Social Determinants of Oral Health in Visually Impaired Children: A Community-Based Study in Kerala

Abstract

Background: There are unique challenges associated with oral health of visually impaired children, however, social factors influencing their oral health outcomes have not been studied extensively in the Indian setting. This community-based study involved analysis of the social determinants of dental caries, oral hygiene and gum health among visually impaired children of Kerala. Materials and Methods: A cross sectional survey was carried out involving 312 visually challenged children from ages 6-17 years from selected districts of Kerala, from special school and integrated education units. Caries experience (dmft/DMFT), Simplified Oral Hygiene Index (OHI-S), gingival bleeding and traumatic dental injuries in accordance with the World Health Organization (WHO) criteria were recorded through clinical examinations. Structural and intermediary social determinants were collected by a questionnaire administered to caregivers. Bivariate analyses and multivariable logistic regression were performed to determine factors associated with caries. Results: The overall prevalence of dental caries was 68.3%, mean caries experience was 3.0 (SD = 2.8) and mean OHI-S was 2.4 (SD = 0.7). Higher odds of caries were independently associated with the education of the mother, the lowest tertile of household income, total blindness, and infrequent tooth brushing and frequent snacking. Conclusions: There is a definite social gradient in oral disease among visually impaired children in Kerala. Comprehensive measures are required, including adapted oral hygiene instruction, coupled with measures upstream in social conditions.