|Year : 2015 | Volume
| Issue : 3 | Page : 280-284
Comparison of caries and oral hygiene status of child laborers and school children: A cross-sectional study
Chanchal Gangwar, Manish Kumar, L Nagesh
Department of Public Health Dentistry, Institute of Dental Sciences Campus, Bareilly, Uttar Pradesh, India
|Date of Web Publication||14-Sep-2015|
Department of Public Health Dentistry, Institute of Dental Sciences Campus, Bareilly, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Child labor is recognized as a global health problem and child laborers are exposed to unique living, working conditions and face such events in life, which are not usually faced by other children. Research on its health impact and oral health impact has been very limited and inconsistent. Aim: The aim was to assess and compare dental caries and oral hygiene status of child laborers and school children of Bareilly city. Materials and Methods: A total of 400 child laborers by snowball sampling technique and 400 school children by random sampling technique were included in the study. A specially designed pretested proforma was used to collect data related to the sociodemographic profile, adverse habits and frequency of dental visits. Decayed, missing, and filled teeth index (DMFT) and oral hygiene index-simplified (OHI-S) were used. Results: The mean age of child laborers and school children was 13.07 ± 1.3 and 13.03 ± 1.5. The majority of child laborers (82.8%) had no mouth rinsing habit. Tobacco-related habits were found among 37.8% of child laborers. Most of the child laborers (91%) never visited dentists. The mean DMFT was 3.8 ± 1.7 and 2.9 ± 1.6 for child laborers and school children, respectively, (P < 0.05). The mean OHI-S score was 2.3 ± 0.70 and 2.1 ± 0.9 in child laborers and school children, respectively, (P < 0.05). Conclusion: The study demonstrated that the child laborers have poorer oral health status with respect to dental caries and oral hygiene compared to school children.
Keywords: Child labor, children, dental caries, oral hygiene
|How to cite this article:|
Gangwar C, Kumar M, Nagesh L. Comparison of caries and oral hygiene status of child laborers and school children: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:280-4
|How to cite this URL:|
Gangwar C, Kumar M, Nagesh L. Comparison of caries and oral hygiene status of child laborers and school children: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Nov 17];13:280-4. Available from: http://www.jiaphd.org/text.asp?2015/13/3/280/165273
| Introduction|| |
The term "child labor" is often defined as work that deprives children of their childhood, their potential and their dignity, and, that is, harmful to physical and mental development.
It refers to work that: Is mentally, physically, socially or morally dangerous, and harmful to children; and interferes with their schooling.  Some child rights activists argue that child labor must include every child who is not in school because he or she is a hidden child worker.
The United Nations Children's Fund (UNICEF) points out that India faces major shortages of schools, classrooms, and teachers particularly in rural areas where 90% of child labor problem is observed.  About 1 in 5 primary schools have just one teacher to teach students across all grades.  Child labor is still common in many parts of the world. The incidence of child labor in the world decreased from 25% to 10% between 1960 and 2003, according to the World Bank. Nevertheless, the total number of child laborers remains high, with UNICEF and International Labor Organization acknowledging an estimated 168 million children aged 5-17 years worldwide were involved in child labor in 2013. 
About 60% of the child labor is involved in agricultural activities such as farming, dairy, fisheries, and forestry. Another 25% of child laborers are in service activities such as retail, hawking goods, restaurants, load and transfer of goods, storage, picking and recycling trash, polishing shoes, domestic help, and other services. The remaining 15% laborers are in assembly and manufacturing in the informal economy, home-based enterprises, factories, mines, packaging salt, operating machinery, and such operations. Two out of three child laborers work alongside their parents, in unpaid family work situations. Some children work as guides for tourists, sometimes combined with bringing in business for shops and restaurants. 
In absolute terms, Asia, being the most densely populated region of the world, has the largest number of child workers. About 61% are found in Asia, 32% in Africa, and 7% in Latin America.  India is sadly the home to the largest number of child laborers' in the world. The census found an increase in the number of child laborers' from 11.28 million in 1991 to 12.59 million in 2001.  A major concern is that the actual number of child laborers goes undetected. Laws that are meant to protect children from hazardous labor are ineffective and not implemented correctly.
Oral health is a neglected area among economically weaker sections and vulnerable population such as child laborers. Many of them work for long hours in unhealthy conditions under a lot of mental stress and suppressed anguish. These environmental conditions may have a profound influence on their oral health. According to the life course approach, oral health may be considered as an outcome of multiple factors related to living conditions, working conditions, events, and circumstances intimately associated with life in various periods of a life-time. ,
On extensive literature search and to the best of our knowledge, no study has ever been reported to assess oral health status among child laborers who are under-privileged, needy, poor, disadvantaged and deprived of basic education, and needs. With this background, the aim of the study was to assess and compare oral health status with respect to dental caries and oral hygiene status among child laborers and school going children of Bareilly.
| Materials and methods|| |
A descriptive, cross-sectional survey was conducted to assess and compare dental caries and oral hygiene status of child laborers and school going children of Bareilly, (U.P).
The study protocol was submitted to the IRB, Institute of Dental Sciences, Bareilly, and ethical approval was obtained on 6 th October 2014. Informed consent was obtained from the participants' parents or guardians by sending a copy of the informed consent letter and the participant information letter, which was drafted in the local language. Some of the parents and guardians could not read, such parents were personally consulted by the investigator at their place of residence or workplace and read out the contents of an informed consent letter and participant information letter and later consent was obtained. In addition, to this assent was obtained from every participant before administering the question paper.
Instrument for data collection
A specially designed pretested proforma for the purpose of collecting data was used in the survey. The proforma consisted of three parts. The first part of the proforma had a provision to collect data related to the sociodemographic profile of child laborers and school children in terms of age, gender, education, income, occupation, and duration and time of working. The second part consisted of five questions assessing oral hygiene habits, adverse habits, and frequency of dental visit. The third part had the provision for recording dental caries experience by applying decayed, missing, filled teeth (DMFT) Index with suggested modification by WHO  and oral hygiene status by applying oral hygiene index-simplified (OHI-S) (1964).  The proforma was translated from English to regional language (Hindi) with the help of a qualified translator for using it among local people.
A single examiner (CG) performed all the examinations. The examiner was trained and calibrated with the gold standard (faculty member, MK) in the Department of Public Health Dentistry. Kappa statistics revealed intra-examiner variability as 0.76 and 0.78 for DMFT index and OHI-S, respectively. Inter-examiner variability was 0.8 and 0.82 for OHI-S and DMFT index, respectively. All the correlation coefficient values were found to be high reflecting a high degree of concordance.
For including a child under child laborer, the subjects had to be engaged in labor either inside or outside the home, and for school children the subjects had to be studying in a school.
Inclusion criteria (child laborers and school children)
- Subjects are belonging to 12-15 years age group.
Exclusion criteria (child laborers and school children)
Sample size estimation
- Subjects with any serious systemic health problems, which can compromise their oral health
- Subjects who could not comprehend the questionnaire.
Sample size estimation was done using the prevalence of "dental caries" by conducting a pilot study on 50 child laborers (data excluded from the main study) and was found to be 80%. Based on this prevalence, the sample size for the present study was calculated as 400 using the following formula: N = 4Pq/L 2 , where P = Prevalence of "dental caries," which was 80%; q = (1−P); L = Allowable error (5%); of the prevalence (precision) =5% of the P.
The sample consisted of 400 child laborers and 400 school going children. There are totally 127 secondary schools in Bareilly city according to Basic Shiksha Adhikari, Bareilly Zone. Schools were broadly categorized into government and private aided, thereby giving a chance to incorporate school going children from different backgrounds. There are 77 government and 50 private schools. Bareilly city was divided into four zones, North, East, West, and South. From each zone, 2 government schools and 2 private schools (total 16 schools) were selected by using simple random sampling method (Lottery method). Based on stratified random sampling technique, 25 students from each school (age 12-15 years) were selected randomly by using a lottery method to be included in the study.
Since there is no published available data on child laborers in Bareilly city, snowball sampling technique was used to collect the required sample. The child laborers were selected from small restaurants, zari and embroidery industry, garage, domestic labor, picking and recycling trash, retail shops, and factories.
The examiner visited a maximum of ten subjects on any scheduled day and collected the required data. The questionnaire was administered by the investigator to the child laborers as they were majorly illiterates and could not read. It was self-administered by the children in the schools and the investigator assisted where it was required, as in the case of any doubts, clarifications were provided by the examiner.
The data obtained were entered into the excel sheet and analyzed using the IBM Statistics SPSS version 21.0 to generate descriptive and inferential tables. Unpaired t-test was used to find out any significant difference between child laborers and school children with respect to caries status and oral hygiene status. One-way ANOVA was used to find out the association between adverse habits and frequency of dental visits with caries and oral hygiene status. A P value was set at < 0.05 to be statistically significant.
| Results|| |
The mean age of the child laborers and school going children was 13.07 ± 1.3 and 13.03 ± 1.5, respectively. All the child laborers were males, whereas in school going children 210 males and 190 were females. The mean working hours for child laborers were 7.4 ± 0.5.
The majority of the child laborers (81.5%) and school going children (94%) brushed their teeth with the help of toothbrush and toothpaste. All the child laborers brushed their teeth once a day, whereas 56.8% school going children brushed their teeth once daily. The majority (82.8%) of the child laborers did not have rinsing habit while the majority of (52%) school is going children had mouth rinsing habit after every meal [Table 1].
About 28% of child laborers had an adverse habit in the form of Gutkha chewing, whereas no school going children had any adverse habit. The majority (91%) of the child laborers never visited dentist, whereas 43% of the school going children visited the dentist at every 6 months [Table 2].
|Table 2: Adverse habits and frequency of dental visit of child laborers and school children |
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Higher debris scores, missing teeth and filled teeth were found among school children when compared to child laborers, and this difference was statistically significant (P < 0.05). However, overall, oral hygiene status (mean OHI-S scores) and caries status (mean DMFT) were found to be poorer in child laborers when compared to school children, and this difference was statistically significant (P < 0.05) [Table 3].
|Table 3: Comparison of OHI - S and DMFT of child laborers and school children |
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The difference between the frequency of tooth brushing with caries and oral hygiene status was assessed. It was found that children who brushed their teeth only once per day had higher DMFT scores and was found to be statistically significant (P < 0.01). However, no such association was found with respect to poorer oral hygiene status [Table 4].
|Table 4: Mean difference between frequency of tooth brushing with caries and oral hygiene status |
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The difference between adverse habits and frequency of dental visits with caries and oral hygiene status was assessed. It was found that children with adverse habits and infrequent dental visits had higher DMFT (P < 0.05); adverse habits had no effect on the oral hygiene status.
| Discussion|| |
Child labor is illegal but is still in practice in different degrees in several countries all over the world. As it is illegal in the majority of the countries, it is an unorganized sector. In India "the child labor acts, 1986" was passed "As an act to prohibit the engagement of children in certain employments and to regulate the conditions of work of children in certain other employments."  Research evidence suggests that such children are highly prone to injuries and ill health. Child labor is an important global issue associated with poverty, inadequate educational opportunity, gender inequality, and the range of health risk. 
In the present study, the oral hygiene aids commonly used by the child laborers and school children were toothbrush and toothpaste, 81.5%, and 94%, respectively. This finding is similar to the study conducted on school children by Avinash et al.,  where 96.7% children used toothbrush and toothpaste to clean their teeth.
Overall, the mean OHI-S scores were found to be higher among child laborers when compared to school children. The possible reason for poorer oral hygiene status among the child laborers might be due to brushing only once daily (100%), no mouth rinsing (82.8%), Gutkha chewing (28.3%), and smoking (9.5%). However, in the present study, no association was found statistically between adverse habits and the frequency of tooth brushing with poorer oral hygiene status.
The child laborers had more decayed teeth than missing and filled teeth demonstrating higher unmet treatment needs. This might be due to financial constraints, competing priorities in life, lack of awareness, lack of time due to long working hours, lack of availability of dental care, higher level of dental anxiety, negative attitude toward utilization of available health care services, cultural and other social forces.  The other possible reasons in the present study for higher DMFT status among child laborers might be due to brushing once daily, adverse habits and infrequent dental visits.
The frequency of dental visit by child laborers has been found to be very poor in the present study. Only 9% of the child laborers in the present study ever visited a dentist, and the reason cited was only during discomfort or distress. Similar findings indicating relation between poorer frequency of dental visits and high unmet treatment needs involving children have been observed in the study conducted by Lopez and Baelum. 
The present study is not without limitation. Due to lack of literature throwing light on the oral health status of child laborers, very limited comparisons could be done. Hence, the comparison of the child laborers in the present study is done with other studies conducted on school children and other populations.
| Conclusion|| |
The current research has clearly highlighted the poorer oral hygiene status and caries status of such children when compared to school going children. Unless the living condition and economic condition of children working as laborers improves, they are not fully ready for promotional health interventions. These two are inter-twined, and elevating one automatically implies the elevation of the other. A concerted effort on the part of government agencies, private agencies, and civil society is essential to make inroads into this complex problem. Further studies need to be conducted to assess the possible factors associated with poorer oral hygiene status and caries status among the child laborers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]