|Year : 2016 | Volume
| Issue : 3 | Page : 292-297
Periodontal health status, oral mucosal lesions and adverse oral habits among sea food industry employees of Bhubaneswar, Odisha
Gunjan Kumar, Vinay Suresan, Avinash Jnaneswar, Goutham Bala Subramanya, Kunal Jha
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India
|Date of Web Publication||28-Jul-2016|
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Campus-5, Patia, Bhubaneswar - 751 024, Odisha
Source of Support: None, Conflict of Interest: None
Introduction: Industrial employees are often readily available and constitute a well-defined population group although not representing nationwide samples. Aim: To assess the periodontal status, prevalence of oral mucosal lesions, and adverse oral habits among seafood industry employees of Bhubaneswar. Materials and Methods: A cross-sectional descriptive survey was conducted among 21–60 years old 790 seafood industry employees. The questionnaire was designed to record demographic details, routine oral hygiene habits, adverse oral habits, community periodontal index, and prevalence of oral mucosal lesions. One-way analysis of variance and t-test analysis were used. Results: The majority of the subjects (72.6%) used toothbrush and toothpaste to clean their teeth. Smoking and pan chewing was recorded among 130 (16.5%) and 188 (23.8%) subjects, respectively. The prevalence of periodontal disease was 86.1% among the study population. The prevalence of calculus among the age group 39–48 years was statistically significant across the age groups. Females as compared to males had lower attachment loss levels. About 56 (7%) subjects had leukoplakia and 7 (0.8%) subjects had acute necrotizing gingivitis. Conclusions: The findings of this study provided an insight into the periodontal health status, adverse oral habits, routine oral hygiene practices, and the prevalence of oral mucosal lesions of sea food industry employees, which may be useful in designing and planning oral health promotion programs.
Keywords: Cross-sectional study, employees, oral hygiene, periodontal index, prevalence
|How to cite this article:|
Kumar G, Suresan V, Jnaneswar A, Subramanya GB, Jha K. Periodontal health status, oral mucosal lesions and adverse oral habits among sea food industry employees of Bhubaneswar, Odisha. J Indian Assoc Public Health Dent 2016;14:292-7
|How to cite this URL:|
Kumar G, Suresan V, Jnaneswar A, Subramanya GB, Jha K. Periodontal health status, oral mucosal lesions and adverse oral habits among sea food industry employees of Bhubaneswar, Odisha. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Nov 20];14:292-7. Available from: http://www.jiaphd.org/text.asp?2016/14/3/292/187176
| Introduction|| |
India has 8118 km of marine coastline and 3827 fishing villages. India's fresh water resources consist of 195,210 km of rivers and canals. In 2006, the country exported over 600,000 metric tonnes of fish, to some 90 countries, earning over $1.8 billion. Today, India is the second largest fish producing nation in the world constituting about 5.68% of the global fish production.
Fishing in India employs about 14.5 million people. The fishing industry includes any industry or activity concerned with taking, culturing, processing, preserving, storing, transporting, marketing, or selling fish or fish products. Directly or indirectly, the livelihood of over 500 million people in developing countries depends on fisheries and aquaculture, and fisheries sector has been faring high regarding its forex earning potential and employability of vast majority of coastal community. Odisha is one of the major maritime States in India having huge potential for marine fisheries development. About 2.95% populations (10.84 lakh) of Odisha depend on fisheries for their livelihood.
“Industrial studies” are performed in periodontal epidemiologic research.,,, Industrial employees constitute well-defined population groups, and although not representing nationwide samples, such groups are often readily available; therefore, have several practical advantages in epidemiologic studies. As an initial step, the collection of baseline information on the periodontal status is necessary in a state where no prior studies are conducted on this specific population which, comprises a major industry in this Eastern region. Until now, there are no reports regarding the periodontal health status of sea food industry employees. The prevalence of tobacco use in various forms is very high in the state of Odisha, yet; there is no literature in regard to the prevalence of oral mucosal conditions in this region. Hence, the aim of this study was to assess the periodontal health status, oral mucosal conditions and prevalence of oral habits among the seafood industry employees in Bhubaneswar, Odisha.
| Materials and Methods|| |
A cross-sectional descriptive survey was conducted to assess the periodontal status, routine oral hygiene habits, adverse oral habits, and prevalence of oral mucosal lesions among 21–60 years old seafood industry employees in the Chandaka Industrial Estate in Bhubaneswar, Odisha, India. Bhubaneswar, the capital city Odisha comprises most of the seafood industries and is a major exporter of frozen seafood.
The ethical clearance was obtained from the Institutional Review Board, and permission was obtained from the authorities of the seafood industries and written informed consent were obtained from all the participants who fulfilled the eligibility criteria of voluntary participations, being systemically healthy and are not under any antibiotic coverage for the past 15 days.
The questionnaire was designed to record demographic details, routine oral hygiene habits, adverse oral habits along with, community periodontal index (CPI), and prevalence of oral mucosal lesions as recorded in the World Health Organization Oral Health Assessment form (1997). Training and calibration of the examiner were done in the Department of Public Health Dentistry, Kalinga Institute of Dental Sciences among a preselected group of subjects who possessed the full range of the periodontal conditions (kappa value = 90%) and oral mucosal conditions before the commencement of the study.
A pilot study was carried out among 25 seafood industry employees, to determine the feasibility of the study and also to obtain the prevalence of the periodontal diseases. The pilot study reported a disease prevalence of 50%. The sample size was calculated the disease prevalence, a 95% of confidence level and a 5% of allowable error, applied to the total population size of 4137. This resulted in a sample size of 789 which, was rounded off to 790.
The total sample of 790 was equally divided among the five seafood industries giving rise a sample of 158 per se a food industries. Further, these 158 subjects were randomly selected from the employee list using the table of random numbers. Type-III clinical examination was carried out as per American Dental Association specification. Subjects were made to sit on an ordinary chair, and the examinations were carried out under adequate illumination. All the examinations were carried out by a single examiner assisted by a trained recording clerk. A total of 25–30 subjects were examined every day. Data collection was carried out from August to November 2014.
The data were analyzed using SPSS (Statistical Package for Social Sciences) version 15 software (SPSS Inc., Chicago, Illinois, USA). One-way analysis of variance was used for comparing the mean number of sextants which were affected by periodontal diseases, according to the age groups and t-test was used to compare the frequency of the CPI scores and the loss of attachment (LOA) between genders. The level of significance was set at P ≤ 0.05.
| Results|| |
A total of 790 subjects were examined, out of which 373 (47.2%) were males, and 417 (52.8%) were females. The age-wise distribution of the study population is illustrated in [Figure 1]. The age of subjects ranged from 21 years to 60 years with the mean age being 26.27 years. A mere 1% of the subjects were found to be illiterates whereas; 47.5% had attended middle school. Sorting the subjects according to their duration of work, 575 (72.8%) of subjects had 1–3 years of experience [Table 1].
It was found that 574 (72.6%) of the individual used a toothbrush and toothpaste to clean their teeth, and only 10 (1.3%) used toothpowder and finger. Six hundred and ninety-eight (88.4%) subjects brush twice a day [Table 2]. The average frequency of changing the brush among the subjects was found to be 4.12/year. Smoking was recorded among 130 (16.5%) of the subjects. Duration of smoking ranged from 2 months to 25 years with a mean of 6 years. The frequency of smoking ranged from 1 to 25 cigarettes per day with a mean of 4.2 cigarettes per day. One hundred and eighty-eight (23.8%) subjects were pan chewers. Duration of habit ranged from 0.5 to 25 years with a mean of 5.2 years. Frequency was found to be 1–25 per day with a mean of 5.3 pan per day.
|Table 2: Prevalence of oral hygiene practices and personal habits (n=790)|
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The prevalence of periodontal disease was 680 (86.1%) among the study population and 31 (100%) among the 59 years and above age group. [Table 3] depicts the CPI codes across the age groups. The results show that the calculus codes for the group 39–48 years was highest, and the difference was statistically significant across the age groups. There was no significant difference in pockets (4–5 mm) and ≥6 mm across the age groups. Calculus was more in female as compare to male (P = 0.001) as presented in [Table 4].
|Table 3: Comparison of community periodontal index codes across the age groups|
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|Table 4: Comparison of community periodontal index codes between the genders|
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LOA of 0–3 mm was highest in the 29–38 years of age group and lowest in the 19–28 years old group. The difference was statistically significant across the age group [Table 5]. LOA of 0–3 mm was more in males as compared to females (P = 0.001) as presented in [Table 6].
|Table 5: Comparison of loss of attachment index codes across the age-groups|
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|Table 6: Comparison of loss of attachment index codes between the genders|
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Examination of the oral mucosa revealed that 56 (7%) subjects had leukoplakia and 7 (0.8%) subjects had acute necrotizing gingivitis. Seventy-nine (10%) subjects needed to be referred to the nearest center due to pain and infection.
| Discussion|| |
The countries of the world are progressing toward an industrialization era. The progress of the country can be attributed to the growth of its industrial sector. As industries have progressed both in size and complexity, occupational health problems and diseases are also becoming more prominent. The work environment comprises numerous interactions between people and the chemical and/or physical demands involved with performing job. It is believed that periodontal disease is triggered by a disruption of the balance between the host resistance and the factors which provoke the disease. This is the first study to concentrate on the periodontal health status of seafood industrial employees in Bhubaneswar. The seafood industry employees may be identified as the high-risk group due to a high prevalence of the adverse habits such as pan chewing and smoking also complicated with prolonged working hours and adverse working conditions.
In this study, the number of male (47.2%) and female (52.8%) employees were almost equal. This could be because females often joined the sea food industries due to the less laborious nature of work. The education level of the present study population shows that 47.5% had completed middle school and 41.9% had completed high school or above.
The most prevalent oral hygiene practices among the subjects were the use of toothbrush and toothpaste (76%), and the use of toothpowder was 20.8%. These observations are corresponding with a study by Sakthi et al. where 76.9% of the building construction employees used toothbrushes and toothpaste for cleaning their teeth. Contradicting evidence was reported in a study conducted among Kota stone employees  who presented with poor oral hygiene habits as 82.4% subjects never cleaned their teeth.
The overall prevalence of tobacco use was 40.3%; the prevalence of smoking and tobacco chewing were 16.5% and 23.8%, respectively. The tobacco use prevalence in our study was lower than those which were reported by Sanadhya et al., (24.7% and 10.5%, respectively) Mou et al., (19.1% and 30.5%, respectively) and Ansari et al., (62.28% and 66.07%, respectively). The prevalence of the tobacco usage increased subsequently in the old age groups as compared to that in the younger age groups. The lower rates of tobacco smoking and pan chewing were reported in this study is due to the restriction to carry or use tobacco products in the factory premises.
In this study, the prevalence of periodontal disease was found to be 86.1%. In many studies, the prevalence of periodontal disease was found to be nearly 100% in adults.,,,,, However; there is a considerable range in the findings of different epidemiological studies. In this study, higher proportion of patients with bleeding gums was seen in lower age group, whereas calculus and deeper periodontal pockets were more common in higher age groups for all the sextants. Healthy scores were found in younger age groups; more bleeding was recorded among 29–38 years age group, calculus was most widespread among the 39–48 years age group. The results of our study were in concordance with the studies done on factory employees in Shanghai, China, Araraquara in Brazil, and Davangere city, Karnataka  that reported that calculus was the most common score among industrial employees. Whereas the highest prevalence of shallow periodontal pockets was seen among the 49–58 years age group, which were similar to the findings of the study conducted on aluminum factory employees by Hetland L et al.
Moreover, females (1.83 ± 0.40) had a greater number of healthy sextants per person than males (1.43 ± 0.45), which was in confirmation to other studies., Similarly, the LOA of 0–3 mm was highest in the 29–38 years of age group and lowest in the 19–28 years old group. LOA of 0–3 mm was more in males as compared to females. The observed gender difference in disease prevalence may be explained via the study conducted to ascertain the periodontal status among male industrial employees in Finland; it was found that smoking, which in the present study population was prevalent at 16.5% as the strongest independent factor which affected the periodontal status.
Poor lifestyle is a significant factor in high prevalence of periodontal disease. Lack of awareness was observed to be an important factor in Japanese employees  for high prevalence of periodontal disease and poor oral hygiene practices. A previous study from Finland also showed that periodontal disease increased with the poor standard of oral hygiene and unhealthy lifestyles.
In this study, the total prevalence of oromucosal lesions was found to be 7.8%, of which 7% comprised leukoplakia. This prevalence of oral mucosal lesions was comparatively less when compared to other studies. Leukoplakia was report as the most common lesion among Iranian textile employees. Tobacco pouch keratosis was also reported in few studies  as the most common lesion oral lesion also the prevalence of oral sub mucous fibrosis was reported. The workplace environment has an influence on the oral health status through the behavior and habits which are exerted by their personal and work characteristics. This also may be due to the fact that the level of education itself determines the income or the socioeconomic status, which in turn determines the awareness level and the utilization pattern of the dental health services.
This cross-sectional study does not draw any inferences about causal relationships. Further, more research is required, which involves a longitudinal study on the same target population, which would consider the risk factors involved in the causation of oral disease in previously disease-free mouths.
| Conclusions|| |
Among the many sectors which play a key role in national development, industrial sector is one among them. The responsibility of such groups not just monetary but also health-wise is on the shoulders of the employer. However, time and again this responsibility is neglected.
The findings of this study provide an insight into the periodontal health status of sea food industry employees and the high prevalence of tobacco use. More importantly, this data will help in planning oral health promotion programs and tobacco habits cessation counseling sessions at regular intervals which will help to prevent accumulation of healthcare demands of the factory employees.
We acknowledge the Ministry of fisheries, Odisha Sector. In addition, the administrative heads of various sea food industries and every subject who consented to participate in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fisheries and Aquaculture in our Changing Climate Policy Brief of the FAO for the UNFCCC COP-15 in Copenhagen; December, 2009. Available from: ftp://ftp.fao.org/FI/brochure/climate_change/policy_brief.pdf. [Last accessed on 2014 Apr 08].
Bellini HT, Gjermo P. Application of the periodontal treatment need system (PTNS) in a group of Norwegian industrial employees. Community Dent Oral Epidemiol 1973;1:22-9.
Markkanen H. Periodontal treatment need in a Finnish industrial population. Community Dent Oral Epidemiol 1978;6:240-4.
Hetland L, Midtun N, Kristoffersen T. Effect of oral hygiene instructions given by paraprofessional personnel. Community Dent Oral Epidemiol 1982;10:8-14.
Lie T, Due NA, Abrahamsen B, Böe OE. Periodontal health in a group of industrial employees. Community Dent Oral Epidemiol 1988;16:42-6.
World Health Organization. Oral Health Surveys: Basic Methods. 4th
ed. Geneva, Switzerland: WHO Press, World Health Organization; 1997.
Patil VV, Shigli K, Hebbal M, Agrawal N. Tooth loss, prosthetic status and treatment needs among industrial workers in Belgaum, Karnataka, India. J Oral Sci 2012;54:285-92.
Sakki TK, Knuuttila ML, Vimpari SS, Kivelä SL. Lifestyle, dental caries and number of teeth. Community Dent Oral Epidemiol 1994;22 (5 Pt 1):298-302.
Nagarajappa R, Sanadhya S, Sharda AJ, Asawa K, Tak M, Batra M, et al.
Assessment of the periodontal status among Kota stone workers in Jhalawar, India. J Clin Diagn Res 2013;7:1498-503.
Sakthi SS, John J, Saravanan S, Kumar RP. Periodontal health status and treatment needs among building construction employees in Chennai, India. J Int Oral Health 2011;3:7-14.
Sanadhya S, Nagarajappa R, Sharda AJ, Asawa K, Tak M, Batra M, et al.
The oral health status and the treatment needs of salt workers at Sambhar Lake, Jaipur, India. J Clin Diagn Res 2013;7:1782-6.
Mou J, Fellmeth G, Griffiths S, Dawes M, Cheng J. Tobacco smoking among migrant factory workers in Shenzhen, China. Nicotine Tob Res 2013;15:69-76.
Ansari ZA, Bano SN, Zulkifle M. Prevalence of tobacco use among power loom workers – A cross-sectional study. Indian J Community Med 2010;35:34-9.
Sheiham A. The prevalence and severity of periodontal disease in British populations. Dental surveys of employed populations in Great Britain. Br Dent J 1969;126:115-22.
Markkanen H, Rajala M, Paunio I. Evaluation of periodontal status in a Finnish industrial population. Community Dent Oral Epidemiol 1979;7:96-100.
Hugoson A, Jordan T. Frequency distribution of individuals aged 20-70 years according to severity of periodontal disease. Community Dent Oral Epidemiol 1982;10:187-92.
Hohlfeld M, Bernimoulin JP. Application of the community periodontal index of treatment needs (CPITN) in a group of 45-54-year-old German factory workers. J Clin Periodontol 1993;20:551-6.
Kumar S, Dagli RJ, Chandrakant D, Prabu D, Suhas K. Periodontal status of green marble mine labourers in Kesariyaji, Rajasthan, India. Oral Health Prev Dent 2008;6:217-21.
Shaikh H, Shankar S, Vinay S. Assessment of periodontal status and treatment needs among beedi factory employees Harapanahalli town, Davangere district, Karnataka. J Indian Acad Dent Spec 2011;2:13-7.
Pilot T, Lu ZY, Lin ZQ, Yen WP, Cao GR. Periodontal conditions in 35-44-year-old factory workers in Shanghai. Community Dent Oral Epidemiol 1989;17:216.
Dini EL, Guimarães LO. Periodontal conditions and treatment needs (CPITN) in a worker population in Araraquara, SP, Brazil. Int Dent J 1994;44:309-11.
Corbet EF, Holmgren CJ, Lim LP, Davies WI. Sex differences in the periodontal status of Hong Kong adults aged 35-44 years. Community Dent Health 1989;6:23-30.
Paulander J, Axelsson P, Lindhe J. Association between level of education and oral health status in 35-, 50-, 65-and 75-year-olds. J Clin Periodontol 2003;30:697-704.
Tirth A, Shankar TL, Mathur A, Tandon V. Oral hygiene practices and periodontal health among brass Industry employees and general population of Moradabad city, India. J Oral Health Res 2013;4:8-12. Available from: http://johr.in/index.php/JOHR/article/view/123/88.
[Last accessed on 2015 Mar 19].
Doughan B, Kassak K, Bourgois DM. Oral health status and treatment needs of 35-44 years old adults in Finland. Int Dent J 2000;50:395-9.
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.
Jahanbani J. Prevalence of oral leukoplakia and lichen planus in 1167 Iranian textile workers. Oral Dis 2003;9:302-4.
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.
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.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]