|Year : 2013 | Volume
| Issue : 3 | Page : 105-109
Oral health status and treatment needs among factory employees in Baddi-Barotiwala-Nalagarh Industrial hub, Himachal Pradesh, India
Mohit Bansal1, KL Veeresha2
1 Department of Community Dentistry, Oral Health Sciences Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Public Health Dentistry, M.M. College of Dental Sciences and Research, Ambala, Haryana, India
|Date of Submission||24-Nov-2012|
|Date of Acceptance||02-Nov-2013|
|Date of Web Publication||12-Dec-2013|
Senior Resident, Department of Community Dentistry, Oral Health Sciences Center, Post Graduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
Objective: The aim of this study was to assess the oral health status and treatment needs among factory employees in Baddi (Himachal Pradesh), India.
Materials and Methods: A cross-sectional study was carried out among 1384 employees in 38 factories. Information regarding demographic details, habits and data on oral health status and treatment needs was collected on modified World Health Organization (WHO) format (1997) and WHO criteria and Pindborg's colored atlas were used for diagnosis of oro-mucosal lesions.
Results: Tobacco pouch was the most common lesion found and buccal mucosa was the most common site involved. The prevalence of caries was found to be 18.5% of which males were 15.2% and females were 84.8%. The mean decayed filled missing teeth was 2.18 and was higher among females (3.18) than males (2.0). Need for one unit prosthesis was required for both maxillary and mandibular arches (9.5% and 14.8% respectively). Community periodontal index score 2 was found more in males 58.4% than females 48.8%, which was significantly related to brushing frequency.
Conclusion: The result from the baseline study indicate that primary oral health-care programs like dental screening and oral health education at regular intervals should be made mandatory, which will help to prevent accumulation of health-care demands of the factory employees.
Keywords: Community periodontal index, dental caries, factory employees, oral health, oro-mucosal lesions, treatment needs
|How to cite this article:|
Bansal M, Veeresha K L. Oral health status and treatment needs among factory employees in Baddi-Barotiwala-Nalagarh Industrial hub, Himachal Pradesh, India. Indian J Oral Sci 2013;4:105-9
|How to cite this URL:|
Bansal M, Veeresha K L. Oral health status and treatment needs among factory employees in Baddi-Barotiwala-Nalagarh Industrial hub, Himachal Pradesh, India. Indian J Oral Sci [serial online] 2013 [cited 2019 Jan 21];4:105-9. Available from: http://www.indjos.com/text.asp?2013/4/3/105/122951
| Introduction|| |
Oral health is a vital part of general health and is a valuable asset of every individual. Oral diseases are one of the most common of non-communicable diseases affecting varied population It is an important public health problem owing to the prevalence, socio-economical aspect, expensive treatment and lack of awareness.  Oral health status has a direct impact on general health and conversely general health influences oral health. Though oral and dental diseases are rarely life-threatening, they do have an impact on the quality-of-life. The health-care in India is still under various stages of development with vast differences between regions and states.
For the oral health of the general population at the global level, marked changes in oral disease pattern has been observed over past decades.  Oral health report of the studies carried out, over past 40 years revealed contrasting disease trend, depending upon country population group and socio-economic condition.  During the last 10-15 years evidence has accumulated in several western industrialized countries, in encouraging trends in prevalence and severity of dental disease.  Majority of people living in rural areas have limited access to essential oral health-care due to geographic and economic barrier.  Various previous studies suggested that cigarette smoking and tobacco habits co-existing in a significant proportion of male adolescent will have major implication on oral diseases. 
According to the state industries department, the Baddi-Barotiwala-Nalagarh (BBN) industrial hub has 1,075 industrial units worth Rs. 4000 crores with 123 large and medium and 440 small units. The total population of the town is more than 3 lakhs providing employment to nearly 43,726 employees out of which more than 12,000 are migrants. 
A majority of studies regarding factory employees were conducted abroad with very few studies from Asia. Until now, there are no reports regarding the oral health status of factory employees in Baddi, Himachal Pradesh. Hence, the aim of this study was to assess the oral health status, treatment needs and prevalence of oral habits among the employees in Himachal Pradesh.
| Materials and Methods|| |
The study was conducted to assess oral health status and treatment needs among factory employees in Baddi (Himachal Pradesh). The consent for conducting the study was taken from BBN Development Authority Solan. After obtaining ethical clearance from institutional ethical committee, the examiner was calibrated and a pilot study was conducted among 63 employees. Prior permission from CEO/Director Human Resources Department of the respective factories telephonically and personally was taken to conduct the camps on prescheduled dates. The study was conducted mainly in the day shift being more convenient to the working units. The study was carried using simple random sampling technique and all the employees present at the time of examination were included.
Information regarding demographic details, habits and data on oral health status and treatment needs was collected on modified World Health Organization (WHO) format (1997).  WHO criteria and Pindborg's colored Atlas More Details were used for diagnosis of oro-mucosal lesions.  The examination was carried out using mouth mirror, explorer and adequate light. The data was recorded with the help of a trained recording assistant and was made to sit close enough to the examiner.
Data was analyzed using SPSS version 13.0. (SPSS Inc., Chicago, USA). Chi-square analysis was used to find the significance of the cross-tabulation of counts of two or more variables. Student t-test (unpaired) and analysis of variance were used to find the significance of the cross-tabulation of a variable with the mean of another variable.
| Results|| |
A total of 1384 subjects were examined with a minimum age of 15 years and a maximum of 63 years. Mean age of the employee was 29.18 years. 84.3% (1167) were males and 15.7% (217) were females. 62.6% (866) were migrants and 37.4% (518) were resident of Himachal Pradesh. Among the migrant subjects mainly were from Uttar Pradesh 33.3% (288). Socioeconomic status was measured using BG Prasad's classification revealed that majority of the employees belonged to poor class 70% (969). Educational qualification revealed that 26.2% (362) had at least cleared high school education [Table 1].
Nearly 90.9% (1258) used toothbrush, 3.1% (43) treestick, 0.5% (7) finger and 5.5% (76) used more than one aid for brushing. 91.3% (1263) used toothpaste, 3.9% (54) toothpowder, 3.4% (48) no material and 1.4% (19) used more than one material for brushing. 82.3% (1193) brushed their teeth once a day, 17.1% (237) brushed their teeth twice daily and only 0.6% (8) brushed occasionally. The frequency of brushing once a day was higher among uneducated subjects (94.5%) than educated class. Brushing frequency when compared with the socio-economic condition showed that 68.4% of the upper high brushed twice-a-day in comparison to 13.2% of poor class who brushed twice-a-day. 45.7% (632) subjects used tongue cleaner, 27.4% (379) toothbrush, 3% (42) finger, 2.1% (29) datun and the remaining 21.8% (302) did not clean their tongue. Prevalence of varicose vein was found to be 21.2% (239) among the subjects.
Prevalenceoforo-mucosal lesions was 11.4% (158). Tobacco pouch was the most common lesion found among 6.2% (44) of the subjects [Table 2]. The prevalence of lesions among males was high than females. Distribution of oro-mucosal lesions with gender showed that tobaccopouch 3.8% was most common among the males than abscess 1.8% among females. The most common site involved was buccal mucosa 39.2% followed by sulci 25.3%, palate 21.5%, alveolar ridges/gingiva 10.8%, tongue and floor of mouth 1.3% and 0.6% on commissures. Data regarding deleterious oral habits revealed that 77.2% (1069) of the subjects had one or the other deleterious habits. All the deleterious habits increased with the increase in age. Oral lesions were significantly related to socio-economic status. 80.3% of lesions occurred in poor class.
The mean decayed filled missing teeth (DMFT) was 2.18, which increased with the increase in age. The number of mean teeth present per person decrease with the increase in age. Mean number of teeth filled with no decay, missing due to caries and missing due to other reasons were 0.151, 0.525, 0.201 respectively and these were significantly related with the age. Females had a higher number of mean decayed teeth and missing due to caries, where as higher number of mean teeth filled with no decay was present in males than females. Poor class exhibited more caries in comparison to upper high (1.41 and 0.6842 respectively). Uneducated subjects had a higher number of mean decay teeth and teeth missing due to caries when compared with educated subjects. There were no filled teeth in uneducated subjects as compared to educated one.
One surface filling gradually decreased with the increase in age. Extraction of teeth was the most required treatment, which increased with the increase in age. Females had higher treatment needs when compared to males. The mean number of teeth requiring the filling of one surface and extraction were both found more in females than males. One surface filling and extraction both were higher in subjects belonging to low socio-economic group.
Bridge 0.7% was the common finding in the maxillary arch while a partial denture 0.4% was the common finding observed in the mandibular arch. Need for one unit prosthesis was required for both maxillary and mandibular arches (9.5% and 14.8% respectively) followed by the need for combination of prosthesis in the mandibular arch 10.9%. Prosthetic need increase with the increase with age in the maxillary arch among 55-63 years age group need for a combination was found to be highest. In the mandibular arch need for one unit and the combination was found to be highest in the age group of 35-44 years. Need for full prosthesis is more in both arches. Need for one unit prosthesis for both maxillary and mandibular arches was found to be higher in females (10.5% and 17.5% respectively).
Community periodontal index (CPI) score 2 (calculus) was found more in males than females. When CPI compared with educational status it was found that uneducated class had more calculus score than educated class. Subjects brushing occasionally had 62.5% calculus which was more as compared to the subjects who brushed once 56.8% or twice daily 55.6%. Subjects with all the habits had pocket >6 mm (3.2%) and the subjects having tobacco and smoking habit (4.4%) had pocket <4-5 mm. Males require having oral prophylaxis as their treatment need compared with females.
Nearly 39.2% of the subjects had varying amount of dental fluorosis. 1.37% of the subjects had a life-threatening condition whereas 8.95% had acute pain.
| Discussion|| |
In the present study, there were very less number of females (15.7%) than males. This could be because the females seldom join the factories because of laborious nature of work done in factories. However, male to female ratio in our study was very high than that reported by Roman and Pop.  Major portion of employees (62.6%) were migrant workers from neighboring states. This indicates the lack of employment resources in such states. 70% of the employees belong to poor socio-economic class as per BG Prasad classification. Uneducated employees were only 5.3%. This may be attributed to successful compulsory primary education (CPE) program in India. However, further efforts are needed to achieve 100% CPE.
The prevalence of tobacco habit 24.5% was more than smoking habit 18.5% and 6.5% had both habits. Among them khaini chewing habit was more common. It looks that the prevalence could be still higher as the people don't give true history of the amount of oral habits. The prevalence of tobacco chewing and smoking was very low, but the subjects having both habits were same as reported by Akman et al.,  but was more as reported by Saraswathi et al. Though 90.8% used tooth brush to clean their teeth and 91.2% used toothpaste, only 17.1% brushed their teeth twice-a-day. This shows lack of professional health education to the minth is regard.
In our study, the prevalence of oro-mucosal lesions was found to be 11.4%, which was very less as reported by Malaovalla et al.  and more as reported by Jahanbani.  The prevalence of lesion increased with age in our study which is same as that reported by Malaovalla et al. but contrary with the study done by Mikkonen et al. Furthermore, the most common oro-mucosal lesion in our study was tobacco pouch whereas in other studies leukoplakia is the most common lesion. Tobacco pouch was found to be 3.2%, which was high as reported by Ikeda et al.  The most common site affected by the lesions was buccal mucosa, which was same reported by Ikeda et al.  and GarcÏa-Pola Vallejo et al. The prevalence of oral submucous fibrosis was found to be 1.5%, which was less as reported by study carried out by Tang et al.
The mean number of teeth lost per worker showed a significant increasing trend with age in our study and it was same as that reported by Hayashi  and mean number of teeth loss were significantly greater in the age group of 55-63 years which was also same in both studies. Bridge was the most common prosthesis worn by the subjects. This finding was same as reported by Petersen and Gormsen.  Prevalence of edentulousness and presence of removable denture in the jaws was less than that reported by Helöe and Kolberg. 
Regarding the periodontal status of the subjects, higher percentages of subjects in our study were free from any signs of periodontal disease than that reported by Srikandi and Clarke.  Teeth with probing depths greater than 4 mm increased with the increase in age in this study and it was same as that reported by Lie et al. The most prevalent treatment need in the present study was oral prophylaxis which was same as reported by Roman and Pop.  Periodontal status of the subjects was significantly associated with socio-economic status, which was contrary to Srikandi and Clarke. 
The mean number of carious teeth was same in our study as reported by Ahlberg et al. The frequency of decayed tooth and average DMFT index was very less in our study than that reported by Bachanek et al. It can be attributed to high fluoride belt in parts of north India. Dental decay increased with the increase in age in our study and was same as reported by Duraiswamy et al. The mean DMFT in our study also increased with the increase in the age which was same as reported by Petersen.  Amongst the younger workers in our study more number of mean teeth showed no need for treatment, which was contrary to that reported by Tomita et al. Females had more missing teeth due to caries than males, which was contrary with Ekanayaka.  Majority of the subjects needed one surface filling, which was same as reported by Duraiswamy et al. Mean number of missing teeth due to caries were maximum in older age group which was same as reported by Petersenand Tanase.  Percentage of subjects, which were caries free was very high than reported by Duraiswamy et al. Missing teeth was the dominant expression of caries experienced in the older age-groups and it was same in both studies. 32.6% of the subjects had various degrees of dental fluorosis. This may be due to high fluoride belt in parts of north India.
| Conclusion|| |
Primary oral health-care programs like dental screening and oral health education at regular intervals should be made mandatory which will help to prevent accumulation of health-care demands of the factory employees. Apart from the agricultural sector, industrial sector plays a key role in national development. The factory employees who form the lifeline of any factory area special group of the population working in a confined factory environment in par with machines with high risks. However, many a times they are not given due importance. Hence, continuous professional research and development is essential to improve overall health and development of such population, so as to have a healthy productive labor population for development of any nation.
| Acknowledgments|| |
The authors thank all the CEO of respective factories for giving the permission and all employees who participated in this study for their co-operation.
| References|| |
|1.||Petersen PE. Dental visits, dental health status and need for dental treatment in a Danish industrial population. Scand J Soc Med 1983;11:59-64. |
|2.||Barmes DE. Indicators for oral health and their implications for developing countries. Int Dent J 1983;33:60-6. |
|3.||Varenne B, Petersen PE, Ouattara S. Oral health status of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2004;54:83-9. |
|4.||Petersen PE, Kaka M. Oral health status of children and adults in the Republic of Niger, Africa. Int Dent J 1999;49:159-64. |
|5.||Bhowate RR, Borle SR, Chinchkhede DH, Gondhalekar RV. Dental health amongst 11-15-year-old children in Sevagram, Maharashtra. Indian J Dent Res 1994;5:65-8. |
|6.||Wickholm S, Galanti MR, Söder B, Gilljam H. Cigarette smoking, snuff use and alcohol drinking: Coexisting risk behaviours for oral health in young males. Community Dent Oral Epidemiol 2003;31:269-74. |
|7.||Office of CEO pollution control board, Baddi. |
|8.||Oral Health Surveys: Basic Methods. 4 th ed. World Health Organization Geneva; 1997. AITBS publishers and distributers Delhi. |
|9.||Dunning JM. Principles of Dental Public Health. 4 th ed. United States of America: Harvard University Press; 1986. p. 339. |
|10.||Roman A, Pop A. Community periodontal index and treatment needs values (CPITN) in a factory worker group in Cluj-Napoca, Romania. Int Dent J 1998;48:123-5. |
|11.||Akman H, Akal KU, Redzep E, Delilbasi C. Prevalence of oral lesions in a selected Turkish population. Turk J Med Sci 2003;33:39-42. |
|12.||Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5. |
|13.||Malaovalla AM, Silverman S, Mani NJ, Bilimoria KF, Smith LW. Oral cancer in 57,518 industrial workers of Gujarat, India: A prevalence and followup study. Cancer 1976;37:1882-6. |
|14.||Jahanbani J. Prevalence of oral leukoplakia and lichen planus in 1167 Iranian textile workers. Oral Dis 2003;9:302-4. |
|15.||Mikkonen M, Nyyssönen V, Paunio I, Rajala M. Prevalence of oral mucosal lesions associated with wearing removable dentures in Finnish adults. Community Dent Oral Epidemiol 1984;12:191-4. |
|16.||Ikeda N, Handa Y, Khim SP, Durward C, Axéll T, Mizuno T, et al. Prevalence study of oral mucosal lesions in a selected Cambodian population. Community Dent Oral Epidemiol 1995;23:49-54. |
|17.||García-Pola Vallejo MJ, Martínez Díaz-Canel AI, García Martín JM, González García M. Risk factors for oral soft tissue lesions in an adult Spanish population. Community Dent Oral Epidemiol 2002;30:277-85. |
|18.||Tang JG, Jian XF, Gao ML, Ling TY, Zhang KH. Epidemiological survey of oral submucous fibrosis in Xiangtan City, Hunan Province, China. Community Dent Oral Epidemiol 1997;25:177-80. |
|19.||Hayashi N, Tamagawa H, Tanakai M, Haniokai T, Maruyama N, Takeshita T, et al. Association of tooth loss with psychosocial factors in male Japanese employees. J Occup Health 2001;43:351-5. |
|20.||Petersen PE, Gormsen C. Oral conditions among German battery factory workers. Community Dent Oral Epidemiol 1991;19:104-6. |
|21.||Helöe LA, Kolberg JE. Dental status and treatment pattern in a group of commuting laborers in Norway. Community Dent Oral Epidemiol 1974;2:203-7. |
|22.||Srikandi TW, Clarke NG. Periodontal status in a South Australian industrial population. Community Dent Oral Epidemiol 1982;10:272-5. |
|23.||Lie T, Due NA, Abrahamsen B, Böe OE. Periodontal health in a group of industrial employees. Community Dent Oral Epidemiol 1988;16:42-6. |
|24.||Ahlberg J, Tuominen R, Murtomaa H. Subsidized dental care improves caries status in male industrial workers. Community Dent Oral Epidemiol 1996;24:249-52. |
|25.||Bachanek T, Paw³owicz A, Tarczyd³o B, Chalas R. Evaluation of dental health in mill workers. Part I. The state of dentition. Ann Agric Environ Med 2001;8:103-5. |
|26.||Duraiswamy P, Kumar TS, Dagli RJ, Chandrakant, Kulkarni S. Dental caries experience and treatment needs of green marble mine laborers in Udaipur district, Rajasthan, India. Indian J Dent Res 2008;19:331-4. |
|27.||Tomita NE, Chinellato LE, Lauris JR, Kussano CM, Mendes HJ, Cardoso MT. Oral health of building construction workers: An epidemiological approach. J Appl Oral Sci 2005;13:24-7. |
|28.||Ekanayaka A. Tooth mortality in plantation workers and residents in Sri Lanka. Community Dent Oral Epidemiol 1984;12:128-35. |
|29.||Petersen PE, Tanase M. Oral health status of an industrial population in Romania. Int Dent J 1997;47:194-8. |
[Table 1], [Table 2]