Abstract

KEYWORDS: Oral health, orphans, perception, practices

INTRODUCTION

The pattern of orphanage living differs greatly from that of family living in that the former provides physical security, food, and shelter but lacks psychological security. The issues of orphan children are diverse and are linked to the living conditions of the institution.[1] According to UNICEF, UNAIDS, and USAID, orphanages may not provide an environment conducive to a child’s healthy growth and development.[2] Orphanages may have negative effects on adolescents[3] due to their physical conditions, a lack of personnel, people’s perceptions of orphanages, and a lack of family support for children. Being an orphan is one of the most important predictors of poor oral health because these children rarely have access to dental care. Children’s health issues in orphanages can be complicated.

Oral health and general health are inextricably linked, and the latter is part of the larger context of general health. Due to their widespread prevalence and incidence in all parts of the world, oral diseases are classified as major public health issues.[4]

According to a study on orphans conducted by Hans et al., the majority of the orphans had acquired knowledge about oral health and were aware of the importance of maintaining good oral hygiene and regular dental visits.[5] Shanbhog et al.[6] discovered a higher prevalence of dental caries, gingivitis, and poor oral hygiene status among orphans in their study. Comprehensive oral health programs aiming prevention of oral diseases can help in reducing the burden of oral diseases among orphans.[7] Ignorance, absence of funding and financial support, and lack of an adequate number of caretakers are all factors that deny primary prevention of oral diseases.[8] The lack of protective figures and increased stress can lead to risk-taking behaviors. This leaves a significant proportion of orphans vulnerable to substance abuse and associated morbidities in later stages of life.[9]

MATERIALS AND METHODS

This is a cross-sectional study where data were collected from chosen inmates in Bengaluru City orphanages between the ages of 12 and 17. Children who were physically or mentally disabled and those who had any systemic disorders were excluded.

The Department of Women and Child Development provided a list of government and private orphanages in Bengaluru City. In Bengaluru City, there were 593 children between the ages of 12 and 17 living in orphanages. The Department of Women and Child Development provided a list of orphanages in Bengaluru. It consisted of 39 orphanages, each serving as a cluster. Orphanages were chosen by lottery method from the clusters, and all members of the selected clusters were recruited in the study. In this way, nine orphanages were chosen to create a 250-person study sample. The study’s objective and design were explained to all participants, and their informed consent was obtained.

Before being enrolled in the study, caretakers signed a written informed consent form. The Department of Women and Child Development gave its permission to conduct the research in orphanages. The questionnaire was obtained from the World Health Organization’s Oral Health Basic Survey Methods.[10] There are 14 items about the perception of oral health and habits in the questionnaire. The pilot study was carried out to determine the feasibility of the investigation, as well as to train and calibrate the investigator and assess the questionnaire’s test-retest reliability. Before the pilot study, questionnaires were translated into Kannada and back translated to English by an independent translator. The final questionnaire was created once any necessary corrections were made.

Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 16.0. Armonk, NY: IBM Corp. IBM SPSS Version 16.0. P < 0.05 was considered statistically significant.

RESULTS

The study enrolled a total of 269 people. The study group’s average age was 14.19 ± 1.62 years, with individuals ranging in age from 12 to 17 years. Males made up 159 (59.1%) of the group, while females made up 110 (40.9%).

The perception of the participants of the health of their gums and teeth is shown in . There was a statistically significant difference in the perceived health of both gums and teeth (P < 0.05).

One hundred and fourteen participants rarely had any experience of toothache, while 72 reported had a pain occasionally and 43 had never experienced a toothache in the past 12 months. The difference in the experience of pain was statistically significant (P < 0.05).

Among the study participants, 181 brushed their teeth two or more times a day and 68 brushed once daily (P < 0.05). The distribution of participants based on various oral hygiene aids is shown in . Considering the impact of teeth and mouth on oral health-related quality of life, 97 participants had difficulty in chewing and 96 participants found it difficult to bite hard foods. Among the study subjects, 86 participants were not satisfied with the appearance of the teeth and 57 participants avoided smiling and laughing because of teeth problems. Thirty-seven participants reported that other children made fun of their teeth and 25 participants missed class at schools due to dental reasons.

Fresh fruits were consumed by 107 participants once a week, 45 participants several times a week, and by 44 participants at least once a day. Ninety-five participants had biscuits, cakes, and sweet pies several times a week, while the daily consumption was seen among 57 participants. Jam and honey were consumed daily by 149 participants and several times a week by participants. Eighty-seven participants reported having chewing gum with sugar several times a week and 83 participants reported a daily consumption. Sweets and candies were consumed once a week by 100 participants, several times a week by 74 participants, and at least once a day by 29 participants. Beverages in the form of lemonade or soft drinks, milk, tea, and coffee containing sugar were consumed daily by 156 participants.

Among the study participants, the consumption of tobacco in the form of cigarettes, pipes, or cigars was seen among 12 (4.5%) and 15 (5.6%) reported chewing tobacco or snuff, and the difference was not statistically significant. The distribution of participants based on the past dental visit and the reason for the visit is given in Tables and .

DISCUSSION

In the present study, 16% of the participants had never experienced dental pain in the past 1 year. This is in contrast with the study by Khedekar et al. who found that 94% of residents in orphanages had toothache once in the past 6 months.[11] The frequency of dental visits among the participants of this study was very low with 71% of the participants who reported that they never made a dental visit. A study carried out by Shanbhog et al. showed that only 11.3% of children visited a dentist and another study by Khadekar et al. showed that 98% of orphans did not receive any dental treatment.[11,12] The results were in contrast to a study by Hans et al. where only 33% did not make any dental visits. This probably could be due to the reason that all the children were provided with education facilities, and hence, the oral health awareness among these children was high.[5] The very low proportion of the children who visited dentists in this study may be due to neglect from the side of caretakers who might not have felt oral health as an integral part of general health.[13]

One of the chief reasons for the dental visits was reported as toothache. This stresses the lack of any preventive programs and regular dental checkups which causes the participants to visit a dentist at a terminal situation. On clinical evaluation, Caries, traumatic injuries, oral ulcers, and temporomandibular joint pain were identified as the main reasons for the dental visit. When children report pain, they are given symptomatic medication to relieve the pain, but no dental visits or treatment is planned for them. Another reason could be cost. Many orphanages are heavily supported by donations. As a result, dental treatments are frequently the least prioritized. For children raised at home, parents are the primary motivators for using dental services. Children in our study who are in pain due to oral conditions caused by untreated caries are ignored and not treated. According to a study conducted by Christian et al., the prevalence of caries among children living in orphanages is higher than that of children living with their families.[14]

In most of the orphanages, children were provided with toothpaste and brush by the authorities. In this study, 85% of the children reported that they brushed their teeth using toothpaste and toothbrush. This was in accordance with the study by Hans et al. where 82% brushed their teeth using toothpaste and toothbrush.[5] The findings of the present study showed that 67.3% of the participants cleaned their teeth twice daily, which can be attributed to the lack of supervision. This was in contrast with the study by Al-Maweri et al. where only 19.3% of inmates brushed their teeth twice per day.[15] Dental floss was used by only three participants.

In a study by Sandström et al., 21% of kids brushed their teeth for <1 min, while 91% of participants brushed twice or more times.[16]

Looking at the dietary aspect, the daily fresh fruit consumption in this study was low. The daily consumption of tea, sugar, and candies was also less. A study by Gaur et al. found that the frequency of snacking between meals was low in children residing in juvenile homes.[17] About 32% of the participants were not satisfied with the appearance of their teeth, 35.7% had difficulty in biting hard foods, and 36.1% had difficulty in chewing. The results were in agreement with the study conducted by Hans et al. who found that 57% of participants not satisfied with the appearance of their teeth and Arun Kumar et al., who found that 50.5% of participants satisfied with their teeth in his study.[5,18] Lack of knowledge about the correct brushing techniques, poor oral hygiene practices before being institutionalized, and lack of supervision may be enlisted as the attributing factors.

CONCLUSION

Orphanage children’s oral health practices and dental visit patterns are inadequate. It is possible to conclude that this community has a low utilization of preventive or therapeutic oral health services. The findings of this study suggest that awareness of the importance of oral health should be increased among Bengaluru’s orphanage children.

REFERENCES