The opportunities in implementing assistive technology in oral health care for individuals with sensory impairments: a systematic review

PURPOSE

People with sensory impairments (SI) face unique challenges in out-of-home care, especially in oral health (OH) care, compared to the general population. Various assistive technologies (ATs) and media are used to influence OH behaviors and outcomes for individuals with SI. This systematic review (SR) aimed to identify the types of ATs and assess their effectiveness for individuals with SI.

METHODS

A comprehensive search strategy was applied across Scopus, PubMed, Cochrane Library, ProQuest, and Scopus databases, using expert-validated keywords, with manual searches for relevant articles published from June 2013 to June 2023. The SR followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies focused on the use of ATs as OH education tools for individuals with SI and assessed their impact on OH behavior and status.

RESULTS

Eighteen of the 1298 identified studies were included in the data synthesis. ATs, such as images, software, multimedia, audio, video, audio-tactile performance, and combination methods, were effective for OH care in individuals with SI. However, this SR limitations include study heterogeneity in sample sizes, intervention types, and outcomes, as well as the exclusion of non-English studies.

CONCLUSIONS

Oral health education using a combination of video training and audio-tactile performance is particularly effective for individuals with SI, engaging multiple senses for learning. Future research should focus on standardizing methodologies and incorporating larger sample sizes to enhance the efficacy of these technologies in improving OH care for individuals with SI. PROSPERO REG. NO.: CRD42023485523.

Effectiveness of Braille and ATP Technique in Improving Oral Hygiene Status of Visually Impaired Children: An Interventional Study

AIM

The study aimed to subject two groups of visually challenged children to Braille and audio-tactile performance (ATP) techniques of oral health education and compare the effectiveness of each technique through a comparison of OHI-S index scores.

MATERIALS AND METHODS

30 visually challenged children of 6-12 years belonging to a Government-aided blind school were divided into two study groups based on the method of oral health education (n = 15). Group I received oral hygiene instructions in Braille while group II received instructions through audio clips, tactile sensations of tooth models, and closely supervised performance of brushing technique. OHI-S index was measured pre- and 2 months postintervention and compared between groups. Data was recorded and statistically analyzed.

RESULTS

At the end of the study, both the groups showed a decrease in mean OHI-S index scores (Braille-1.286 vs 0.903; ATP-1.364 vs 1.058). No statistically significant difference was observed between the groups indicating that no method was superior or more effective to the other. No statistically significant difference was observed between males and females as well.

CONCLUSION

Improvement in oral hygiene was exhibited by both the groups at the end of the study and the groups did not significantly differ from each other. No difference was found between males and females in each group.

CLINICAL SIGNIFICANCE

By adapting oral health education methods appropriate for the visually challenged children and providing regular reinforcements of the same, the oral hygiene status of this vulnerable population could be improved bringing equity in oral health and realizing the goal of inclusive dentistry. How to cite this article: Siddique KPS, Minimol Z, Kumar K, et al. Effectiveness of Braille and ATP Technique in Improving Oral Hygiene Status of Visually Impaired Children: An Interventional Study. J Contemp Dent Pract 2024;25(9):851-855.

Effectiveness of Audio-Tactile Performance Versus Other Oral Health Education Methods in Improving Oral Health in Visually Impaired Children and Adolescents: A Systematic Review

The aim of this study was to compare the effectiveness of audio-tactile performance (ATP) versus other oral health education methods in improving the oral health status of visually challenged children and adolescents. The review was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was performed on the effectiveness of ATP in improving the oral health of visually impaired children. The search was conducted in Scopus, Google Scholar, PubMed, Embase, Lilacs, Web of Science, and Cochrane until December 2022. The risk-of-bias tool for randomized trials (RoB-2) was used to analyze the risk of bias. Meta-analysis was carried out for included studies that made similar comparisons and reported the same outcome measures. The initial search retrieved 368 records, of which nine studies were included for qualitative synthesis. Out of the nine included studies, five studies were included for quantitative synthesis. Two studies evaluating plaque index at 180 days (MD = -0.10; p = 0.0009; CI = -0.17 to -0.02) and five studies evaluating gingival index at 90 days (MD = -0.15; p < 0.00001; CI= -0.21 to -0.09) exhibited a significant mean difference favoring ATP. Three studies that evaluated gingival index at 30 days and 180 days showed significant mean differences (MD = -0.27; p < 0.000; CI = -0.40 to -0.15 and MD = -0.09; p = 0.01; CI= -0.15 to -0.02) favoring ATP. The ATP technique produced significant improvements in oral health when compared with other conventional techniques. However, the studies had high heterogeneity, and hence, the result must be inferred with caution.

Oral health in youth with visual impairment: A longitudinal survey

This longitudinal survey aims to demonstrate improvement in oral hygiene among a group of youth with visual impairment (VI) achieved by repeated oral hygiene training, compare their progress with healthy peers (CG) and assess their oral health knowledge. In 100 VI (55♀, 45♂; ± 17.8 years) and 45 CG (23♀, 22♂; ± 17.2 years) oral hygiene training and a Quigley-Hein Plaque Index (QHI) rating were repeated six times at three-month intervals. The VI were divided into four subgroups according to the toothbrush hardness/type. A questionnaire was given to both groups. Appropriate statistical analyses were performed at 5% significance level. Both groups showed reduction in QHI, the VI had overall higher QHI values than CG. Use of an electric toothbrush in VI led to lower QHI in the last examination (p < 0.03). 69% of participants recommended dental specialists to improve communications by acquiring more illustrative aids. VI changed toothbrush less often (p < 0.02). A higher incidence of dental plaque was confirmed in VI compared to CG. After education and individual training, gradual plaque reduction has occurred in both groups. Using an electric toothbrush in VI resulted in better QHI outcomes. Repetitive preventive intervention in youth with VI helped them to adopt healthier oral hygiene habits.

The implications of oral health education interventions in providing oral hygiene care for individuals with visual impairment: A systematic review

INTRODUCTION

Individuals with visual impairment (VI) are doubly disadvantaged by their lack of vision and poor oral hygiene (OH). Implementing oral health education (OHE) interventions should be set as goals to improve OH status and prevent oral diseases. However, few studies have examined the specific teaching method of OH skills. This study aimed to identify the most influential OHE interventions enabling individuals with VI worldwide, especially those in countries where VI is most frequent, to maintain OH and improve knowledge and practices.

METHODS

An extensive literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis method. This study systematically searched electronic databases (PubMed via Medline, Cochrane, Embase, and Google Scholar) using expert-validated keywords, complemented by manual searches, to identify relevant articles published between April 1, 2012, and September 30, 2022.

RESULT

PICOS criteria were formulated for study inclusion. The bibliographical search identified 1485 articles, which were subsequently filtered. Two researchers separately screened the articles for eligibility and to reduce the risk of bias in the included studies. Finally, the most pertinent 21 articles were scrutinized for data synthesis.

CONCLUSION

Most studies identified combination methods, including customized educational demonstrations, as the best at improving OH status, knowledge, and practices. However, long-term, rigorously designed, and effective patient-centered communication trials, including those on innovative methods, are still needed for individuals with VI.

Comparison of Different Modes of Oral Health Education in Visually Impaired Children

To compare the effectiveness of various modes of oral health education in visually impaired children. A total of 100 students aged 8-15 years were included. The children were divided randomly into four groups. Children in Group I received oral hygiene instructions through Braille pamphlets. In Group II, children received instructions through nonvisual desktop access (NVDA). For children in Group III, both Braille and NVDA were used to deliver the instructions. Children included in Group IV served as controls, who did not receive any information in any form for the study period. After oral examination to record plaque and OHI-S scores, a questionnaire was given to the children to assess their knowledge scores. The same questionnaire was repeated after 1 month to reassess the knowledge score in different groups. Chi-square test, Wilcoxon test, and post hoc analysis tests were used. The mean plaque scores among the control group children at the follow-up were significantly higher (2.5 ± 0.64) than any other group. Similarly, the control group had higher mean oral hygiene simplified scores (1.75 ± 1.32) than the Braille (1.12 ± 0.65), NVDA (0.85 ± 1.38), and Braille + NVDA (0.2 ± 0.64) groups at follow-up. With regards to the mean total knowledge score, the control group scored the least (2.16 ± 1.46), while the Braille, NVDA, and Braille + NVDA groups scored 3.16 ± 1.43, 4.52 ± 1.12, and 6.36 ± 0.52, respectively. Combination of Braille and NVDA was found to be effective in educating and motivating visually impaired children regarding maintenance of oral hygiene.

Oral Hygiene Status, Salivary and Microbiological Parameters Among Visually Impaired and Normal-Sighted Children After Specialized Oral Health Education: An Interventional Study

Aim and objectives To assess oral hygiene status and salivary and microbiological parameters among 12 to 15-year-old visually impaired and normal-sighted children before and after oral health education (OHE). Methodology An interventional study was conducted among 25 visually impaired children (Group A) and 25 normal-sighted children (Group B) in the age range of 12 to 15 years. Simple random sampling was used to select the study participants. A questionnaire was designed to record socio-demographic data and the dietary habits of the children on pre-decided days. The oral hygiene practices and the Decayed Missing Filled Teeth (DMFT) index were recorded, and salivary physicochemical parameters for all the selected children were evaluated, followed by saliva collection for microbial analysis. After baseline assessment, the Audio-Tactile Performance technique for Group A and the animated visual performance technique for Group B children were used to impart OHE. Periodic assessments of salivary parameters were conducted at one-month and three-month intervals. Unpaired T test/Mann-Whitney U test, repeated measures analysis of variance (ANOVA)/Friedman test, followed by Bonferroni's post hoc test were carried out to determine the difference between and within groups, respectively. All statistical tests were performed at a significance level of 5%. Results Group A demonstrated a greater change in salivary pH (6.20 ± 0.41 to 6.96 ± 0.20), salivary buffering capacity (5.80 ± 0.82 to 7.20 ± 0.65), and Streptococcus mutans count (9.36 ± 0.41 to 8.7 ± 0.45 x 104 CFU/mL) when compared to Group B. Group B demonstrated a greater Lactobacillus acidophilus count reduction (7.96 ± 0.66 to 7.50 ± 0.64 x 104 CFU/mL) when compared to Group A. Conclusion The appropriate use of specialized OHE holds particular significance in the improvement of oral hygiene status and salivary parameters, along with a reduction in the bacterial count in both visually impaired children and normal-sighted children.

Effectiveness of Oral Health Education Interventions Using Braille on Oral Health among Visually Impaired Children: Proposal for a Systematic Review

To assess how oral health education (OHE) techniques using braille affect visually impaired children's awareness of oral health, oral hygiene status and practices, plaque, gingival health, and dental caries status. From 2010 to 2020, a thorough literature search will be conducted for studies in the English language using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Grey. Data extraction will be done after two reviewers extensively evaluate the papers for qualifying requirements. In accordance with the research designs, a quality evaluation of the chosen studies will be conducted. With the use of the program Review Manager 5.3, a meta-analysis will be completed.

Evaluation of oral health education programs for oral health of individuals with visual impairment: An umbrella review

AIM

To exemplify, summarize and critically appraise the systematic reviews (SRs) that evaluated different oral health education (OHE) interventions in individuals with visual impairment (VI).

METHODOLOGY

Six electronic databases were searched for SRs evaluating OHE programs in individuals with VI. The internal validity of the included SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool. The degree of overlap of the primary studies in the included SRs was calculated using the "corrected covered area (CCA)" approach.

RESULTS

Seven SRs were included in this umbrella review that included 30 primary studies with a CCA of 26% (very high overlap). Six of the included SRs were assessed to have critically low confidence in the results, whereas only one had moderate confidence.

CONCLUSIONS

A combination of various OHE methods for individuals with VI might be better than using one method alone to improve oral hygiene. There is no conclusive evidence that one OHE method is superior to others. However, the evidence of OHE in improving the outcomes related to dental trauma or caries is inconclusive. Furthermore, it appears that most of the evaluations of oral health programs come from limited parts of the world, and data from many other regions is lacking.

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.

Unleashing the most effective oral health education intervention technique for improving the oral hygiene status and oral health knowledge in visually impaired young individuals: A systematic review and meta-analysis

Appropriate oral health education (OHE) plays a vital role in prevention of oral diseases and would bridge the gap between dentists and visually impaired individuals. Hence, this systematic review was planned with an aim to evaluate effectiveness of various OHE techniques on the oral hygiene status and oral health knowledge of visually impaired young individuals. An electronic search extended to September 30, 2020 was conducted on PubMed, Wiley, ProQuest, ScienceDirect, Cochrane library, EBSCO, and Google Scholar. Two independent reviewers assessed the studies using a two-stage process; data were extracted according to PRISMA statement. Risk of bias assessment of selected studies was executed according to the study designs. Meta-analysis using the random-effects model was conducted for the outcomes for all oral health education techniques using STATASE 16.1 software. Hand and electronic search identified 3829 articles. After screening for titles and duplicates, 37 articles were retrieved, which were screened through abstract and full text. Of the 37 articles, 17 articles were included for qualitative synthesis, and out of that, 13 were for meta-analysis. Ten variations in oral health education (OHE) techniques were used in the included 17 studies to impart oral health education to visually impaired young individuals. Overall, all OHE techniques demonstrated a positive impact on oral hygiene status. The pooled overall cumulative mean difference of the oral hygiene status after imparting education in ATP, Audio, and Braille was 1.33 [1.06, 1.59], 1.76 [1.11, 2.42], and 1.96 [1.40, 2.55], respectively. An appropriate OHE technique boosts confidence in visually impaired young individuals, making the learning process an enjoyable experience. Use of either Braille or the ATP OHE technique was found to be a reliable and useful method to improve oral hygiene of visually impaired young individuals.

Interventions in improving the oral hygiene of visually impaired individuals: A systematic review

The deteriorated oral hygiene in visually impaired individuals has paved way for the emergence of different interventions for oral health promotion. This systematic review assessed the effectiveness of different interventions in improving the oral hygiene of visually impaired individuals. A search using PubMed, Cochrane Library, Science Direct, Wiley online and Scopus search engines published before September 2020 was carried out. Dental plaque, gingival status, oral hygiene status and improvement in knowledge status were assessed. The systematic review consisted of nine studies fulfilling the eligibility criteria and seven studies after checking for quality of evidence. The interventions significantly improved plaque scores, gingival and oral hygiene status, as well as the knowledge of visually impaired individuals. The combination of two or more interventions was reported to be better in improving oral health when compared with the individual interventional techniques for visually impaired individuals.

Effectiveness of oral health education methods on oral hygiene in children and adolescents with visual impairment: A systematic review

BACKGROUND

Conventional methods of oral health education (OHE) are not suitable for children with visual impairment, as these methods usually involve visual demonstration with models or plaque-disclosing dyes.

AIM

To systematically review the literature to support the best approach for providing OHE to children and adolescents with visual impairment.

DESIGN

A systematic search of five electronic databases and grey literature was conducted. Randomized controlled trials that compared different OHE methods in children and adolescents with visual impairment were included. The Cochrane risk-of-bias tool (RoB 2) was used for the risk-of-bias assessment. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to determine the certainty of evidence.

RESULTS

Nine randomized controlled trials with a total of 804 participants were included in this review. Seven OHE methods were compared. Seven studies were assessed to be at high risk of bias, one study was assessed to have some concerns, and one study was assessed to be at low risk of bias. The overall certainty of evidence was very low according to GRADE.

CONCLUSION

There was insufficient evidence to recommend a particular method of OHE as more effective in improving the oral hygiene of children with visual impairment, but combination methods may show similar or better results.

A systematic review of oral health educational media innovation for visually impaired children: Which one brings the best impact of change?

AIM

Various innovations of oral health education media were used to bring an impact on oral health behavior and status among visually impaired children. This paper was aimed to systematically investigate which innovation brings the best impact of change.

METHODS

A systematic searching strategy in Scopus, PubMed, ProQuest, ScienceDirect, EBSCO, SAGE, and Cochrane Library database was applied in this study, then followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Studies from the last 10 years that investigate the innovation of oral health education media for visually impaired children and its impact on change were included.

RESULTS

Of 653 studies identified, 10 were included in the data synthesis. Audio, Braille, audio-tactile performance, verbal, tactile, or combinations were found to be utilized as the alternative media innovation of oral health education for visually impaired children. The combination of two or more media brings the best impacts of oral health behavior and oral health status among them.

CONCLUSIONS

The combination of oral health education media may involve various senses of learning. Due to its impact on the improvement of oral health behavior and status among visually impaired children, this innovation should be chosen.

Effectiveness of oral health educational interventions on oral health of visually impaired school children: A systematic review and meta-analysis

AIM

To evaluate the effect of newer and traditional oral health education (OHE) methods in improving oral health knowledge, oral hygiene status and practices, plaque, gingival, and dental caries status of visually impaired children.

METHODOLOGY

Comprehensive literature search was performed by using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google scholar, and Open Gray from 2010 to 2020 for studies in English language. Two reviewers critically assessed the studies for eligibility criteria, and data extraction was performed. Quality assessment of selected studies was executed according to the study designs. A meta-analysis was carried out using Review Manager 5.3 software.

RESULTS

Twenty-four articles were included for qualitative synthesis and out that 11 in meta-analysis. Cumulative standardized mean difference for plaque (Silness and Loe, 1964) and gingival index (Loe and Silness, 1963) was -0.45 (-0.88, -0.02, p = 0.04) and -0.54 (-1.10, 0.03, p = 0.06), respectively favoring newer OHE group as compared to traditional OHE group. Comparison of different newer OHE methods had similar effects on the oral health of visually impaired children.

CONCLUSION

The study period of included studies was short-term, so long-term effectiveness could not be assessed, however newer OHE methods were effective in improving plaque and gingival scores over a short period.

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.

Factors predicting the oral health behaviors of the Iranian students in the District 1 Tehran, Iran

Aim: The purpose of this examination is determining the predictors of oral health behaviors among Iranian students in district 1 Tehran based on the health belief model with added commitment to plan construct. Methods: This cross-sectional study was conducted on 351 four grade female students in the first district of Tehran, Iran in 2017. The multi‑stage random cluster sampling method was used to recruit students. The inclusion criteria were being in four – graded level of elementary schools of the 1st district in Tehran, being female students aged between 9-11 years and being physically and psychologically healthy student. Logistic regression analysis was used to identify the variables that predict oral health behaviors. Results: Totally, (N= 31.8%) students  reported that they were brushing less than twice a day and (N=   55.2% ) students claimed  using of dental floss once a week or less than once a day. The results indicated that perceived self-efficacy (OR=1.46, 95% CI=0.57-3.78, P<0.001), commitment to plan (OR=1.13, 95% CI=1.04-1.23, P<0.001) and cues to action (OR=1.42, 95% CI=1.14–1.76, P=0.002) were the significant predicting variables of brushing twice a day, and use of dental floss once a day or more (OR=1.02, 95% CI=0.23-3.53, P=0.003). Conclusion: This study has shown the effectiveness of the health belief model with added commitment to plan construct to predict oral health behavior in female students. Thus, it seems that the model as a acceptable framework for designing training programs to improve oral health behavior in students.