|Year : 2020 | Volume
| Issue : 2 | Page : 156-160
Impact of sociodemographic factors on oral health among 35- to 44-year-old adults of Sri Ganganagar City
Deeksha Gijwani1, Simarpreet Singh1, Manu Batra1, Yogesh Garg1, Aditi Sharma2
1 Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
2 Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India
|Date of Submission||06-Jun-2019|
|Date of Decision||02-Mar-2020|
|Date of Acceptance||15-Apr-2020|
|Date of Web Publication||24-Jun-2020|
Dr. Deeksha Gijwani
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Dental caries and periodontal diseases are the most prevalent dental diseases and important contributors to the global burden of oral disease, and socioeconomic factors are recognized as being the key determinants of oral health inequalities. Aim: To assess the impact of sociodemographic factors on oral health among 35- to 44-year-old adults of Sri Ganganagar city. Methods: The present cross-sectional study was conducted among the index age group of 35–44 years as recommended by the World Health Organization, and the total sample comprised of 995 adults. Data collection was carried out with the help of a predesigned and pretested questionnaire, and the clinical assessment of dental caries and periodontal status was done using the guidelines of WHO Oral Health Assessment form (2013). The data were analyzed statistically using the SPSS Version 22.0 software with tests such as Student's t-test, Chi-square test, and Kruskal–Wallis test, and level of statistical significance was set at P < 0.05. Results: Males had a higher prevalence of periodontal disease and dental caries compared to females (P = 0.03). The mean decayed teeth component (5.50 ± 1.91) was higher among the participants those having lower socioeconomic status (SES) (P = 0.02). The gingival pocket depth (4–5 mm) and loss of attachment was seen maximum among lower SES (P = 0.001). Conclusion: The prevalence of dental caries and periodontal disease was higher among the study participants. In light of the high treatment needs of the study population, the health policy that emphasizes oral health promotion and prevention would seem more advantageous in addition to the traditional curative cure.
Keywords: Dental caries, loss of attachment, periodontal, socioeconomic status
|How to cite this article:|
Gijwani D, Singh S, Batra M, Garg Y, Sharma A. Impact of sociodemographic factors on oral health among 35- to 44-year-old adults of Sri Ganganagar City. J Indian Assoc Public Health Dent 2020;18:156-60
|How to cite this URL:|
Gijwani D, Singh S, Batra M, Garg Y, Sharma A. Impact of sociodemographic factors on oral health among 35- to 44-year-old adults of Sri Ganganagar City. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2021 Dec 1];18:156-60. Available from: https://www.jiaphd.org/text.asp?2020/18/2/156/287636
| Introduction|| |
The World Health Organization's definition of health encompasses the physical, social, and psychological well-being of an individual and not merely an absence of disease or infirmity. Numerous factors play an integral role in shaping an individual's health status, among which oral health is an important determinant.
Dental caries and periodontal diseases are the most prevalent dental diseases and important contributors to the global burden of oral disease. However, as these diseases except oral cancer are neither life threatening nor severely debilitating, there is a general apathy toward oral health care. Good oral health encompasses the health of dental, periodontal, and mucosal tissues of the oral cavity.
Socioeconomic factors are recognized as being the key determinants of oral health inequalities. Gender, race, and ethnicity influence the prevalence of oral diseases and care. Despite public health laws and policies that suggest otherwise, differences in education, income, and geographic location also alter the oral health needs. One of the most significant barriers to care is the high cost for oral health services. Other nonfinancial barriers include the geographical distribution and practice behaviors of dental professionals; dental care provider's bias regarding different racial, ethnic, and medically compromised groups; and individual's lack of awareness regarding proper diet and oral hygiene.
Previous studies have demonstrated that socioeconomic position is negatively associated with oral health and dental disease,,, which means the higher the socioeconomic position, the better the perception of oral health and the less experience of clinically diagnosed dental diseases. Education and income are the most common and relevant indicators used in the epidemiology for socioeconomic status (SES) measurement.
India with a population of more than 100 crores accounts for a high proportion of dental morbidity. It was estimated that in India, eight out of ten persons suffer from oral diseases. According to the first National Oral Health survey conducted by the Dental Council of India, 8.2% of 35- to 44-year-old has dental caries, and periodontal disease is prevalent in 89.6% of 35 years olds. In India, 65% of males and 33% of females use some form of tobacco.
In “oral health survey and fluoride mapping” of Rajasthan by Bali et al. (2002), it was reported that the standard of oral hygiene for adults was poor and bleeding and calculus problems were frequent (17.6%), whereas the prevalence of advanced periodontal disease was low (0.9%). Dental caries experience was present among 67.5% of people, and also decayed, missing, filled teeth (DMFT) score of 1 to 3 were among 49.7%.
As recommended by the WHO, the 35- to 44-year-old age group was the standard age group for the surveillance of oral health conditions among adults. By utilizing data of this age group, health planners and decision makers can assess the full effect of dental caries, the level of severe periodontal involvement, and the general effects of oral health care provided. Hence, the present study was done to assess the role of sociodemographic factors on the dental caries and periodontal status of 35- to 44-year-old adults of Sri Ganganagar city.
| Materials and Methods|| |
The present cross-sectional study was conducted among adults of the index age group of 35–44 years as recommended by the World Health Organization during the month of March 2017 to August 2017. Ethical approval (SDCRI/IEC/2015/014) to conduct the study was obtained from the Institutional Ethical Review Board. Written informed consent was obtained from the participants after explaining them the aim and objectives of the study. All the domicile residents aged 35–44 years and those who gave consent were included in the study. The residents those suffering from any chronic illness and having limited mouth opening were excluded from the study.
For the purpose of estimating the sample size, a pilot study was conducted to estimate the expected disease prevalence to calculate the sample size and to check the reliability and validity of the questionnaire. The questionnaire was prepared in English. Through the pilot study, the prevalence of dental caries was found to be 66%, free of dental caries was 34%, allowable error was 0.3, and point on normal deviation was 1.96. The sample size was calculated using the following formula: N = z2pq/d2. Hence, after calculation, “n” was equal to 957.8, which were rounded off to 1000.
A multistage random sample design was used in which Sri Ganganagar city was divided into four geographical zones, i.e., north, south, east, and west. From each of the four divided zones, four locations were randomly selected by lottery method, and then households were randomly selected in each location. After selecting the households, a door-to-door survey was conducted in each and every house till the desired sample was achieved. In the door-to-door survey, first, we started by reaching the center of the location; there were one or more lanes, we selected any one lane arbitrarily and then we selected the households randomly on that lane. For example, any 5th or 7th household having 35- to 44–year-old age group was selected and afterward every 5th or 7th household, and so on, till the completion of the required number of individuals of that area. The sampling sites or clusters were four from each zone, which makes a total of 16 sampling sites. From each zone – approximately 249 individuals were randomly selected, so the total sample comprised 996 adults.
Data collection was done through face-to-face interviews using a standardized, pretested questionnaire applied to all participants in the English language. The questionnaire was piloted on a group of twenty cases who were interviewed to gain feedback on the overall acceptability of the questionnaire in terms of length and language clarity. Based on their feedback, the questionnaire did not require any corrections. Cronbach's coefficient was found to be 0.80, which showed an internal reliability of the questionnaire. The mean content validity ratio was calculated as 0.87.
The pretested questionnaire included information regarding individual's age and gender or sociodemographic characteristics such as family education level, monthly family income, and occupation, which were classified according to the Kuppuswamy's Scale for SES showed in [Figure 1].
|Figure 1: Proposed updating of Kuppuswamy's classification of socioeconomic status in January 2015|
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The clinical examination was conducted by a single calibrated examiner for whom kappa statistics was determined as 88% 2 days before the study. World Health Organization Type III Examination was carried out using the World Health Organization probe, natural light, a mouth mirror, and an explorer, and the patients were seated in a well-illuminated room. Sterilization was carried out using autoclave. Spot sterilization was done during the survey using chemical sterilizing solution to reduce the risk of infection.
After the interview, oral clinical examination was conducted in which periodontal status and dental caries were recorded according to the rules and criteria of the community periodontal index and DMFT index, respectively, and loss of attachment (LOA) was recorded according to the guidelines of WHO Oral Health Assessment Form 2013.
The data were statistically analyzed using IBM SPSS (Statistical Package for the Social Sciences) Statistics Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). The statistical analysis was determined by the Student's t-test, Chi-square test, and Kruskal–Wallis test, and level of statistical significance was set at P < 0.05.
| Results|| |
Among 996 participants who completed the questionnaire, one did not agree to be examined, resulting in a sample size of 995 participants. The present study comprised 995 participants, in which 57.99% were male and 42.01% were female. Majority of the participants (34.77%) belonged to lower-middle socioeconomic class and 31.05% of participants belonged to upper-middle SES [Table 1].
|Table 1: Distribution of the participants according to gender and socioeconomic status|
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The mean decayed teeth (DT) in the male and female population was 3.92 ± 2.35 and 4.08 ± 2.60, respectively. The overall mean DMFT score was higher in males (5.74 ± 2.49), and it was found to be nonstatistically significant (P = 0.95). The mean DT component (5.50 ± 1.91) was higher among the participants those having lower SES. The overall mean DMFT score was higher among upper-lower SES. When different SESs were compared in relation to DMFT, it was found to be statistically significant (P = 0.01) [Table 2].
|Table 2: Prevalence of dental caries among the participants according to gender and socioeconomic status|
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Male had higher gingival problem in which 99.1% of them having bleeding, 55.1% had gingival pocket depth (4–5 mm), and 16.5% of pocket (≥6 mm). The pocket (4–5 mm) was seen majorly among those belonging to lower (100%) and upper-lower SES (70%) and the pocket (≥6 mm) was seen higher among lower-middle SES. The overall periodontal problem was seen higher among lower SES, and it was found to be statistically significant (P = 0.001) [Table 3].
|Table 3: Distribution of participants having positive community periodontal index scores according to gender and socioeconomic status|
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Nearly 31.6% of female had an LOA score of 0, which was higher than that of males (30.2%). LOA score of 1 was highly recorded among females, but LOA score 2 or 3 was more commonly seen among males. Almost 54.2% of the participants with upper SES had an LOA score of 0. None of the participants in the Socioeconomic category had an LOA score of 4. LOA score of 1 or 2 was seen more commonly among those belonging to upper-lower SES, but LOA score of 3 was more commonly among those belonging to lower-middle SES. When different SESs were compared in relation to LOA, it was found to be statistically significant (P = 0.001) [Table 4].
|Table 4: Distribution of participants having loss of attachment scores according to gender and socioeconomic status|
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| Discussion|| |
Oral health remains a low-priority area particularly in developing countries due to other basic needs such as food, clothing, shelter, and medical facilities. Dental caries and periodontal diseases have historically been considered the most important global oral health burdens. The significant role of sociobehavioral as well as environmental factors in oral disease and health is demonstrated in a large number of epidemiological surveys. The intention of study was to provide systematic information on the role of SES on dental caries and periodontal status, and the results would aid in the planning and evaluation for prevention and oral health promotion program.
The present study showed that males (5.74) had slightly higher mean DMFT than females (5.73). This finding was in contrast to various studies in literature such as studies done by Hessari et al., Kamberi et al., and Stojanović et al., although a study done by Patro et al. in New Delhi showed approximately similar kind of results in which DMFT is higher among males than females. This might be due to females having more positive habits and behaviors related to oral health than males. However, in the present study, DT component of females was higher than males, this could be due to the flow and composition of saliva, hormonal fluctuations during pregnancy, genetic variation, and early eruption of teeth in females, which are biological factors that determine the dental health of women. With increasing SES, a decrease in the mean DMFT was observed in the present study, which was statistically significant for the overall population. This could be because low social class has a significantly higher rate of dental caries. Income strongly affects access to services in relation to both private dental services and public dental care, which may be characterized by lengthy waiting results. In contrast to the present study, Eustaquio et al. found that DMFT was higher among middle/high social class in comparison to low social class. However, there is no universally acceptable relation of SES with oral disorders. This may be because SES is a very broad categorization. However, usually, higher prevalence of oro-dental disorders was reported in lower socioeconomic strata.
Males had higher prevalence of periodontal disease than females. It is in accordance with a study done by Salman et al., which showed that females tended to have higher percentage of healthy gingiva. Another study done by Macêdo et al. showed similar result that in males, the proportion of periodontal disease was 35% higher than their counterparts. A study done by Kumar et al. and Krustrup andErik Petersen has also showed that females had healthier periodontium than males. This might be due to the fact that females are more aware about the maintenance of their oral hygiene and regular professional dental care. Males are more exposed to deleterious oral habits such as tobacco chewing and smoking, which are established as high-risk factors for periodontal diseases.
The present study showed that the population who belong to lower and upper-lower SES had higher percentage of bleeding, pocket (4–5 mm), and LOA. It is in accordance with a study done by Chandra Shekar et al., which showed that those individuals who belong to lower and upper-lower SES had higher percentage of bleeding and pocket (4–5 mm) and LOA. Another study done by Almerich-Silla et al. showed that those belonging to lower SES had higher percentage of periodontal pockets. This might be due to oral hygiene practices, the utilization of dental services, presence or absence of deleterious oral habits such as smoking and pan chewing, and the awareness on the dental diseases, which are some of the proven factors said to have a role in determining the periodontal status in an individual.
Thus, this epidemiological survey has provided baseline information about the dental caries and periodontal status in 35- to 44–year-old adults of Sri Ganganagar city to underpin the implementation of oral health programs. In light of the high treatment needs of the study population, the health policy that emphasizes oral health promotion and prevention would seem more advantageous in addition to the traditional curative cure. Furthermore, more research is required involving longitudinal study on the same target population impinging the risk factors involved in the causation of oral disease. Sri Ganganagar zone can be used as a model, to find the effectiveness of these programs in bringing down the oral diseases and maintenance of the oral health of the people on a long-term basis.
To improve the oral health status of rural population of Sri Ganganagar city, it is suggested that a community-based approach can be designed with an initial curative care followed by preventive care. Because the literacy rate is low in a rural area in comparison to an urban area, in a rural area, more emphasis should be laid on the behavioral sciences and community-based oral health education by addressing the importance of oral hygiene and making people aware of the deleterious effects of substance abuse on oral health.
As the present study was cross-sectional in nature, a lot more can be explored by conducting longitudinal studies. The results of the present study cannot be generalized with other zone/district, as there are differences in culture, lifestyle, health and hygiene practices, and geographical variations. Another limitation could be reporting bias in which there is suppression of information by the participants with regard to personal and adverse habits.
| Conclusion|| |
The prevalence of dental caries and periodontal disease is higher among 35- to 44–year-old adults of Sri Ganganagar city, Rajasthan. The population belonging to lower and upper-lower SES showed higher prevalence of dental caries and periodontal problems. This epidemiological survey has provided baseline information to underpin the implementation of oral health programs. In light of the high treatment needs of the study population, the health policy that emphasizes oral health promotion and prevention would seem more advantageous in addition to the traditional curative cure.
We would like to acknowledge the authorities of Institute for co-operating and Dr. Vikram Pal Aggarwal for helping us with the statistical analysis and providing vital support without which this study was not possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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