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Year : 2017  |  Volume : 15  |  Issue : 2  |  Page : 127-130

Oral health status among workers of lead acid battery factories in Ghaziabad: A cross-sectional study

1 Department of Public Health Dentistry, PGIDS, Rohtak, Haryana, India
2 Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Ghaziabad, Uttar Pradesh, India
3 Department of Public Health Dentistry, MAIDS, New Delhi, India
4 Department of Public Health Dentistry, MB Kedia Dental College, Birgunj, Nepal

Date of Web Publication13-Jun-2017

Correspondence Address:
Hansa Kundu
13-B, DDA SFS Flats, Iskcon Road, East of Kailash, New Delhi - 110 065
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_135_16

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Introduction: Oral health is a vital part of general health which not only depends on the environment in which a person lives but also the one in which he/she works. Exposure to various harmful substances in lead acid battery factory affects various organ systems of the body including tissues of the oral cavity. Aim: The aim of this study is to assess the oral health status among production line workers of lead acid battery factories in Ghaziabad. Materials and Methods: A cross-sectional study was conducted among 1400 production line workers of twenty lead acid battery factories in Ghaziabad. The sample comprised all the workers in the factories including the production line. Oral health status was assessed using the WHO oral health assessment form, 2013. Statistical analysis was performed using SPSS version 19. Results: The mean age of the study group (production line workers) was 32.15 ± 7.91 years and of control group (nonproduction line workers) was 31.49 ± 7.62 years. Mean years of experience were 10.90 ± 7.35 for production line workers and 9.07 ± 5.97 years for nonproduction line workers. Prevalence of gingival bleeding was present among 89.10% of the study group workers and 80.90% of control group workers (P < 0.001). Periodontal pockets were found to be present in 43.3% of workers when compared to 25.6% of control group workers (P = 0.001). Prevalence of dental erosion was found to be 55.5% among study groups as compared to 1.4% among the controls (P < 0.001). Conclusion: This study documents the association of various oral conditions with workplace environment. The present study points the need of establishing appropriate educational, preventive, and treatment measures coupled with efficient surveillance and monitoring in the workplace environment.

Keywords: Lead acids, oral health, tooth erosion, workplace

How to cite this article:
Kundu H, Basavaraj P, Singla A, Gupta R, Jain S, Singh K. Oral health status among workers of lead acid battery factories in Ghaziabad: A cross-sectional study. J Indian Assoc Public Health Dent 2017;15:127-30

How to cite this URL:
Kundu H, Basavaraj P, Singla A, Gupta R, Jain S, Singh K. Oral health status among workers of lead acid battery factories in Ghaziabad: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2023 Mar 30];15:127-30. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2017/15/2/127/207910

  Introduction Top

Oral health is a vital part of general health and is a valuable asset of every individual.[1] There are a number of factors which influence both general and oral health among which one of the most important factors is environment. This environment not only includes the environment in which the individual lives but also the one in which he/she works.[2]

Within a person, factors such as age, sex, socioeconomic status, genetics, self-efficacy, and other performance components have an effect on occupational performance. As well, environmental factors, including social, physical, cultural, and institutional characteristics, interact with personal factors to either facilitate or hinder the performance of roles and a person's occupational performance. The relationship between persons, occupation, and the environment is not only linear but also a dynamic constantly interacting relationship that influences the way in which persons perform daily tasks and activities.[2] The varied and complex occupational environment may predispose to different occupational-related diseases. An “occupational disease” is any disease contracted primarily as a result of exposure to risk factors arising from work activity.[3] Some well-known occupational diseases include occupational lung diseases and occupational skin diseases.[4] Apart from these, exposure to various other harmful substances/elements in different occupations also affects various organ systems of the body.[4]

Lead is also one such element which is widely used in battery factories and has a profound effect on the health of factory workers. The hazardous chemicals used in the lead-making process are lead oxide, spongy lead, and sulfuric acid.[5] The workers, especially, those in production line are exposed to lead through means of inhalation, ingestion, or dermal contact and are a major cause of lead toxicity.[5]

The oral cavity may be affected by toxic agents in the battery factory, either by direct action as exposure to sulfuric acid fumes or through systemic exposure as poisoning with heavy metals, for example, lead and mercury. The dental effects of workers of battery factories and galvanizing occupations include gingivitis, periodontal conditions, erosions, abrasion, and decayed, missing, and filled teeth (DMFT).[6] The chronic process of exposures to acid mists may irritate soft tissues resulting in periodontal changes or oral mucosal lesions. Studies have also reported an association between occupational exposures to acids and symptoms of periodontal disease such as gingival bleeding and periodontal pockets ≥4 mm among exposed workers.[7],[8],[9]

Lesions of noncarious origin may be formed in hard dental tissue as a result of the corrosive action of any one of a number of chemical substances used in the battery factory. In the mineralized tissues of teeth, dental erosion is the common occupational disease, caused by exposure to various types of acidic contaminants in the workplace such as chemicals (sulfuric acid). In erosion, the amount of mineral dissolved from enamel depends on pH, buffer effect, and dissociation constant of acid and length of exposure time.[7]

Studies have shown dental erosion, tooth wear, poor oral hygiene, and presence of periodontal pockets in battery workers.[8],[9],[10],[11] Other studies also found deteriorated oral health status among workers of lead battery factory.[7],[12] Occupational diseases are preventable, but particular attention needs to be paid to the health and safety of workers in hazardous occupations.

There are many small- and large-scale lead battery factories employing many workers who constitute a major part of the Ghaziabad district's population.[13] As not much literature is available on their oral health status, the present study was conducted with the aim to assess the oral health status among lead acid battery factory workers in Ghaziabad.

  Materials and Methods Top

A descriptive cross-sectional study was conducted over 3 months from March to May 2014 among workers of lead acid battery factories in Ghaziabad. Before commencing the study, ethical clearance was obtained from the institutional review board and informed consent from the managers of the factories as well as the workers. A pilot study was carried out in the month of February 2014 for 1 week to check the feasibility. Training and calibration for recording of the WHO basic oral health survey 2013 were done in the department (Cohen's kappa = 0.87).

All the lead acid battery manufacturing units present in the Ghaziabad district were included for the purpose of the study. Using 19.1% prevalence from the previous study and 3% as precision, 0.05 alpha error sample size came out to be 660 which was rounded off and taken as 700 in both the groups.[12] Thus, a total of 20 factories and 1400 workers (700 production line workers and 700 nonproduction line workers) who gave consent were selected based on the following inclusion and exclusion criteria:

Inclusion criteria

  • The workers (production and nonproduction line) with the minimum experience of 1 year in the lead acid battery factory were included in the study.

Exclusion criteria

  • Workers who had hyposalivation, salivary hypofunction, and vomiting as side effects
  • Workers suffering from specific systemic medical conditions including eating disorder and acidic reflux conditions leading to vomiting were excluded from the study.

Age, years of experience, educational status, and dietary history were recorded on a pro forma from the workers. Oral health assessment was done using structured pretested oral health assessment form (the WHO basic oral health survey 2013).[14] The Type III examination using mouth mirror and probe in natural light was carried out for each worker.[15]

Statistical analysis was performed using SPSS version 19 (SPSS Inc., Chicago, IL, USA). Normality was checked using Shapiro–Wilk test. Student's t-test was used for variables which were parametric and Mann–Whitney U-test for variables which were nonparametric (nonhomogeneously distributed data) to compare mean, and Chi-square test was used to compare parameters between both groups.

  Results Top

Mean age of the production line workers was 32.15 ± 7.91 years, whereas it was 31.49 ± 7.62 for nonproduction line workers. Mean work experience was 10.90 ± 7.35 years in production line workers and 9.07 ± 5.97 years in nonproduction line workers. Educational level of the population revealed that 296 (42.3%) were illiterate in production line worker group and 69 (9.9%) in the nonproduction line worker group. Among total participants, primary education, middle primary, and high school education were completed by 302 (43.1%), 99 (14.2%), and 3 (0.4%) in the production line group and 224 (32.0%), 205 (29.3%), and 121 (17.3%) in the nonproduction line group, respectively.

Comparison of the mean DMFT between the study (1.46 ± 1.49) and control groups (1.38 ± 1.58) showed nonsignificant difference (P = 0.16) [Table 1]. Periodontal status was compared based on community periodontal index (CPI) and loss of attachment (LOA) scores; shallow pockets and deep pockets were found among 33.6%, 19.1%, and 9.7%, 6.5% of the study and control group workers, respectively (P = 0.001) [Table 2]. Maximum LOA was 4–5 mm which was found among 41.3% and 34.1% of study and control group workers, respectively (P < 0.001) [Table 3].
Table 1: Dental caries experience (decayed, missing, and filled teeth) between the study and control groups

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Table 2: Periodontal status between both the groups based on community periodontal index scores

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Table 3: Periodontal status between both the groups based on loss of attachment

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In the study group, prevalence of dental erosion (55.5%) was more as compared to the control group (1.4%). Enamel, dentinal, and pulpal erosions were reported in 21.9%, 23.4%, and 10.2% of workers, respectively [Table 4].
Table 4: Dental erosion between the study group and control group

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Oral mucosal lesions were also found to have statistically significant difference among both the study and control group (P < 0.001). The prevalence of the oral mucosal lesion was reported in 21.4% of the workers in the study group as compared to the 11.4% in the control group. The most common observed oral mucosa lesion was leukoplakia 61 (8.7%) in the study group and 46 (6.6%) in the control group [Table 5].
Table 5: Oral mucosal lesions between both the groups based on type of lesion

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  Discussion Top

The workplace of a battery factory usually contains acid mists which gets continuously discharged from open containers and is a mixture of dilute sulfuric acids.[11] The findings from many studies suggested that higher concentrations of acid fumes in the working environment are related to the higher proportions of workers with loss of tooth substance.[11]

The comparison of dental caries in both the groups revealed a statistically nonsignificant difference (P = 0.16) which was similar to the results from the study done by Fukayo et al.[16] An explanation for comparable dental caries in both the groups could be the cariostatic action of an environmental acid. Work environment causes acid exposure of the oral cavity through inhalation which then affects the competition between strains of oral streptococci and thus reduces dental caries.[16]

Comparison of periodontal status in between both groups showed pockets in 43.3% of production line workers as compared to 25.6% of nonproduction line workers. LOA was found among 51.3% of production line workers as compared to 38.9% of nonproduction line workers, and the difference for both CPI and LOA was statistically significant (P = 0.001). These results were similar to those found in the study conducted by Tuominen and Almeida et al.[8],[9] Acid exposure may affect the immunologic defenses or protective components of the saliva which plays an important role in the pathogenesis of periodontal diseases. It may also cause changes in the intra- and extra-cellular pH which plays an important role in the control of cell growth and differentiation and thus leads to periodontitis. Furthermore, changes in intra- and extra-cellular pH due to acid mists play an important role in the control of cell growth and differentiation. Chronic irritation of tissues by acids is responsible for increased frequency of infections which is also found in association with salivary changes such as reduction in pH and buffer capacity both related to periodontal disease.[8],[9]

Industrial environmental factors have also been reported to cause dental erosion. In the present study, enamel erosion was seen among 21.9% of the study group workers and 1.1% of controls, dentinal erosion among 23.4% of the study group workers and 0.3% of controls. None of the control group subjects had pulp involvement due to erosion, whereas 10.2% of study group workers had pulp involvement. The findings were similar to the study conducted by Amin et al.,[7] Khurana et al.,[12] and Gomes.[17] The ready response of enamel to acids then makes it vulnerable to decalcification and thus dental erosion.[17]

In this study, the prevalence of oromucosal lesions was found to be much more in the production line workers as compared to the controls (P < 0.001). These findings were similar to that found in the study by Bansal.[1] Exposure to inorganic acids also leads to immune reactions such as decrease in the phagocytic capacity of macrophages and cytotoxic activity of tumor necrosis factor and increase the number of chromosomal abnormalities in the human lymphocytes. It can compromise the local immune response produced by the saliva as well as the systemic response through immunoglobulin changes which includes the changes in secretory immunoglobulin A which plays an important role in the oral homeostasis.[18]

Although the oral health status of the workers was assessed in the present study, acid concentration could not be assessed in the workplace air. Furthermore, hyposalivation could not be checked using any biochemical test which makes a few limitations of the study.

The findings from the present study point the need of establishing appropriate educational, preventive, and treatment measures coupled with efficient surveillance and environmental monitoring for detection of acid fumes in the workplace environment. In addition, further longitudinal studies are recommended to establish a causal relation between environment of battery factory and oral health status of the workers.

  Conclusion Top

The present study showed a significant difference between both the groups for periodontal status, dental erosion, and oral mucosal lesions, thus showing poor oral health among production line workers as compared to their nonproduction line counterparts. Oral manifestations of occupational origin are readily predisposed and aggravated by neglect of oral health, and the problem of prevention of oral occupational hazards must be attacked both by improving the working conditions and by establishing and maintaining oral health.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Bansal M, Veeresha KL. Oral health status and treatment needs among factory employees in Baddi-Barotiwala-Nalagarh Industrial hub, Himachal Pradesh, India. Indian J Oral Sci 2013;4:105-9.  Back to cited text no. 1
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Law M, Steinwender S, Leclair L. Occupation, health and well-being. Can J Occup Ther 1998;65:81-91.  Back to cited text no. 2
Available from: http://www.who.int/occupational_health/activities/occupational_work_diseases/en/. [Last accessed on 2014 Jan 01; Last updated on 2013 Dec 20].  Back to cited text no. 3
Atsumbe BN, Maigida JF, Abutu F, Amine JD, Enoch EB. Occupational diseases and illnesses in manufacturing industries in Adamawa State: Causes and effects. J Environ Sci Toxicol Food Tech 2013;3:7-13.  Back to cited text no. 4
Kalahasthi R, Barman T, Rao HR. Assessment of the relationship between blood lead levels and hematological parameters among lead acid – Storage battery plant workers. J Environ Occup Sci 2012;1:1-5.  Back to cited text no. 5
Ahmad SA, Khan MH, Khandker S, Sarwar AF, Yasmin N, Faruquee MH, et al. Blood lead levels and health problems of lead acid battery workers in Bangladesh. ScientificWorldJournal 2014;2014:974104.  Back to cited text no. 6
Amin WM, Al-Omoush SA, Hattab FN. Oral health status of workers exposed to acid fumes in phosphate and battery industries in Jordan. Int Dent J 2001;51:169-74.  Back to cited text no. 7
Almeida TF, Vianna MI, Santana VS, Gomes Filho IS. Occupational exposure to acid mists and periodontal attachment loss. Cad Saude Publica 2008;24:495-502.  Back to cited text no. 8
Tuominen M. Occurrence of periodontal pockets and oral soft tissue lesions in relation to sulfuric acid fumes in the working environment. Acta Odontol Scand 1991;49:261-6.  Back to cited text no. 9
Vianna MI, Santana VS, Loomis D. Occupational exposures to acid mists and gases and ulcerative lesions of the oral mucosa. Am J Ind Med 2004;45:238-45.  Back to cited text no. 10
Tuominen M, Tuominen R, Ranta K, Ranta H. Association between acid fumes in the work environment and dental erosion. Scand J Work Environ Health 1989;15:335-8.  Back to cited text no. 11
Khurana S, Jyothi C, Dileep CL, Jayaprakash K. Oral health status of battery factory workers in Kanpur city: A cross-sectional study. J Indian Assoc Public Health Dent 2014;12:80-6.  Back to cited text no. 12
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Available from: http://www.envis.mse.ac.in/problems%20pdf/INDUSTRIES%20IN%20DELHI.pdf. [Last accessed on 2014 Aug 06].  Back to cited text no. 13
World Health Organization. Oral Health Surveys-basic Methods. 5th ed. Geneva: World Health Organization; 2013. p. 52-3.  Back to cited text no. 14
American Dental Association. A Dental Health Program for Schools. Chicago, IL: The American Dental Association; 1954. p. 16.  Back to cited text no. 15
Fukayo S, Nonaka K, Shinozaki T, Motohashi M, Yano T. Prevalence of dental erosion caused by sulfuric acid fumes in a smelter in Japan. Sangyo Eiseigaku Zasshi 1999;41:88-94.  Back to cited text no. 16
Gomes ER. Incidence of chromium-induced lesions among electroplating workers in Brazil. IMS Ind Med Surg 1972;41:21-5.  Back to cited text no. 17
Rashkova M, Baleva M, Toneva N, Jegova G. Secretary Immunoglobulin A (Siga) and periodontal status in children with diseases and conditions influencing the oral environment. J IMAB 2009;2:36-40.  Back to cited text no. 18


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


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