Blindness In Oral Health

Oral health has a strong biological, psychological and social correlation on the overall health of a child especially those with special health needs (1). A handicapped person is “one who over an appreciable period is prevented by physical or mental conditions from full participation in the normal activities of their age group including those of social, recreational, educational and vocational nature”(2). A special child present’s a unique challenge to the dentist’s skills and knowledge as they have poor oral hygiene due to disability-related factors or manual dexterity which is necessary to execute adequate oral hygiene skills. Hence, with adequate training and understanding various complications, these special children can be managed well

The World Health Organization (WHO) in May 2009 estimated that globally around 314 million people are visually impaired and 45 million of them are blind. There are two types of visual disability, namely low vision (partially blind) and absolutely nil vision (totally blind) (5). It may be congenital, through complications arising from systemic diseases or diseases of the eye such as cataract and glaucoma (6).Total visual impairment is one disorder that may result in slow social development, frequent hospitalization and at times separation from family. The capabilities of a child with blindness are difficult to assess because of which these children may be considered developmentally delayed (7). Visually impaired children when compared with their normal sighted peers have poorer oral hygiene and are at a greater risk of dental caries due to their inability to visualize the plaque on tooth surfaces resulting in inadequate plaque removal and progression of dental caries

Absence of visual stimuli acts as a barrier and is a challenging to the dentist in motivating them, thus brushing methods and models were custom designed such self educational manuals in the form of Braille’s, audio tapes, models of teeth etc (10). Braille is a tactile writing system used by visually impaired children and is traditionally written with embossed paper. It is named after its creator, Frenchman Louis Braille, who lost his eyesight due to a childhood accident. Studies have found that periodic oral health awareness increased due to the periodic education along with instructions through Braille’s method, which had a positive impact on oral hygiene and periodontal status of visually impaired children (5, 14, 15).

Audio tactile performance technique (ATP), is a specially designed health education method, very effective communication tool to educate these children regarding oral hygiene maintenance. The children are first verbally informed about the importance of the teeth and methods of brushing (Audio), they were then made to feel the teeth on a large sized model (Tactile). They were taught to brush on the model and then were asked to feel their own teeth with their tongue. The children were then taught to brush their own teeth with assistance (Performance)