• Users Online: 946
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 55-59

Comparative evaluation of audio and audio - tactile methods to improve oral hygiene status of visually impaired school children


Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India

Date of Web Publication22-Dec-2015

Correspondence Address:
R Krishnakumar
Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram - 608 002, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.172403

Rights and Permissions
  Abstract 

Background: Visually impaired children are unable to maintain good oral hygiene, as their tactile abilities are often underdeveloped owing to their visual disturbances. Conventional brushing techniques are often poorly comprehended by these children and hence, it was decided to evaluate the effectiveness of audio and audio-tactile methods in improving the oral hygiene of these children. Objective: To evaluate and compare the effectiveness of audio and audio-tactile methods in improving oral hygiene status of visually impaired school children. Materials and Methods: In this study, the total study group comprised 48 visually impaired children that were randomly divided into two groups, with one group receiving the audio method and the other group receiving the audio-tactile method. Periodic reinforcement of health education was performed at an interval of 2 months. Re-examination was carried out after 2 months of health education to assess plaque scores. Data were statistically analyzed using paired t-test. Results: There was reduction in plaque scores in audio-tactile group after health education. In the audio-tactile group, the mean plaque scores of pre- and post-health education were 1.28 and 0.95, respectively. The difference was statistically significant (P < 0.001). In audio group, the mean plaque scores of pre- and post-health education were 1.15 and 0.14, respectively. The difference was statistically nonsignificant (P < 0.07). Conclusion: Visually impaired children could maintain an acceptable level of oral hygiene when taught using special customized methods. However, reinforcement at regular intervals is required for the maintenance of oral hygiene.

Keywords: Fones method, health education, oral hygiene, plaque, visual impairment


How to cite this article:
Krishnakumar R, Silla SS, Durai SK, Govindarajan M, Ahamed SS, Mathivanan L. Comparative evaluation of audio and audio - tactile methods to improve oral hygiene status of visually impaired school children. CHRISMED J Health Res 2016;3:55-9

How to cite this URL:
Krishnakumar R, Silla SS, Durai SK, Govindarajan M, Ahamed SS, Mathivanan L. Comparative evaluation of audio and audio - tactile methods to improve oral hygiene status of visually impaired school children. CHRISMED J Health Res [serial online] 2016 [cited 2019 Aug 22];3:55-9. Available from: http://www.cjhr.org/text.asp?2016/3/1/55/172403


  Introduction Top


"Just because a man lacks the use of his eyes doesn't mean he lacks vision"

-Stevie Wonder

Vision may be the most important sense for interpreting the world around us, and when sight is impaired in childhood, it can have detrimental effects on physical, neurological, cognitive, and emotional development. Visual impairments vary from total blindness to slight limitations of size, color, distance, and shape.[1],[2] Many individuals become blind through complications arising from various diseases of the eye, and from disorders such as cataract and glaucoma.[3]

Visually impaired patients present a unique population that challenges the dentists' skill and knowledge. People with visual impairment are at a higher risk of developing oral diseases namely periodontal disease because of greater difficulty in attaining good oral hygiene.[4],[5] More awareness of dental healthcare needs of these subjects is essential, especially those who are visually impaired. These individuals often have worse oral health status than the general population. They tend to have a higher incidence of dental caries and difficulty in accessing dental care.[6]

The main reason for the higher prevalence of dental caries in disabled individuals is the inadequate plaque removal. Visually impaired cannot visualize the plaque on the teeth surfaces so even understanding the importance of oral hygiene is difficult for them, which results in the progression of dental caries as well as inflammatory disease of the periodontium. Chemical plaque control is advised in visually impaired for effective plaque control as in patients suffering from cerebral palsy who cannot brush properly due to poor motor control.[7]

Hence, the present study was planned, the objective of which was to describe one such technique that was developed to educate visually impaired children regarding tooth brushing. The second objective was to assess and compare plaque scores before and after health education.


  Materials and Methods Top


Sociodemographic information

The present study was a short-term study which was conducted among children of “Government School for the Blind” and Hellen Keller Children Welfare Trust in Cuddalore District, Tamil Nadu. The study was conducted during September 2014–November 2014 after obtaining permission from school authorities. There were a total of 48 visually impaired children of which 42 boys and six girls of age 6–18 years. All the samples belonged to ICD code: H54.0 group of visual impairment (Blindness, both eyes: Visual impairment categories three, four, five in both eyes) as per the classification of visual impairment by International Statistical Classification of Diseases and related health problems by WHO. Because of the discrepancy in the sample size among boys and girls, gender as a variable was not used for comparison. According to Unkel et al., 2000 and Choo et al., 2001, the development of manual dexterity is related to chronological age, so it is thought that a child of 6 years is capable of independent brushing. For this reason, children under 6 years of age were excluded from this study.

The subjects included in the study were of low socioeconomic status. As most of the children were staying in the hostel in the school premises, verbal consent from the parents were taken by telephone at the start of the study and later when the children went home for a vacation once, written informed consent was obtained from parents. It was a nonrandomized before and after comparison trial without controls. The baseline value of the same group served as its own control.

Study protocol

The study was conducted at various stages.

Stage 1 (interaction)

A series of interactive sessions were conducted with the visually impaired children to understand their level of co-operation and comprehension.

Stage 2 (preeducation examination)

A self-designed format was used to record personal details of the child such as name, age, gender, reason for blindness and method of tooth brushing. This was followed by recording of Silness and Loe plaque index. Prior training was given to two examiners for recording data and conducting examinations. Based on the scores the children were categorized as excellent (0), good (0.1–0.9), fair (1.0–1.9), or poor (2.0–3.0).

Stage 3 (health education)

A series of interactive sessions were conducted at the beginning of the study and it was found that they had good knowledge about oral health but lacked appropriate oral hygiene performance. Hence, it was decided that they required a special health education method by which they could easily master the correct brushing technique. Group I Audio-Tactile group children was educated with a specially designed health education method “Audio tactile performance technique” (ATP), regarding oral hygiene maintenance. The method was so named as children were first verbally informed about the importance of teeth, method of brushing and then they were made to feel the teeth on a large sized model followed by brushing on the model using the Fones method with assistance. This was repeated until the children could perform with ease. The children were asked to feel their own teeth with their tongue and any deposits to be appreciated by feeling of roughness.

Group II Audio group children were educated only about the importance of teeth and brushing on the model using the Fones method with assistance. A total of four health educators were trained regarding the method of health education before educating the children. Then, they were asked to brush their own teeth with the assistance of one of the trained educators. They were also taught regarding the amount of toothpaste to be used. There was no time restriction for health education, and the process continued for each child individually until they could perform it independently, correctly, and confidently. Periodic reinforcement using the same methods was performed at an interval of 2 months. The children were asked to recollect what they could remember from the first health education session. Based on that approach, reinforcement was performed for all the students.

Stage 4 (posteducation examination)

Oral examination was conducted 2 months after imparting health education to assess plaque scores. The examination was performed by the same examiners.

Data analysis

Data obtained was entered into Excel Sheet and analyzed using SPSS (Statistical Package for Social Sciences) version 17 (Chicago IL, USA). Paired t-test was used to assess the difference between the scores before and after health education.


  Results Top


The plaque scores of Group I Audio-tactile group are represented in [Graph 1][Additional file 1]. There were 1, 8, 13, 2 subjects, respectively, in excellent, good, fair, and poor categories before oral hygiene education. After health education 2, 11, 11, 0 subjects, respectively, were categorized as excellent, good, fair, and poor. The difference was statistically significant (P < 0.001).

The plaque scores of [Group II] Audio group are represented in [Graph 2][Additional file 2]. There were 0, 2, 22, 6 subjects respectively in excellent, good, fair, and poor categories before oral hygiene education. After health education, 0, 4, 20, 0 subjects, respectively, were categorized as excellent, good, fair and poor. The difference was statistically nonsignificant (P = 0.07).

Mean plaque scores are shown in [Table 1]. In Audio-tactile group, the prehealth and posthealth education scores were 1.28 and 0.95, respectively, and the difference was statistically significant (P < 0.001).{Table 1}

In Audio group, the mean plaque scores prehealth and posthealth education were 1.15 and 1.14, respectively. However, this association was statistically nonsignificant (P = 0.07).


  Discussion Top


Health education is a process of transmission of knowledge and skills necessary for improvement in quality of life. Health education, a widely accepted approach in prevention of oral diseases, is a process of transmission of knowledge and skills necessary for improvement in quality of life. The goal of planned health education program is not only to bring about new behaviors but also to reinforce and maintain healthy behaviors that will promote and improve individual, group, or community health.[1]

Two of the most common oral diseases affecting mankind are dental caries and periodontal disease. Although the disease mechanisms are different, both diseases are initiated by the presence of microbial dental plaque. Dental plaque that is present on tooth surfaces will affect the oral hygiene status of an individual by gingivitis followed by periodontitis. So in other words, presence of dental plaque, calculus, and gingival bleeding are indications of oral hygiene status and this directly affects periodontal status.[2]

A common mode of delivery of oral hygiene messages is the personal instruction approach on one-to-one basis. Although this approach has been shown to be effective in improving oral hygiene and gingival health, it is time consuming and may not be practical from a community perspective. Substitution of personal instruction by other means of communication has been investigated, such as the use of self-educational manuals and audiovisual aids.[3]

Visually impaired patients present a unique population that challenges the dentists' skill and knowledge.[4] People with visual impairment are at a higher risk of developing oral diseases namely periodontal disease because of greater difficulty in attaining good oral hygiene.[5] They differ from normal patients with regard to professional relationship between patient and the dentist. Therefore with adequate training and understanding of various medical complications and handicapping conditions and with adequate alteration in the dentist's treatment protocol, these patients can be managed well. Providing a comprehensive dental care for visually impaired is not only rewarding but is also a community service, that healthcare provider are obligated to fulfil.[6]

Oral hygiene status was also found to be poorer compared to normal children. The reasons could be the lack of development of self-help skills, inability to see and remove plaque, and most of the children were staying in hostel thus leading to lack of supervision while brushing.[7]

Conventional methods for teaching oral hygiene involves use of visual perception, using disclosing agents to visualize the plaque and tooth brushing to remove it, and re-disclosing periodically to monitor their improvement of oral hygiene status. Unfortunately, none of these measures are beneficial to visually impaired children who depend much more on feeling and hearing to learn. The main factor of differentiation between normal patients and blind ones is the difficulty in removing plaque.[8]

Since visually impaired students cannot visualize the plaque deposit on tooth surface, they need regular dental visit, education, and motivation regarding oral health hygiene measures and its impact on oral as well as overall health.[9]

Hence, this study was planned to design a customized brushing technique to improve oral health. “ATP Technique” a specially designed health education method was used to educate these children regarding oral hygiene maintenance. Periodic reinforcement of health education was performed at an interval of 2 months. Re-examination was carried out after 2 months of health education to assess plaque scores.

In a study conducted by Hebbal and Ankola, comprising 96 visually impaired children aged 6–18 years old. Silness and Loe plaque index scores were recorded at baseline. ATP Technique a specially designed health education method was used. Periodic reinforcement of health education was performed at an interval of 9 months. Re-examination was carried out after 18 months of health education to assess plaque scores. There was an increase in the frequency of tooth brushing after health education. The mean plaque scores pre- and post-health education were 1.41 (±0.58) and 0.63 (±0.39), respectively. The difference was statistically significant (P < 0.001).[10]

The results of this study were in accordance with the above mentioned study when audio-tactile and audio methods to improve oral hygiene status were used along with periodic reinforcement in visually impaired children.

Most of the children used tooth brush and tooth paste to clean their teeth at base line. However, the frequency was only once daily. After health education the frequency increased to twice daily among most of the subjects. There was a significant reduction in the plaque scores after health education. Most of the subjects changed from poor and fair categories to the good category posthealth education which was statistically significant (P < 0.001). This shows that merely using tooth brush and paste will not help to improve the oral hygiene. The correct brushing technique and frequency is more important. It has been reported that the absence of visual stimuli prevents rapid learning, representing a challenge for dentists in motivating these individuals to have appropriate oral hygiene. This is in contrast to the present study where they could learn satisfactory brushing techniques when well trained, thus maintaining healthy oral conditions. This could be due to the fact that these children were staying in a residential school and lead a disciplined life style and were very receptive to learning new things.

The health education method in this study was very successful resulting in reduction in plaque scores. The strong motivation of children and meticulous training and reinforcement by the health educators could have led to success.

Audiotactile method and health education provided in this study showed a strong motivation to the visually impaired children and reinforcement at regular intervals reflected in the oral health of the children by the change in the poor and fair categories to good categories of plaque scores.

To overcome the fear and negative attitudes to the dentistry we should develop special customized health education techniques as per needs of the subjects.


  Conclusion Top


People with disabilities deserve the same opportunities for oral health and hygiene as those who are healthy. The present short-term study showed that visually impaired children can maintain an acceptable level of oral hygiene when taught with special customized methods. However, reinforcement at regular intervals is required for the maintenance of oral hygiene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lim LP, Davies WI, Yuen KW, Ma MH. Comparison of modes of oral hygiene instruction in improving gingival health. J Clin Periodontol 1996;23:693-7.  Back to cited text no. 1
    
2.
Ahmad MS, Jindal MK, Khan S, Hashmi SH. Oral health knowledge, practice, oral hygiene status and dental caries prevalence among visually impaired students in residential institute of Aligarh. J Dent Oral Hyg 2009;1:22-6.  Back to cited text no. 2
    
3.
Mohd-Dom TN, Omar R, Malik NA, Saiman K, Rahmat N. Self-Reported oral hygiene practices and periodontal status of visually impaired adults. Glob J Health Sci 2010;2:184-91.  Back to cited text no. 3
    
4.
Naveen N, Reddy CV. A study to assess the oral health status of Institutionalized blind children in Mysore City, Karnataka. J Orofac Sci 2010;2:12-5.  Back to cited text no. 4
  Medknow Journal  
5.
Shetty V, Hegde AM, Bhandary S, Rai K. Oral health status of the visually impaired children – A south Indian study. J Clin Pediatr Dent 2010;34:213-6.  Back to cited text no. 5
    
6.
Nandini NS. New insights into improving the oral health of visually impaired children. J Indian Soc Pedod Prev Dent 2003;21:142-3.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
McDonald ER, Avery RD, Dean AJ. Dental problems of children with disabilities. Dentistry for the Child and Adolescent. 8th ed. Mosby Elsevier Publication;Gurgaon, Haryana, India; 2004. p. 550-1.  Back to cited text no. 7
    
8.
AlSarheed M, Bedi R, Alkhatib MN, Hunt NP. Dentists' attitudes and practices toward provision of orthodontic treatment for children with visual and hearing impairments. Spec Care Dentist 2006;26:30-6.  Back to cited text no. 8
    
9.
Ahmad MS, Jindal MK, Khan S, Hashmi SH. Oral health knowledge, practice, oral hygiene status and dental caries prevalence among visually impaired students in residential institute of Aligarh. J Dent Oral Hyg 2009;1:22-6.  Back to cited text no. 9
    
10.
Hebbal M, Ankola AV. Development of a new technique (ATP) for training visually impaired children in oral hygiene maintenance. Eur Arch Paediatr Dent 2012;13:244-7.  Back to cited text no. 10
    



This article has been cited by
1 Interventions to improve functioning, participation and quality of life in children with visual impairment: a systematic review
Ellen BM. Elsman,Mo Al Baaj,Gerardus HMB. van Rens,Wencke Sijbrandi,Ellen GC. van den Broek,Hilde PA. van der Aa,Wouter Schakel,Martijn W. Heymans,Ralph de Vries,Mathijs PJ. Vervloed,Bert Steenbergen,Ruth MA. van Nispen
Survey of Ophthalmology. 2019;
[Pubmed] | [DOI]
2 Effectiveness of different oral health education interventions in visually impaired school children
Barkha S. Tiwari,Anil V. Ankola,Sagar Jalihal,Pratibha Patil,Roopali M. Sankeshwari,Bhargava R. Kashyap
Special Care in Dentistry. 2019;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References

 Article Access Statistics
    Viewed1578    
    Printed32    
    Emailed0    
    PDF Downloaded328    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]