Prevalence
Globally, at least 2.2 billion people (i.e. 28%) have a near or distance vision impairment [1].
Vision loss can affect people of all ages; however, most people with vision impairment and blindness are over the age of 50 years [1].
In less than two decades, the population of the visually impaired in the United States doubled [2,3].
Effects on Oral Health
Reduced vision limits certain daily activities such as oral hygiene that can lead to the accumulation of biofilm, the main etiological factor of caries and periodontal diseases [11].
Dental caries is frequent in individuals with visual impairment. Studies showed that people with visual impairment have a significantly higher Decay-Missing- Filled teeth (DMFT) index than the general population [11].
Interestingly, without sight (unable to detect early symptoms such as gingival inflammation and bleeding), other senses are heightened such as touch and smell (able to detect dental hypersensitivity and halitosis) [11].
Vision impairment could facilitate the occurrence of accidents, contributing to a higher frequency of falls or collisions [8]. Thus, dental trauma appeared to be more frequent in visually impaired compared to sighted children [7].
Sidenote:
55-70% of blind people suffer from Non-24-hour sleep-wake disorder, which is a type of circadian rhythm sleep disorder [4]. With lower quality of sleep, this population is more susceptible to periodontal disease [5,6].
Bidirectional Relationship?
Current studies showed that periodontitis could increase the occurrence of glaucoma, which is one of the most common causes of visual impairment [9].
How to Help as a Dentist:
Education using touch and sound to give oral hygiene instructions. If there is a caregiver, involve them into the dental care process [12]. Also, give safe environment counseling to reduce risk of dental trauma. As a dentist, make sure to get a thorough medical history. Acquired v. Congenital visual impairment: Your patients with acquired visual impairment will have a difficult time accepting their new reality of visual limitations and thus their oral hygiene will not be their top priorities [10, 11]. Approach patients with compassion and understanding when explaining the importance of their oral health.
References
[1] World Health Organization. (2023, August 10). Blindness and visual impairment. Retrieved February 29, 2024, from https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual- impairment
[2] National Eye Institute. (n.d.). More Americans facing blindness than ever before. National Institutes of Health. Retrieved March 2, 2024, from https://www.nei.nih.gov/about/news-and- events/news/more-americans-facing-blindness-ever
[3] Centers for Disease Control and Prevention. (2022, October 31). Prevalence estimates – Vision loss and blindness. CDC. Retrieved March 2, 2024, from https://www.cdc.gov/visionhealth/vehss/estimates/vision-loss-prevalence.html
[4] National Organization for Rare Disorders. (n.d.). Non-24-hour sleep-wake disorder. Retrieved March 2, 2024, from https://rarediseases.org/rare-diseases/non-24-hour-sleep-wake-disorder/
[5] Alqaderi, H., Goodson, J. M., & Agaku, I. (2020). Association between sleep and severe periodontitis in a nationally representative adult US popu- lation. Journal of Periodontology, 91(6), 767–774. https://doi.org/10. 1002/JPER.19-0105
[6] Karaaslan, F., & Dikilitas, A. (2019). The association between stage-grade of periodontitis and sleep quality and oral health-related quality of life. Journal of Periodontology, 90(10), 1133– 1141. https://doi.org/10. 1002/JPER.19-0034
[7] Silva-Freire, L. C. (2022). Oral health issues in children and adolescents with vision impairment: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 32, 877-893. https://doi.org/10.1111/ipd.12967
[8] Rathore, K., Rao, D., & Masih, U. (2020). Dental trauma experience of visually impaired and sighted children residing in residential schools – a comparative cross-sectional study. Special Care in Dentistry, 40(2), 219–226. https://doi.org/10.1111/scd.12555
[9] Sun, K.-T., Shen. (2020). Periodontitis and the subsequent risk of glaucoma: results from the real-world practice. Scientific Reports, 10(1), 17568. https://doi.org/10.1038/s41598-020-74589- 6
[10] Cunha, L. D., Proença. (2015). Relationship between periodontal status and degree of visual impairment in institutionalized individuals. European Journal of Dentistry, 9(3), 324–328. https://doi.org/10.4103/1305-7456.163322
[11] Blanco López, M. A., Freitas, M. D., Limeres Posse, J., Hernández-Vallejo, G., & López- Pintor, R. M. (2022). Oral health status and dental care for individuals with visual impairment. A narrative review. Special Care in Dentistry. https://doi.org/10.1111/scd.12764
[12] Vozza, I., Barbato, L., Corridore, D., Solomita, S., di Prisco, F. O., Guerra, F., & Ottolenghi, L. (2016). Oral hygiene management in patients with visual sensory disabilities. Senses & Sciences, 3(3), 215-220. DOI: 10.14616/sands-2016-3-215220