The Oral Health of 6-15 Year Old Special Needs Children in Baghdad

S.M Yahya Hanoush, Bashar Helail

International Journal of Dental Sciences and Research

The Oral Health of 6-15 Year Old Special Needs Children in Baghdad

S.M Yahya Hanoush1, Bashar Helail2,

1B.D.S Baghdad, D.D.P.h.RCS England, M.C.D.H England

2Post Graduate, Dip Bristol England


Objectives: To provide a critical review of the current evidence that implicates special needs as a risk factor for dental caries, relating to different special needs types and their effect on oral hygiene. Design: qualitative research. Setting: Mainly hospital-based patients or subjects. Outcome measures: The relationship between special needs and dental caries and gingivitis. Results: The prevalence of dental caries and oral hygiene status were assessed in 496 special needs children aged 6-15 years, attending 7 special needs institutes in Baghdad. The effect of different types of special needs condition or oral hygiene and dental caries was also evaluated. On the basis of the finding, it was concluded that a high proportion of carious lesion were untreated in all ages the F component was less than 20%. The prevalence of gingivitis was high, over 85% of the children were affected, with poor level of oral hygiene increasing by age. The only significant trends to emerge from the different handicap types were that those with impaired hearing and communication problems had much better oral hygiene. Conclusion: The relationship linking dental caries and gingivitis with poor oral hygiene and in special types of special needs children is relatively strong.

Cite this article:

  • S.M Yahya Hanoush, Bashar Helail. The Oral Health of 6-15 Year Old Special Needs Children in Baghdad. International Journal of Dental Sciences and Research. Vol. 4, No. 5, 2016, pp 79-84.
  • Hanoush, S.M Yahya, and Bashar Helail. "The Oral Health of 6-15 Year Old Special Needs Children in Baghdad." International Journal of Dental Sciences and Research 4.5 (2016): 79-84.
  • Hanoush, S. Y. , & Helail, B. (2016). The Oral Health of 6-15 Year Old Special Needs Children in Baghdad. International Journal of Dental Sciences and Research, 4(5), 79-84.
  • Hanoush, S.M Yahya, and Bashar Helail. "The Oral Health of 6-15 Year Old Special Needs Children in Baghdad." International Journal of Dental Sciences and Research 4, no. 5 (2016): 79-84.

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At a glance: Figures

1. Introduction

In the recent years there has been an increasing awareness of the problem of special needs as a challenging group from dental aspect which lies in their physical disability to keep proper oral hygiene, with the difficulty in receiving adequate dental care in general dental practice [16, 17, 22].

Although studies carried out on the prevalence of dental caries suggested that very little difference exist between the prevalence of dental decay seen in special needs children and normal controls, there is definitely a much higher level of untreated dental diseases that have been reported. Special needs children tend to have more decayed and missing teeth [16, 18, 20].

On the other hand, most investigators noted a significantly poor level of oral hygiene with a higher incidence of gingival and periodontal disease amongst special needs children [7, 16, 17], which varies considerably with the degree and type of special need [6].

However, studies on the prevalence of the dental caries and periodontal diseases in Iraqi children (with no special needs) have been published for many years but probably none have dealt with special needs children.

Therefore, this study was organized to ascertain more about the dental state of special needa children to provide basic information for future dental services to be planned. In addition, the affect of different types of special needs on these parameter has been investigated.

2. Setting up the Health Service for Special Needs

On June 28th, 1980, the law of Social Welfare was issued in Iraq, in which the State takes the responsibility to provide health services (including dental services) for those with special needs, with the corporation of the various ministries and health departments.

The welfare and rehabilitation doctorate were established which direct (51) special institute and schools for various types of need throughout the country towards the regulations of rehabilitation

The total number of the special needs is not exactly well known as not all the special needs registered at the welfare department, but at the time of this study there were 4425 children officially registered at 17 special institutes in Baghdad and 34 institute distributed in other cities around the country.

Most of the children lived at home and none of them were institutionalized on a permanent basis.

3. Material and Methods

A sample of 496 special needs children aged 6 to15 years, attending 7 special needs institutes were included in the study.

They represent the three main groups of special needs (deaf & deaf-mute, blind& physically special needs).

The Mental special needs children were excluded from this study.

A stratified sample of 194 deaf & deaf-mute children were selected randomly from five institutes out of nine deaf and deaf- mute special needs institutes distributed in the Baghdad province.

Since there was only one physically and one blind institute in Baghdad, so all the 303 children were examined. Table 1 shows the distribution of the children according to their age and need.

Table 1. Distribution of the study sample according to age group and main special needs

Permission was given from the welfare department to carry out the dental examination at the institutes, and all the head-masters of each institute involved were approached personally prior to the examination.

All the examinations were performed by the first author so initial training and calibration of the examiner was followed by a pilot study to finalize the diagnostic criteria.

A reproducibility study was carried out at one of the deaf-mute institutes with a 4 weeks interval.

Differences recorded between data was not found to be statistically significant (P>0.05).

All the dental examination were carried out at the respective institutes in a classroom. Each child sat on an upright chair except for those with severely physically special needs as they had to be examined on their chair; day light was a constant source of light. The examination took place using a No.4 plain mouth mirror and sickle probe.

4. Diagnostic Criteria

4.1. Dental Caries

The diagnostic criteria selected for the assessment of dental caries were used following the WHO oral health surveys basic methods 1977.

4.2. Gingival Condition and Oral Hygiene Status

The criteria for measuring both gingival and hygiene condition were kept as simple as possible in order to keep the duration of examination to a minimum.

Both conditions were assessed using the good, fair, poor index of James et al 1960.

The data processing was carried out using the following statistical test.

Quantitative data = t-test.

Quantitative data= X2 test.

5. Results

Dental caries prevalence

The caries experiences for both sexes’ were found to be similar, so the results have been presented in combined form.

A total of 496 children were examined for dental caries.

The results are presented in three age groups

6-9 year olds; 10-12year olds, and 13-15 year olds.

Caries experience in the deciduous dentition are shown in Table 2.

Table 2. Caries experience among special needs Deciduous Dentition

• The mean DMF of 6-9 year olds group was 3.9 teeth, and 24%were caries free.

• While in age 10-12 year olds. The mean DMF was 5.1, and only 19% were caries free. 63% of carious lesion remain untreated.

Table 3. Caries experience among S.N permanent dentition

The prevalence of dental caries in permanent dentition is recorded in Table 3,

• The percentage of caries decrease from 31% at age 6-9 years old to16% by age of 13-15yr.

• The mean DMF increases from 3.3 in 6-9 years old to 7.4 by age of 13-15 years.

The breakdown of the:-

• DMF value showed 77% of carious lesions were untreated and only 11% were filled at age 6-9 years.

• In the 13-15 year old group 83% of carious lesions were untreated and only 4% had been filled.

Caries experience by Special needs condition

When the caries experience of the special needs children was analyzed according to their special need condition Table 4 it was clear there is a difference in the prevalence of the dental caries between the three groups. Deaf and deaf-mute shows the least DMF value in all age groups, while the blind children show a significantly greater value of DMF compared to the other two groups. (P<0.05).

Table 4. Caries experience among S.N. by their major special need type

Dental cleanliness and gingival condition

The dental cleanliness and gingival health of 496 children were recorded, Table 5 shows the proportion in each group with good, fair, and poor gingival condition which illustrate that the gingival health deteriorated with increasing age, in the 6-9 years old group only 10% had poor gingival condition and only 2% had good gingival condition.

Table 5. Gingival condition and dental cleanliness among Special needs children

Similarly the plaque scoring obtained shows that in the age 6-9 years old group, 25% of children were in good oral hygiene, while in the 13- 15 years old group, 3% had good oral hygiene.

On the other hand, there were significant differences in oral hygiene standards and gingival health among the three major special needs groups. Table 6 shows that blind and physically special needs had the worst condition, 47% had poor condition, while the deaf and deaf-mute was the least, only 29% with a bad oral hygiene.

Very little differences exist between the physically special needs children and blind children.

Table 6. Oral hygiene and gingival health among H.C. by Special need category

6. Discussion

The results obtained from this study showed a relatively high dental caries level among special needs children, which confirms the finding of other investigators [16, 17, 21].

• The mean DMF calculated for deciduous dentition in Table 2 ranged from (3.9) at 6-9 years of age to (5.7) at 10-12 years, which was relatively higher compared to the normal Iraqi children (Virgin 1982).

• The special needs children tended to have more missing and decayed teeth.

This may be attributed to a number of associated factors. There is a tendency from the parents to keep the feeding bottle for much longer than is wise, there is frequent intake of soft sugary foods given to the children to pacify them at time of stress, together with neglected oral hygiene procedures, all of which leads to considerable tooth destruction and advanced stage of dental caries end with multiple extraction of the teeth. In permanent dentition Table 3 the mean DMF ranged from:

• (3.34) at 6-9 years.

• (4.64) at age of 10-12 years.

• And (7.45) at age of 13-15 years respectively.

The caries prevalence was related to age difference, with the older aged children having more permanent teeth at risk, and this is in agreement with a great number of reports that concluded that dental caries are strongly and positively associated with age [5, 9].

The D&M component combined form over 80% of the DMF in all age groups, and restorative component was less than 20%, which means high percentage of carious lesion were untreated, this emphasises the fact that special needs children are still receiving less dental care and when treatment is provided, there more likely to have extractions rather than restorative as has been shown to be the case in other studies [11, 16, 17, 22].

When the caries experience of the special needs children was analyzed by the three major special needs condition, the blind and physically special needs children showed the highest

DMF value in every age groups Table 4, while the deaf and deaf-mute group showed relatively lower caries prevalence.

This would perhaps be anticipated for the first two groups, either because of a difficulty in keeping good oral hygiene, or a lack of co-operation and a difficulty in the management of those children during treatment which ends in most cases by simple treatment of the child.

The current investigation has also confirmed the poorer levels of oral hygiene and greater prevalence of gingival conditions in special needs children, which agree with other studies [4, 17, 20].

Both conditions get worse with increasing of age, as might be expected from previous data on normal and special needs children [12, 14, 16, 17].

The comparison of the oral hygiene and gingival conditions within different groups shows that the incidence of these conditions varies considerably with the type of condition Table 6.

The blind group scored lowest in terms of "good" oral hygiene, and most of them required periodontal treatment. Children with impaired hearing and communication problems had much better oral hygiene, and this is agree with other studies [17].

The scrutiny of the component of carie index (Figure 4) and gingival status (Figure 5) indicated poor dental health of many special needs children with consequent inadequacy of dental care provision, there are a number of factors that can explain this. Firstly most of the special needs institutes are not visited by a dentist on a regular basis, with no routine dental examination offered for the special needs childre which may be due to insufficient manpower.

Secondly most of those the dental profession are reluctant to provide dental treatment to those with special needs, either because they have a personal fear of inadequacy to cope with the situation, which lead to the child refusing the treatment [10], or because they do not have the time or the treatment equipment, or even because they do not consider it to be economical.

Whatever the reason, the results emphasise the need for good quality dental services together with establishing a comprehensive preventive measure at an early stage for special needs children which includes oral hygiene instruction with much effort placed on the methods of teeth brushing to suit the individual requirements, dietary adviceabout reducing sugar containing foods, fluoride supplements, and a regular check up with a dental professional.

Figure 4. Figure Percentage of caries free in the permanent dentition
Figure 5. Gingival condition among Special needs children

However, many authors have emphasised the importance of a preventive approach whether to patients, or parents or the dentists [8, 19, 23].

Therefore the present investigation stress the vital importance of preventive measures of dental diseases for special needs patients and they should receive absolute priority. In fact, after the general well-being of the child the prevention of dental disease is the most important aspect of any treatment program.

7. Summary

The prevalence of dental caries and oral hygiene status were assessed in 496 special needs children; aged 6-15year olds. On the basis of the findings it was concluded that a high proportion of carious lesions were untreated, in all ages. The F component was less than 20%.

The prevalence of gingivitis was high, over 85% of the children were affected, by a poor level of oral hygiene which increase by age.

This study stresses the importance of preventive measures to improve the dental health for this group in the community.


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