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Year : 2016  |  Volume : 5  |  Issue : 2  |  Page : 137-141

Prevalence of dental caries in people attending special schools in Hyderabad-Secunderabad, India

Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Center, Dilsuknagar, Hyderabad, Andhra Pradesh, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Mahesh Kumar Duddu
Department of Pedodontics and Preventive Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Center, Dilsuknagar, Hyderabad - 500 060, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2277-8632.185452

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Aim: The present cross-sectional study was conducted to determine the decayed, missing, filled primary and permanent teeth (dmft-DMFT) indices and its association with the type of disability in 856 disabled individuals attending special schools in twin cities of Hyderabad and Secunderabad, Andhra Pradesh State, India.
Materials and Methods: Participants were grouped according to their disability such as: Mild, moderate, severe mental retardation, hearing and speech defect and others (39) (including Down's syndrome [20], autism [9], hyperactive [4], microcephaly [2], border line cases [4]). Examination was carried out at their schools, with participants seated in ordinary chairs and examined under natural light with mouth mirror and probe. Subjects were of different age groups ranging from 1 to 55 years.
Statistical Analysis Used: Analysis of variance with post-hoc Games-Howell test was used for statistical analysis.
Results: Mean dmft; DMFT scores were as follows: 2-6 years: 1.58 ± 1.9; 2.18 ± 2.94, 7-12 years: 1.1 ± 2.4; 1.9 ± 2.13, 13-30 years: 2.38 ± 2.5, 30+ years: 2.13 ± 3.2. Overall only 23% of subjects were caries free. "dmft" was statistically higher among moderate mentally retarded group while DMFT was statistically higher in mild and moderate mentally retarded groups.
Conclusions: These findings emphasize the need of educating parents and caregivers of disabled individuals in preventive dental procedures, especially those of the mild and moderate mentally challenged group.

Keywords: Dental caries, disabled individuals, index, special children

How to cite this article:
Duddu MK, Muppa R, Nallanchakrava S, Bhupatiraju P. Prevalence of dental caries in people attending special schools in Hyderabad-Secunderabad, India. J NTR Univ Health Sci 2016;5:137-41

How to cite this URL:
Duddu MK, Muppa R, Nallanchakrava S, Bhupatiraju P. Prevalence of dental caries in people attending special schools in Hyderabad-Secunderabad, India. J NTR Univ Health Sci [serial online] 2016 [cited 2022 Sep 27];5:137-41. Available from: https://www.jdrntruhs.org/text.asp?2016/5/2/137/185452

  Introduction Top

People with special needs form a substantial portion of the community and are underserved in society. [1] According to National Sample Survey Organization report, the number of disabled persons in India was estimated to be 18.49 million. [2] They formed about 1.8% of the total population. [2] According to the Indian census 2001, they form 2.13% of the Indian population. [2] "Intellectually disabled" and "mentally challenged" is a preferred term than "mentally retarded" and this population accounts for 4-9% of the disabled Indian population. [2]

According to the World Health Organization, disabilities are an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person's body and features of the society in which he or she lives. [3]

Mental retardation has been defined by the American Association of Mental Deficiency as "a deficiency in the theoretical intelligence that is congenital or acquired in early life." An individual is classified as having mild mental retardation if his or her IQ score is 50-55 to about 70; moderate retardation: IQ level 35-40 to 50; severe retardation: IQ 20-25 to 35; and profound retardation: IQ below 20-25.

The American Association on Mental Retardation, offered the following definition of mental retardation in 2002: Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18. [4]

American Association on Intellectual and Developmental Disabilities, in 2010, also gives the same definition (mentioned above) of intellectual disability.

Oral disease is the major health problem for people with disability. High rates of dental caries, missing teeth, periodontal disease and malocclusion are all indicators of poor oral health. Among all oral diseases, dental caries is the most unmet condition among children including the disabled. The present study was carried out to estimate the prevalence of dental caries in the disabled population in terms of decayed, missing, filled primary and permanent teeth index, that is, dmft, DMFT indices.

  Materials and Methods Top

The present study was conducted in Hyderabad and Secunderabad, Andhra Pradesh State, India. The study population consisted of people attending 13 special schools in the twin cities. The subjects were diagnosed as disabled by physicians and this was the criteria for admission to the special school. Consent letter was taken from school authorities. The sample comprised of 856 subjects of both genders, aged ranges from 1 to 55 years. Information on gender, date of birth, socioeconomic status was obtained from the questionnaire given to the parent or guardian. Clinical examination data was also recorded. The examination was performed in the school, under natural light with mouth mirror and probe. Participants were seated in ordinary chairs and examination was carried out with the subject seated in the knee-to-knee position. A chip blower was used to dry the tooth and a brownish-black lesion, which was soft and produced a "catch" while probing (with a straight probe), was used as the criteria for diagnosis. No radiographic examination was done. The subjects were examined by two of the authors in the presence of the other authors. Calibration of examiners was not done as the diagnostic criteria was fairly simple. The primary and permanent teeth, which were dmft, DMFT were recorded and the indices were calculated.

Inclusion criteria

People attending special schools who were either:

  • Mentally challenged (mild, moderate, severe - as per the school records)
  • Hearing and speech impaired
  • Downs syndrome
  • Microcephaly
  • Autistic
  • Hyperactive
  • Other borderline cases.

Exclusion criteria

Individuals with:

  • Visually impairment
  • Physical disability only but not mentally challenged.

Participants were divided into five groups:

  1. Mild mental retardation (357)
  2. Moderate mental retardation (203)
  3. Severe mental retardation (82)
  4. Hearing and speech defect (175)
  5. Others 39 (included Down's syndrome {20}, autism [9], hyperactive [4], microcephaly [2], border line cases [4]).

Subjects who were grouped under mild/moderate/severe mental retardation were ones who did not have any underlying systemic condition as the cause for mental retardation.

Data were recorded in a MS Excel table and subjected to statistical analysis. Analysis of variance (ANOVA) with post-hoc Games-Howell test was used to determine significant difference in data. The distribution of the subjects according to sex and age is given in [Table 1].
Table 1: The distribution of the participants in the five groups according to sex and age

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  Results Top

Among the 856 participants in this study, the majority (65.8%) were male (n = 563). The majority (63%) of the individuals were above 13 years (n = 540). The ages of the participants ranged from 1 to 55 years. [Table 1] shows the distribution of the study population in five groups according to age and sex.

Moderate mentally retarded subjects had the highest score of dmft with mean ± standard deviation of 2.03 ± 2.63 when compared to remaining groups. DMFT was significantly higher among mild retardation group when compared to severely retarded and children with hearing and speech defects (P < 0.01). DMFT was also significantly higher among moderate mentally retarded group when compared to children with hearing and speech defect [Table 2].
Table 2: Mean and standard deviations of dmft and DMFT with intergroup comparison

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DMFT and dmft did not show statistically significant difference between the age groups [Table 3] and [Table 4]. Though, the DMFT was the highest among those older than 13 years.
Table 3: DMFT scores according to the age groups

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Table 4: DMFT scores according to age groups

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  Discussion Top

Dental caries is the most prevalent disease among disabled children worldwide and "dental treatment is the greatest unattended health need of the disabled." [5] Disabled children are thought less capable of taking care of themselves and are often missed by oral health campaigns [6] and there is a higher prevalence of untreated dental disease in handicapped children than in normal children. [7],[8] Some of the important reasons may be inadequate recall system, practical difficulties during treatment sessions, socioeconomic status, underestimation of treatment need or pain, communication problem and lack of cooperation. [8],[9],[10],[11],[12]

Poor oral health has a negative impact on nutrition, digestion, the ability to chew on food, speech and general health of individual but children and adolescents with disability appear to have poorer oral health than others. This may be contributed by their potential motor, sensory and intellectual disability. [13] Dental caries is one of the major health problems among individuals with a disability. This may be related to low physical ability of individual in tooth brushing and other conditions as mentioned before.

Children with mental disability have poor oral health as compared to their normal counterpart which makes functions of the oral cavity like eating, swallowing, speech, chewing difficult for them resulting in malocclusion, poor esthetics and general health. Good oral health is required for them because the severity of medical conditions and perceived general health are significantly correlated with dental functional status and severity of dental disease. For persons with disabilities, the effect of dental disease on general health and function appears greater than for similar groups without a disability. [14] Proper care is required to manage side-effects of medication, for example, dry mouth, gingival overgrowth and problems with speech, swallowing, and taste.

In the present study, dental caries was observed among 77% of subjects and 23% were caries free. The presence of high dmft and DMFT scores in people with moderate mental retardation coincided with a study by Dαvila et al. [15] The reason why the moderately retarded had a higher dmft/DMFT as compared to the severely retarded may be because of more attention given by caretakers to the severe mentally retarded, with regard to their oral hygiene, and an assumption that others are able to brush their teeth better by themselves. In this study, the examination was done under natural light. A brownish-black lesion which was soft and produced a "catch" while probing (with a straight probe) was used as the criteria for diagnosis.

Using this method initial carious lesion could have been missed out and therefore the prevalence of dental caries may actually be higher in all groups.

Shaw et al. [16] in their study have reported dmft and DMFT values of 1.36 and 1.85, respectively, for children with disabilities; Gizani et al. [17] have reported a mean DMFT value of 2.9; and Shyama et al. [18] reported a mean DMFT of 4.5 for this group. The results of the 1990 oral health in Turkey report, [19] found the prevalence of caries to be over 90% among children aged 5-6 years and approximately 80% among children 6-12 years. The report also found that dmft and DMFT values increased with age, with a mean DMFT of 4.3 for children and young adults aged 15-19 years - a value which is higher than that for any of the groups in the present study.

Shaw et al. [16] have discussed that home care is essential to an effective plaque control and oral hygiene for special children is dependent on quality of care given by parents and guardians. Parents can be taught various techniques to enable them to care for their children's oral health more easily and completely.

It is well-known that systematic counseling and plaque control programs have a good effect on dental health and similar schemes have been shown to reduce the risk of dental disease in disabled children. In summation, prevention of dental decay brings about many positive results, each of which leads to still another gain in healthier, happier, more confident person.

  Conclusion Top

The present study was conducted to assess the prevalence of dental caries in subjects attending special schools in Hyderabad and Secunderabad, Andhra Pradesh State, India. Following conclusions can be drawn:

  1. The dmft and DMFT scores are high in subjects with mild and moderate mentally retarded group as compared to the other groups
  2. Prevalence of caries didn't significantly differ in different age groups.

Preventive measures play an important role in reducing the prevalence of dental caries. There is a critical role for the dentist to play by providing proper dental education to parents and care takers of disabled individuals. In addition, oral hygiene habits of individuals with a disability can be improved by close monitoring and periodic dental checkups.

  References Top

Glassman P, Miller C. Dental disease prevention and people with special needs. J Calif Dent Assoc 2003;31:149-60.  Back to cited text no. 1
National Sample Survey Organization. Disabled Persons in India. NSS Report No. 485 (58/26/1). New Delhi: Ministry of Statistics and Program Implementation. Govt. of India; 2003.  Back to cited text no. 2
World Health Organization. Available from: . [Last retrieved on 2013 Mar 07].  Back to cited text no. 3
Luckasson R, Borthwick-Duffy S, Buntinx WHE, Coulter DL, Craig EM, Reeve A, et al. Mental retardation: Definition, classification, and systems of supports. 10 th ed. Washington DC: AAMR; 2002.  Back to cited text no. 4
Jain M, Mathur A, Sawla L, Choudhary G, Kabra K, Duraiswamy P, et al. Oral health status of mentally disabled subjects in India. J Oral Sci 2009;51:333-40.  Back to cited text no. 5
Weraarchakul W, Weraarchakul W, Angwarawong O. Oral health status and treatment need of disabled children in rehabilitation school in Khon Kaen, Thailand. Srinagarind Med J 2005;20:17-23.  Back to cited text no. 6
Murray JJ, McLeod JP. The dental condition of severely subnormal children in three London boroughs. Br Dent J 1973;134:380-5.  Back to cited text no. 7
Swallow JN. The dental problems of handicapped children. R Soc Health J 1965;85:152-7.  Back to cited text no. 8
Boj JR, Davila JM. Differences between normal and developmentally disabled children in a first dental visit. ASDC J Dent Child 1995;62:52-6.  Back to cited text no. 9
Brandes DA, Wilson S, Preisch JW, Casamassimo PS. A comparison of opinions from parents of disabled and non-disabled children on behavior management techniques used in dentistry. Spec Care Dentist 1995;15:119-23.  Back to cited text no. 10
Dicks JL. Outpatient dental services for individuals with mental illness: A program description. Spec Care Dentist 1995;15:239-42.  Back to cited text no. 11
Glassman P, Miller CE, Lechowick J. A dental school′s role in developing a rural, community-based, dental care delivery system for individuals with developmental disabilities. Spec Care Dentist 1996;16:188-93.  Back to cited text no. 12
Brown JP, Schodel DR. A review of controlled surveys of dental disease in handicapped persons. ASDC J Dent Child 1976;43:313-20.  Back to cited text no. 13
Bhambal A, Jain M, Saxen S, Kothari S. Oral health preventive protocol for mentally disabled subjects - A review. J Adv Dent Res 2011;1:21-6.  Back to cited text no. 14
Dávila ME, Gil M, Daza D, Bullones X, Ugel E. Dental caries amongst mentally retarded people and those suffering from Down′s syndrome. Rev Salud Publica (Bogota) 2006;8:207-13.  Back to cited text no. 15
Shaw L, Maclaurin ET, Foster TD. Dental study of handicapped children attending special schools in Birmingham, UK. Community Dent Oral Epidemiol 1986;14:24-7.  Back to cited text no. 16
Gizani S, Declerck D, Vinckier F, Martens L, Marks L, Goffin G. Oral health condition of 12-year-old handicapped children in Flanders (Belgium). Community Dent Oral Epidemiol 1997;25:352-7.  Back to cited text no. 17
Shyama M, Al-Mutawa SA, Morris RE, Sugathan T, Honkala E. Dental caries experience of disabled children and young adults in Kuwait. Community Dent Health 2001;18:181-6.  Back to cited text no. 18
Ertuðrul F, Elbek-Cubukçu C, Sabah E, Mir S. The oral health status of children undergoing hemodialysis treatment. Turk J Pediatr 2003;45:108-13.  Back to cited text no. 19


  [Table 1], [Table 2], [Table 3], [Table 4]

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