Oral health status, oral hygiene behaviors, and caries risk assessment of individuals with special needs: a comparative study of Pakistan and Saudi Arabia.

Abstract

Background: Individuals with disabilities often experience greater challenges in managing oral diseases, including dental caries and periodontal conditions, due to functional limitations. This study aims to: (1) assess the oral health status of disabled individuals in Pakistan and Saudi Arabia, (2) evaluate their oral hygiene knowledge and behaviors, and (3) determine their caries risk using the Caries Management by Risk Assessment (CAMBRA) protocol.

Methods: A cross-sectional study was conducted on 189 participants aged 13 years and older, including both young people and adults with hearing, visual, or intellectual disabilities from Pakistan and Saudi Arabia between September 2023 and April 2024. The participants were recruited from the Institute of Special Education, Pakistan, and the Saudi Institute of Rehabilitation Medicine, Saudi Arabia. Intraoral examinations and bitewing radiographs assessed oral health, including Decayed, Missing, and Filled Teeth (DMFT) index, Gingival Index, visible plaque, and molar alignment. A self-administered questionnaire gathered sociodemographic data and evaluated oral hygiene knowledge and behaviors. Caries risk was analyzed using the CAMBRA tool. Data were analyzed using descriptive statistics, Chi-square tests, and binary logistic regression.

Results: The mean DMFT score was 6.30 (SD = 1.83), with a statistically significant difference between Pakistan and Saudi Arabia (p = 0.007). Gingival health was fair to poor in 47% of participants, while 43.4% exhibited bleeding on probing and 34.9% had visible plaque. Class III malocclusion affected approximately 30% of participants in both countries. Tooth brushing frequency showed a significant difference between the two groups (p = 0.005). Most participants (76% in Pakistan, 62% in Saudi Arabia) were classified as high caries risk. Deep pits and fissures (69.4%) and frequent snacking (63.8%) were the main risk factors in Pakistan, while frequent snacking (71.6%) and heavy plaque (60.4%) were prevalent in Saudi Arabia. Saudi participants had a significantly higher likelihood of being in the high-risk group for caries (OR = 1.86, 95% CI [0.95-3.65], p = 0.04).

Conclusion: The disabled individuals in both countries face significant oral health challenges, with high caries risk and poor oral hygiene practices. Targeted preventive measures and improved dental care access are essential to addressing these disparities.