This comparative study provided information on the medical and dental health status, and the oral health knowledge of visually impaired and sighted female children aged 6–12 years living in Riyadh, Saudi Arabia. A higher percentage of the mothers of the visually impaired children were illiterate. Neglecting themselves and their education might result from their children occupying so much of their time. The high percentage of illiterate mothers among the visually impaired group may have contributed to the lower percentages of participants with good OHI scores, which in turn caused higher levels of GI and DMFS within the stated group. This is in accordance with a study that found that children’s oral health status is often related to social dimensions such as parental income and education [22].
Nearly a quarter of the visually impaired children had reported medical problems, the incidence of which was lower among the control group. This might be related to visually impaired children’s regular visits to the doctor for their vision problems, which may aid in the early diagnosis of any other medical conditions. The distribution of psychological problems was higher among the visually impaired group, as vision loss may be associated with depression, anxiety, and negative psychosocial consequences that affect everyday life. This is consistent with the findings of a previous study [11]. This may arise because of feelings of inadequacy, and facing difficulties in social interactions and making contacts [11]. Therefore, social support is important and needed from both family members and communities, and may help ameliorate the consequences of vision loss. Medical condition such as diabetes, epilepsy and physiological problems have been proven to affect oral health status and are common factors in the development of periodontal disease [23, 24]. These conditions might have increased the GI scores among the visually impaired group.
This study showed that dental visits by the visually impaired group were infrequent compared with in the sighted children. Although the frequency of dental visits might be related to the guardian’s compliance, the percentage of children regularly visiting a dentist was significantly lower than in the control group. This might be because the parents of visually impaired children are preoccupied with managing more pressing disability-related issues and consequently neglect dental care.
In general, most of the children had acceptable oral hygiene but a higher proportion of the sighted children had good oral hygiene compared with the visually impaired children. This result was consistent with earlier studies [4, 13]. This might in part be due to the sensory impairment, which makes maintaining good oral hygiene more difficult for the visually impaired group [1, 2]. However, in a study done in 2013, visually impaired children living in an institutional arrangement showed more consistent oral hygiene compared with sighted children because their caregivers enforced a mandatory oral hygiene routine [1]. This shows that visually impaired children area as capable of maintaining adequate oral hygiene as sighted children, as long as they are provided with adequate and consistent supervision.
The visually impaired children showed higher scores for plaque accumulation, consistent with Bimstein et al. (2013) [3]. This high plaque score led to more gingival inflammation, which was also significantly different between the two groups. More than one quarter of the visually impaired children showed moderate gingivitis; therefore, prevention programs directed toward the visually impaired children are essential. These programs can achieve promising results when proper communication methods are used with the patient as well as their caregivers. There are several methods that can help to increase the efficiency of implementing such programs in such groups. These include: avoiding wearing masks while speaking to the visually impaired; lessening background sounds; avoiding the use of visual aids; increasing the involvement of the child’s caregivers (parents and/or teachers); and regular oral health checkups to evaluate how well the dental hygiene instructions were received and how well they are being implemented [3].
In this study, the visually impaired children experienced higher mean DMFS scores when compared with their sighted peers. This finding is comparable to a study conducted in Turkey [5]. However, in primary dentition, the sighted children had higher dmfs values. These results are consistent with a previous study conducted in Turkey [5]. High mean DMFT and dmft values were found among both groups, which supports the high caries prevalence found in a previous study among the general child population of Riyadh [25].
The visually impaired children had received less information regarding oral health compared with the sighted group, which was consistent with the results of Chang and Shih (2004) [9]. This could be due to the difficulty visually impaired children may have in visualizing their oral health, and in understanding its importance. Parents’ role in informing the children regarding their oral health was more pronounced in the control group in comparison with the visually impaired children. This may be due to the lack of dental educational programs available for dentists that are directed toward groups with disabilities, their families, and caregivers. Therefore, special educational programs with a greater emphasis on oral health and oral hygiene practices for visually impaired children and their parents should be provided. Teachers were reported as a source of information by more than one third of the visually impaired group. This is contrary to a study by Bekiroglua et al. [26], which found that only 6.5% of visually impaired children were informed about oral health by their teachers. The lack of media participation in providing knowledge about oral health to both groups was also noticeable. This finding is in keeping with those of a study in Turkey, which showed that only 1.1% of visually impaired children reported having used the media as a source of information [26]. Further attention is required from the Ministry of Culture and Information to raise the priority of oral health and advocate practicing oral habits and dental hygiene, thus playing a more active role in educating society regarding their oral and general health.
Lack of cooperation was noted among the visually impaired children, compared with completely positive behavior in their counterparts. This could be related to their inability to see, which can make it difficult for them to relax and cooperate. Knowing the best way to communicate with visually impaired children and familiarizing them with the dental setting is the responsibility of the dental professional, and could help in improving the experience for these children [5].
More attention from the responsible authorities should be directed toward these groups of children, and oral health educational, preventive and curative programs need to be developed to accommodate their needs.
One of the limitations in this study was the inability to include males in the study sample, as well as the inability of female dentists to enter male schools and perform examinations because of social segregation. There was also difficulty in dealing with the institutions caring for the visually impaired children, and their cooperation was limited. Further studies should be conducted comparing both males and females and including other age groups, as well as in populations from other areas of the kingdom.