406**
DMFT
t =2.354 *
DT
t = 3.737**
MT
t =7.293 **
FT
df = 114, * Significant P<0.05, ** Highly Significant P<0.001.
Table (5): Caries- experience of deciduous teeth (dmft) among study group by age and
gender.
Age (year)
6-9
10-13
<13
Total
Sex
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male and female
Mean
0.81
1.60
1.19
0.78
1.08
0.92
0.00
0.00
0.00
0.84
m
SD
0.98
0.97
1.03
0.70
1.08
0.89
0.00
0.00
0.00
0.95
Mean
0.27
0.20
0.23
0.14
0.33
0.23
0.00
0.00
0.00
0.19
321
f
SD
0.65
0.63
0.62
0.36
0.78
0.59
0.00
0.00
0.00
0.54
Mean
0.18
0.10
0.14
0.14
0.17
0.15
0.00
0.00
0.00
0.12
dmft
SD
0.40
0.32
0.36
0.36
0.58
0.46
0.00
0.00
0.00
0.38
Mean
1.27
1.90
1.57
1.07
1.58
1.30
0.00
0.00
0.00
1.16
SD
0.79
0.88
0.87
0.62
0.90
0.79
0.00
0.00
0.00
0.93
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Table (6): Caries- experience of deciduous teeth (dmft) among control group by age
and gender.
Age (year)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Mean
1.54
2.30
1.90
1.21
1.50
1.34
0.00
0.00
0.00
SD
1.04
0.82
0.99
1.12
1.38
1.23
0.00
0.00
0.00
Mean
0.36
0.30
0.33
0.35
0.66
0.50
0.00
0.00
0.00
SD
0.50
0.48
0.48
0.74
1.30
1.03
0.00
0.00
0.00
Mean
0.18
0.30
0.23
0.28
0.33
0.30
0.00
0.00
0.00
SD
0.40
0.67
0.54
0.83
0.89
0.84
0.00
0.00
0.00
1.29
1.21
0.34
0.76
0.22
0.65
6-9
10-13
<13
Total
Sex
dmft
Mean
SD
2.09
0.83
2.90
0.57
2.47
0.81
1.85
0.77
2.50
0.80
2.15
0.83
0.00
0.00
0.00
0.00
0.00
0.00
1.86
1.18
Table (7): Statistical differences in dmft between study and control groups.
Study
dmft
Control
dmft
dt
mt
ft
t = 3.586**
t =2.213*
dt
mt
t =1.262
ft
t =1.048
Table (8): Number and percentage of subjects in study group with traumatic injury.
Age (year)
6-9
10-13
<13
Total
Sex
Number of individuals
percentage
Male
Female
Male
Female
Male
Female
Male and female
11
10
14
12
5
6
58
1(9.1)
322
0(0)
2(14.3)
1(8.3)
2(40)
0(0)
6( 10.3)
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Table (9): Number and percentage of subjects in control group with traumatic injury.
Age (year)
6-9
10-13
<13
Total
Sex
Number of individuals
percentage
Male
Female
Male
Female
Male
Female
Male and female
11
10
14
12
5
6
58
0(0)
0(0)
1(7.1)
0(0)
1(20)
0(0)
2(3.4)
Table (10): Statistical difference in traumatic injuries between study and control
groups.
Study
Traumatic injury
Control
t = 2.047*
Traumatic injury
Table (11): Plaque, gingival and calculus indices (means and standard deviation) of
study group by age and gender.
Age (year)
6-9
10-13
<13
Total
Sex
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male and female
PLI
Mean
SD
2.13
0.09
2.08
0.08
2.11
0.09
2.11
0.10
2.11
0.11
2.11
0.10
2.18
0.05
2.11
0.06
2.14
0.07
2.12
0.09
GI
Mean
2.01
2.04
2.03
2.12
2.11
2.11
2.15
2.01
2.08
2.08
CaI
SD
0.07
0.05
0.06
0.10
0.11
0.10
0.10
0.08
0.11
0.18
Mean
0.00
0.02
0.01
0.05
0.06
0.05
0.10
0.05
0.07
0.04
SD
0.00
0.06
0.04
0.09
0.12
0.11
0.10
0.08
0.09
0.09
Table (12): Plaque, gingival and calculus indices (means and standard deviation) of
control group by age and gender.
Age (year)
6-9
10-13
<13
Total
Sex
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male and female
PLI
Mean
1.06
1.10
1.08
1.16
1.11
1.14
1.16
1.17
1.17
1.13
GI
SD
0.10
0.11
0.10
0.13
0.13
0.13
0.05
0.11
0.08
0.12
323
Mean
1.07
1.05
1.06
1.17
1.12
1.14
1.16
1.18
1.17
1.04
CaI
SD
0.21
0.15
0.18
0.13
0.13
0.13
0.05
0.11
0.08
0.13
Mean
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.02
0.01
0.001
SD
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.04
0.03
0.01
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Table (13): Statistical differences in Plaque, gingival and calculus indices between
study and control groups.
Study
Plaque index
Control
Gingival index
Calculus index
t = 51.377**
Plaque index
t =35.856**
Gingival index
t =3.397*
Calculus index
Table (14): Number and percentage of subjects in study group in need of any type of
dental care.
Age
group
No. of
individuals
Pit and
fissure
sealants
(%)
One
surface
filling
(%)
Two
surface
s filling
(%)
Crowns
(%)
Veneers
(%)
Pulp
care
(%)
Extraction
(%)
6-9
21
10(17.2)
1(1.7)
1(1.7)
0(0)
0(0)
4(6.9)
5(8.6)
10-13
26
6(10.3)
2(3.4)
4(6.9)
0(0)
0(0)
6(10.3)
8(13.8)
>13
11
2(3.4)
1(1.7)
0(0)
0(0)
5(8.6)
3(5.2)
Total
58
18(31)
6(10.3)
0(0)
0(0)
15(25.9)
16(27.6)
0(0)
3(5.2)
Table (15): Number and percentage of subjects in control group in need of any type of
dental care.
21
26
Pit and
fissure
sealants
(%)
8(13.8)
4(6.9)
One
surface
Filling
(%)
5(8.6)
7(12.1)
Two
surfaces
filling
)%)
5(8.6)
9(15.5)
>13
11
0(0)
3(5.2)
Total
58
12(20.7)
15(25.9)
Age
group
No. of
individual
s
6-9
10-13
Crowns
(%)
Veneers
(%)
Pulp care
(%)
Extraction
(%)
0(0)
0(0)
0(0)
0(0)
1(1.7)
2(3.4)
2(3.4)
4(6.9)
5(8.6)
0(0)
0(0)
1(1.7)
2(3.4)
19(32.8)
0(0)
0(0)
4(6.9)
8(13.8)
324