Is the oral health of visually impaired children and adolescents different compared to their sighted peers?

Abstract

Data sources The review searched for articles via PubMed, Web of Science, Scopus, and Ovid. OpenGrey and the Brazilian Digital Library of Thesis and Dissertations (BDTD) were used to search for grey literature. As well as a manual searches of the reference lists from the included studies, a Google Scholar search was undertaken and the first 300 hits were screened. There was no restriction on date or language.Study selection Two authors screened initially 10% of the abstracts against the inclusion and exclusion criteria and then a calibration calculation was completed showing excellent agreement (kappa coefficient = 0.93). In phase one, abstracts were screened independently between the same two authors and discrepancies were discussed and resolved. In phase two, the full articles of those abstracts accepted were screened, as well as those whose abstracts were unavailable. Discrepancies were discussed with a third author for the final decision.Data extraction and synthesis Data extracted included: study characteristics (authors, year of publication, study design, country, sampling, the presence of a pilot study, aim, calibration and losses); population (age range and sex, sociodemographics and sample size); exposure (eligibility criteria and type and classification criteria of vision impairment); and outcome (prevalence and mean and standard deviation of oral health issues, such as dental plaque, gingivitis, calculus, periodontitis, oral hygiene [OH], dental caries and traumatic dental injuries [TDI]). Discrepancies were discussed with a third author for the final decision. In total, 15 studies were included in the systematic review and 12 in the meta-analysis. For the meta-analysis, heterogeneity was measured using I2 statistics.Results The meta-analysis found visually impaired children and adolescents had significantly higher levels of plaque (mean difference [MD] = 0.80; 95% confidence interval [CI] = 0.58-1.02; I2= 96%), gingival inflammation (MD = 0.69; 95% CI = 0.02-1.37; I2 = 100%), calculus (MD = 0.04; 95% CI = 0.03-0.06; I2 = 0%), OH indices (MD = 0.71; 95% CI = 0.24-1.18; I2 = 97%) and decayed missing filled surface (DMFS/dmfs) (MD = 0.90; 95% CI = 0.68-1.13; I2 = 26%) compared to sighted peers. TDI were statistically significantly higher (OR = 3.86; 95% CI = 2.63-5.68; I2 = 0%) in visually impaired children and adolescents. There was no significant difference in decayed missing filled teeth and DMFS/dmfs or caries.Conclusions Children and adolescents who are visually impaired are at greater risk of TDI and levels of dental plaque, gingival inflammation, calculus and DMFS and poorer OH. Furthermore, robust homogenous studies are required to strengthen any evidence of association between oral health outcomes and visual impairment in children and adolescents. Future research should also explore the directionality of these relationships.