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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 3  |  Page : 198-200

Assessment of oral health status and developmental disturbances of oral structures among endosulfan victims of Kasaragod District, Kerala


1 Department of Oral and Maxillofacial Pathology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
2 Department of Periodonotology, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Date of Submission24-Mar-2019
Date of Acceptance08-Aug-2019
Date of Web Publication12-Sep-2019

Correspondence Address:
Dr. P S Ashwin
Sushravya House, Kodangai, Bantwal, Dakshina Kannada - 574 243, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_38_19

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  Abstract 


Background: Endosulfan, an organochlorine pesticide, is a broad-spectrum contact insecticide widely used in pest control. Aerial spraying of this pesticide was being carried out in the cashew plantations in the Kasaragod district of Kerala, India, for several years. Various reports have been published on the serious adverse effects of this chemical on human health. Data on the oral health of endosulfan victims are scarce in the literature. Aim: This study aimed to assess the oral health status and developmental disturbances of oral structures among endosulfan victims of Kasaragod district, Kerala. Materials and Methods: A cross-sectional study was conducted among the endosulfan victims of 12–60 years of age using World Health Organization Oral Health Survey pro forma 2013 and a separate form to record the developmental disturbances of oral structures at BUDS Special School for Endosulfan Victims and Primary Health Center, Perla, Kasaragod. Descriptive statistics were used to analyze the data. Results: There were a total of 25 subjects in the age range of 12–60 years. The mean DMFT score of the subjects aged below 15 years (n = 12) was 3 ± 2.94 and for the subjects aged above 15 years was 4.23 ± 3.81. Bleeding on probing was present in all the participants. Micrognathia, microglossia, and fissured tongue were the main features observed in the study. Conclusion: The overall oral health status was found to be unsatisfactory due to the disabilities of the endosulfan victims. The current study has set a milestone and calls for the need of the assessment of endosulfan victims of other parts of the state.

Keywords: Dental caries, development disorders, endosulfan, oral health, pesticides


How to cite this article:
Suresh T, Ashwin P S. Assessment of oral health status and developmental disturbances of oral structures among endosulfan victims of Kasaragod District, Kerala. J Indian Assoc Public Health Dent 2019;17:198-200

How to cite this URL:
Suresh T, Ashwin P S. Assessment of oral health status and developmental disturbances of oral structures among endosulfan victims of Kasaragod District, Kerala. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Oct 23];17:198-200. Available from: http://www.jiaphd.org/text.asp?2019/17/3/198/266764




  Introduction Top


Endosulfan is a highly toxic agrichemical used in cashew plantations. The Stockholm Convention held in April 2011 recommended a global ban on the manufacture and use of endosulfan because of its adverse effects on human health and the environment. It is a matter of concern to health professionals worldwide. The World Health Organization (WHO) classifies endosulfan under Category 2 (moderately hazardous).[1]

Its impact on the quality of food, water, and beverages and its ability to cause neurobehavioral disorders, congenital malformations in females, and abnormalities related to the male reproductive system are studied,[2] but information regarding the oral health of endosulfan victims is scant.

Endosulfan aerial spraying was done in Kasaragod district by Plantation Corporation, which is currently banned since 2000. Despite the ban, its effects have been noticed in current generations. More and more health problems were reported from the areas surrounding the plantations of Cheemeni, Periya, Rajapuram, Panathadi, Muliayar, and Perla. Some schoolchildren in the area were reported to have congenital anomalies, mental retardation, and other central nervous system-related problems. All these were alleged to be due to the aerial spraying of endosulfan.[3] This study aims to assess the oral health status and developmental disturbances of oral structures among endosulfan victims of Kasaragod district, Kerala.


  Materials and Methods Top


A cross-sectional study was conducted on 25 subjects in BUDS Special School for Endosulfan Victims and at the Primary Health Center (PHC), Perla, Enmakaje of Kasaragod district, with permission from the concerned officials. Clinical examination and recording as part of the study was conducted over a period of 1 month from September 1, 2016, to September 30, 2016. Ethical clearance was obtained from the Institutional Ethics Committee (letter reference number GDCRI/ACM/PG/PHD/5/2016-17). Informed consent was obtained from the subjects/teacher/guardians/parents.

The subjects were already diagnosed and registered as endosulfan victims in the records of PHC, Perla. Among the 25 subjects of the study, 18 were examined at BUDS Special School, Perla, and the rest of the seven subjects were examined at PHC, Perla. Those who were co-operative for the oral health assessment were included, whereas those with severe mental and physical disability as per the records were excluded. On the days scheduled for assessment, 25 subjects were examined and their data were recorded.

The subjects were asked to sit comfortably on a chair in a well-ventilated room, and clinical examination was carried out under natural light with a mouth mirror, an explorer, and a community periodontal index probe. Clinical examination and recording was done by one of the investigators. The examiner was calibrated prior, and consistency was checked by examining the children and determining intra-examiner variability. The kappa coefficient value for intra-examiner reliability for the investigator was 0.9. The data were recorded by the investigator on a WHO Oral Health Assessment Form 2013. Subjects under 15 years of age were examined, and their data were recorded as per the Oral Health Assessment Form for children. Community Periodontal Index-modified (pockets were assessed and scored) and loss of attachment were assessed among the subjects above the age of 15 years. A self-designed form was utilized to record the developmental disturbances of oral structures. Time taken for clinical examination and recording of data was around 20–35 min per subject. A sufficient number of autoclaved instruments were taken for day-to-day examination. Infection control measures were observed throughout the study.

Statistical analysis

The data were further entered and processed using the software Microsoft Excel 2013. IBM SPSS version 21.0, USA was used for statistical analyses. Descriptive statistics were calculated.


  Results Top


Age and gender distribution

The age of the subjects ranged from 12 to 60 years. Among the subjects, 12 were found to be within 15 years of age and the other 13 subjects were above the age of 15 years. There were 10 female subjects and 15 male subjects in this study. Among the subjects, 8 male subjects and 5 female subjects belonged to above 15 years' age group. Five female subjects and seven male subjects belonged to below 15 years' age group [Table 1].
Table 1: Age and gender distribution

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The mean dmft score of the subjects below 15 years' age group was 3 ± 2.94 (range: 0–9). The mean DMFT score of the subjects above 15 years' age group was 4.23 ± 3.81 (range: 0–14) [Table 2].
Table 2: Caries experience among the subjects - DMFT/dmft

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Bleeding on probing was present in all the subjects. Loss of attachment was found to be less severe as only two out of the 13 children had attachment loss of more than 6–8 mm [Table 3].
Table 3: Periodontal status of the subjects (n=13)

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Dental trauma was noted among two subjects, with one subject sustaining a trauma of right central incisor with pulpal involvement and the other individual had lost both of the central incisors due to trauma. No oral mucosal lesion was found in any of the subject. No dentures were noted among any of the individuals [Table 4].
Table 4: Dental trauma, oral mucosal lesions, and denture status among the subjects (n=25)

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Developmental disturbances of teeth, jaws, tongue, lip, and palate were assessed. The observations were recorded in a self-designed form. Enamel hypoplasia, micrognathia/macrognathia, microglossia/macroglossia, bifid tongue, fissured tongue, and cleft lip/palate were the developmental disturbances of the oral structures observed [Table 5].
Table 5: Developmental disturbances of oral structures among the subjects (n=25)

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  Discussion Top


Aerial spraying of endosulfan was carried out for several years in some parts of Kerala between the years 1980 and 2000. The use of this chemical has been reported to be associated with a high incidence of central nervous system disorders, cancer, and reproductive disorders. As more and more health issues were reported from the areas which were being sprayed with endosulfan, it was banned for further use. It is still a burning issue as the ill effects are being observed in the present generation also. The results of this study conducted among the endosulfan victims of Enmakaje panchayath of Kasaragod throw light on the oral health aspect of the victims. Although governmental and nongovernmental organizations have taken bold steps in the rehabilitation of the victims, oral health care needs to be addressed separately and promptly. The oral health status of endosulfan victims was first assessed by Dayakar et al. at the Endosulfan Remediation Cell, Kokkada, Belthangady taluk of Karnataka.[3] This study is conducted in one of the highly affected areas of Kasaragod district, Kerala. It is unique and the first of its kind to have assessed the oral health status and assessment of developmental disturbances of oral structures. Micrognathia, microglossia, and fissured tongue were the main features observed in the study.

Periodontal status was not very satisfactory as bleeding on probing was a consistent feature in all the subjects and majority of the subjects among the assessed (n = 8) had periodontal pocket scores of 1 and 2, indicating pocket depth >4 mm. These observations are in accordance with a previous study which has reported that overall periodontal status among the study participants was considerably poor.[3] It can be attributed to the physical and mental disability status of the subjects and inadequate professional dental care.

Enamel hypoplasia was noted among 16% (n = 4) of the subjects. Dental trauma was observed in the maxillary anterior teeth of two subjects who were mentally retarded, which calls for the need of extra care and rehabilitation. A previous study by Dayakar et al. has not reported any case of enamel hypoplasia and dental trauma.[3] Other observations with regard to denture status, mucosal lesions, and dental fluorosis are same as those of the results of this study with no evidence of such cases among the assessed subjects.

A study was conducted to report the characteristics of cancer patients from the endosulfan-affected areas of Kasaragod district. Of the reported twenty cases in the study, seven had head-and-neck cancer, with the specific cancer sites being buccal mucosa in two cases and hypopharynx, nasopharynx, oropharynx, eye–conjunctiva, and lip in one case each.[4] In the present study, no mucosal lesions were found among the assessed subjects. However, developmental disturbances such as enamel hypoplasia, micrognathia/macrognathia, microglossia/macroglossia, bifid tongue, fissured tongue, and cleft lip/palate were observed.

The current study was conducted in the limits of one panchayath, and the sample of the study was small in number. This study was based only on clinical examination, which limits the capacity of the study to directly attribute the effects of endosulfan on oral health and the development of oral structures. Despite the ban on endosulfan use, the harmful effects are observed in the current generations too. There is a need of long-term investigation on the oral health of endosulfan victims with more detailed examinations and also researches to assess and establish the harmful effects of endosulfan on oral hard- and soft-tissue structures.


  Conclusion Top


The overall oral health status was found to be unsatisfactory due to the disabilities of the endosulfan victims. Micrognathia, fissured tongue, and microglossia were the consistent features among the victims. The results of this study with regard to the developmental disturbances of oral structures set a milestone in the literature and call for the need of the assessment of endosulfan victims of other parts of the state. As it is not possible to conclude that the developmental disturbances are the direct effects of endosulfan, there is a definite need of more epidemiological research studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. The WHO Recommended Classification of Pesticides by Hazard and Guidelines to Classification. Geneva: World Health Organization; 2009. Available from: http://www.who.int/ipcs/ publications/pesticides_hazard_2009.pdf/. [Last accessed on 2016 Jul 25].  Back to cited text no. 1
    
2.
Menezes RG, Qadir TF, Moin A, Fatima H, Hussain SA, Madadin M, et al. Endosulfan poisoning: An overview. J Forensic Leg Med 2017;51:27-33.  Back to cited text no. 2
    
3.
Dayakar MM, Shivprasad D, Dayakar A, Deepthi CA. Assessment of oral health status among endosulfan victims in endosulfan relief and remediation cell – A cross-sectional survey. J Indian Soc Periodontol 2015;19:709-11.  Back to cited text no. 3
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4.
Bhaskarapillai B, Kumar SS, Balasubramanian S. A descriptive analysis of cancer cases from Endosulfan-affected areas of Kasaragod district, Kerala. Health Sci 2012;1:1-8.  Back to cited text no. 4
    



 
 
    Tables

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



 

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