Oral health of young Romanian Special Olympics athletes: parental perception versus clinical findings

Abstract

Aim: To investigate parental perceptions on oral health of young Romanian Special Olympics (SO) athletes and compare it to clinical findings. Methods: Parents/legal representatives of 118 Romanian SO athletes under 18 years of age participating in a National SO event (Deva, 2019) answered a printed questionnaire regarding their children’s oral health and perceived impact on the quality of life (QoL). A cross-sectional study was conducted on the answers. Clinical examination of the athletes was subsequently performed under field conditions using a dental mirror and probe. Individual data were recorded and oral health parameters (caries prevalence index Ip, DMF-T and components, restoration index RI, Plaque index PI) were calculated. Results: Seventy-five percent of the parents rated their children’s oral health as good to excellent; 55% felt that oral health status had little or no impact upon QoL; 66.1% stated their children had never had oral pain; 64.4 had never noticed gingival bleeding. Most parents (88.9%) had already taken their kids to the dentist for pain (20.8%), obvious caries (24%) or regular check-ups (50%). Only 35.6% of the children had benefited from community-based caries prevention programs (Special Smiles mostly mentioned). Clinical examination of the athletes revealed: 9.4% were caries-free; mean DMF-T was 7.80, with mean D component 4.88. Mean RI was 18.32%. PI was 1.49 and 66% of the subjects had gingivitis. Conclusions: Although it is commonly known that children with disabilities have higher risk of oral conditions (caries, periodontal disease, malocclusion), many parents are not aware of their child’s actual oral status. Oral treatment needs are underestimated and remain unmet. Early information of family will help recognizing child’s dental needs. O.S.C.A.R. platform can be a useful tool for increasing parent’s knowledge and awareness, as well as for encouraging efficient communication with the dental team.

Key words: oral health, intellectual disability, parental perception

Funding: This research is partly supported by Erasmus + Project 2019-1-RO01-KA202-063820 Oral Special Care Academic Resources O.S.C.A.R.

Conflict of interest: none

Paper presented at the 2^nd International Association of Paediatric Dentistry Global Summit, Rome, November10-13, 2022, Rome, Italy

Background

Intellectual disability (ID) is a condition characterized by significant limitations in both intellectual functioning and adaptive behavior that originates before the age of 22, according to the definition by the American Association on Intellectual and Developmental Disabilities [https://www.aaidd.org/intellectual-disability/definition]. Many medical conditions involve various degrees of intellectual disability and there are a number of factors that make children with intellectual disabilities more prone to oral disease than typical children. Malfunctions (e.g. oral breathing, common for many intellectual disabilities, comes with gum disease, orthodontic problems and caries [2, 8]), medication (anti-epileptic drugs such as phenytoin may generate gingival overgrowth and favor food retention with subsequent periodontal inflammation, chronic administration of drugs with sugary vehicle encourage decay, some psychotropic drugs may decrease the salivary flow rate, favoring both decay and periodontal conditions [4]), dietary particularities (semi-solid food) and lesser abilities of children with ID to understand and perform efficient brushing [3] are as many reasons for a challenged oral health in these children and, at the same time, reasons for parents to introduce and reinforce home oral hygiene habits from a very young age. On the other hand, taking care of an intellectually challenged child on a day-to-day basis may be quite overwhelming, therefore many parents tend to push oral health towards a secondary level of concern.

Aim

The present paper aims to evaluate parents’ perception on the oral health status of a group of intellectually disabled children and compare it to the actual clinical findings.

Material and methods

A cross-sectional retrospective study was performed on 118 Romanian SO athletes aged 8 to 18 years (mean age 13.87y, SD 2.50) participating in a national SO competition (2019), examined under field conditions (dental mirror and probe, natural light and headlights), by trained dentists. Demographics, status of each tooth (sound, D=Decayed, F=Filled, M=Missing), presence of sealants, signs of gingivitis, and oral hygiene habits were individually recorded. Caries Prevalence (Ip), DMF-T index, Restorative index RI [F/(D+F)]x100 and Plaque Index (IP) were subsequently calculated. Parents or legal representatives of the athletes answered a printed questionnaire regarding their children’s oral health and perceived impact on the quality of life (QoL). Statistical analysis was performed using SPSS 20.0 for Windows and Microsoft Excel.

Results

Results of the clinical examination are summarized in Table 1. The proportion of caries free subjects was 9.4%.  Mean DMF-T was 7.80 [SD 4.42], with a D component of 4.88 [SD 4.21]. Mean RI – showing the proportion of met treatment needs within the actual need – was 18.32% [SD 26.07]. PI index was 1.49 [SD 0.91] and 66% of the subjects had gingivitis.

Table1. Results of the clinical examination

Most of the parents (75%) felt their children had good to excellent oral health (figure 1).

Figure 1. Parents’ perception on overall oral health of their children

Influence of oral health upon QoL as seen by the parents is given in figure 2.

Figure 2. Parents’ perception regarding the impact of oral health upon QoL

Oral pain was seldom remarked by parents (figure 3) and so was gum bleeding (figure 4).

Figure 3. Presence of oral pain as seen by parents

Figure 4. Presence of oral bleeding as seen by parents

Reported reasons for previous dental visits are given in figure 5, with “regular check-ups” as the main reason, cited by 50% of the parents.

Figure 5. Reasons for previous dental visits.

Discussion

Given the age of the study group, oral health status can be regarded as poor, with over 90% of the subjects affected by caries and an average of almost 5 decayed teeth per individual. DMF-T is mainly given by the “D” component, stating little previous interaction of subjects with dental professionals. In the present study, less than 1/5 of the total treatment needs are actually met. No sealants were found, showing little concern for prevention. These findings are consistent with the report of Anders and Davis (2010), who pointed out that the levels of untreated dental decay are consistently higher in subjects with ID, with more missing and decayed teeth, but fewer filled teeth in this category than in the general population [1]. Oliveira et al. (2013) also reported restricted access to oral health services for people with mental impairment as compared to people without ID [5]. There is a number of factors that contribute to a limited access of people with ID to oral care, among which the high cost of dental treatment in private practice plays an important role. In countries where such services are supported by the government, access remains difficult due to long waiting lists for accessing public dental services [11]. Economic status of the geographic region of residency is also cited as factor that may influence access to professional oral care for people with intellectual disabilities in Romania [9].

Less than half of the parents in our study group acknowledged a high impact of oral health upon QoL. This perception could be motivated by the fact that oral health issues are seen as a small part of an already complex situation these families face. A recent study (Prakash et al, 2021) regarding parental perception of oral health-related quality of life in children with autism reported that 18.33% of the parents were aware of the fact that oral health can influence general health [6]. Another study however noted significant impact of dental caries on parents’ perception of the oral health related quality of life of children with intellectual disabilities [10].

In the present study, poor oral health and little treatment compared to the actual needs are findings in contrast with parents’ statement that their children attend regular dental visits. This contrast suggests either a possible lack of dental compliance during those visits, limiting provision of both prevention and treatment, or a “politically correct” answer by some of the parents. Prakash et al (2021) note that 59.1% of the parents of the 300 autistic children in their study group only considered taking their kids to the dentists’ when suffering form pain, while pain was the reason for 21% of the parents in our study to plan a dental visit and two thirds of the parents in our study stated they had never noticed signs of oral pain in their children [6].

Almost three quarters of the parents had hardly seen any gum bleeding, despite the high proportion of subjects with gingival inflammation. A possible explanation for this discrepancy could be sought in children brushing their own teeth, giving parents less opportunities to notice the bleeding. Practicing sports gives Special Olympics athletes self-confidence, helps social integration and [7], encouraging some degree of independence, which may limit parents’ involvement in home oral hygiene habits. However, the level of intellectual disability can limit the efficiency of self-performed brushing, making parental help almost always necessary [3], regardless the age of the person with ID. This is why caregivers’ training is an important aspect to be taken into consideration when designing oral health programs for intellectually challenged people [9].

Conclusions

Although children with disabilities reportedly have higher risk of oral conditions such as caries, periodontal disease, malocclusion or trauma, many parents may not be aware of their child’s actual oral status, especially when there is no obvious pain. In the first stages of oral disease, treatment needs are often underestimated by parents and therefore remain unmet. Early information of families and caregivers will help recognizing child’s dental needs, encourage regular dental check-ups and increase the chances for efficient prevention. Web-based tools like the open access O.S.C.A.R. platform (https://oscarpd.eu/) can be useful tools for increasing parent’s knowledge and awareness, as well as for promoting efficient communication with the dental team.

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