Impact of the Visual Performance Reinforcement Technique on Oral Hygiene Knowledge and Practices, Gingival Health, and Plaque Control in Hearing- and Speech-Impaired Adolescents: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Setting
2.2. Sample Size Calculation
2.3. Inclusion and Exclusion Criteria
2.3.1. Inclusion Criteria
- (1)
- Participants in the age group of 12–15-years old, possessing hearing loss with speech impairment.
- (2)
- Those who were not utilizing hearing aids.
- (3)
- Those who were trained in sign language.
- (4)
- Those having a plaque score greater than one.
2.3.2. Exclusion Criteria
- (1)
- Participants with other disabilities, in addition to hearing and speech impairment.
- (2)
- Participants and their parents/guardians who did not provide assent and written informed consent to participate in the study.
- (3)
- Those with uncooperative behavior.
- (4)
- Those who were unable to cope with the oral examination procedure.
- (5)
- Those undergoing orthodontic treatment and/or any other dental treatment in the previous six months.
- (6)
- Those with underlying systemic disease.
- (7)
- Those with special health care needs.
- (8)
- Those using medications that could affect gingival health.
2.4. Ethical Considerations
2.5. Assessment Plan
2.5.1. Preparatory Phase
2.5.2. Pre-Education and Randomization
2.5.3. Administration of Intervention
2.6. Follow-Up
2.7. Statistical Analysis
3. Results
4. Discussion
4.1. Strength and Limitations
4.2. Future Prospects and Recommendations
4.3. Clinical Significance
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Singh, V. Hearing in India: All aspects. Online J. Otolaryngol. 2015, 5, 39. [Google Scholar]
- World Health Organization. Deafness and Hearing Loss; World Health Organization: Geneva, Switzerland, 2022; Available online: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss (accessed on 10 September 2022).
- World Health Organization. Global Costs of Unaddressed Hearing Loss and Cost-Effectiveness of Interventions: A WHO Report 2017; World Health Organization: Geneva, Switzerland, 2017; Available online: https://apps.who.int/iris/handle/10665/254659 (accessed on 10 September 2022).
- Government of India; Social Statistics Division, Ministry of Statistics and Programme Implementation. Persons with Disabilities (Divyangjan) in India—A Statistical Profile: 2021. Available online: http://www.mospi.gov.in (accessed on 4 September 2022).
- Government of India. Persons with Disabilities in India; Report No. 583(76/26/1); National Sample Survey Organisation: New Delhi, India, 2019. Available online: https://pib.gov.in/PressReleasePage.aspx?PRID=1593253 (accessed on 7 September 2022).
- Sandeep, V.; Kumar, M.; Vinay, C.; Chandrasekhar, R.; Jyostna, P. Oral health status and treatment needs of hearing impaired children attending a special school in Bhimavaram, India. Indian J. Dent. Res. 2016, 27, 73–77. [Google Scholar] [CrossRef]
- Sanjay, V.; Shetty, S.M.; Shetty, R.G.; Managoli, N.A.; Gugawad, S.C.; Hitesh, D. Dental health status among sensory impaired and blind institutionalized children aged 6 to 20 years. J. Int. Oral Health 2014, 6, 55–58. [Google Scholar]
- Jain, M.; Mathur, A.; Kumar, S.; Dagli, R.J.; Duraiswamy, P.; Kulkarni, S. Dentition status and treatment needs among children with impaired hearing attending a special school for the deaf and mute in Udaipur, India. J. Oral Sci. 2008, 50, 161–165. [Google Scholar] [CrossRef] [Green Version]
- Kvam, M.H.; Loeb, M.; Tambs, K. Mental health in deaf adults: Symptoms of anxiety and depression among hearing and deaf individuals. J. Deaf Stud. Deaf Educ. 2007, 12, 1–7. [Google Scholar] [CrossRef] [Green Version]
- Suma, G.; Das, U.M.; Bs, A. Dentition status and oral health practice among hearing and speech impaired children: A cross sectional study. Int. J. Clin. Pediatr. Dent. 2011, 4, 105–108. [Google Scholar] [CrossRef]
- Vignehsa, H.; Soh, G.; Lo, G.L.; Chellappah, N.K. Dental health of disabled children in Singapore. Aust. Dent. J. 1991, 36, 151–156. [Google Scholar] [CrossRef]
- Kalaivani, S.; Shavi, G.R.; Shanmugam, S.; Sanga, R.; Gunasekaran, L.; Rahila, C. Oral health status of hearing and speech-impaired schoolchildren in Erode district, Tamil Nadu—A crosssectional study. SRM J. Res. Dent. Sci. 2021, 12, 198–203. [Google Scholar] [CrossRef]
- Hashmi, S.; Mohanty, V.R.; Balappanavar, A.Y.; Yadav, V.; Kapoor, S.; Rijhwani, K. Effectiveness of dental health education on oral hygiene among hearing impaired adolescents in India: A randomized control trial. Spec Care Dentist 2019, 39, 274–280. [Google Scholar] [CrossRef]
- Loe, H. The gingival index, the plaque index and the retention index systems. J. Periodontol. 1967, 38, 610–616. [Google Scholar] [CrossRef]
- Silness, J.; Löe, H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol. Scand. 1964, 22, 121–135. [Google Scholar] [CrossRef]
- Bell, M.L.; Kenward, M.G.; Fairclough, D.L.; Horton, N.J. Differential dropout and bias in randomised controlled trials: When it matters and when it may not. BMJ 2013, 346, e8668. [Google Scholar] [CrossRef]
- Roland, L.; Fischer, C.; Tran, K.; Rachakonda, T.; Kallogjeri, D.; Lieu, J.E. Quality of life in children with hearing impairment: Systematic review and meta analysis. Otolaryngol. Head Neck Surg. 2016, 155, 208–219. [Google Scholar] [CrossRef] [Green Version]
- Flanders, R.A. Effectiveness of dental health educational programs in schools. J. Am. Dent. Assoc. 1987, 114, 239–242. [Google Scholar] [CrossRef]
- Do, C. Applying social learning theory to children with dental anxiety. J. Contemp. Dent. Pract. 2004, 5, 126–135. [Google Scholar] [CrossRef] [Green Version]
- Herrera-Fernandez, V.; Puente-Ferreras, A.; Alvarado-Izqueirdo, J.M. Visual learning strategies to promote literacy skills in prelingually deaf readers. Rev. Mex. Psicol. 2014, 31, 1–10. [Google Scholar]
- Fitzpatrick, E.M.; Hamel, C.; Stevens, A.; Pratt, M.; Moher, D.; Doucet, S.P.; Neuss, D.; Na, E. Sign language and spoken language for children with hearing loss: A systematic review. Pediatrics 2015, 18, e20151974. [Google Scholar] [CrossRef] [Green Version]
- Fageeh, H.N.; Mansoor, M.A. The effectiveness of oral hygiene instructions in sign language among hearing impaired adults in Saudi Arabia. Spec. Care Dentist 2020, 40, 41–48. [Google Scholar] [CrossRef]
- Sandeep, V.; Vinay, C.; Madhuri, V.; Rao, V.V.; Uloopi, K.S.; Sekhar, R.C. Impact of visual instruction on oral hygiene status of children with hearing impairment. J. Indian Soc. Pedod. Prev. Dent. 2014, 32, 39–43. [Google Scholar] [CrossRef]
- Doichinova, L.; Peneva, M. Motivational training programme for oral hygiene of deaf children. Int. J. Sci. Res. 2015, 4, 1124–1126. [Google Scholar]
- Shetty, V.; Kumar, J.; Hegde, A. Breaking the sound barrier: Oral health education for children with hearing impairement. Spec. Care Dentist 2014, 34, 131–137. [Google Scholar] [CrossRef]
- Pareek, S.; Nagaraj, A.; Yousuf, A.; Ganta, S.; Atri, M.; Singh, K. Effectiveness of supervised oral health maintenance in hearing impaired and mute children—A parallel randomized controlled trial. J. Int. Soc. Prev. Community Dent. 2015, 5, 176–182. [Google Scholar] [CrossRef] [Green Version]
- Hauser, P.C.; O’Hearn, A.; McKee, M.; Steider, A.; Thew, D. Deaf epistemology: Deafhood and deafness. Am. Ann. Deaf 2010, 154, 486–492. [Google Scholar] [CrossRef]
- Emier, B.F.; Windchy, A.M.; Zaino, S.W.; Feldman, S.M.; Scheetz, J.P. The value of repetition and reinforcement in improving oral hygiene performance. J. Periodontol. 1980, 51, 228–234. [Google Scholar] [CrossRef]
- Baliga, M.S.; Deshpande, M.A.; Thosar, N.; Rathi, N.; Bane, S.; Deulkar, P. Comparison of impact of oral hygiene instructions given via sign language and validated customized oral health education skit video on oral hygiene status of children with hearing impairment. J. Indian Soc. Pedod. Prev. Dent. 2020, 38, 20–25. [Google Scholar] [CrossRef]
Questions | Response | VPR Technique (n = 38) | Statistics | Sign Language (n = 37) | Statistics | |||
---|---|---|---|---|---|---|---|---|
Before | After | p-Value | Before | After | p-Value | |||
1. | Does oral hygiene have any role in the maintenance of general health? | Yes α | 27 (71.1%) | 36 (94.7%) | 0.012 * | 26 (70.3%) | 30 (81.1%) | 0.454 |
No β | 11 (28.9%) | 2 (5.3%) | 11 (29.7%) | 7 (18.9%) | ||||
2. | Which among the two is the best tooth cleaning agent? | Toothpaste α | 26 (68.4%) | 36 (94.7%) | 0.006 * | 30 (81.1%) | 32 (86.5%) | 0.754 |
Toothpowder β | 12 (31.6%) | 2 (5.3%) | 7 (19.9%) | 5 (13.5%) | ||||
3. | How long should you brush your teeth? | 2 to 3 min α | 6 (15.8%) | 21 (55.3%) | 0.001 ** | 11 (29.7%) | 32 (86.5%) | 0.001 ** |
45 s β | 32 (84.2%) | 17 (44.7%) | 26 (70.3%) | 5 (13.5%) | ||||
4. | How many times should you brush your teeth in a day? | Twice a day α | 2 (5.3%) | 30 (78.9%) | 0.001 ** | 1 (2.7%) | 10 (27.0%) | 0.012 * |
Once in a day β Once in two days β | 36 (94.7%) | 8 (21.1%) | 36 (97.3%) | 27 (73.0%) | ||||
5. | Which is the best time to brush your teeth? | Morning and night α | 23 (60.5%) | 32 (84.2%) | 0.001 ** | 20 (54.1%) | 36 (97.3%) | <0.001 ** |
Only morning β Only night β | 15 (39.5%) | 6 (15.8%) | 17 (45.9%) | 1 (2.7%) | ||||
6. | How do you clean your teeth regularly? | Brushing with toothpaste, toothbrush and rinsing after meal α | 4 (10.5%) | 32 (84.2%) | <0.001 ** | 3 (8.1%) | 7 (18.9%) | <0.001 ** |
Brushing with finger β Brushing with toothpaste and toothbrush β | 34 (89.5%) | 6 (15.8%) | 34 (91.9%) | 30 (81.1%) | ||||
7. | When do you have to change your toothbrush? | Once every three months α | 6 (15.8%) | 34 (89.5%) | <0.001 ** | 2 (5.4%) | 32 (86.5%) | <0.001 ** |
Once a month β Once every two months β Once every six months β | 32 (84.2%) | 4 (10.5%) | 35 (94.6%) | 5 (13.5%) | ||||
8. | Which brushing technique is the best to clean your teeth? | Gentle downward and upward strokes, along with a circular motion α | 7 (18.4%) | 30 (78.9%) | <0.001 ** | 9 (24.3%) | 32 (86.5%) | <0.001 ** |
Horizontal scrub motion β | 31 (81.6%) | 8 (21.1%) | 28 (75.7%) | 5 (13.5%) | ||||
9. | What will happen if you do not brush your teeth regularly? | Both of the above α | 16 (42.1%) | 30 (78.9%) | 0.004 * | 18 (48.6%) | 24 (64.9%) | 0.263 |
Tooth decay causing tooth loss β Gum disease causing tooth loss β I don’t know β | 22 (57.9%) | 8 (21.1%) | 19 (51.4%) | 13 (35.1%) | ||||
10. | You should clean your teeth after every meal. | True α | 30 (78.9%) | 36 (94.7%) | 0.070 | 32 (86.5%) | 36 (97.3%) | 0.125 |
False β | 8 (21.1%) | 2 (5.3%) | 5 (13.5%) | 1 (2.7%) | ||||
11. | Sweet and sticky foods containing sugar are healthy for your teeth. | False α | 22 (57.9%) | 30 (78.9%) | 0.096 | 22 (59.5%) | 27 (73.0%) | 0.359 |
True β | 16 (42.1%) | 8 (21.1%) | 15 (40.5%) | 10 (27.0%) | ||||
12. | Periodic check-up visits to a dentist are important to maintain the health of your mouth. | True α | 25 (65.8%) | 38 (100%) | - | 22 (59.5%) | 32 (86.5%) | 0.021 * |
False β | 13 (34.2%) | 0 (0%) | 15 (40.5%) | 5 (13.5%) | ||||
13. | How often should you visit the dentist? | Once every 6 months α | 5 (13.2%) | 32 (84.2%) | <0.001 ** | 5 (13.5%) | 16 (43.2%) | 0.013 * |
Once a month β Once every 3 months β Once a year β | 33 (86.8%) | 6 (15.8%) | 32 (86.5%) | 21 (56.8%) |
Questions | Response Frequencies n (%) | |||||||
---|---|---|---|---|---|---|---|---|
Response | VPR Technique (n = 38) | Statistics | Sign Language (n = 37) | Statistics | ||||
Before | After | p-Value | Before | After | p-Value | |||
1. | Do you use fluoride-containing toothpaste? | Yes α | 5 (13.2%) | 22 (57.9%) | <0.001 §,** | 4 (10.8%) | 19 (51.4%) | <0.001 §,** |
No β | 33 (86.8%) | 16 (42.1%) | 33 (89.2%) | 18 (48.6%) | ||||
2. | Do you use dental floss? | Yes α | 0 (0%) | 20 (52.6%) | - | 1 (2.7%) | 11 (29.7%) | 0.006 §,* |
No β | 38 (100%) | 18 (47.4%) | 36 (97.3%) | 26 (70.3%) | ||||
3. | Do you clean your tongue? | Yes α | 4 (10.5%) | 24 (63.2%) | <0.001 §,** | 7 (18.9%) | 16 (43.2%) | 0.004 §,* |
No β | 34 (89.5%) | 14 (36.8%) | 30 (81.1%) | 21 (56.8%) | ||||
4. | Where did you get this information? | Parents/guardians | 7 (%) | 0 (%) | 0.001 ||,** | 6 (%) | 0 (0%) | 0.001 ||,** |
Teachers | 16 (%) | 5 (%) | 13 (%) | 9 (0%) | ||||
Dentist | 3 (%) | 0 (%) | 1 (%) | 0 (0%) | ||||
Have not received any information on this (before intervention) | 12 (%) | - | 17 (0%) | - | ||||
From this health education module (after intervention) | 33 (%) | 28 (%) |
Knowledge Score | VPR Technique (n = 38) | Sign Language (n = 37) | Statistics | |||
---|---|---|---|---|---|---|
Mean ± SD | 95% CI | Mean ± SD | 95% CI | t-Value | p-Value || | |
Before intervention | 5.26 ± 1.22 | 4.81–5.62 | 5.49 ± 1.22 | 5.08–5.89 | −0.023 | 0.982 |
After intervention | 10.97 ± 1.31 | 10.56–11.44 | 9.03 ± 1.57 | 8.50–9.55 | 5.842 | <0.001 ** |
t-value | 21.432 | 12.599 | ||||
p-value § | <0.001 ** | <0.001 ** | ||||
Knowledge gain | 5.71 ± 1.64 | 5.17–6.25 | 3.54 ± 1.71 | 2.97–4.11 | <0.001 ** |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Kumar, R.S.; Deshpande, A.P.; Ankola, A.V.; Sankeshwari, R.M.; Hampiholi, V.; Hebbal, M.; Jalihal, S.; Pai Khot, A.J.; Valakkunja, D.; Kotha, S.L. Impact of the Visual Performance Reinforcement Technique on Oral Hygiene Knowledge and Practices, Gingival Health, and Plaque Control in Hearing- and Speech-Impaired Adolescents: A Randomized Controlled Trial. Children 2022, 9, 1905. https://doi.org/10.3390/children9121905
Kumar RS, Deshpande AP, Ankola AV, Sankeshwari RM, Hampiholi V, Hebbal M, Jalihal S, Pai Khot AJ, Valakkunja D, Kotha SL. Impact of the Visual Performance Reinforcement Technique on Oral Hygiene Knowledge and Practices, Gingival Health, and Plaque Control in Hearing- and Speech-Impaired Adolescents: A Randomized Controlled Trial. Children. 2022; 9(12):1905. https://doi.org/10.3390/children9121905
Chicago/Turabian StyleKumar, Ram Surath, Apurva Prashant Deshpande, Anil V. Ankola, Roopali M. Sankeshwari, Vinuta Hampiholi, Mamata Hebbal, Sagar Jalihal, Atrey J. Pai Khot, Deepika Valakkunja, and Sree Lalita Kotha. 2022. "Impact of the Visual Performance Reinforcement Technique on Oral Hygiene Knowledge and Practices, Gingival Health, and Plaque Control in Hearing- and Speech-Impaired Adolescents: A Randomized Controlled Trial" Children 9, no. 12: 1905. https://doi.org/10.3390/children9121905