|Year : 2019 | Volume
| Issue : 2 | Page : 125-129
Sleep quality impact on the oral health status of sugar mill workers of Fazilka, Punjab: A cross-sectional study
Salvi Setia1, Simarpreet Singh1, Anmol Mathur2, Manu Batra1, Vikram Pal Aggarwal1, Deeksha Gijwani1
1 Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
2 Department of Public Health Dentistry, Dr DY Patil Vidyapeeth Pimpri, Pune, Maharashtra, India
|Date of Submission||15-May-2018|
|Date of Acceptance||16-Apr-2019|
|Date of Web Publication||20-Jun-2019|
Dr. Salvi Setia
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: A trend toward adopting a 24/7 lifestyle, long working hours, and shift works in industries can adversely affect the sleep health of workers. Sleep deprivation not only has an adverse effect on physical health but may also affect oral health. Aim: The aim of the study is to assess the impact of sleep quality on the oral health status of sugar mill workers of Fazilka, Punjab. Material and Methods: This cross-sectional study comprised 237 participants. The oral health status of mill workers was assessed using simplified oral hygiene index (OHI-S), decayed-missing-filled surface (DMFS), community periodontal index (CPI), loss of attachment (LOA) indices, and sleep quality by Pittsburgh Sleep Quality Index (PSQI) questionnaire. The data were analyzed using IBM SPSS Statistics Windows, Version 20.0. (Armonk, NY, USA: IBM Corp) for statistical analysis. Chi-square test and t-test were applied, and the level of statistical significance was set at P < 0.05. Results: Production line workers (72.25%) reported poor sleep quality in comparison to administrative workers. The oral health assessment showed statistically significantly higher DMFS, OHI-S, CPI, and LOA scores in workers with poor sleep (P < 0.05). Conclusion: Working environment of sugar mill was associated with the sleep quality of the workers which in turn affects their oral health as sleep deprivation leads to neglected oral care, more adverse habits, and thus poor oral health.
Keywords: Administrative staff, oral health, shift work, sleep, workers
|How to cite this article:|
Setia S, Singh S, Mathur A, Batra M, Aggarwal VP, Gijwani D. Sleep quality impact on the oral health status of sugar mill workers of Fazilka, Punjab: A cross-sectional study. J Indian Assoc Public Health Dent 2019;17:125-9
| Introduction|| |
Development and abilities of the community are dependent on the health of people and consequently the health of society. Occupational environment has great influence on general as well as oral health. An occupational disease may be defined as a negative change in health condition directly resulting from more or less prolonged exposure to harmful substances or conditions immediately related to an individual's work. Modern era is the era of industrialization. Workers of any industry are essential capital of any country. However, it is distressing to say that they are facing a lot of troubles in their working environment that affects their overall health. Unplanned industrialization without estimation of social and environmental impact causes serious troubles for human environment and mainly the industrial workers who are directly exposed to physical and social environment of the industry. Furthermore, a trend toward adopting a 24/7 lifestyle, long working hours, and shift works in industries can adversely affect the sleep health of the workers. Medical conditions and social and familial responsibilities further contribute to sleep restriction. Shift work can be defined as “a way of organizing daily working hours in which different persons or team work in succession to cover more than the usual 8-h workday, up to and including the whole 24 h.” In practical terms, any work schedule is considered shift work if they are not within the 09:00–17:00 or 08:00–16:00 time range. Shift workers usually have symptoms similar to those seen in people with a jet lag because of disruption of their internal biological clock. They often become uncontrollably drowsy during work. People working in shifts have an increased risk of mental, heart, gastrointestinal, and emotional problems. It has also been observed that sleep deprivation has an adverse effect on physical health of individuals. This is because of decrease in overall immunity, a state of systemic inflammation with increased inflammatory markers, and upregulation of hormones that may cause deterioration of periodontal health.
Sugar industry is an imperative agro-based industry. After Brazil, India is the second largest manufacturer of sugar in the world and is also the largest consumer. Sugar industry affects rural livelihood as it gives employment to about 50 million sugarcane farmers and around 5 lakh workers in sugar mills. Long working hours and shift work also affects the oral health and general health of sugar mill workers due to longtime sugar exposure, inadequate sleep, and heavy workload.
Hence, the current study was conducted with the aim to assess the impact of sleep quality on the oral health status of sugar mill workers of Fazilka, Punjab, India.
| Material and Methods|| |
The present cross-sectional study was conducted among the employees working in the sugar mill of Fazilka, Punjab, during March 2017. Ethical approval (SDCRI/IEC/2016/012) to conduct the study was obtained from the ethical committee of respective Dental College and Research Institute, before commencing the study.
Written informed consent was obtained from the participants of this study. Before the inclusion of respondents in the survey, an evaluator was responsible for checking the legitimacy of participation, explaining the details of the research, aim of the research, procedures, and the content of the questions. Anonymity, confidentiality, and privacy of data were explained and guaranteed. Both production line and administrative line workers, who gave consent for the study, were included in the study. Workers, who were edentulous or were suffering from any systemic disease which could alter healing response of periodontium or who had received any periodontal treatment in the past 6 months, were excluded from the study. There were 288 workers registered in the sugar mill, of which 33 did not give consent, 11 did not meet the inclusion criteria, and 7 were absent. Hence, the final sample of 237 participants was selected for the study.
Data collection was done through face-to-face interviews using a standardized pretested questionnaire applied to all participants. The questionnaire was piloted on a group of 20 cases who were interviewed to gain feedback on the overall acceptability of the questionnaire in terms of length and language clarity and to check the validity of questionnaire. Few adjustments were made in the instrument before its application. Reproducibility was evaluated by measuring test–retest reliability. Cronbach's alpha was used to measure the internal consistency and reliability of the questionnaire, which was found to be 0.80.
The questionnaire included various demographic factors (age, sex, type of work, years of work experience, shift work, and working hours per day) and habits including personal habits (method, frequency, and duration of brushing) and adverse habits (smoking, tobacco chewing, and alcohol) with their duration and frequency, and the overall sleep quality of each worker was determined using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is an instrument used to measure the quality and patterns of sleep in the older adult. It is brief, reliable, valid, and standardized self-reported measure of sleep quality. It differentiates “poor” from “good” sleep by measuring seven domains: (1) subjective sleep quality (self-perceived), (2) sleep latency (how long it usually take to fall asleep), (3) sleep duration (actual sleeping hours), (4) habitual sleep efficiency, (5) sleep disturbances (while sleeping), (6) daytime dysfunction, and (7) use of sleep medication over the last month. All participants rated each of these seven areas of sleep. PSQI questionnaire was modified from the original to include the seven questions representing each domain.
Scoring of the answers was based on a 0–3 scale, whereby 3 reflected the negative extreme on the Likert scale. Finally, we added up the points obtained for the seven questions that contribute to the total score. The component scores were summed to produce a global score (range 0–21). 0 indicates no difficulty in sleep while 21 indicates severe difficulty.
The clinical examination was conducted by a single calibrated examiner for whom kappa statistics was determined 88% 2 days before the study. The WHO Type III examination was carried using the WHO probe, natural light, mouth mirror, and explorer while the study participants were seated on ordinary chairs.
After the interview, an examiner assessed debris and calculus according to the simplified oral hygiene index (OHI-S), whereas periodontal status and dental caries were recorded according to the rules and criteria of the community periodontal index (CPI) and decayed-missing-filled surface (DMFS) index, respectively, and loss of attachment (LOA), enamel fluorosis, dental erosion, dental trauma, oral mucosal lesions, denture status, and treatment need were recorded according to the guidelines of WHO Oral Health Assessment Form 2013.
The data were analyzed using IBM SPSS. Statistics Windows, Version 20.0. (Armonk, NY, USA: IBM Corp) for statistical analysis. Chi-square test and t-test were applied, and the level of statistical significance was set at P < 0.05.
| Results|| |
The present study was conducted on a study population of 237 participants of which 191 (80.59%) were production line workers and 46 (19.41%) were of administrative staff. Results showed that 127 (53.59%) workers were employed in the sugar mill from >20 years. Of total workers, 149 (62.86%) were doing shift work. Nearly, 181 (75%) workers were working for >8 h/day. A total number of 149 (62.86%) workers had the habit of smoking, 117 (49.37%) had the habit of chewing tobacco, and 86 (36.29%) workers were consuming alcohol. Most of the workers (159, 67.09%) were using brush, 43 (18.14%) were using finger, and 35 (14.77%) were using datun as tooth cleaning aid [Table 1].
Participant's scores for the seven components of PSQI showed that subjective sleep quality of most of the workers (150, 63.3%) was fairly good. Maximum workers 155 (65.4%) had sleep latency of ≤15 min and 101 (42.6%) workers had sleep for 5–6 h in a day. Most of the workers (233, 98.3%) have good sleep efficiency. Of 237 workers, 102 (43%) had sleep disturbance for once in a night and 93 (39.2%) never had sleep disturbance. Workers who felt daytime dysfunction for about twice in a week during work were 77 (32.5%) and for once in a week were 66 (27.8%). Around half of the workers did not need any medication for sleep during the last month, and 111 (46.8%) workers require medication once in a week [Table 2].
|Table 2: Participant's scores for the seven components of Pittsburgh Sleep Quality Index|
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Association of sociodemographic variables of the participants with respect to sleep health status based on the PSQI illustrated that 72.25% and 10.87% of the production and administrative workers, respectively, reported poor sleep, and it was found to be statistically significant when analyzed using Chi-square test (P < 0.05). Similar type of statistical difference was reported among the workers when compared in relation to years of work experience, shift work, working hours per day, and adverse habits (P < 0.05) [Table 3].
|Table 3: Association of participant's sociodemographic variables to their sleep health status based on the Pittsburgh Sleep Quality Index|
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Statistically significant difference was seen among the poor and good sleep workers when compared for the variables such as decayed, missing, filled, DMFS, OHI-S, CPI, and LOA (P < 0.05) [Table 4].
|Table 4: Comparison of participant's oral health status variables on the basis of sleep health status|
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| Discussion|| |
This study is an attempt to evaluate the impact of sleep deprivation on the oral health status of sugar mill workers of Fazilka, Punjab, India. The present study shows that maximum workers were employed in the sugar mill from over 20 years. These findings were in contrast with the study done in Israel  among sweet industry workers, in which maximum workers were employed from 3 to 10 years. Majority of workers in the current study were engaged in shift work and longer working hours (8–12 h) in a day, and this finding is in accordance with the study done on bakery workers in Lucknow city.
Most of the workers were smokers in our study which was in contrast with the study done in Lucknow city  in which workers were more engaged in other adverse habits (paan masala and gutka).
The findings of the current study reveal that the maximum participants (150, 63.3%) reported their subjective sleep as fairly good. Maximum workers in the present study sleep only for 5–6 h in a day have good sleep efficiency and did not require any medication to fall asleep, but they usually got disturbed during sleep only for once. This may be due to the fact that majority of the workers work for long working hours and got tired with greater physical activity. These findings are in accordance with the study done in Nigeria.
When sleep latency was evaluated, maximum workers in the present study usually took ≤15 min to fall asleep; majority of the workers reported daytime dysfunction for once, twice, or thrice in a week, and this was in contrast with the study done in Nigeria  in which maximum workers never had daytime dysfunction.
Previous study in Hordaland has shown that a person's occupation can influence the occurrence and prevalence of sleep disorders in an individual. In the current study, it was found that majority of the production line workers and those having shift work and workers who work for > 8 h a day have poor sleep quality and those of administrative staff had good sleep quality who usually work for less hours and were not doing shift work. This was in accordance with the study done on factory workers in Saudi Arabia  which confirmed that shift workers usually have poor sleep quality as compared to nonshift workers. In another study done in Nigeria  in which out of all types of health workers, poor sleep was commonly reported by nurses, especially those engaged in shift work.
Sleep deprivation adversely affects cognition and motor performance. This might impair an individual's capacity to maintain adequate oral hygiene practices.
In the present study, the mean CPI and LOA were more in workers with poor sleep quality as compared to those with good sleep quality. This finding was in accordance with the study done in Dera Bassi (Punjab) in which mean PSQI score was highest in periodontitis group followed by gingivitis group. This is because sleep deprivation can cause unfavorable hormonal profile and host immune modulation and inflammatory mechanisms that lead to increase lymphocyte activation with overproductions of interleukin-1 (IL-1), IL-6, IL-17, and tumor necrosis factor alpha.
The present study showed that most of the production line workers were engaged in shift work and have poor sleep quality. This was in accordance with the study done on factory workers in Saudi Arabia  in which shift workers usually have poor sleep quality as compared to nonshift workers.
Results showed that mean decayed surface, missing surface, filled surface, and DMFS are higher in workers with poor sleep who are mostly production line workers and this may be due to more exposure to sugar dust and sugar fumes in the sugar mill. This is in accordance with the studies done in Uttar Pradesh, India, Denmark, and Israel.
As the present study is mainly based on responses to the questionnaire, social desirability bias is inherent in this study. Further, it is possible that individual participant replies are influenced by response style and that the same response bias is at work in each person's answers to the respective questions. Strength of the present study lies in the fact that there are studies that have assessed the sleep quality of workers, but fewer studies have been reported that used PSQI for recording sleep quality of workers and found the association of sleep quality and their oral health.
| Conclusion|| |
The current study has shown that a significant proportion of production line workers, especially shift workers, had poor sleep quality. Working environment of sugar mill influences the sleep quality of the workers which indirectly affects their oral health as sleep deprivation leads to neglected oral care, more adverse habits, and thus poor oral health. The findings of the present study encourage a need for altering sugar mill working environment which might bring positive change in sleep quality and will help to improve the oral health of workers. To further assess the concerned scenario, there is a need to assess the knowledge, attitude, and practice among the mill workers to have an insight into the level of awareness regarding oral health.
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]