Oral Health Status And Hygiene Practices Among Visually Impaired Children Attending Thika Primary School For The Blind In Kiambu County, Kenya

Abstract

Background: Worldwide studies have reported poor oral health among visually impaired individuals. This has been attributed to several factors which include difficulty in attaining good oral hygiene, difficulty in evaluating effective plaque removal and also because demonstration of oral hygiene instructions via visual aids is not appropriate. Lack of parental supervision and the absence of manual-visual coordination have also been implicated. There is inadequate information available on dental health among Kenyan children who are visually impaired. Study objective: To determine the oral health status and hygiene practices among visually impaired children attending Thika Primary School for the Blind in Kiambu County, Kenya. Study population: One hundred and fifty-nine children in category I and II educational visual impairment, aged 10-19 years old attending Thika Primary School for the Blind. Study design: This was a descriptive cross-sectional study. Materials and methods: Participants were selected using proportionate stratified random sampling. Data collection methods constituted completion of a questionnaire and a clinical examination component. The questionnaire was administered in a face-to-face interview by the principal investigator and contained both open and close-ended questions to record the children’s social demographic variables and oral hygiene practices. Data was keyed into the computer database and analysed using Statistical Package for Social Sciences (SPSS) version 23.0 of Windows. The results have been presented in tables and figures and where appropriate univariate, bivariate and multivariate analysis performed and appropriate statistical inferences made. Results: A total of 159 children participated in the study. There were 85 (53.5%) male participants and 74 (46.5%) female participants and the mean age was 13.91±2.27. Ninety-four (59.1%) and 105(66%) of the participants perceived having good dental and gingival health status respectively. There was a statistically significant association on comparison (X2) of gingival health perception with age of participants (P=0.05). All participants used toothbrushes to clean their teeth with older children (p= 0.004) and female children (p= 0.001) more likely to replace their toothbrushes within three months when compared (X2) to younger children and to male participants. The mean plaque score was 0.95 + 0.45 (p=0.38) depicting good oral hygiene with majority 116 (72.9%) of the children not reporting to experience challenges in practice of oral hygiene. The overall prevalence of gingivitis was 88.1% (n=140) with a mean gingival score index of 0.28 + 0.25. On comparison (ANOVA) of gingival score index with age, there was a statistically significant association (p=0.02). Dental caries prevalence was 42.1% (n=67) among in permanent dentition and 8.2% (n=13) in deciduous dentition. Age of participants influenced (ANOVA) dental caries prevalence among participants in deciduous dentition (p=0.04). The overall DMFT/dmft was 0.99±1.70 and 0.16+0.63 respectively with decay (D,d) forming the highest component. In permanent dentition, mean DMFT was higher 1.13+2.14 among female participants compared (t-test) to male 0.72+1.15 participants. This difference was statistically significant (p=0.05). Visual impairment also had an influence on dental caries experience in deciduous dentition (t=2.27, p=0.02). There was a statistically significant association when plaque score index was compared (spearman’s correlation) with dmft index (p=0.04) and gingival score index (p=0.001). Null hypothesis was tested using Spearman’s correlation for association between oral hygiene practices and oral health status. Oral hygiene practices did not influence oral hygiene status and dental caries status. However, an association was shown between frequency of toothbrush replacement and gingival index score (p=0.003). Conclusion: Majority of the children attending Thika Primary School for the Blind have adequate oral hygiene practices. All used conventional toothbrushes with majority using toothpaste and brushing 2-3 times daily. All participants were found to have good oral hygiene (plaque score= 0.95+0.45) and mild gingivitis (gingival score = 0.28 + 0.25) with low dental caries experience (dmft= 0.16+0.63; DMFT=0.99±1.70. Only 27.1% of the participants reported experiencing challenges in practice of oral hygiene measures. Category of visual impairment had an influence on dental caries experience among participants in deciduous dentition, being more among Category I visually impaired participants. Plaque score index increased with age of participants and influenced both the gingival score index and dmft score index. Gingival score index increased with age of participants but had no influence on dmft/DMFT score index. Dental caries experience in permanent dentition was influenced by gender and was more among female participants. Overly, oral hygiene practices did not influence oral hygiene and dental caries status. However, there was an association between frequency of toothbrush replacement and gingival score index. Recommendations: There is need to reinforce oral hygiene practices among visually impaired children with emphasis towards frequency of toothbrush replacement within 3 months so as to achieve maximum benefits in maintenance of oral hygiene. There is need to introduce modalities for preventive measures and early diagnosis of dental caries, more so among children in deciduous dentition with Category I visual impairment. Further studies with more dose components of oral hygiene practices such as duration of brushing in each session and number of strokes used during tooth brushing are recommended to better assess the relationship between oral hygiene practices and oral hygiene status.