Access Barriers to Dental Care Among Visually Impaired Children: Perspectives and Challenges in Kerala

Abstract

Visually impaired children are a small yet disproportionately large population within the oral health system that is not well served. Children with visual impairment still have worse oral health, including oral hygiene, caries experience and significant treatment needs, compared to children with sight. Children with visual impairment have significant oral health treatment needs, more caries experience, and poor oral hygiene compared to children with sight despite the many advantages that Kerala has in terms of literacy, primary health infrastructure, and human development indicators. This is a narrative review which collates the existing literature on the visual impairment children's access to dental care from the Indian and international context with a specific focus on the context of Kerala. Drawing on the classic five-dimensional approach of Penchansky and Thomas (1981) to providers, caregiver, child, and system-level barriers, evidence is organised accordingly. The prevalence of dental caries in visually impaired (VI) children in the permanent dentition is reported among the children aged between 40–52% and the main barriers identified by the providers are lack of training and low motivation of the caregivers (Adyanthaya et al., 2017). Results from research on facilitators show that multisensory oral health education (MOHe) (Braille text, audio aids and audio-tactile performance techniques) has been shown to have measurable short-term effects on oral health knowledge and plaque control. The review concludes there is a need for a coordinated effort to improve access through dental education, school-based screening, financing, and physical and communicative design of dental services. Recommendations are provided for health planners, special schools and clinicians in Kerala.