Smiles in the Dark: New Insights into Dental Care for the Blind and Low-Vision

As eyes perceive the world, a healthy smile is a universal symbol of well-being and confidence. But for the blind and low-vision community, maintaining oral health is an often-overlooked challenge — not just physically but socially too. A recent comprehensive study led by researchers at Zagreb University sheds light on dental care realities, caries experience, and oral hygiene habits among visually impaired adults in Croatia. The research reveals important insights into their dental health status and highlights the urgent need for tailored preventive programs and inclusive dental services.

This is more than just about teeth—it is about dignity, health equity, and access to care for a group of nearly 80,000 people facing unique hurdles.

Understanding the Challenge: Why Oral Health Matters in Visual Impairment

Blindness and low vision affect millions worldwide, and in Europe alone, over 30 million people live with some form of visual impairment. Croatia registers more than 21,000 visually impaired individuals, many relying heavily on specialized services.

Vision loss limits the ability to perform daily self-care, especially meticulous activities involving hand-eye coordination—like brushing and flossing teeth effectively. Without visual feedback, it becomes difficult to detect dental plaque buildup, early signs of cavities, or gum disease. Consequently, blind and low-vision individuals face an elevated risk of oral health problems, which if untreated, can compromise nutrition, comfort, and overall quality of life.

The Study: Who Participated and What Was Measured

From 2014 to 2018, the “Project for Oral Health Promotion in Blind and Visually Impaired Persons” took shape at the Zagreb School of Dental Medicine. It brought together 85 adults with visual impairment—50 totally blind and 35 with low vision—aged between 18 and 98 years. These participants underwent clinical dental examinations and answered detailed questionnaires on their oral health habits.

To paint an accurate picture, their results were compared with a control group of 85 sighted individuals of similar age, sex, and education living in Zagreb.

Key metrics evaluated included:

• DMFT index (Decayed, Missing, Filled Teeth) indicating cumulative dental caries experience.
• Self-reported oral hygiene routines like brushing frequency, use of fluoridated toothpaste, and flossing.
• Dietary habits, including sugary food and beverage consumption.
• Tobacco and alcohol usage.
• Frequency and motivations for dental visits.

Revealing the Reality: High Caries Experience With Unique Patterns

The average DMFT score—a widely accepted measure of dental health—was surprisingly high in both visually impaired and sighted groups, around 17 and 16 respectively. This score reflects the cumulative effect of dental decay, missing teeth, and restorations. The similarity could be partly due to the sample’s characteristics: mostly urban, reasonably educated, and having access to public health services.

However, when digging deeper:

• Age was a key factor: Older participants showed a significant increase in the number of missing teeth and overall DMFT score, reflecting the natural accumulation of dental issues over a lifetime.
• Smoking and sugary drinks mattered: There was a significant link between the number of decayed teeth and consumption of soft drinks as well as tobacco usage, underscoring modifiable risk factors.
• Non-correlation with brushing frequency: Surprisingly, neither brushing frequency nor floss use correlated strongly with caries experience, possibly reflecting challenges in proper brushing technique or overestimation of self-reported habits.

Table 1: DMFT Index and Components Among Visually Impaired vs. Control Groups

Group	Median Decayed (D) Teeth	Median Missing (M) Teeth	Median Filled (F) Teeth	Median Total DMFT Score
Visually Impaired	1.0	6.5	6.0	17.0
Control (Sighted)	1.0	7.0	5.5	16.0

Note: P-values showed no significant difference between groups overall.

Oral Hygiene Habits: Awareness High, Yet Challenges Remain

Most visually impaired participants reported brushing their teeth twice or more daily (73%), the same rate as the control group. However, less than a third used dental floss regularly, likely due to difficulty with fine motor coordination and lack of sensory cues.

Interestingly, awareness and regular use of fluoridated toothpaste was significantly higher among visually impaired individuals compared to controls. This reflects successful education efforts but also spotlights the room for improvement in technique and interdental care.

Table 2: Oral Hygiene Practices in Visually Impaired vs. Control Group

Habit	Visually Impaired (%)	Control Group (%)
Brushing 2+ times/day	73	73
Use of Fluoridated Toothpaste	56	26
Regular Dental Floss Usage	28	39
Dental Visit in Last 6 Months	41	49

Access and Barriers: Dental Visits Mostly Triggered by Pain

Many participants sought dental care only when experiencing pain or problems (about 38%), with only 18% attending for routine checkups. This pattern mirrors that of the sighted control group and points toward a reactive rather than preventive approach to dental health in Croatia.

Barriers for the visually impaired include:

• Difficulties in transportation and clinic accessibility.
• Lack of awareness of oral health issues due to no visual cues.
• Need for specialized dental education and communication skills among dental teams.
• Time-consuming need for tactile oral hygiene instruction.

The study emphasizes the importance of tailored dental programs focusing on motivation, accessible education, and constant support for this vulnerable group.

Why This Study Matters: Toward Inclusive Oral Healthcare

This pioneering study is among the first to systematically assess oral health status and behaviors in visually impaired adults in Croatia, providing valuable data for healthcare providers, policymakers, and advocates.

Key takeaways include:

• The high caries burden in visually impaired adults calls for urgent, continuous preventive dental care.
• Oral hygienic habits require adaptation, with training on tactile brushing and flossing techniques.
• Regular dental visits and awareness campaigns are crucial to encourage preventive care rather than treatment only during pain.
• Educational and systemic reforms are needed to train dental professionals in special care dentistry to address specific needs.
• Broader public health strategies should integrate oral health promotion with accessibility plans for people with disabilities.

Call to Action: How Can Society Help?

For the blind and low-vision community:

• Accessible oral hygiene tools and braille or audio guides on brushing and flossing can empower self-care.
• Increased public and professional awareness can reduce stigma and improve service quality.
• Government policies should focus on integrating special care dentistry education within dental curricula, and fund outreach programs.

Everyone benefits when healthcare systems are inclusive and adaptive. Oral health is fundamental to well-being, and no one should be left behind due to disability.

Reference: Dumančić, J.; Radić Vuleta, M.; Lončar Brzak, B.; Savić Pavičin, I.; Kurpez, T.; Striber, N.; Čuković-Bagić, I. Caries Experience and Oral Health-Related Habits in Blind and Low-Vision Individuals in Croatia. J. Clin. Med. 2025, 14, 5576. https://doi.org/10.3390/jcm14155576