Document Type : Original Article


Department of Public Health Dentistry, SGT Dental College Hospital and Research Institute, SGT University, Gurgaon, Haryana, India


CONTEXT: Vision is the most important sense for interpreting the world and when sight is impaired,
especially in childhood it can have detrimental effects on one’s life. To maintain the oral health status
of such group requires special approach.
AIM: The aim of this study is to evaluate the impact of Braille text and verbal, oral hygiene instructions
on the oral health status of visually impaired children.
SETTINGS AND DESIGN: A prospective nonrandomized before and after comparison trial without
any control group was conducted among 165 children aged 7–19 years residing in one of the blind
schools in Delhi.
MATERIALS AND METHODS: A questionnaire was developed to record the source of oral health
knowledge and practices. Oral health status of the children was evaluated by recording plaque
index (PI) and gingival index (GI) scores at 1, 3, and 5 months intervals. Periodic reinforcement of
oral health education was performed with the help of instructions in Braille language.
STATISTICAL ANALYSIS: Paired t‑test and McNemar tests were used to assess the difference
between the scores before and after oral health education.
RESULTS: Among completely blind children, the mean difference of PI and GI score from baseline
to the last evaluation was found to be 0.56 and 0.28, whereas among partially blind children, it was
found to be 0.58 and 0.25, respectively. All the above values were statistically significant (P < 0.001).
CONCLUSION: Visually impaired children irrespective of the degree of blindness could maintain an
acceptable level of oral hygiene when taught using Braille text for instructions. However, continuous
motivation and reinforcement at regular intervals are required for the maintenance of oral health status.


1. Gift HC, Atchison KA. Oral health, health, and health‑related
quality of life. Med Care 1995;33:NS57‑77.
2. Nandini NS. New insights into improving the oral health of
visually impaired children. J Indian Soc Pedod Prev Dent
3. Brown D. An Observational Study of oral Hygiene Care for
Visually Impaired Children BDS, Elective; 2008. Available from: [Last accessed on 2016 Jan 23].
4. World Health Organization. Visual Impairment and
Blindness (Fact Sheet 282); 2011. Available from: http://www. [Last accessed on
2016 Feb 24].
5. Solanki J, Gupta S, Chand S. Comparison of dental caries and oral
hygiene status among blind school children and normal children,
Jodhpur City, Rajasthan, India. Univ Res J Dent 2014;4:22‑5.
6. Schembri A, Fiske J. The implications of visual impairment in an
elderly population in recognizing oral disease and maintaining
oral health. Spec Care Dentist 2001;21:222‑6.
7. Kumar S, Konde S, Raj S, Agarwal M. Effect of oral health
education and fluoridated dentifrices on the oral health status of
visually impaired children. Contemp Clin Dent 2012;3:398‑401.
8. Anaise JZ. Periodontal disease and oral hygiene in a group of
blind and sighted Israeli teenagers 14‑17 years of age. Community
Dent Oral Epidemiol 1979;7:353‑6.
9. O’Donnell D, Crosswaite MA. Dental health education for the
visually impaired child. J R Soc Health 1990;110:60‑1.
10. Mahantesha T, Nara A, Kumari PR, Halemani PK, Buddiga V,
Mythri S, et al. A comparative evaluation of oral hygiene
using braille and audio instructions among institutionalized
visually impaired children aged between 6 years and 20 years:
A 3‑monthfollow‑up study. J Int Soc Prev Community Dent
11. Krishna Kumar RV, Fareed N, Shanthi M. The Effectiveness
of oral health education program with and without involving
self – Maintainable oral hygiene skills among the visually
impaired children. Int J Sci Study 2013;1:51‑5.
12. Löe H. The gingival index, the plaque index and the retention
index systems. J Periodontol 1967;38:Suppl: 610‑6.
13. Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence
and severity. Acta Odontol Scand 1963;21:533‑51.
14. Snellen’s illiterate E chart. Available from: http://www.apps. 7/H53‑H54. Last accessed
on 24‑05‑2015.
15. Wei SH, Lang KP. Periodontal epidemiological indices for children
and adolescents: I. Gingival and periodontal health assessments.
Pediatr Dent 1981;3:353‑60.
16. Emler BF, Windchy AM, Zaino SW, Feldman SM, Scheetz JP. The
value of repetition and reinforcement in improving oral hygiene
performance. J Periodontol 1980;51:228‑34.
17. Titiyal JS, Pal N, Murthy GV, Gupta SK, Tandon R, Vajpayee RB,
et al. Causes and temporal trends of blindness and severe visual
impairment in children in schools for the blind in North India.
Br J Ophthalmol 2003;87:941‑5.
18. Yalcinkaya SE, Atalay T. Improvement of oral health knowledge
in a group of visually impaired students. Oral Health Prev Dent
19. Chang CS, Shih Y. Knowledge of dental health and oral hygiene
practices of Taiwanese visually impaired and sighted students.
J Vis Impair Blind 2004;98:5.
20. AhmadMS, JindalMK, Khan S, Hasmi SH. Oral health knowledge,
practices, oral hygiene status and dental caries prevalence among
visually impaired students in residential institute of Aligarh.
J Dent Oral Hyg 2009;1:22‑6.
21. Dorout IA, Tobaigy FM, Moaleem MM, Ahmad M, Shubayr MA,
Kinani HM. Knowledge and oral health related behaviour among
visually impaired subjects in Jazan region, Saudi Arabia. J Dent
Oral Hyg 2015;7:33‑9.
22. Chowdary PB, Uloopi KS, Vinay C, Rao VV, Rayala C. Impact of
verbal, braille text, and tactile oral hygiene awareness instructions
on oral health status of visually impaired children. J Indian Soc
Pedod Prev Dent 2016;34:43‑7.
23. Krishnakumar R, Silla SS, Durai SK, Govindarajan M,
Ahamed SS, Mathivanan L. Comparative evaluation of audio and
audio – Tactile methods to improve oral hygiene status of visually
impaired school children. CHRISMED J Health Res 2016;3:55‑9.
24. Bansal M. Effect of auditory aid in improving oral hygiene
among visually impaired children in Chandigarh city, India – A
Longitudinal study. Oral Health Dent Manage 2014;13:894‑6.
25. Avasthy K, Bansal K, Mittal M, Marwaha M. Oral health status
of sensory impaired children in Delhi and Gurgaon. Int J Dent
Clin 2011;3:21‑3.
26. Ganapathy AK, Namineni S, Vaaka PH, Vamsilatha K, Das R,
Devi M, et al. Effectiveness of various sensory output methods in
dental health education among Blind children – A comparative
study. J Clin Diagn Res 2015;9:zc75‑8.
27. Kadkhoda J, Rezaie A, Amiri A. Effect of visual impairment
education on the improvement of oral hygiene and reduction of
periodontitis prevalence. Int J Med Dent 2014;4:7‑12.
28. Joybell C, Krishnan R, V SK. Comparison of two brushing
methods‑ fone’s vs modified bass method in visually impaired
children using the audio tactile performance (ATP) technique.
J Clin Diagn Res 2015;9:ZC19‑22.
29. Beverley CA, Bath PA, Booth A. Health information needs of
visually impaired people: A systematic review of the literature.
Health Soc Care Community 2004;12:1‑24.