Effect of visual impairment upon oral health care: a review

Association between intrinsic capacity and oral health in older patients in a frailty clinic

PURPOSE

This study aimed to investigate how intrinsic capacity (IC) deficit is associated with oral functional decline.

METHODS

This cross-sectional study enrolled older adults at a research hospital frailty clinic between July 2021 and May 2023. IC evaluation included the locomotion, cognition, vitality, psychology, and sensory domains. Criteria for deficits were established within each domain, and the number of IC deficit domains was calculated for each patient. Oral function assessment included oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Patients who met three or more criteria were classified into the oral hypofunction (OHF) group. Univariate and multivariate logistic regression analyses were performed to investigate the relationship between IC deficit and OHF.

RESULTS

Of 222 included patients (mean age 78.3 ± 6.3 years; 39.6% men), 105 (47.3%) met the criteria for OHF. This OHF group showed a significantly higher prevalence of locomotion, cognition, psychology, and sensory domain deficits than the normal oral function group. Multivariate analysis adjusted for age and sex revealed a significant association between IC deficits and OHF (odds ratio [OR], 1.33; 95% confidence interval [CI] 1.04-1.70). A significant association was also observed between the locomotion domain and OHF (OR, 2.06; 95% CI 1.13-3.76).

CONCLUSION

This study highlights the potential relationship between the number of IC domain deficits and oral functional decline, with the most significant domain being locomotion. Furthermore, it suggests a possible link between sensory and oral function.

Oral Health Status and Oral Health-Related Behaviours of Hong Kong Students with Vision Impairment

This cross-sectional epidemiological study aimed to describe dental caries and oral hygiene conditions among visually impaired students in Hong Kong. Students aged 6-21 years from two specialised schools for those with vision impairment were invited. Information on sociodemographic background and oral health-related behaviours was collected through an online parent-reported questionnaire. Dental caries and oral hygiene were assessed using the Decayed, Missing and Filled Teeth (DMFT) index and the Visible Plaque Index (VPI), respectively. Chi-square, Mann-Whitney U and Kruskal-Wallis H tests were conducted to analyse the association between students' background and oral health status. A total of 73 participants were recruited, of whom 57.5% were male. Their mean (SD) age was 12.9 (4.7) years. Their mean DMFT score (SD) was 1.0 (1.8), and 43.8% had caries experience. The mean VPI (SD) was 0.76 (0.30). Their caries experience was significantly associated with their snacking habits (p = 0.013). Male participants had poorer oral hygiene than females (p = 0.048). In summary, dental caries is prevalent among visually impaired students in Hong Kong and their oral hygiene condition is unsatisfactory. Caries experience is significantly associated with snacking frequency, whereas oral hygiene is associated with gender. More specially designed preventive oral health measures should be provided for visually impaired students and their caretakers.

Influence of visual acuity, manual dexterity and handgrip strength on oral and denture hygiene ability of non-frail older people: Development of the Gerostomatological Assessment Battery

BACKGROUND

Due to the heterogeneity of older people, it is difficult to identify reliable factors influencing oral health.

OBJECTIVE

The aim was to illustrate the influence of visual acuity, manual dexterity, and handgrip strength on the oral and denture hygiene ability of older non-frail people.

METHODS

In a cross-sectional study, conducted at a specialized dental clinic, at baseline, all participants received professional prophylaxis and instruction on daily oral and denture hygiene regimes for a 6-week intervention period. Data on the Quigley and Hein modified plaque index (QHI), respectively, the Denture Hygiene Index (DHI), visual acuity, manual dexterity and handgrip strength in non-frail participants (≥ 65 years) were collected. Recruitment was done within the clinic's patient clientele and within the staff (control cohort).

RESULTS

Women showed significantly better manual dexterity than men (Mann-Whitney U, p = .01), while women's mean handgrip strength was significantly lower (Mann-Whitney U, p < .01). Manual dexterity (Mann-Whitney U, p = .003) and handgrip strength (Mann-Whitney U, p = .052) were associated with age. However, visual acuity, manual dexterity and handgrip strength had no influence on oral or denture hygiene.

CONCLUSION

Visual acuity, manual dexterity and handgrip strength have no influence on oral and denture hygiene ability in older non-frail people. Further studies should investigate whether these factors also have no influence on oral and denture hygiene in vulnerable older patients. Therefore, an assessment tool for the evaluation of potential influencing factors of oral and denture hygiene is proposed in a dental context. This Gerostomatological Assessment Battery (G-AB) can be used as a helpful tool to check the individual cognitive function and comprehension, dental therapy approaches and their individual adaption.

Oral health status of students with visual or hearing impairments in Northeast China

BACKGROUND

Visual or hearing impairments in students seriously affect their quality of life. The aim of this study was to identify oral hygiene status and its influencing factors on visual or hearing impairments in students in Northeast China.

METHODS

This study was conducted in May 2022. A total of 118 visually impaired students and 56 hearing impaired students from Northeast China were included in this study via census. Oral examinations and questionnaire-based surveys of students and their teachers were conducted. The oral examinations included caries experience, prevalence of gingival bleeding and dental calculus. The questionnaires included three parts: Social demographics (residence, sex and race) and parents' educational level; Oral hygiene habits and medical treatment behaviors; Knowledge and attitudes towards oral health care. This questionnaire was selected from the Fourth China National Oral Health Survey and the reliability and validity of the questionnaire were previously tested. T tests, one-way ANOVA, χ² tests and multivariate logistic analyses were conducted to evaluate the differences and dependent variables of dental caries.

RESULTS

The prevalence of dental caries in visually impaired and hearing impaired students were 66.10% and 66.07%. The mean number of DMFT, prevalence of gingival bleeding and dental calculus in visually impaired students were 2.71 ± 3.06, 52.08% and 59.38%, respectively. The mean number of DMFT, prevalence of gingival bleeding and dental calculus in hearing impaired students were 2.57 ± 2.83, 17.86% and 42.86%, respectively. The results of the multivariate logistic analysis showed that fluoride use and parents' educational background had an impact on the caries experience of visually impaired students. The daily toothbrushing frequency and parents' educational background had an impact on the caries experience of hearing impaired students.

CONCLUSIONS

The oral health situation of students with visual or hearing impairments remains severe. It is still necessary to promote oral and general health in this population.

Oral health status and dental care for individuals with visual impairment. A narrative review

Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals' skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.

Dental Care for Older Adults

There is a global increase in the older population. Unfortunately, dental conditions in the older population can sometimes be poor as a result of worsened physical conditions and the cumulative damage caused by dental diseases in the past. Many suffer from oral diseases such as dental caries and periodontal disease but receive no regular dental care. Oral conditions and systemic problems are interrelated. Chronic medical problems and polypharmacy are common among them. These conditions may lead to xerostomia with or without a decrease in saliva output. Additionally, many older adults have deteriorated masticatory function associated with physical health issues such as frailty. Preventive measures are crucial to stop oral diseases from progressing and the replacement of missing teeth is needed when masticatory function is impaired. Older adults also suffer a higher risk of oral cancer because of their less resilient but more permeable oral mucosa. With the increasing need for elderly dental care, dentists should equip themselves with knowledge and skills in geriatric dentistry. They should help older adults to develop and maintain the functional ability that enables well-being in older age. This communication article aims to discuss the relevant medical conditions, common dental diseases, and dental care for older adults.

Oral hygiene status, malocclusion and dental trauma among institutionalized visually impaired and sighted adolescents in Lagos State, Nigeria

AIM

To compare prevalence of oral hygiene status, dental trauma and malocclusion among institutionalized visually impaired (VI) and non-visually impaired (NVI) adolescents in Lagos State, Nigeria.

METHODS AND RESULTS

A cross sectional study conducted among institutionalized VI and NVI adolescents in Lagos State, Nigeria. One hundred and thirty-two randomly selected VI adolescents aged between 9 and 23 years and 138 NVI participants aged between 9 and 17 years were recruited using a multi-stage random sampling technique. Oral examination assessed oral hygiene status, dental trauma and malocclusion. Data entry and analysis was by SPSS version 20. Associations were analyzed using chi-square test. Statistical significance was set at p < .05. Male to female ratio among the VI and NVI participants, were 1.5:1 and 1:3, mean ages were 15.03 ± 3.36 and 12.96 years ± 1.89 SD, prevalence of dental injury were 16.67% and 7.2% and malocclusion were 15.2% and 11.6% respectively. More of the NVI participants had good oral hygiene status (29.0%).

CONCLUSION

Uncomplicated dental injury was more prevalent among the VI male participants than their NVI counterparts while malocclusion was significantly less among the NVI participants. There is an urgent need for the development of policy and protocol on oral health of persons with special needs.

Dental management of patients with sensory impairments

This article discusses the different types of sensory impairments and their aetiology. It considers how the oral health status in patients with sensory impairments is impacted by their disability and the barriers these patients face in dental care. It also discusses legislation relevant to dental care professionals when caring for patients with disabilities, including the Mental Capacity Act (2005), the Equality Act (2010) and the Accessible Information Standard (2016). Finally, it provides recommendations to dental care professionals on how they can best manage patients with sensory impairments and communicate with them effectively in order to provide them with quality dental care.

New vision for improving oral hygiene status of visually impaired students aged from 9 to 17 years

Background:

Visually impaired patients are at a higher risk of developing periodontal disease because of greater difficulty in attaining good oral hygiene. This study aims to assess and compare the oral hygiene status of visually impaired students before and after oral health education interventions using special customized methods.

Methods:

The present study was a randomized control trial of 180 visually impaired students divided into three groups. Each group includes 60 students selected randomly from blind school. Oral health education was given using Braille in Group 1, Audio Tactile performance (ATP) technique in Group 2, and a combination of Braille and ATP technique in Group 3. Plaque index (PI) scores and gingival index (GI) scores were calculated and evaluated at baseline and after 3 months. Intergroup comparison and intragroup comparison of PI and GI at baseline and 3 months was by using one way ANOVA and Paired t test, respectively.

Results:

There was a highly significant difference seen for the intergroup comparison of post PI (P < 0.01) and post GI (P < 0.01) with least mean in Group 3. There was a statistically highly significant difference seen for the intra group comparison of pre and post PI and GI (P < 0.01) with lesser means in post as compared to pre in all three groups.

Conclusions:

Visually impaired children could maintain an acceptable level of oral hygiene when taught using combination of Braille and ATP technique.

Estimation of Dental Anxiety Levels Before and After Dental Visit in Children with Visual Impairment Using Modified Dental Anxiety Scale in Braille Text

Objective:

Dental anxiety and fear of dental treatment in special children has been recognized as a public health dilemma. Dental anxiety (being the fear of unknown in a dental setting) would definitely have a substantial effect on the children with visual impairment. Assessment of the dental anxiety makes it possible to design intervention programs aimed at reducing the anxiety levels in children with visual impairment. Thus, the aim of this study was to assess the dental anxiety levels before and after dental visit in children with visual impairment using Modified Dental Anxiety Scale (MDAS) printed in braille.

Materials and Methods:

A total of 144 institutionalized children with visual impairment in the age group of 6–13 years, residing at an institutionalized blind school, participated in the study. Dental anxiety was assessed pre- and post-dental-screening visit using MDAS printed in braille. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test.

Results:

Of 144 children, just before dental screening visit, 78 (54.1%) had severe dental anxiety, 52 (36.11%) had mild anxiety, and 14(9.72%) reported no anxiety, whereas after dental education, only 28 (19.44%) had severe anxiety, 22 (16.66%) had mild anxiety, and 94 (63.88%) reported no anxiety.

Conclusion:

In our study, there was a significant decrease in dental anxiety after dental screening and education. Therefore, proper behavior management techniques and dental health education programs would decrease dental anxiety in children with visual impairment.

Effectiveness of braille and audio-tactile performance technique for improving oral hygiene status of visually impaired adolescents

Background:

Visually impaired people encounter numerous challenges in their daily life which makes it a cumbersome task to pay special attention to oral health needs. Furthermore, there is little knowledge about oral health practices among caretakers and visually impaired individuals, due to which oral health is often neglected when compared to the general health. Hence, there was a need to educate visually challenged individuals about oral hygiene practices in a customized format so that the comprehension of brushing techniques could be conveyed at its best.

Materials and Methods:

The present study was a randomized control trial of sixty visually impaired adolescents who were divided into three groups of 20 each. In Group 1, Braille was used, whereas in Group 2, audio-tactile performance (ATP) technique and in Group 3, a combination of both the methods were used to teach tooth brushing as a part of oral health education. Pre- and post-plaque index score using Silness and Loe (1967) after health education were calculated and tabulated for statistical analysis.

Results:

The postintervention mean plaque index score increased in Group 1 from 29.45 to 42.98, whereas the mean plaque score decreased in Groups 2 and 3 from 30.83–29.9 to 30.23–18.73, respectively. Intergroup comparison of postplaque index score using Kruskal–Wallis and ANOVA analysis showed significant difference among all three study groups.

Conclusion:

The combination of Braille and ATP technique of health education served as the most effective medium to teach oral hygiene methods to visually impaired adolescents.

Relationship between periodontal status and degree of visual impairment in institutionalized individuals

Objective:

Periodontal disease is a set of inflammatory infections that affect the supporting structures of the dentition. Patients with visual impairment (VI) may have more difficulty in cleaning and maintaining oral health. The purpose of this study was to investigate the possible relationship between periodontal status and degree of VI in institutionalized individuals.

Materials and Methods:

Fifty-two visually impaired individuals were included in this cross-sectional study. The periodontal parameters assessed were clinical attachment level (CAL), probing depth (PD), and visible plaque index. The degree of VI was established as: Group 1 (mild or moderate VI), Group 2 (severe or profound VI), and Group 3 (completely blind); and the types of VI were considered as congenital and acquired. Fisher's exact, Kruskal–Wallis, Mann–Whitney, and Spearman correlation coefficient test were used. The level of significance was set at 5%.

Result:

Only plaque index was higher on proximal surfaces of subjects with mild/moderate VI when compared to the other degrees of VI (P = 0.01). Furthermore, we observed higher values for interproximal CAL (P = 0.01), total PD (P = 0.04), and interproximal PD in subjects with acquired VI when compared to subjects with congenital VI (P = 0.01).

Conclusions:

These findings suggest that periodontal status may be more related to the type of disability than with the degree of VI. Acquired VI people presented a worse periodontal health than the group with congenital VI.

Oral health-care utilization in adults with disabilities in Belgium

Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.

To evaluate the comparative status of oral health practices, oral hygiene and periodontal status amongst visually impaired and sighted students

The aim of this study was to evaluate the comparative status of oral health practices, oral hygiene, and periodontal status amongst visually impaired and sighted students. In this study, 142 visually impaired children from a blind school in the age group of 6-18 years were enrolled with a similar number of age and sex matched sighted students studying in different schools of Chandigarh. The outcome variables were oral hygiene practices, oral hygiene status, and periodontal status. The visually impaired had been found to have better oral hygiene practices, a nonsignificant difference of oral hygiene scores but a significantly high value for bleeding scores as compared to sighted students. Age wise comparisons showed that bleeding scores were highly significant in 9-11 years and 12-14 years age group as compared to 6-8 years and 15-18 years age group. It could be related that the increased prevalence of bleeding sites despite of better oral hygiene practices in visually impaired group might be the result of their handicap to visualize plaque.

Oral health care utilization in children with disabilities

OBJECTIVES

The objectives of this report were to survey the utilization of oral health care in children and adolescents with disabilities over a 7-year period and to compare these data with the utilization pattern of their peers without disabilities. For most countries, these data have not been published in the international literature so far.

MATERIAL AND METHODS

The cohort used was the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents. The database comprised prospective data on oral and general health care utilization and sociodemographic variables collected from 2002 up to 2008.

RESULTS

Data were available from 326 children and adolescents with and 53,589 without disabilities. Dental attendance rates were low in both subgroups: only 50 % had a dental visit in four or more of the seven observation years. Emergency oral and medical care was recorded significantly more often in children with disabilities whereas radiographs, restorations, and orthodontic assessments and treatments more frequently in children without disabilities.

CONCLUSION

The present study demonstrated that dental attendance rates in both subgroups were low and that in those who attended, preventive oral health care was only infrequently attested. Further research is needed to elucidate whether the lower number of radiographs and restorations and the higher number of emergency visits observed in the subgroup with disabilities reflect unmet oral treatment needs.

CLINICAL RELEVANCE

Objective data on health care utilization are essential to enable governments and stakeholders to devise appropriate care and to optimize access to care for persons with disabilities.