|Year : 2015 | Volume
| Issue : 1 | Page : 14-18
Assessment of disease burden among army personnel and dependents in Lucknow city
Anil Ahuja, Brig Narinder Singh
Department of Public Health Dentistry, Command Military Dental Centre, Lucknow, Uttar Pradesh, India
|Date of Web Publication||19-Mar-2015|
Dr. Anil Ahuja
Department of Public Health Dentistry, Command Military Dental Centre, 10/165 Indira Nagar, Lucknow - 226 016, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Oral health is a valuable asset for an individual. The oral cavity has a significant role to play in providing a satisfactory lifestyle including proper mastication, phonetics, esthetics, appearance, communication abilities and an overall emotional well-being. Very fewer studies have been carried out in the past on disease burden of army personnel and their dependents. Materials and Methods: This study was carried out on 2160 army personnel and their dependents reporting to Command Military Dental Center, Lucknow. The study population was screened for caries, periodontal status and prosthetic status and treatment need, oral hygiene practice and prevalence of the tobacco habit. All relevant information was noted into a Proforma. Statistical analysis was performed using SPSS 16.0 version (Chicago, Inc., USA). The results are presented in percentage and mean (±standard deviation). The unpaired t-test and Chi-square test were used. The P < 0.05 was considered as significant. Results: The oral hygiene awareness is adequate among serving, and dependents and practices of oral hygiene were also adequate. The higher prevalence of the tobacco habit was found among young army personnel than older. There was a significant association of smoking and periodontal disease. Leukoplakia was common oral mucosal lesion between smokers. Conclusion: This study will help to access dental disease occurrence rate and evaluate treatment needs and also to formulate a plan for augmentation of resources. The study will also create awareness about oral hygiene practices and oral habits among army personnel and their dependents.
Keywords: Army personnel, decayed, missing and filled teeth, periodontal disease, and smoking
|How to cite this article:|
Ahuja A, Singh BN. Assessment of disease burden among army personnel and dependents in Lucknow city. J Indian Assoc Public Health Dent 2015;13:14-8
| Introduction|| |
Oro-dental diseases are among the most widespread diseases around the globe. Although they are not an important cause of mortality, these may have sometimes serious repercussions upon the general health of people suffering from such diseases. Morbidities arising out of it may be sometimes disabling, and it is concerned with urgent need of action in promoting oral health, prevention of dental caries and periodontal diseases.
The Indian Army occupies the most disciplined organization in the country. The role of Indian Army is to provide security and to create a peaceful and law abiding community when called upon. This warrants good general as well as oral health. But, on the other hand, military personnel are a group of professionals who have altogether a different working environment with 24 h duty and often being exposed to highest physical strain and mental stress. Because of their odd working pattern, they often miss timely food, sleep, rest and recreation and family contacts. This complicates their life and pulls down their level of the living. , To maintain efficient military force, the health of army officials is of utmost importance.
The recruits after selection and initial training are posted to units in peace and field areas spread all over the country. Some of the units endure glacier, jungles and snow covered mountains where specialized dental treatment is not always available. Very fewer epidemiological studies have been conducted which assess the oral health status of military personnel and their dependents. This study was designed to assess the disease burden of army personnel and their dependents, their oral hygiene practices and oral habits under cover of Command Military Dental Center (CC) Lucknow.
| Materials and Methods|| |
A cross-sectional study was conducted on 2160 subjects comprising army personnel and their dependents selected randomly, reporting to Out Patient Department of CC, Lucknow during the period of Aug 2013 to Nov 2013.
Age groups for serving personnel
In the present study, the serving army personnel were selected with age varying from 18 to 59 years. The lower age range represent the army personnel joining army service after initial selection, and the higher limit reflect the age limit acquired by senior army officer till the rank of Brigadier. The above age group was further subdivided into 18-35 years and 35-59 years.
Age groups for dependents were 2-5 years, 6-17 years, 18-35 years, 36-59 years and 60 + years. The study population was screened for caries, periodontal status and prosthetic status and treatment need, oral hygiene practice and prevalence of the tobacco habit. All relevant information was noted into a Proforma.
Statistical analysis was performed using SPSS 16.0 version (Chicago, Inc., USA). The results are presented in percentage and mean (±standard deviation). The unpaired t-test was used to compare mean decayed, missing and filled teeth (DMFT) between army personnel and dependents. Chi-square test was used to find a relation between periodontal disease and smoking. The P < 0.05 was considered as significant.
| Results|| |
In the present study, more than half (65.7%) of army personel and 44% of the dependent were in the age group of 18-35 years. About half of the male (48.9%) and female (49.5%) were in the age group 18-35 years [Table 1].
The study shows that brushing with toothpaste is more prevalent among all the age groups only statistically insignificant number used tooth powder for cleaning.
Tobacco habit was seen in 23.5% in age group 50 and above. One-fifth of the army personnel (19.4%) and dependents (21.3%) of the age group 18-35 years had habit of pan chewing. However, 17.7% of army personnel and 20.5% of dependents had habit of pan chewing. The smoking habit was observed among 17.6% army personnel and 26.3% dependents in age group of 18-35 years. However, 13.8% army personnel and 25.1% dependent of age 36-59 years had the habit of smoking. About one-tenth (10.9%) of dependent of age 60 + had a habit of smoking [Table 2] and [Table 3].
In this study, the shallow pocket was found among 10.4% of age 18-35 years and 12.2% in 36-59 years in army personnel. However, calculus was observed in 17.6% of age 18-35 years and 19.3% of age 36-59 years in army personnel. Shallow pocket was observed in 5.6% of age group 6-17 years, 9.1% in 18-35, 13% in 36-59 and 19.1% in 60 + of dependents. The calculus was found in 17.7% in 36-59 years, 12% in 18-35, 8.2% in 6-17 and 18.2% in 60 + years of dependents [Table 4] and [Table 5]. In the present study, there was significant (P = 0.0001) association between smoking and pan chewing habit with periodontal disease [Table 6].
|Table 6: Periodontal disease and smoking among study subjects (army personnel) |
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More than one-tenth 16% of army personnel and 17.7% of dependent of age 36-59 had prosthesis. However, 11.3% of army personnel and 12% of dependents of age 18-35 years had prosthesis. More than 10% of army personnel (13.3%) and 24.7% of dependent age group 36-59, the prosthesis need was present [Table 7].
Leukoplakia was observed among 8.9% of army personnel in the age group of 18-35 years and 12.6% in the age group of 36-59 years. Leukoplakia was observed among the army personnel who were smokers in age group 18-35 (20%) and 36-59 (35%). The lichen planus was in 1 army personnel of age group 18-35 and 36-59 years who were pan chewers. But no association had been reported to pan chewing habit and lichen planus.
Decayed teeth were found among 19.4% of age 18-35 years of army personnel and 29.3% in the age group of 36-59 years. The decayed teeth were found among 10.2% of age 6-17 years of the dependent, 9.5% in 18-35, 31.2% in 36-59 and 42% in 60+. The mean decay was significantly (P < 0.05) lower among army personnel compared with dependents. However mean missing teeth was significantly (P < 0.05) higher among army personnel (0.80 ± 0.06) compared with dependents (0.69 ± 0.02). There was no significant (P > 0.05) difference in DFMT between army personnel (1.92 ± 0.08) and dependents (1.96 ± 0.05) [Table 8], [Table 9], [Table 10]. In this study, the mean number of decayed and missing teeth were (1.67 ± 2.16) and (1.46 ± 2.8), respectively and their relation with age was found to be statistically significant (P < 0.01, ANOVA).
| Discussion|| |
The Indian Army is the most regimented organization. It is one of the most fascinating population for the study. Total number of samples considered for the study was 2160 which were divided into different age groups.
Oral hygiene awareness is adequate among serving and dependent. They have better knowledge about correct agent and materials required for proper cleaning of teeth. Contrary to present study, a study in Jodhpur by Jain et al. in 2012,  Rajasthan, showed the brushing not much used as oral hygiene practice. The oral hygiene practices had been better among the subjects in the upper class than the lower once among municipal employees of Mysore city according to Chandra et al. 2011. 
It was revealed that there was a high prevalence of caries, probably due to faulty brushing habit (P < 0.01). Periodontal disease was prevalent in the age group of 30-50 years. They were more prone to bleeding on probing. This was due to faulty brushing habit or because of reduced frequency of brushing. This observation was in agreement with the study by Anagnou in 1982. 
In the present study, the oral habits of the subjects were assessed in the form of pan chewing and smoking. The lower percentage of smoking in the age group 36-59 years in the present study might be due to oral health awareness lecturers and educating the troops about harmful effects of tobacco habits and adequate assessment done on regular basis as part of annual medical examination. Anmol et al. in 2007  reported in their study that most of the tobacco consumers are in their 40s. People younger than 30 years used betal quid in abduance (47.1%). Bidi was the choice of tobacco for 41-50 years of age group. Burungule et al. in 2013  reported in their study that 57.27% smokers were below 40 years of the age, while remaining 42.73% were above 40 years of age respectively. Among smokers, the youngest age was 22 years of age while oldest age was 78 years respectively. Ahuja in 2003  reported 20% in the age group 22-56 years army personnel had oral habits, in the study conducted at 3 Cantonments in Pune. Serving as well as dependents, the prevalence of oral habit like smoking, quid keeping, pan and betel nut chewing was more in serving especially among age 20-30 years and other ranks of age 30-50 years due to ignorance to ill effect of tobacco. In a study by Dileep,  50% recruits had these habits that are in favor of our study. While correlating oral habits with various age groups, no relationship was found between specific ages. This statement is supported statistically with Chi-square.
In the present study, the shallow pocket was found among 12.2% in 36-59 years in army personnel when compared with 13% in 36-59 of dependents. However, calculus was observed in 19.3% of age 36-59 years in army personnel when compared with 17.7% in 36-59 years. Jayakrishna et al. in 2005  found that prevalence of periodontal disease was highest in the age group of 45-50 compared to 30-34 years reference group and also among current tobacco smokers compared to nonsmokers. They noted progressive nature of the disease with an increase in age. Singh et al. in 2012  demonstrated that deep pocket was observed to be maximum 31% in > 56 years of age. It decreased with age as follow; 25% in 46-55, 28.2% in 36-45, and 11.3% in 25-35 years of age group respectively.
More than one tenth of the army personnel and 17.7% of dependent of age 36-59 had prosthesis. More than 10% of army personnel (13.3%) and 24.7% of dependent age group 36-59, the prosthesis need was present. Kumar et al. in 2011  reported that 96.5% of the subject were free from any kind of prosthesis, and only 3.5% were with prosthesis. The overall prosthetic treatment needs was 15.5%. Prosthetic needs increased as the age increases, with the age group 45-54 showing the greatest. In another study, Gambhir et al. in 2013,  47.6% of subjects needed some prosthesis.
Oral mucosal condition and lesion could be due to lifestyle factors such as the usage of tobacco in the form of chewing, smoking, combination or pan chewing. In present study only leukoplakia was observed among the army personnel who were the smokers in both age group 18-35 (30.9%) and 36-59 (55%) and lichen planus was found in 1 army personnel of age group 18-35 and 36-59 years.
A study reported the prevalence of leukoplakia 33.3% among mine workers by Dagli et al. in 2008.  However, another hospital-based study, the prevalence of leukoplakia was reported to be 8.2% Patil et al. in 2013.  A study reported that the odd number of developing oral lesion in subject with the tobacco habit was nearly 11.92 times than that of nonusers in 2013 by Patil et al. 
The DMFT index has been in use for about 65 years and is well-established leading measure of caries experience in dental epidemiology. The mean decay was significantly (P < 0.05) lower among army personnel compared with dependents. However mean missing teeth was significantly (P < 0.05) higher among army personnel (0.80 ± 0.06) compared with dependents (0.69 ± 0.02). In this study, the mean number of decayed and missing teeth were (1.67 ± 2.16) and (1.46 ± 2.8), respectively, and their relation with age was found to be statistically significant. Gambhir et al. in 2013.  Asmyhr et al. in 1994  reported 10.2 mean DMFT among male army recruit in Norway in 1990.
| Conclusion|| |
The study showed that:
- Oral hygiene awareness is adequate among serving and dependent
- High prevalence of tobacco habits 35% among army personnel
- High prosthetic treatment need of army personnel in the age group 50 and above
- Periodontal diseases more or less increased with an increase in age
- Association between age and caries status.
- Education to the families of army personnel and school children about oral health should be a regular feature
- It should be our policy to increase the awareness about the harmful effects of tobacco through posters, pamphlets, tobacco cessation boards and lectures to troops in their units
- Consumption of tobacco in any form should be strictly prohibited in office complexes and various messes
- In order to lower the DMFT status regular usage of topical fluoride in the form of gel and varnish should be advocated. 1.23% APF gel should be issued to units through AFMSD.
| References|| |
Chisick M, Arthur JS, York A, Poindexter F. Designing a standardized oral health survey for the tri-services. Mil Med 1994;159:179-86.
Ahuja A. Community dentistry in armed forces. Med J Armed Forces India 2003;51:17-8.
Jain N, Mitra D, Ashok KP, Dundappa J, Soni S, Ahmed S. Oral hygiene-awareness and practice among patients attending OPD at Vyas Dental College and Hospital, Jodhpur. J Indian Soc Periodontol 2012;16:524-8.
Chandra SB, Ready S, Manjunath BC, Suma S. Dental health awareness, attitude, oral health habits and behavior in relation to socio-economic factors among the municipal employees of Mysore City. Ann Trop Med Public Health 2011;4:99-106.
Anagnou-Vareltzides A, Tsami A, Zervogianes D, Mitsis FI. Oral hygiene and gingival health in Greek airforce cadet candidates. Community Dent Oral Epidemiol 1982;10:60-5.
Anmol M, Manish J, Mohit S, Mohit NM, Prabhu SN. Tobacco habit and risk of oral cancer: - A retrospective study in India. Int J Bifurcat Chaos 2007;3:111-6.
Burungule SU, Durge PM, Burungule DS, Gund DK. Assesment of tobacco and alcohol consumption habits among adult of urban slum of Nagpur, India. J Acad Ind Res 2013;1:1-5.
Dileep CL. Oral Health Status, Treatment Requirements, Knowledge Towards Oral Health of Police Recruits in Karnataka," Paper Read at the 3 rd
National Conference IAPHD, Mangalor; 1998.
Jayakrishna R, Sarma PS, Thankappan KR. Prevalence of periodontal disease among adult in Trivendrum district, Kerala, India. Malays Dent J 2005;26:97-104.
Singh A, Agarwal V, Tuli A, Khattak BP. Prevalence of chronic periodontitis in Meerut: A cross-sectional survey. J Indian Soc Periodontol 2012;16:529-32.
Kumar S, Tadakamadla J, Tibdewal H, Prabu D, Kulkarni S. Dental prosthetic status and treatment needs of green marble mine laborers, Udaipur, India. Dent Res J (Isfahan) 2011;8:123-7.
Gambhir RS, Sogi GM, Veeresha KL, Sohi RK, Randhawa A, Kakar H. Dental health status and treatment needs of transport workers of a northern Indian city: A cross-sectional study. J Nat Sci Biol Med 2013;4:451-6.
Dagli RJ, Kumar S, Mathur A, Balasubrimanyam G, Duraiswamy P, Kulkarni S. Prevalence of leukoplakia, oral submucous fibrosis, papilloma and its relation with stress among green marbles mine laborers, India. Med Oral Patol Oral Cir Bucal 2008;13:E687-92.
Patil PB, Bathi R, Chaudhari S. Prevalence of oral mucosal lesions in dental patients with tobacco smoking, chewing, and mixed habits: A cross-sectional study in South India. J Family Community Med 2013;20:130-5.
Asmyhr O, Grytten L, Grytten J. Changing trends in caries experience among male military recruits in Norway. Community Dent Oral Epidemiol 1994;22:206-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]