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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 31-36

Oral health status and treatment needs among Group D workers of four government hospitals in Bengaluru


1 Reader, Department of Public Health Dentistry, Chettinad Dental College and Hospital, Chennai, Tamil Nadu, India
2 Professor, Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission20-May-2022
Date of Acceptance03-Jun-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Y S Prasanna Kumar
No. 576, Banashankari 3rd Stage, 2nd Phase, 6th block, 2nd main, Bangalore - 560 085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_14_22

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  Abstract 


Aim and Objectives of the Study: The aim of the study was to assess the oral health status and treatment needs among Group D workers of four government hospitals in Bengaluru and the objectives of the study were to assess the prevalence of dental caries, periodontal health status, oral mucosal lesions, and treatment needs and to know the possible relationship between low socioeconomic status and this particular occupation with oral health status.
Materials and Methodology: A total of 800 Group D workers were examined according to the WHO Basic Oral Health Survey Assessment Form 1997, and the required data were collected in a prepared format consisting of sociodemographic details, habits, oral hygiene practices, and few questions to assess their knowledge and awareness. The oral cavity of the workers was examined using CPI probe and mouth mirror plane.
Results: About 283 (35.4%) workers had one or the other forms of oral mucosal lesions of these, majority (102; 12.8%) had Chewer's mucosa, 67 (8.4%) had smoker's melanosis, 58 (7.3%) had leukedema, 27 (3.4%) had leukoplakia, 17 (2.1%) had oral submucous fibrosis, 8 (1%) had smoker's palate, and 2 (0.3%) had lichen planus.
Conclusion: The present study concludes that there is a strong relationship between poor oral health status and higher treatment needs with the low social class, low educational levels, and occupation.

Keywords: Group D workers, oral health status, treatment needs


How to cite this article:
Sangeeta T, Kumar Y S. Oral health status and treatment needs among Group D workers of four government hospitals in Bengaluru. Int J Prev Clin Dent Res 2022;9:31-6

How to cite this URL:
Sangeeta T, Kumar Y S. Oral health status and treatment needs among Group D workers of four government hospitals in Bengaluru. Int J Prev Clin Dent Res [serial online] 2022 [cited 2022 Aug 16];9:31-6. Available from: https://www.ijpcdr.org/text.asp?2022/9/2/31/348709




  Introduction Top


Oral health is an integral part of general health. It is often known that dental caries and periodontal diseases are the most common oral diseases affecting the humankind, and the prevalence of these diseases is high in the developing countries.

One of the enduring puzzles of public health is why some populations are healthier than others, the answers to such apparently simple questions, although it is complex to formulate, are crucial in understanding of oral diseases and how they might be eliminated or controlled through the development of appropriate public policies and programs.

The dental status has been shown to be related to factors such as marital status, attitudes toward dental care, social factors such as social class, education and level of urbanization and dental care habits.[1] Over the last century, health status has improved significantly. However, this improvement has not been experienced equally across the population, being considerably greater among the better off. Within less developed countries, there is a clear direct relationship between average per capita income and measures of health status such as life expectancy.[2]

The relationship between health and socioeconomic status is widely recognized. Many studies from Western countries have demonstrated a connection between low socioeconomic status and poor dental care and dental health.[3]

Studies have demonstrated that socioeconomic status is associated with a variety of health outcomes. These inequalities in health are thought to occur as a result of interactions among environmental, psychosocial, and biological factors because oral health is a component of overall health; one would expect an association between socioeconomic and objective measures of oral health as well.[4]

Since long, it was known that people of lower socioeconomic status and underprivileged have poor oral health status, and at the same time, availing oral care facilities is very poor among such people. This could be an account of lack of awareness, knowledge, education, poverty, etc. Ultimately, it leads to enormous percentage of untreated or unmet dental problems.[5]

More international studies demonstrated the relationship between socioeconomic status and dental health among both children and different strata of population. However, none of the studies have been conducted so for among Group D workers. With this background, the present study was undertaken to investigate the possible association between age, sex, education, and per capita income with the oral health status among Group D workers of four government hospitals in Bengaluru. Hence, the aim of the study is to assess the oral health status and treatment needs among Group D workers of four government hospitals in Bengaluru.


  Materials and Methodology Top


Under the Central Public Sector Employment, Group D workers are considered Safai Karamcharis, meaning staff for cleaning/sweeping.

All the duties are directed toward providing basic sanitation and cleanliness in the hospital premises.

The present field study was conducted for the period of 2 months (October 2004 to November 2004). Required permission to carry out the study was sought from concerned authorities (chief medical superintendents) of the government hospitals. About 2000–2500 Group D workers are working for government hospitals in Bengaluru. The pilot study was conducted among 50 Group D workers to know the feasibility, to redesign the format, and to calculate the sample size of the study. The sample size was fixed for 800 after the pilot study.

The study was carried out in the government hospitals (from four zones, namely, East, West, South, and North).

The government hospitals chosen for the study were

  • Vanivilas Hospital
  • Victoria Hospital
  • K. C. General Hospital
  • Bowring Institute and Lady Curzon Hospital.


A total of 800 Group D workers were examined, of which 462 (57.8%) were female and 338 (42.3%) were male. Oral examination was done according to the WHO Basic Oral Health Survey Assessment Form 1997,[6] and the required data were collected in a prepared format consisting of sociodemographic details, habits, oral hygiene practices, and few questions to assess their knowledge and awareness. The oral cavity of the workers was examined using CPI probe and mouth mirror plane under natural light (torch used sometimes). Assistance from the trained house surgeons was taken for the purpose of recording. The instruments were sterilized chemically using 2% glutaraldehyde. All the workers who need emergency care and treatments were referred to a government dental college for further treatments. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant.

The socioeconomic status was assessed according to BG Prasad's criteria[7]

Original classification of per capita income for socioeconomic status as per prices in 1961 was as follows:



This was modified using the formula:

Monthly income as per 1961 × multiplying factor.

Multiplying factor = Consumer price index × fixed number 0.05.

Consumer price index for Bengaluru as on October 2004 was–510.

(Taken from RBI, Bengaluru).

Hence, the per capita income for the present socioeconomic status was as follows (as on October 2004):



Statistical analysis

The data were analyzed using SPSS package. The means were compared using ANOVA test for statistical significance; P < 0.05 was considered statically significant.

The present study was undertaken to find out the possible association between age, sex, education, and per capita income with the oral health status among Group D workers of four government hospitals in Bengaluru. A total of 800 Group D workers were examined, of which 462 (57.8%) were female and 338 (42.3%) were male.


  Results Top


The majority of workers (372; 46.5%) belonged to the age group of 41–50 years, followed by 194 (24.3%) belonged to 31–40 years, 160 (20%) belonged to 51–58 years, and 74 (9.3%) belonged to 21–30 years [Table 1]. The study group consists of 462 (57.8%) females and 338 (42.2%) males; in all the age groups, females outnumbered males except in 21–30 years' age group where males were more than females. The educational status of the workers showed that the majority of the workers (549; 68.6%) were illiterates and only 251 (31.4%) were literates, of which the majority (133; 16.6%) had completed lower primary, 65 (8.2%) had completed higher primary, and the least (53; 6.7%) had completed high school education.
Table 1: Distribution of Participants' according to their age group and gender

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The majority of the workers (761; 95.1%) were Hindus, followed by 31 (3.9%) Christians and the least (8; 1%) Muslims. According to the BG Prasad's criteria of classification, the majority of the workers (509; 63.6%) belonged to upper middle class, followed by 172 (21.5%) belonged to lower middle class, 61 (7.6%) belonged to upper lower class, 52 (6.5%) belonged to upper class, and the least (6; 0.8%) belonged to lower lower class [Table 2].
Table 2: Distribution of Participants' according to their socioeconomic status

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About 530 (66.3%) workers were free from systemic illnesses and 270 (33.8%) workers had one or the other systemic illnesses, of which 97 (12.1%) had arthritis, 76 (9.5%) had hypertension, 38 (4.8%) had both diabetes and hypertension, 23 (2.9%) had diabetes, and 36 (4.5%) workers had other systemic illnesses such as respiratory diseases, tuberculosis, and skin diseases. The majority of the workers (781; 97.6%) were of mixed diet and few (19; 2.4%) were vegetarians. The majority of the workers (386; 48.3%) had Rice and Ragi as the staple diet, followed by only Ragi in 145 (18.1%), only rice in 104 (13%), Rice, Ragi, and Wheat in 95 (11.9%), and Rice and Wheat in 70 (8.8%). Nearly 510 (63.8%) workers had one or the other habits, of which majority (158; 19.8%) had pan chewing habit, followed by smoking habit in 88 (11%), quid habit in 73 (9.1%), alcoholic habit in 53 (6.6%), Gutkha habit in 11 (1.4%), and multiple habits in 127 (15.9%). Whereas, 290 (36.2%) workers were free of habits.

Distribution of workers according to the oral hygiene practices

  • Type of cleaning: Nearly 508 (63.5%) workers used toothbrush to clean their teeth and the rest 276 (34.5%) used finger to clean their teeth.
  • Frequency of cleaning: The majority of the workers (760; 95%) cleaned their teeth once in a day and few workers (24; 3%) cleaned their teeth twice daily.
  • Frequency of changing toothbrush: The majority of the workers (290; 57.1%) changed their brush once in 4–6 months, followed by 201 (39.6%) once in 1–3 months and 17 (3.3%) once in 6 months and above.
  • Method of cleaning: The majority of the workers (777; 97.1%) cleaned their teeth horizontally and 7 (0.9%) cleaned their teeth in vertical motion.
  • Time of cleaning: Nearly 760 (95%) workers cleaned their teeth before meal and 24 (3%) workers cleaned their teeth after meal.


The majority of the workers (439; 54.9%) used toothpaste to clean their teeth, of which majority 201 (25.1%) used nonfluoridated toothpaste and 115 (14.4%) used fluoridated toothpaste and 123 (15.4%) workers were not aware of the type of paste they use. Nearly 231 (28.9%) workers used toothpowder to clean their teeth and 114 (14.2%) workers used charcoal/other materials clean their teeth.

The majority of the workers (507; 63.4%) had never visited a dentist before and only 293 (36.6%) workers visited a dentist earlier. Among 293 (36.6%) workers visited to the dentist which was mostly for extractions 233 (29.1%) which was followed by 19 (2.4%) for toothache, 17 (2.1%) for prosthesis, 11 (1.4%) for restorations, 6 (0.8%) for both extractions and replacements, 4 (0.5%) for both extractions and restorations and few 3 (0.4%) for oral prophylaxis. Among those who visited dentist 293 (36.6%) majority of them 176 (22%) were availing services at private clinics and rest 117 (14.6%) were at Government hospital. The majority of the workers 526 (65.8%) did not answer for any question, followed by 221 (27.6%) workers answered only one question correctly, 49 (6.1%) workers answered only two questions correctly and only 4 (0.5%) workers answered only three questions correctly out of five questions asked. The majority of the workers 486 (60.8%) did not answer for any question, followed answered only one question correctly by 238 (29.8%), answered only two questions correctly by 58 (7.2%), and answered only three questions correctly out of five questions asked by only 18 (2.2%). Nearly 78 (9.8%) workers had temperomandibular joint signs (clicking/tenderness/limitation of mobility) and few (12; 1.5%) had temperomandibular joint symptoms (pain). About 283 (35.4%) workers had one or the other forms of oral mucosal lesions, of these majority (102; 12.8%) had Chewer's mucosa, followed by smoker's melanosis in 67 (8.4%), leukedema in 58 (7.3%), leukoplakia in 27 (3.4%), oral submucous fibrosis in 17 (2.1%), smoker's palate in 8 (1%), and lichen planus in 2 (0.3%). The rest of the workers (517; 64.6%) were lesions free.

Distribution of oral mucosal lesions according to the site of involvement [Table 3]
Table 3: Distribution of Oral Mucosal lesions according to the site of involvement

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Among the workers having oral mucosal lesions (283; 35.4%), buccal mucosa was the most common site (201; 71%) affected, followed by both buccal and labial mucosa 61 (21.6%), palate 8 (2.8%), tongue 6 (2.1%), labial mucosa 3 (1.1%), sulci 2 (0.7%), and commissures 2 (0.7%).

Nearly 13 (1.6%) workers had CPI code 1, followed by CPI code 2 in 367 (45.9%), CPI code 3 in 199 (24.9%), and CPI code 4 in 177 (22.1%), and none of the workers had 0 in all the six sextants [Table 4]. The CPI code of 0 was seen in 1.6 ± 0.82 mean sextants, followed by code 1 in 0.49 ± 0.32, code 2 in 3.45 ± 1.32, code 3 in 0.97 ± 0.41, and code 4 in 0.71 ± 0.22, and 0.42 ± 0.16 mean sextants were excluded. The majority of the workers (335; 41.9%) had code 0 loss of attachment, followed by code 1 in 280 (35%), code 2 in 113 (14.1%), code 3 in 18 (2.3%), and code 4 in only one worker [Table 5]. The loss of attachment code of 0 was seen in 4.04 ± 2.07 mean sextants, code 1 in 1.08 ± 1.55 mean sextants, code 2 in 0.26 ± 0.71 mean sextants, code 3 in 0.02 ± 0.17 mean sextants, and code 4 in 0.002 ± 0.05 mean sextants; 0.34 ± 1.1 mean sextants were excluded and 0.42 ± 1.07 mean sextants were not recorded.
Table 4: Distribution of Participants' with respective CPI scores

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Table 5: Distribution of Participants' with respective attachment LossI scores

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The majority of the workers (784; 98%) were dentate and 29.51 ± 4.43 were the mean teeth present. About 386 (48.3%) workers had caries experience and 1.68 ± 2.6 was the mean decayed teeth. Only 10 (1.3%) workers had filled with no decay with a mean of 0.028 ± 0.27. About 173 (21.6%) workers had missing teeth due to decay with a mean of 2.52 ± 6.03. Nearly 227 (28.4%) workers had missing teeth due to other reasons with a mean of 2.71 ± 5.99 teeth. About 78 (9.8%) workers had fractured teeth with a mean of 0.1 ± 0.32, the majority of the workers (311; 38.9%) had cervical abrasions with a mean of 1.76 ± 2.98, and about 249 (31.1%) workers had generalized attrition [Table 6]. About 330 (41.3%) workers had root exposures with a mean number of teeth affected 2.24 ± 3.89 and few (14; 1.75%) had root decay with 0.033 ± 0.016 mean teeth affected. The prevalence of dental caries was 539 (67.4%) and the rest (261; 32.6%) were caries free. The mean D component was 1.68 ± 2.6; the mean M component was 2.52 ± 6.03; and the mean F component was 0.028 ± 0.27. The total mean DMF-T was 4.16 ± 6.36. The mean DMF-T was increasing with increase in age and it was statistically significant (P = 0.000). The males had higher mean DMF-T (4.71 ± 6.25) when compared to females wherein the mean DMF-T was 3.75 ± 6.41 and the difference was statistically significant (P = 0.03). The majority of the workers (463; 57.9%) needed one surface filling with mean teeth of 2.32 ± 3.89, followed by extractions with mean teeth of 1.62 ± 3.25 in 353 (44.1%), pulp care and restoration with mean teeth of 0.37 ± 1.08 in 147 (18.4%), two or more surface fillings with mean teeth of 0.25 ± 0.67 in 125 (15.6%), fissure sealant with mean teeth 0.21 ± 0.24 in 77 (9.6%), crown requirement for the mean teeth 0.05 ± 0.03 in 18 (2.3%), preventive care in 6 (0.75%), and immediate care in 48 (6%). The majority of the workers (771; 96.4%) had no prosthesis in maxillary arch and 785 (98.1%) had no prosthesis mandibular arches. About 12 (1.5%), 5 (0.6%) had bridges, followed by 9 (1.1%), 2 (0.3%) had partial dentures, 8 (1%), 8 (1%) had complete removable dentures in maxillary and mandibular arches respectively. The majority of the workers 436 (54.5%), 446 (55.8%) did not need any prosthesis in the maxillary and mandibular arches respectively, which was followed by 190 (23.8%), 185 (23.1%) needs one and/or multiunit prosthesis, 129 (16.1%), 122 (15.3%) needs one unit prosthesis and 45 (5.6%), 47 (5.9%) needs for full prosthesis in maxillary and mandibular arches, respectively.
Table 6: Distribution of Participants' with respective Dentition status

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  Discussion Top


The present field study was conducted for the period of 2 months (October 2004 to November 2004), to assess the oral health status and treatment needs among Group D workers of four government hospitals in Bengaluru. The direct comparison of the study results cannot be made because of the limited reported literature in this regard and also variation in the geographic area of the population, type of the work, age of the study population etc. Among the 800 workers 462 (57.8%) were female and 338 (42.3%) were male. The study findings revealed that the majority of the study population belongs to 41–50 years (46.5%). This shows that there is a lack in fresh recruitment. Regarding the habits related to oral cavity, 63.8% had various harmful personal habits. This could be due to their low educational levels, social background, and type of work, which might have influenced the habits.

Even today, nearly 276 (34.5%) workers used finger to clean their teeth. Nearly 231 (28.9%) workers used toothpowder as a cleaning material and about 110 (13.8%) workers used charcoal, brick powder, etc. This shows that there is a clear lack in awareness regarding oral hygiene measures. A similar association of poor oral hygiene practices with low social class was shown by Whittle and Whittle[8] The majority of the workers (507; 63.4%) had never visited a dentist in their lifetime, even though they had some or the other oral diseases, and among those who have visited a dentist, it was mostly for extractions and tooth pain. This clearly shows that there is a lack of awareness, affordability, and accessibility and even could be due to negligence. A similar association of poor utilization of dental care services with low socioeconomic class was shown by Osterberg et al.[9] The majority of the workers did not answer for any questions correctly asked to assess knowledge and awareness, among those who answered it was for very few. This also shows that there is a lack in both knowledge and awareness regarding oral health, which needs to be improved. A similar association of lack of knowledge and awareness with low social class was reported by Thomson et al.[10] The prevalence of oral mucosal lesions was very high (283; 35.4%) among the workers, which could be attributed to the high prevalence of deleterious habits. A similar association of higher prevalence of oral mucosal lesions with deleterious habits was shown by Zachariah et al.[11] and Pindborg et al.[12]

Regarding periodontal health status, the prevalence of periodontitis was 45.9% and of gingivitis 47.5% (total constitutes about 93.4%). This may be attributed to their poor oral hygiene practices and harmful personal habits. The prevalence of dental caries was high (67.4%) and the mean DMF-T was 4.16 ± 6.36; however, the mean missing component (2.52 ± 6.03) is much higher than mean decayed component (1.68 ± 2.6), which indicates the lack of awareness and not utilization of dental care services. A similar association of high prevalence of dental caries with low social class was shown by Al-Mohammadi et al.[13] The prevalence of cervical abrasion was 38.9%, and root exposures (41.3%) were high, which could be due to the faulty brushing technique and use of materials such as charcoal and brick powder to clean their teeth. The present results in this regard cannot be compared due to lack of previous literature in this regard. About 21.6% had missing teeth due to decay, 28.4% of the workers had missing teeth due to other reasons, and about 2% of the workers were completely edentulous at the time of examination. Almost all workers needed some or the other treatments such as periodontal care including oral prophylaxis, restorations, extractions, and replacements. About 46.9% of the study population needed prosthetic care like two or multiunit prosthesis. Similar association of high treatment needs with low social class shown by Megas and Athanassouli.[14] On whole, the results conclude that there is a lack of knowledge and awareness regarding oral health. The utilization of dental care services was very poor and had poor oral health status. This has tended to result in high unmet treatment needs.


  Conclusions Top


The present study concludes that there is a strong relationship between poor oral health status and higher treatment needs with the low social class, low educational levels, and occupation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Hanson BS, Liedberg B, Owall B. Social network, social support and dental status in elderly Swedish men. Community Dent Oral Epidemiol 1994;22:331-7.  Back to cited text no. 1
    
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Prasad BG. Social classification. J Indian Med Assoc 1968;5:365-6.  Back to cited text no. 7
    
8.
Whittle JG, Whittle KW. Household income in relation to dental health and dental health behaviors: The use of super profiles. Community Dent Health 1998;15:150-4.  Back to cited text no. 8
    
9.
Osterberg T, Lundgren M, Emilson CG, Sundh V, Birkhed D, Steen B. Utilization of dental services in relation to socioeconomic and health factors in the middle aged and elderly Swedish population. Acta Odontol Scand 1998;56:41-7.  Back to cited text no. 9
    
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Thomson WM, Poulton R, Kruger E, Boyd D. Socio-economic and behavioral risk factors or tooth loss from age 45 to 65 among participants in the Dunedin multidisciplinary health and development study. Caries Res 2000;34:361-6.  Back to cited text no. 10
    
11.
Zachariah J, Mathew B, Varma NA, Iqbal AM, Pindborg JJ. Frequency of oral mucosal lesions among 5000 individuals in Trivandrum, South India. J All India Dent Assoc 1966;38:190-4.  Back to cited text no. 11
    
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Pindborg JJ, Bhatt M, Devanath KR, Narayana HR, Ramachandra S. Frequency of oral white lesions among 10,000 individuals in Gangalore, South India. A preliminary report. Indian J Med Sci 1966;20:349-52.  Back to cited text no. 12
    
13.
Al-Mohammadi SM, Rugg-Gunn AJ, Butler TJ. Periodontitis and Caries prevalence in males aged 35 to 64 years according to socio-economic status in Riyadh, Saudi Arabia. Community Dent Oral Epidemiol 1997;25:184-6.  Back to cited text no. 13
    
14.
Megas BF, Athanassouli TN. Dention status of the permanent teeth in Greek individuals related to age, sex, urbanization and social status. Community Dent Health 1989;6:131-7.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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