The institution where this study was carried out is a private institution, therefore patronized mostly by parents from the upper and middle socioeconomic status. Twenty-four percent had attended the dental clinic for treatment previously. This finding shows a better exposure to oral health care services than those subjects from public schools (3.6%) seen in an earlier study from the same environment and of comparable age range [15
]. It is expected that the higher the educational level of an individual, the better the health seeking behaviour of that individual and the family members.
The majority of the subjects were caries-free, although the proportion of caries-free subjects was relatively low compared with that of subjects with special needs in public schools (93%). Some authors have however reported a lower caries prevalence in children with disabilities compared with those without disabilities [19
]. The conflicting results from different studies are due to different age groups, severity of impairments and type of residence of the population studied. The major component of the 'decayed, missing and filled teeth' index was the decayed teeth (dt) which is similar to findings from studies in other countries [21
]. Some of the reasons given for increased occurrence of dental caries in this group of individuals are increased thirst, 'eating for consolation' or 'comfort' consumption of sweets and drinks [23
] and long-term consumption of medications in form of sweetened syrups. When parents attend the clinic with their children, it is important they are educated on the need to reduce and as much as possible to substitute cariogenic snacks with fruits and vegetables.
Only two children have had an amalgam and Glass Ionomer Cement restorations. Although this proportion who had received dental care is indeed small, it is encouraging because previous surveys in this environment showed no index of restorative care in the large population studied [15
In contrast to dental caries, almost half of the subjects in this study (46.3%) had good oral hygiene compared with lower proportions of those in earlier studies in this environment and elsewhere but among children from parents of lower educational background [14
]. This shows that the educational status of parents has a positive effect on the dental care of persons with SHCN [25
]. These individuals require help for oral hygiene performance irrespective of their medical condition in order to achieve good oral cleanliness. There was also no significant difference in the oral hygiene status between females and males, and age groups in this study. This is because most of the subjects are dependent on parents or care givers to carry out their routine oral hygiene activities. These findings confirm earlier reports that the prevalence of dental disease tends to be affected by demographic factors [26
A high prevalence of unmet needs is still evident in this study despite the educational background of the parents and the fact that the school and residence of the subjects are located in an urban area of the state. Other studies in developed countries have shown that dental care is the most prevalent unmet health care need for children with special health care needs [1
]. There are various factors which create barriers to receiving oral health care even among the elite; these include low priority placed on oral health by parents and chronicity of oral diseases. If oral health is not perceived as being important, the children would not be taken for dental check-up [28
]. A family's inability to be committed to the children's dental care may also result from lack of understanding of the long-term health risks that may burden a child who does not receive urgently-needed care [29
]. In these individuals, oral health needs are competing with already burdensome chronic health conditions. The consequences of unmet oral health care needs include infection of the oral tissues, negative behaviour and aggravation of concomitant medical conditions [30
]. This group of children would also not be able to complain when in pain so the condition may go un-noticed until it reaches the acute phase. The children may also not cooperate in the dental chair. In this case other forms of behaviour management methods may be utilized by the attending dentist for effective delivery of care.
More than half of the subjects with Down syndrome (DS) had class III malocclusion which is similar to reports from previous studies on those with DS [33
]. Class II malocclusion was also more prevalent in those subjects with cerebral palsy. A few participants in this study (7.4%) would benefit from orthodontic treatment with the support of parents. Orthodontic treatment had been carried out successfully in some patients with disabilities [34
]. Intellectual or physical impairments should not be a barrier to receiving orthodontic care. Rather, the dentist should critically assess the severity of the malocclusion, the possible effects of leaving the case untreated as well as establish realistic goals and outcomes of treatment [35
]. For such patients, greater reliance may have to be placed on care givers for the maintenance of satisfactory oral hygiene [36
] which is required for successful orthodontic treatment.
Primary health care providers may influence access to dental care by oral health assessment and prompt dental referral [12
]. One of the current themes in disability policy is the promotion of partnership with all key stakeholders including people with disabilities and their families and carers [38
], such as this screening exercise. The establishment of relationships with family support groups to reach parents and other caregivers will improve the oral health of the children [39
]. This study is limited by the small number of subjects who participated in the screening. Some subjects did not return their consent forms, some were not in school on the days of screening, some were very ill and some were uncooperative so excluded from participating. All these factors are common in such institutions. The enrolment in such institutions are however increasing and more institutions are being established so larger populations are expected in future studies.