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Munifah A1,2

Department of Oral Maxillofacial Surgery; and 2

Bluestone Center for Clinical Research, New York University College of

Dentistry, 421 First Avenue, 233W, New York, NY 10010, USA;
*corresponding author, bls322@nyu.edu

J Dent Res 91(5):447-453, 2012

Abstract

The study aimed to determine the knowledge and health status of oral teeth
with an index (DMF-T, OHI-S, PBI) in deaf children and comparison with
normal children. Subjects in this study were taken by Total Sampling, the
number of research subjects was 61 students with hearing impairment from
Special Schools (SLB) for the Education of Children with Disabilities (YPAC)
and normal children from madrasah ibtidaiyah 1, national junior high school
19, national senior high school 9 Banda Aceh who were present at the time of
data collection and were willing to become research subjects. Data obtained
were primary data obtained directly through questionnaires and dental and oral
examination on 61 students. Data were then analyzed statistically using the
Anova test and Chi-square test. The results on the Chi-Square test, the P-value
was 0.001 (P <0.05), which means that there was a relationship between age
and OHI-S. A total of 18 subjects in the 17-20 year age group had an average
of 3-4 teeth with dental caries (DMF-T = 4.77 / high category), normal children
in the same age group had an average of 6-7 teeth with dental caries. Followed
by 33 age group subjects 12-16 years old from deaf children and normal
children had an average 3 tooth caries (DMF-T = 3.72) and 10 subjects in the
age group 7-11 years old on average 1-2 tooth caries (DMF-T = 2.10), but
normal children from the same age group had an average 9 caries tooth. 38.9%
of 17-20 years old deaf children had bad OHIS and 33.3% of normal children
OHIS was bad. The conclusion was normal children had higher oral health
knowledge and better OHIS compare to deaf children.

Keywords

Deaf children, Oral health status

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 Deaf Children Oral Health status with DMFT and OHIS Index in Special
Schools: a Comparison Study with Normal Children
Munifah Abdat 1, and Adintya Humaira2
Introduction
Deaf children are part of children with special needs who have special
characteristics that are different from children in general, they need help and
collaboration with others to maintain their health.1 Deaf children will have
different experiences in social and emotional which impact their quality of life.
This problem arises from their difficulties in communication.2 Therefore, deaf
children have difficulties to capture and convey the problem in their body,
including toothache. Maintaining post-treatment would be a great challenge for
them too. Therefore, prevention is the most basic and important thing which
should be applied to deaf children.3
Dental and oral health is an inseparable part of general body health which
affects the quality of life. In children poor oral health would affect children's
food intake, speaking, their self-esteem, etc.4 The results of the 2018 basic
health research (Riskesdas) revealed a high level of dental and oral health
problems of 57.6% and those receiving services from new dental medical
personnel by 10.2%.5 Somehow, deaf children have a higher risk of dental and
oral health problems.6 This thing was shown by a study of deaf children in
Indonesia at jembarna district was 72.2% was poor and 27.8% was moderate.7
This significant difference of caries is caused by Communication limitations
which cause a low level of knowledge about dental and oral health.7
Characteristics and obstacles possessed by children with special needs requires
them to choose special education, deaf children need sign language as a
medium of communication.8
Hearing loss or deafness can be caused by a genetic, syndromic, bacterial, or
viral disease.9 Etiologies of hearing loss or deaf can be caused either by a viral
or bacterial disease. mumps, measles, herpes zoster oticus, meningitis, syphilis,
or cytomegalovirus infection), or head injury with a temporal bone fracture.10
Some Syndromic deafness can affect the oral too, for example down syndrome
and Treacher colin syndrome.10 Children with down syndrome have learning
difficulties and delayed in learning speaking.11,12 Moreover 80% of them
experiences deafness too and they are prone to malformation of the oral cavity
and tooth. This combination leads to a high risk of periodontal disease and
caries.9,13
Treacher collin is a syndrome caused by mutation of gene TCOF1.13 Treacher
collin is called mandibulofacial dysostosis because one of its features is
craniofacial deformation and 30 % experienced conductive hearing loss.8,14,15
Intraoral condition of treacher collin is affected too such as cleft palate,
micrognathia, mandibular hypoplasia, dental malocclusion, etc.8,14 Therefore
deaf children need more attention than normal children because deaf children
tend to relate with other abnormalities.
It is mandatory for children to have a dentist's appointment in their
childhood.16 In this stage, they will introduce to their oral health. Dentist
should teach
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them the basics of oral health its self such as how to keep their teeth clean, how
to brush cleanly, etc.17 The most important thing that should be learned by the
children is a dentist is not their enemy and the dental appointment is not scary
or painful at all. Therefore the dentist should give them a really good
experience so that they would be excited to take care of their own teeth and
would willingly come back for the next appointment.18 Communication is the
most important key of every dental treatment.19 However its a really different
case for deaf children. There is a communication barrier between the dentist
and children its self. The parents or caregiver would be needed as a third party
to help this interaction. Somehow there is still a problem which is the children
its self has not known yet about their oral and the problem. It would be a really
big difficulty for them to explain it to their parent or caregiver. But if oral
health knowledge of their parents is minimum too, there would be a
misinterpretation which leads to wrong treatment.21 That is why the dentist
should have an approach to both children and their parents or care giver.22
Dentists should know the level of impairment. According to WHO, there are 5
levels of hearing loss such as no impairment, slight impairment, moderate
impairment, severe impairment, profound impairment including deafness.20
Next, the dentist should know the type of communication skill and preferred
method of communication.23 Deaf children have some choice to communicate
such as written or sign language. Some of them are using hearing aids.24 Some
of the deaf children had speech therapy so they can communicate with lip
reading.25
The dentist should open their mask while talking to deaf children.21 Somehow
since the plague of the coronavirus is attacking the world, using masks is
mandatory for everyone. Therefore practician has come up with a solution
which is a clear mask. So hearing loss patients can do lip reading while the
treatment.26 Dentist should talk slowly and use a simple word which will be
easily understood by parents or caregivers and deaf children its self. Dentist can
use some expression, illustration, or demonstration.21 This method will be a
great help since deaf children tend to use lip riding too to communicate.25
Parents or caregivers should avoid bringing children to the dentist when
children have already have a dental problem, which is when the primary molar
eruption.27 Children would be terrified even before the dentist start to check
their teeth, and they would be afraid to express their problem to the dentist
especially deaf children.28 Forcing them to get treatment would lead to dental
fear and anxiety, which impacting them through all of their life.29,30 This
thing would be a great problem if their deafness was syndromic which impact
their whole body health.10 Furthermore dental fear and anxiety tend to occur in
children from low social-economic life due to lack of information and
awareness of their parents.31 That's why the government's dental initiatives
need to reach out all of the community and make them aware of how important
it is to take care of their oral health since early-stage.32
Based on the description above, the researcher is interested in deaf child-oral
hygiene and caries status of deaf children in special schools. The purpose of
this study was to determine the knowledge and health status of oral teeth with
an index (DMF-T, OHI-S, PBI) in deaf children and comparison with normal
children at Special Schools.1
Materials and Methods
 This study uses a cross-sectional study design. Located at the Special Schools 7 (70,0%)
(SLB) of the Foundation for the Education of Children with Disabilities
(YPAC) Kuta Alam District, Banda Aceh city in December 2018. The control 22 (66.7%)
group was 61 normal children from madrasah ibtidaiyah 1, national junior high
school 19, national senior high school 9 Banda Aceh. 20 (60,6%)

This study used an experimental design The subjects in this study were taken 11 (61.1%)
by total sampling Special Schools (SLB) for the Education of Children with
Disabilities (YPAC), the number of research subjects was 61 students with 12 (66,7%)
hearing impairment and 61 normal students who were present at the time of
data collection and were willing to be the subjects of research. The subject Bad
group was split into 3 groups based on their age 7-11 years old, 12-16 years
old, and 17-20 years old. 3 (30.0%)

1 (10,0%)

11 (33.3%)
7-11years old
1 (3,0%)
12-16 years old
7 (38.9%)
17-20 yeas old
6 (33,3%)
OHI-S
Close-end questioner was given to all the of the subject group. Deaf children
(mean ± SD) were helped by their teacher and care taker when filling the questioner. This
questioners was made based on WHO oral health basic method 2013.33
Deaf Children Questioner was meant to get information about children knowledge and
behavior towards their oral health.33
Normal children
The following procedures were oral examination. Type IV examination was
Deaf Children applied to gain OHIS scores and DMF-T of every child. The examiner was
using mouth mirror, explorer, and probe under good illumination. The children
Normal children were asked to sit in front of the examiner while the examiner examines their
mouth, then the assistant would write down the result of the examination.
Deaf Children Children's dental caries were recorded using the DMFT index. DMFT criteria
for this research were based on WHO.34 The examiner would record every
Normal children decayed tooth (DT), missing tooth (MT), and filled tooth (FT). DMFT scores
then applied to a category based on WHO which is 0.0-1.1 categorized as very
DI-S low, 1,2—2.6 categorized as low, 2.7-4.4 categorized as moderate, 4.5-6.5
categorized as high, and >6.6 categorized very high.
1.48 ± 0.71
OHIS status was based on green and vermilion's oral hygiene index
0,99± 0,36 simplified.35 OHIS status of children was examined from 6 surfaces of 4
posterior teeth and 2 anterior teeth. Tooth debris was covering less than one
1.47 ± 0.37 third tooth surface scored 1, covering half of the tooth surface scored 2, and
covering more than two-third tooth surface scored 3. Criteria for calculus was 0
1,01± 0,52 was no calculus present, 1 was supragingival calculus and covering no more
than 1 one third tooth surface, 2 was supragingival calculus covering less than
1,64 ± 0,35 two-thirds of the tooth surface or there was a fleck of subgingival calculus, 3
was supragingival calculus covering more than two-thirds of tooth surface and
1,39± 0,41 a continuous heavy band of subgingival calculus. The sum of the Calculus
index and debris index was the Oral Hygiene index to determine the OHIS
CI-S status of the children. The oral Hygiene index consisted of 3 categories which
were 0-0.6 was good, 0.7-1.8 was moderate, and 1.9-3 was bad.
1.08 ± 0.37

0,21± 0.23

1,33 ± 0,65
RESULT
0,74± 0,51

1.47 ± 0.61
The subjects of this study consisted of 61 deaf children, 31 boys (50.8%), and
1,47± 0,68 30 girls (49.2%). Deaf children were compared with normal children 36 boys
and 25 girls. The age group of subjects was 7-11 years old, 12-16 years old,
OHI-S n (%) and 17-20 years old.

Good Table 1 shows the statistically significant differences in the DMFT index in the
three age groups. In the 17-20 year age group had an average of 3-4 teeth with
0 dental caries (DMF-T = 4.77 / high category). Normal children from the same
age group had 6-7 tooth decay with (DMF-T=6,56/high category). Followed by
2 (20,0%) 12-16 years old group subjects on average 3 tooth caries (DMF-T = 3.72).
Normal children in the same age group had 3 decayed teeth (DMF-T=3,00).
0 The last 7-11 years old group subject had 1-2 tooth caries (DMF-T = 2.10).
Normal children from the same age group subject had 9 decayed teeth (DMF-
12 (36,4%) T=9,20/very high).

0 (0%) 7-11 years old

Moderate 12-16 years old

7 (70.0%) 17-20 years old

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 themselves. From age group 13-14 years old, 31 deaf children cleaned teeth by
themselves and 2 of them helped by others. 32 of normal children were
Deaf chidren cleaning teeth by themself and 1 of them was under supervision. From age
group, 16-17 years old, both deaf and normal children were cleaning teeth by
Normal themselves. Static analysis was using chi-square shows that children's condition
has a significant impact on their knowledge, which is normal children have
Deaf chidren higher knowledge and behavior compare to deaf children.

Normal

Deaf chidren

Normal knowledge and behavior

D 7-11 years old

1.90 ± 1.10 Chi-Square

4,60 ± 2,76 P-value

3.09 ± 1.87 13-14 years old

2,58 ± 2,42 Chi-Square

3.72 ± 3.04 P-value

5,89 ± 3,59 16-17 years old

M Chi-Square

0.20 ± 0.63 P-value

4,60 ± 4,58

0.48 ± 0.83 Normal

0,21 ± 0,78 n(%)

1.00 ± 1.13 Deaf children n(%)

0,22 ± 0,55

0 Normal

0 n(%)

0,24 ± 0,56 Deaf children

0,21 ± 0,65 n(%)

0.55 ± 0.23

0,44 ± 1,65

DMFT Normal

2,10 ± 1,44 n(%)

9,20 ± 5,51 Deaf children

3.72 ± 2.06 n(%)

3,00 ± 2,62

4.77 ± 3.11

6,56 ± 3,50 Needs Help When Cleaning Teeth

by themselves

Table 2 shows that of the 61 people, the subjects with the highest number of 10 (100)
bad OHIS scores were the 17-20 year-old-age group of 7 people (38.9%), and
the last group with bad OHIS scores was the 7-11-year-old group of 3 people 5 (50)
(30 %). On the other hand, normal children had bad OHIS scores in 17-20
years old age group 6 children (33.3%), and the least group with bad OHIS 6.667
scores was the 12-16-year-old subject group 1 child (3,0%). So it can be
concluded that the deaf children group subject had more children with bad 0.010
OHIS scores.
32 (96.9)

31 (93.9)
Table 3 showed that 5 deaf children from age group 7-11 years old helped by
other people when cleaning their teeth and 5 deaf children by themself. On the 3.016
other hand, 10 normal children from the same age group cleaning teeth by

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 0.221 -

18 (100) -

18 (100) 17 (94.4)

- 18 (100)

- 1.029

helped by other people 0.310

0 Finger

5 (50) 0

2 (6.1) 0

0 1 (5.6)

Under supervision

0 Charcoal

0 0

1 (3.1)

0 0

0 0

How to Clean Teeth

toothbrush Others

10 (100) 0

10 (100) 0

33 (100)
0
33 (100)

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 0 0.003

1 (3)

14 (42.4)

15.737
0
0.000
0
1 (5.6)

6 (33.3)

5.905

0.052
Using toothpaste
Twice a day or more
Yes
10 (100)
10 (100)
4 (40)
10 (100)

33 (100)
30 (90.9)
33(100)
19 (57.6)
-

18 (100)

18 (100) 15 (83.3)

- 12 (66.7)

No

0
Once a month
0
0

0
0

0
0

Frequency of Brushing Teeth

Once a day
2-3 times a month
0
0
6 (60)
0
8.571

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 Brushing method

Horizontal

3 (30)
2 (6.1)
10 (100)
0
10.769

0.005

12 (36.3)

21 (63.6)
2 (11.1)
10.902
0
0.012

5 (27.8)

11 (61.1)

4.917
Once a week
0.178
0
Vertical
0
5 (50)

0
10 (30.3)

11 (33.3)

0
2 (11.1)

2 (11.1)

2-6 times a week

0
Round
0
2 (20)

0
9 (27.3)

1 (3.1)

0
10 (55.6)

5 (27.8)

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 0.146

No
consuming vegetable and fruits
0
Yes
0
10 (100)

20.000

0.000
0
12 (36.4)
0
0

30.8

0.000

5 (27.8) 2 (11.1)

0 0

5.808

0.016

No

0 Visiting dentist

10 (100) Yes

6 (60)

2 (20)

3.331

21 (63.6) 0.68

33 (100) 23 (70)

35.302

0.000
13 (72.2)
11 (61)
18 (100)
0

15.84

0.000

No
consuming other than vegetable and fruits
4 (40)
Yes
8 (80)
10 (100)

10 (100)

-
10 (30)
33 (100)
33 (100)
33 (100)

16 (88.9) 7 (39)

18 (100) 18 (100)

2.118

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 In this study, deaf children had less carious teeth compared to normal children
in all age groups. This study contrast with a study by Sudipta Kar et all, where
deaf children had higher caries prevalence compared to normal children.50 The
reason for this difference could be parental oral hygiene knowledge, diet, etc.51
Recent study showed that diet with reducing carbohydrate intake, and
increasing non-vegetable fats, micronutrient intake, and sufficient protein can
prevent caries and periodontal disease. Somehow this diet plan needs to be
consulted to the physician of the patient or dentist.52 Dentists can do dietary
counseling to promote their oral health and evaluate their fluoride intake.53
Floride can be gain from water, food such as fruit, milk, etc, and dental
products.54 Somehow not every child gets an adequate amount of Flouride.
Insufficient, Flouride intake can make children more susceptible to caries but
excesses of Flouride can create flourosis. Therefore dentists should evaluate
children's Flouride intake so they could make an appropriate diet plan for them.
Parent and caregiver must be involved in this diet plans to gain maximum
outcome.55
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All of the deaf children in this study were not consuming vegetables and fruits,
which is the source of fluoride.54 They also increase the secretion of saliva
which has a washing effect.56 Therefore they can help prevents dental caries
Discussion
and periodontal disease.57 But besides the washing effect, they also contain
natural sugar and acidity. This sugar content even higher in fruit juice with the
This study showed that normal children have higher oral health knowledge
addition of sugar in it. Therefore, it's highly recommended to consume fresh
compare to deaf children. Deaf children have limitations in gaining knowledge
fruit and vegetable which contain natural. However, in consuming vegetable
and experience in dental expertise.36 This limitation comes from a combination
and fruit should follow guidelines so it would not cause caries.58
of communication difficulties and dependence toward caregivers or
parents.37,38 Therefore caregiver or parents is the important point in the
Acknowledgments
development of deaf children oral health knowledge.38 Somehow, dentist its
self takes a responsibility toward deaf children oral health. Dentist tends to not
This research was helped by teachers of Special Schools (SLB) of the
treat them maximally because of the communication barrier. Even though
Foundation for the Education of Children with Disabilities (YPAC).
parents or caregivers would be there to help them to communicate, the message
would not be fully interpreted. So that the dentist would not be able to treat
them to what is supposed to be.39 However in this study, all of the deaf
children and a small number of normal children in every age group hadn't
visited the dentist.

The whole subject can clean their teeth without supervision and using a
toothbrush. This is associated with the research of Prasad et al (2018) that the
majority of deaf children can clean their own teeth without the help of others
and brush their teeth with toothpaste.40
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The Role ofDiet andOral Hygiene

inDental Caries

The Role ofDiet andOral Hygiene

inDental Caries

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