Abstract
BackgroundDespite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available.MethodTwenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives.ResultsDC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25–4.86 for COHI; OR = 2.01, 95% CI = 1.77–2.28 for COCNI; OR = 5.25, 95% CI = 4.55–6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7–4.6 for COHI; OR = 1.52, 95% CI = 1.38–1.69 for COCNI; OR = 1.53, 95% CI = 1.39–1.69 for COPI).ConclusionClinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.
Highlights
Oral health is often considered as a probable source of health inequalities in persons with neuromotor and mental deficiencies
Refusals to participate were declared in 332 cases, absence from the institution at the time of evaluation was recorded in 808 cases, and two children died before the investigator visit
2,487 children aged 6 to 12 years old were included in the DC group (935 males, 552 females; mean age6SD: 9.7561.88 years), and 4,772 adolescents and young adults aged 13 to 20 years old were included in the DA group (2,920 males, 1,852 females; mean age6SD: 15.8561.92 years)
Summary
Oral health is often considered as a probable source of health inequalities in persons with neuromotor and mental deficiencies. The quality of the evidence base supporting this assumption is not high despite numerous studies reporting poor oral health in patient groups with disabilities. Many studies have no control group, use inappropriate indicators or report a partial evaluation of oral health. Self-rated questionnaires on oral health-related quality of life aim to offer a global measure of the concept of health but their use is not feasible by the majority of people with intellectual disability [15,16,17]. This study was designed to provide epidemiological data on oral health gathered using original indicators from a representative sample of children and adolescents with disabilities in France. Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available
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