Oral health inequalities between differently abled and healthy school children in Bengaluru-A cross-sectional study

Prevalence of dental caries among children and adolescents with intellectual disability in India: A scoping review

BACKGROUND

Children with intellectual and developmental disabilities are at a higher risk of developing dental caries. Few scoping reviews have been conducted in India to understand their issues. We aimed to summarise the distribution and risk factors of dental caries among children and adolescents with intellectual disabilities in India.

METHODS

A scoping review was conducted based on the Arksey O Malley framework. Quality assessment of studies, descriptive and thematic analyses were also conducted.

RESULTS

We charted, collated, and summarised from four databases. Thirty-one studies met the study criteria consisting of children and adolescents with intellectual disabilities. Median caries prevalence was 70%, decayed missing and fIlled permenant teeth (DMFT) was 2.4, decayed missing and filled decidous teeth (dmft) was 2.36, and DMFS was 3.7. Major determinants were the severity of disability, socioeconomic status and parents' education. Oral care and dental visits were inadequate.

CONCLUSION

Further exploration is required to improve access and reduce caries experience and prevalence among children with intellectual and developmental disabilities in India.

A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research

INTRODUCTION

Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India.

METHODOLOGY

The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review.

RESULTS

In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India.

CONCLUSIONS

This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.

Assessment of dental malocclusion and soft-tissue features among children with special needs in the Western UP region: A cross-sectional study

Aims

Assessment of dental malocclusion and soft-tissue features among children with special needs and their correlation with normal children.

Subjects and Methods

A cross-sectional study was carried out among 128 children (63 special health-care needs children and 65 normal children), between 8 and 18 years of age. Two special schools (Vatsalya and Jeevandhara) were included in the study for case group and two local schools (one government and one private) were included in the study for control group. Index of Orthodontic Treatment Need was used to measure the malocclusion. To assess and compare various facial features, extra-oral photographs were taken from two different views (frontal and side).

Statistical Analysis Used

Data were analyzed using ANOVA and Chi-square test, with keeping level of significance at P < 0.05.

Results

The result of the present study demonstrated a significant difference between the study and control group with respect to overjet, caries, stains and calculus, soft-tissue facial profile, lip competency, and Korkhaus lip step. Soft-tissue comparison demonstrated facial asymmetry; lip incompetency was more prevalent in the study group compared to the control group. Overall, it was concluded that malocclusion was more prevalent in the study group compared to their counterparts.

Conclusions

Malocclusion was more prevalent in children with disability compared to their counterparts. On clinical examination, a significant difference in relation to overjet, caries and stains, and calculus was observed, whereas a significant difference on soft-tissue examination was observed in facial profile, lip competency, and Korkhaus lip step in the study group compared to normal children.

Oral health issues in children and adolescents with vision impairment: A systematic review and meta-analysis

BACKGROUND

Children and adolescents with vision impairment (VI) may be at increased risk of oral health issues, such as periodontal inflammation, poor oral hygiene, dental caries, and dental trauma, but this is inconclusive in the literature.

AIM

To systematically review the literature to determine the main oral health issues of children and adolescents with VI compared to those without VI.

DESIGN

Electronic and manual searches were performed to identify observational studies involving children and adolescents with and without VI, to determine and compare their oral health issues. The methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. Studies that had homogeneity of methods were incorporated into meta-analyses.

RESULTS

Fifteen cross-sectional studies were included. Overall, most studies presented methodological flaws and high risk of bias. The meta-analysis showed that children and adolescents with VI were 3.86 times as likely to exhibit dental trauma (OR = 3.86, 95% CI = 2.63-5.68, I²  = 0%) and had higher/poorer values for plaque (MD = 0.80, 95% CI = 0.58-1.02, I²  = 96%), gingivitis (MD = 0.69, 95% CI = 0.02-1.37, I²  = 100%), calculus (MD = 0.04, 95% CI = 0.03-0.06, I²  = 0%), and oral hygiene indices (MD = 0.71, 95% CI = 0.24-1.18, I²  = 97%), as well as DMFS (MD = 0.90, 95% CI = 0.68-1.13, I²  = 26%).

CONCLUSION

Across a wide array of assessments, children and adolescents with vision impairment had worse oral health outcomes than those without VI.

Oral health perceptions, behaviors, and barriers among differently abled and healthy children

AIM

To describe and compare the oral health perceptions, behaviors, and barriers for utilization of dental care among differently abled and healthy children.

METHODS

Participants in this cross-sectional study were differently abled and healthy children belonging to the age group of 7-15 years. A questionnaire for measuring the children's perceptions, behaviors, and barriers was developed, validated, and applied to this study. Cronbach's α was calculated to test reliability, and test-retest reliability was assessed by Pearson's correlation test. Chi-square/Fisher exact test, Mann-Whitney U test, and factor analysis were also applied. Statistical significant differences were defined as P < 0.05, two-tailed.

RESULTS

A total number of 300 children in each group participated in the study. The correlations of test and retest for the questionnaire ranged from 0.69 to 0.86 (P < 0.05) with Cronbach's α score of 0.862. More than half in both the groups were aware of the presence of fluoride in their toothpaste, and parents agreed that a child's dental health is satisfactory yet only one-third of them perceived dental problems as serious. Regarding brushing twice daily, the frequency was better in the study group (26.3% and 17.3%, P = 0.01), most of them changed their toothbrush between 3 and 6 months (67.3% and 82.0%, P < 0.001), and tongue cleaner were regularly used as an oral hygiene aid (62.3% and 88.5%, P = 0.01). Members of the study group appear to have visited the dentist (26.0%) more as compared to the control group (17.7%) (P = 0.01), and most of the respondents (50.0% and 41.5%) consulted the dentist on account of dental caries. In the study group, no priority care (8.82±2.81), difficulty in communicating with the dentist (7.85±1.92), treatment cost (6.90±1.98) and fear of dental instruments (6.90±1.98), respectively, were the barriers with the highest means of scores, whereas in the control group it was related to affordability and fear. Facilities in dental clinics excluding wheelchairs (76.3% and 76.7%) and corridor signs (66.3% and 61.7%) were lacking.

CONCLUSION

Knowledge and attitude scores were adequate but there was a discrepancy present concerning oral health practices. Dental health was not viewed as a threat, and therefore, not many visited the dentist. Priority care and communication problems were the central issues among differently abled children, while among healthy children, the main factor was cost and fear.

Characteristics and Comparison of Dental Treatment under General Anesthesia in Healthy Children and Children with Special Healthcare Needs: A Retrospective Study

Aim and objective

To evaluate the characteristics and treatment modalities performed under general anesthesia in very young children and children with special healthcare needs (SHCN) from January 2016 to December 2018.

Materials and methods

The data was retrospectively collected from the records of the patients who underwent dental rehabilitation under general anesthesia from January 2016 to December 2018. The healthy patients were assigned to group H and children with SHCN were assigned to group S. Comprehensive dental treatment included preventive (oral prophylaxis, fluoride, pit, and fissure sealant), restorations, pulp therapies, and surgical procedures, which were compared.

Results

A total of 46 patients were comprehensively treated under dental general anesthesia (DGA) during the study period. There were 34 males (73.91%) and 12 females (26.08%) with M:F ratio of 2.8:1. The patients in group H were significantly younger than group S. Extraction and restoration were more frequently performed in group S (p < 0.01, p < 0.05). While pulpectomy, pulpotomy, and stainless steel crown (SSC) were more frequently performed in group H (p < 0.01, p < 0.01, p < 0.05).

Conclusion

There was more number of extraction and less number of pulpectomies, pulpotomies, and SSC performed in children with special healthcare needs.

Clinical significance

Dental management of very young children and children with SHCN is a challenging task. DGA is an excellent alternative to undergo full mouth rehabilitation in such patients. Every effort should be made towards restoring oral health of children.

How to cite this article

Sevekar S, Jha MN, Avanti A. Characteristics and Comparison of Dental Treatment under General Anesthesia in Healthy Children and Children with Special Healthcare Needs: A Retrospective Study. Int J Clin Pediatr Dent 2021;14(S-2):S157-S161.