Introduction
People health and consequently the health of society have great influence on development and abilities of the community. Long living accompanied by health is not possible without cooperation of different organs. The function of each part has some effect on others [1] .
Diseases of the masticatory organ are also very common among modern society [2] . Dental caries is one such universal disease which is prevalent in all parts of the world irrespective of the sociodemographic characteristics. The impact of occupational environment on the incidence of dental caries is well documented. The high dental caries experience has been observed among the workers of sugar mills, sugar refineries, confectioners, bakers and fruit industry, who are in regular contact with flour or sugar dust [2] .
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 the individual’s work [3] . It should be differentiated from an occupational accident, which is of sudden occurrence. The injurious effect of occupational hazards may manifest themselves in the teeth, the jaw bones, the periodontal tissues, tongue, lips, and oral mucosa [4] . Injuries of the oral cavity which occur as a direct result of the occupation are of rather common occurrence. In recent years industrial health programs have recognized the necessity of maintaining oral health and have emphasized the need for special precautions to prevent oral injuries [3] .
High prevalence of dental caries among workers who had easy access to sugar cane (sugarcane cutters) has been shown in some researches. Studies have shown that work in bakeries, chocolate and in the candy industry have an increased dental caries as well as periodontal diseases because of a high level of sugar dust in the working environment [5] .
The Indian sugar industry contributes to about 20% of sugar mills and 15% of sugar production of the world. It is the second largest agro-processing industry in the country, with total employed capital of Rs. 5,00,00 crores and an annual turnover of Rs. 25,000 crores. It plays a key role in rural development by creating indirect employment for over 7.5% of rural population engaged in sugarcane cultivation, harvesting and ancillary activities. Uttar Pradesh is the largest sugarcane producing State in India. Approximately; 111 sugar mills are in operation and crush around 64.51 million tones of sugarcane which accounts for almost 50% of the total production of the country. The sugar industry consists of private, cooperative and public sector mills that spread over the western, central and eastern regions of the State [6] .
Still no data is available on dental health of sugar mill workers of Uttar Pradesh, India. Hence, the present study was conducted to assess the oral health status among sugar factory workers of Western Uttar Pradesh, India.
Materials and Methods
Study Design
The present cross-sectional study was conducted at four Government aided and four Private sugar mills of West Uttar Pradesh, India over a period of 2 months (March 2014 and April 2014) to assess the oral health status among the Sugar mill factory workers using a WHO oral health assessment form 1997 proforma [7] [Annexure-1].
Sampling
Uttar Pradesh state is divided into North, South, East and West zones. Western UP was taken as a sampling frame for the Study as there is unmatched cluster of sugar mills in Western Part of Uttar Pradesh. It was further arbitrarily divided into four zones namely North, South, East and West. Using Multistage random sampling method, the total of 600 sugar mill factory workers (449 production line workers and 151 administration staff) were selected from the sampling frame of Western Uttar Pradesh based on the inclusion and exclusion criteria.
Inclusion Criteria
1. Workers in the age group 18 to 60 years.
2. Both production and administrative line workers were included in the study.
3. Workers who gave consent for the study.
Exclusion Criteria
1. Workers suffering from any systemic disease.
2. Workers with less than five years of job duration in the sugar mill.
Ethical Clearance and Informed Consent
The study design was reviewed and approved by the Institutional Ethical Committee (DJD/IEC/2014/year/A009). The permission for the conduct of the study was obtained from the concerned authorities of the Sugar Mills and written informed consent was obtained from the study subjects after explaining them the purpose and methodology of the study.
Data Collection
Clinical assessment was carried out for a total sample size of 600 sugar mill factory workers (449 production line workers and 151 administration staff) in the sequence under the available natural light. The type III examination (inspection using mouth mirror, explorer and adequate illumination) was used. Oral health status was assessed using WHO Oral Health Assessment Form (1997 modified). WHO Dentition Status and Treatment Needs. Community Periodontal Index and Loss of Attachment and Prosthetic status and prosthetic needs were used for clinical assessment of oral health [7] [Annexure]. Subjects requiring emergency treatment (for pain) were referred.
Training and Calibration of Examiners
The survey was conducted by three trained and calibrated examiners. The diagnostic variability was found to be low (Kappa value 0.85).
Statistical Analysis
All the collected data was entered in the Microsoft Word Excel Sheet 2007 version and processed using the SPSS 16 Version. Mean, Standard Deviation and proportions (% of subjects affected) were calculated for each clinical parameter.
The student t-test and Chi-square analysis was done to analyse difference in the clinical parameters between the production line workers and administrative staff of sugar mill. The level of significance was fixed at 5%.
Results
The present study was conducted on a study population of 600 subjects (449 production line workers and 151 administrative staff), where the mean age of the subjects in the production line was 32.5± 16.1 y and 45.9± 14.4 y in the administrative staff. The mean DMFT for the production line workers was 7.67±2.99 and for administrative staff was 3.15± 1.34 and the difference was found to be statistically significant (p=0.001).
[Table/Fig-1] highlights the periodontal condition of the study subjects according to maximum Community Periodontal Index score and Loss of Attachment code and the difference was statistically significant among both the groups. (p=0.324 for CPI), (p=0.035 for LOA).
[Table/Fig-2,3] highlights the prosthetic status and prosthetic need among both the production line workers and administrative staff and the difference was found to be statistically significant (p=0.048 for prosthetic status), (p=0.004 for prosthetic need).
Discussion
Occupation has a relationship on health and well-being and there are diverse aspects on the effect of occupation on health [8] . Occupation can affect health through direct impacts, such as physical job conditions, psychosocial job characteristics and stress, and social support. Occupation may also affect health through indirect mechanisms via income, health insurance, prestige, and authority that are related to occupation. Occupational factors like workplace environment, rules and regulations affecting health habits and influence of coworkers might also have significant impact on general as well as oral health [8,9] . Hence, it is essential to analyse the influence of occupation on health. Same holds true for Sugar Industry in our country. India was the first to begin with the production of sugar following the process of pressing sugarcane to extract juice and boil it to get crystals. Jobs in Indian Sugar Industry have created ample employment opportunities in rural India. Today the Indian Sugar Industry has absorbed about 5 lakh rural people. The working environment in the sugar mills of our country creates a unique environment which might have tremendous influence on the general and oral health of production line and administrative workers [10] . Hence, the present study was conducted to assess the oral health status of the production line workers of sugar mill and compare with that of the administrative staff.
The study results revealed that the dental health was compromised among the production line workers. The caries experience showed that the mean value of DMFT of the production line workers 7.67±2.99 which was greater than the workers of administrative staff 3.15± 1.34 and the difference was found to be statistically significant (p=0.001). This is agreement with the findings of Peterson PE, Frencken JE, et al., Anaise JZ Budner L [3,5,11,12] . However, the findings were quite low as compared to the findings of Bachanek T et al., who reported Mean D.M.F.T among flour mill workers to be 17.77 [2] . In another study by Grover S et al., done on Bakery workers, caries prevalence was seen in 67.6% of the workers [4] . This could most probably be attributed to the relationship between type of work and the relevance of sugar dust as an occupational hazard to dental health as documented in previous studies [4] . Increase in caries experience may also be the result of the increased duration of exposure to sugar dust [13] in the form of airborne contaminants (gases and vapours) or as aerosols [13,14] . Also, the easy access to sugar in the sugar mills might have contributed to the increased dental caries experience among production line workers as compared to administrative staff.
The periodontal status of the study subjects based on maximum Community Periodontal Index scores and Loss of Attachment codes indicated that 80.17% of the production line workers had maximum CPI score 2 in contrast to the administrative staff (63.57%) and the difference was statistically significant (p=0.324) which is not in agreement with Masalin et al., [15] . Loss of Attachment was seen in more of production line workers (40.12%) as compared to administrative staff (24.49%) which is statistically significant (p=0.035). This may be due to the limited awareness about the importance of oral health and neglect of oral hygiene among the mill workers [4] .
Production line workers showed less number of presence of removable or fixed prosthesis (Prosthetic status present in 14.4%) as compared to administrative staff (Prosthetic status present in 23.2%) and the difference was found to be statistically significant (p=0.048). However, the prosthetic needs was more 35.2% in production line workers and (17.9%) in administrative staff. This shows accessibility and financial barrier for production line workers which can be contributed to their work schedule. No previous literature is available on the prosthetic status and prosthetic needs of sugar mill workers, hence the study is the first attempt to assess the prosthetic status and the needs.
Oral hygiene habits were not recorded for the production line workers and administrative staff which proved a major limitation for the study. Also, 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. Further longitudinal studies are recommended to assess the relation of oral hygiene status and sugar dust exposure on oral health status of that of sugar mill workers.
Distribution of study subjects according to highest CPI score and LOA
| CPI score | Production line workers | Administrative staff | p-value (χ2 test) |
|---|
| CPI score 0 | 0 (0%) | 9 (2.25%) | 0.0324* |
| CPI score 1 | 20 (4.45%) | 12 (7.94%) |
| CPI score 2 | 360 (80.17% ) | 96(63.57%) |
| CPI score 3 | 35(7.79%) | 15(9.93%) |
| CPI score4 | 4(0.8%) | 3(1.98%) |
| CPI score x | 30(6.79%) | 16(14.33%) |
| Periodontal status (based on maximum L.O.A scores) among study subjects |
| LOA score | Production line workers | Administrative staff | p-value (χ2 test) |
| LOA score 0 | 247 (55.01%) | 109 (72.18%) | 0.035* |
| LOA score 1 | 160 (35.6%) | 32 (21.19%) |
| LOA score 2 | 23 (5.12%) | 5 (3.3%) |
| LOA score 3 | 0 (0%) | 0 (0%) |
| LOA score4 | 0 (0%) | 0 (0%) |
| LOA score x | 19 (4.27%) | 5 (3.33%) |
*Statistically significant
Distribution of study subjects according to the Prosthetic status
| Prosthetic needs Present | Prosthetic needs Absent | p-value (χ2 test) |
|---|
| Production line workers | 65 (14.4%) | 384 (85.5%) | 0.048* |
| Administrative staff | 35 (23.2%) | 116 (76.8%) |
*Statistically significant
Distribution of study subjects according to the Prosthetic needs
| Prosthetic needs Present | Prosthetic needs Absent | p-value (χ2 test) |
|---|
| Production line workers | 158 (35.2%) | 291 (64.8%) | 0.004* |
| Administrative staff | 27 (17.9%) | 124 (82.1%) |
*Statistically significant
Conclusion
The present study revealed that oral health of sugar mill factory workers is compromised which might be primarily due to the exposure to sugar dust during their job hours and lower awareness level regarding the significance of oral health. This further indicates a need to educate the mill workers about the oral hygiene habits and oral hygiene maintenance. Also, it is recommended that regular dental visits should be advocated and the mill owners along with the Government should actively join hands with dental institutions to organize regular screening and treatment dental camps. Also, setting up of dental clinics within the factory premises can markedly improve the current scenario.
Declaration
The study was presented at FDI Annual World Dental Congress, 11-14 September 2014 New Delhi, India.
*Statistically significant*Statistically significant*Statistically significant
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