Effectiveness of Oral Health Education Interventions Using Braille on Oral Health among Visually Impaired Children: Proposal for a Systematic Review

ABSTRACT

To assess how oral health education (OHE) techniques using braille affect visually impaired children’s awareness of oral health, oral hygiene status and practices, plaque, gingival health, and dental caries status. From 2010 to 2020, a thorough literature search will be conducted for studies in the English language using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Grey. Data extraction will be done after two reviewers extensively evaluate the papers for qualifying requirements. In accordance with the research designs, a quality evaluation of the chosen studies will be conducted. With the use of the program Review Manager 5.3, a meta-analysis will be completed.

INTRODUCTION

Childhood blindness is one of the main issues in public health. According to Deshpande et al. (2023),[1] there are between 1.42 million and 17.52 million children worldwide who are blind or have moderate to severe vision impairment.

Early-onset severe visual impairment in young children can impede their motor, verbal, emotional, social, and cognitive development, with lifetime repercussions. Lower levels of academic success can also be shown in school-age children with vision impairment. Populations with vision impairment have a significantly lower quality of life (World Health Organisation, 2022).[2] Due to numerous environmental and societal barriers, people with disabilities frequently struggle to receive health treatments.

This also applies to dental treatment, which is one of the most challenging medical services to obtain (Mahantesha et al., 2021).[3] There is evidence that people with disabilities have more dental problems, missing teeth, poor oral hygiene, greater tooth wear, and trauma than any other demographic group, yet they also struggle to access dental treatment. Children who are visually impaired typically do not receive the dental health treatment they need. Al-Qahtani and Wyne’s 2003[4] study found that only 29.4% of visually impaired youngsters practiced adequate dental hygiene.

Shetty et al. (2010)[5] discovered a significant prevalence of caries and poor oral hygiene in another investigation. Children who are visually impaired often struggle with maintaining good dental hygiene. Oral hygiene advice is the main tactic used in dentistry to promote oral health. Braille text is a tactile writing style that makes it easy for those who are blind or visually impaired to learn and understand. The blind and visually impaired rely far more on sound, voice, and touch to help them navigate a situation. Because of this, it is necessary to adapt oral health education (OHE) to take into account their impairment.[6]

Dental Braille Education is a learning process in the realm of oral health that is dedicated to the visually impaired or a person with a visual handicap using Braille alphabet media to optimize their dental and oral health status and also their independence in preserving oral health. Its purpose is to educate visually impaired people about dental health solutions, and it is anticipated that after receiving this instruction, oral health will improve and increase.[7]

Rationale for the review/need of the study

Children with impaired vision make up those who have specific medical requirements and are more likely to develop oral illnesses as a result of their disabilities. Due to difficulties in delivering OHE, they may experience difficulties carrying out basic oral hygiene procedures, as well as other barriers to accessing dental treatment, and also have poor oral health literacy. For those who have impairments, OHE is crucial. Unfortunately, the visually handicapped population cannot benefit from conventional teaching strategies, including the use of visual aids and revealing agents.[8,9,10]

Dental teaching programs for visually impaired children are crucial, as they must learn oral hygiene techniques like other children. Despite the abundance of resources, selecting the most effective method can be challenging. This review contributes to existing evidence-based research on OHE for visually impaired children, assessing the effectiveness of braille text in teaching dental health and maintaining good oral hygiene.[11,12,13]

Aim of the review

The purpose of this study is to determine how effectively Braille text works as a teaching tool for visually impaired children between the ages of 5 and 15 in promoting dental health.

Objectives

• To explore, critically evaluate, and assess the most recent published evidence regarding the impact of a Braille-based OHE program on the oral hygiene status of visually impaired children aged 5–15 years.

• To assess how a Braille-based OHE program has improved the understanding of visually impaired children between the ages of 5 and 15 about oral health.

• To formulate suggestions that will help with the creation of guidelines and the distribution of resources for children with visual impairments’ dental health.

MATERIALS AND METHODS

The approaches utilized at different phases of review will be covered in this chapter. This chapter will address the research topic, inclusion and exclusion criteria, search technique, discovery and selection of relevant papers, data extraction, critical appraisal, and result analysis [Table 1].

Table 1.

Review of literature

Author of the study	Study design	Method of OHE used	Duration of the study	Assessment of the outcome	Conclusion by the authors
Agarwal et al.[8]	Randomized clinical blind study	Group 1: Verbal instruction Group 2: Braille Group 3: ATP	3 months	Loe and Silness gingival index 2. Turesky modification of Quigley-Hein plaque index	The results highlight the significance of creating a very effective integrated system of teaching approaches for the dentist that is simple to create and implement
Doichinova et al.[9]	Pre- and post-intervention study	Braille + ATP	1 year	Simplified oral hygiene index (OHI-S)	Children who are visually impaired must be motivated and given help through training models, appropriate music, and Braille instructions to practice proper dental hygiene
Khurana et al.[10]	Pre- and post- nonrandomized before and after comparison without controls	Braille text and verbal, oral hygiene instructions	1-, 3-, and 5-month interval	1. PI (Silness and Loe) 2. GI (Loe and Silness	When taught using Braille text for instructions, visually impaired youngsters, regardless of their level of blindness, could maintain an adequate level of dental hygiene
Tiwari et al.[11]	Non-randomized interventional stud	Group 1: ATP Group 2: Text in Braille Group 3: Both Braille and ATP	21-day, 3-, 6-, and 9-month interval	Plaque scores by Silness and Loe (1964) 2. Gingival scores by Loe and Silness (1963)	The results of this study show that the ATP approach, Braille, OHE, and timely reinforcement are an efficient combination for enhancing the dental hygiene of visually impaired children
Gautam et al.[12]	Prospective study	Group A: Braille and hearing aids Group B: Audio aids + tactile models Group C: Audio aids plus Braille + tactile model	1 and 3 months	Patient hygiene performance index	The study shows that using audio, Braille, and tactile models together is an efficient strategy to teach visually impaired children about dental health and to enhance their OHS

According to the Preferred Reporting Items for Systematic Review and Meta-analysis statement (PRISMA) criteria, this systematic review will be carried out. For a comprehensive evaluation and meta-analysis, the proposal will be prospectively recorded in the worldwide PROSPERO database [Table 2 and 3].

Table 2.

PIO components

Population	Intervention (exposure)	Outcome
Children aged 5–15 who are visually challenged	Braille-based OHE programs	The primary result is the level of oral hygiene Oral health knowledge is a secondary result

Table 3.

Searching for literature using keywords and alternative terms

Keyword	Synonyms/alternate search terms
Visually impaired	• Visually challenged
	• Visually compromised
	• Vision impairment
	• Blindness
OHE using Braille	• Dental Braille education
	• Oral hygiene instructions
	• Dental health education
	• OHE
	• Braille text
Children	• School children
	• Young children
	• Young individuals
Oral health	• Oral health status
	• Oral hygiene status
	• Oral health knowledge
Effectiveness	• Effect
	• Effective
	• Impact

Research question

This review will answer the study question, “How do Oral Health education programmes adopting Braille impact oral hygiene status and knowledge about oral health among children with visual impairments aged 5-15 years?”

Types of research

This evaluation will contain secondary data analysis of the topic’s quantitative, qualitative, and mixed primary research.

Criteria for eligibility

Criterion for inclusion

Primary research on visually impaired children aged 5–15 years, with an emphasis on OHE programs utilizing the Braille approach.

Articles with full text are published in English.

Research was published between 2012 and 2023.

The articles that have been peer reviewed have quantitative, qualitative, and mixed research.

Criterion for exclusion

Studies published before 2013; Studies published in languages other than English; Expert opinions; Narrative Reviews; Editorials; Commentaries; Protocols; Dissertations; Conference Proceedings; Case Reports; Studies conducted among other populations; Studies using other OHE techniques.

Selections for studies

• Articles found in several databases will only be taken into consideration once they have been first screened by title and abstract.

• The PRISMA 2020 flow diagram [Figure 1] will be used to depict the screening, selection, and exclusion of studies at each level of the review.[13,14,15,16,17]

Figure 1.

Systematic review Chart

Data extraction

The whole texts that fulfill the inclusion requirements will be examined by two independent researchers.

• Every featured study will be assigned a unique ID that combines the first author and the year of publication.

• The data extraction will be done after retrieving the complete text of the chosen articles.

• The extracted data will be precisely entered into the Excel sheets.

• There will be a verification list of items that will be taken into account for data extraction, including a study identification code, authors, the year and location of the study, the study design, the aim of the study, sample characteristics, the type of OHE method used, indices used to assess oral hygiene status, knowledge assessment, main findings and conclusion, and limitations of the studies.

• The two reviewers will debate and settle any differences found in the papers.

Reviewing the papers critically and evaluating their quality

To determine the validity of the research as well as the methodological advantages and disadvantages, a critical review of the pertinent studies will be carried out.

The evaluation of the included studies will be conducted using a variety of quality assessment methodologies. For instance, the Critical Appraisal Skills Programme (CASP) (CASP, 2018)[13,14] tool will be used for randomized controlled trials and qualitative studies, and the Critical Appraisal Tool for Cross-Sectional Studies (AXIS)[15,16,17] tool will be used to appraise cross-sectional studies. To determine whether there are any possible biases in RCTs, the Risk of Bias (ROB) tool will be employed (Higgins et al., 2022).[16]

The “Cochrane Handbook for Systematic Review of Interventions” advised using a risk of bias assessment tool to determine the likelihood of bias in each research study. A domain-based evaluation is the suggested method for determining the risk of bias in the collaboration. Sequence creation, allocation concealment, blinding, insufficient outcome data, selective reporting, and other potential sources of bias were among the six areas that made up the assessment criteria. Different domains each received a distinct critical evaluation. Recording “yes” (low risk of bias), “no” (high risk of bias), or “unclear” (lack of information or ambiguity on the possibility of prejudice) served as judgment for each entry.

Data methodology for synthesis

Using Microsoft Excel, the data collected from the included studies will be arranged, and a theme analysis and narrative synthesis will be finished.

Ethics-related issues

This review’s primary goal was to gather information from secondary sources, which mostly entailed giving research projects ethical approval for their clarity and validity. To maximize the study’s results’ ethical impact, this systematic review will make sure they are distributed with audience-appropriate transparency.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.