Oral Health of Children With Disabilities in India: An Integrative Review Mirrored to a Global Perspective.

PURPOSE: To synthesize evidence on the oral health status of children with disabilities in India and to contextualize these findings using systematic reviews and meta-analyses evaluating preventive and therapeutic oral health interventions in children with disabilities.

METHODS: Following PRISMA 2020 guidelines and grounded in integrative review methodology, a comprehensive literature search was conducted across PubMed, Scopus and Embase to identify studies published between 2000 and 2025. Eligible studies included observational research conducted in India and systematic reviews/meta‑analyses primarily involving children and adolescents with physical, intellectual, or developmental disabilities (e.g., cerebral palsy, intellectual disability, autism spectrum disorders). Outcomes included periodontal indices (CPI, Plaque Index, Gingival Index), caries (DMFT/deft), oral hygiene status, and intervention effects. Data extraction and quality appraisal were performed independently using validated tools. Due to heterogeneity, findings were narratively synthesized. Pooled estimates from previously published meta-analyses were reported descriptively for contextual comparison only and were not used to represent oral health status in Indian populations.

RESULTS: Of 173 records screened, 23 studies met inclusion criteria: 15 Indian observational studies and eight systematic reviews/meta‑analyses. These reviews provided international comparisons, with India‑related data noted where relevant. Global reviews were summarized for context only and not used to represent oral health status in India. Indian studies included children with intellectual disabilities, cerebral palsy, Down syndrome, autism spectrum disorders, physical disabilities and sensory impairments, with sample sizes ranging from 60 to 1114 participants. Caries prevalence ranged from 49.6% to 89.8%, with the highest prevalence in children with special healthcare needs (89.8%) and cerebral palsy (up to 86.53%). Poor oral hygiene was reported in up to 57.9% fair and 39.1% poor categories depending on the scale used, with OHI-S scores often exceeding 2.0. Periodontal indices showed elevated scores, with CPI values ranging up to 3.0 ± 0.7 and plaque indices frequently exceeding 2.0-2.3, indicating moderate inflammation and plaque accumulation. Children with disabilities had significantly worse oral health than neurotypical peers, with malocclusion and fractures commonly reported. Meta‑analytic data from global reviews were referenced for comparison only, confirming similar trends internationally: plaque (SMD = 0.70), gingival inflammation (SMD = 0.75) and calculus (SMD = 0.98) were higher in children with cerebral palsy. Interventions such as powered toothbrushes showed significant plaque reduction (SMD = -4.23), while chlorhexidine rinses demonstrated significant improvements in plaque control with risk ratios between 0.34 and 0.63 for plaque reduction. The Indian observational studies constituted the primary evidence base. Systematic reviews/meta-analyses were summarized separately to provide global context for intervention effectiveness and comparative trends, without pooling or extrapolation to the Indian population.

CONCLUSION: Children with disabilities in India experience disproportionately poor oral health, characterized by high caries prevalence, poor oral hygiene, and elevated periodontal disease risk. Although global evidence provides useful context, targeted, inclusive interventions tailored to the Indian setting are urgently needed, especially in low-resource environments.