Dental Erosion, Dental Caries Experience and ...

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JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. II

Dental Erosion, Dental Caries Experience and Periodontal Status among Battery Factory Workers of Ghaziabad Dr. P. Basavaraj1, Dr. Nitin Khuler2, Dr. Mohit Dadu3, Dr. Rajnanda Ingle Khuller4 ABSTRACT Background Occupational exposure to sulfuric acid mists has been described in association with dental erosion and ulcerative mucosal lesions explained by the high irritant and corrosive acid effects that damage the enamel structure, cause inflammatory and immune reactions and reduce the salivary pH that can also compromise resistance to infections in the oral cavity. Aim and Objectives To assess the Dental erosion, Dental caries experience and periodontal status among battery factory workers of Ghaziabad. India Material & Methods Study was conducted in 8 randomly selected battery factories of Ghaziabad. All the subjects present in these factories on the days of examination were included. A total of 562 (Male – 386, Female – 176) aged between 25-58yrs were examined. Results The results show 351 subjects (62.5%) had Dental caries experience The Overall periodontal condition was poor with 85.1% of the subjects showing some or the other signs of periodontal disease. The periodontal health deteriorated with increasing working experience of the workers 1-5 years - 14.3%, 5-10 years - 23.5%, 10+ years - 36.2% showed the pocket depths of 4-5mm. 98.8% showed some degree of dental erosion. 23.7% of the workers with more than 10 years of working experience showed 3rd degree of Dental erosion compared to 0% from 1-10 years and the difference was found to be statistically significant. Conclusion The present study revealed that chronic exposure in the working environment significantly affects oral health condition among exposed workers It can be concluded that the most common adverse effects on dental health of exposed workers were the significant increase in the prevalence of periodontal diseases, dental erosions and in the prevalence of decay. Key words: Battery Factory, Dental Caries, Periodontal Disease, Dental erosion INTRODUCTION

the development of shallow concavities or to rounding and grooving of the edges or the cusps of the tooth surfaces5,6. In patients with severe dental erosion, the enamel is often totally removed, leaving a vulnerable dentine surface which is often associated with a painful sensitivity and is prone to further erosion and mechanical wear. Advanced erosive tooth wear might also constitute near and frank exposures of the pulp requiring dental treatment or lead to complete destruction and tooth loss7. There is very little information available on the oral health status associated with environmental acid exposure; hence the present study is designed to assess the Degree of Dental erosion, Dental caries experience and periodontal status among the Battery factory workers of Ghaziabad.

The oral cavity is vulnerable to external agents, and some occupational exposures are associated with oral changes in both hard and soft tissues. Occupational exposure to sulfuric acid mists has been described in association with dental erosion and ulcerative mucosal lesions1,2 explained by the high irritant and corrosive acid effects that damage the enamel structure, cause inflammatory and immune reactions, and reduce the salivary pH that can also compromise resistance to infections in the oral cavity 3. Dental erosion is defined as the pathologic chronic loss of dental hard tissues due to the chemical influence of extrinsic and intrinsic acids without bacterial involvement4. Initially, dental erosion appears as a smooth silky-shining glazed enamel surface. Further progression may lead to 1

Professor, Dept. of Public Heath Dentistry, 2Reader, Dept. of Periodontics; 3P.G. Student, Dept. of Public Health Dentistry; P.G. Student, Dept. of Prosthodontics, Hitkarini Dental College and Hospital, Hitkarini Hills, Jabalpur

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AIM AND OBJECTIVES •

To assess the Dental erosion, Dental Caries experience and periodontal status among Battery factory workers of Ghaziabad.

•

To assess the Dental caries experience using DMF index.

•

To assess the periodontal status Community Periodontal Index (CPI).

Degree of Dental erosion Type2

the outer layer of the dentin on the lip side has been exfoliated

Type3

the whole tooth, especially the cusp of mandibular incisor, has been impaired or has been subjected to attrition by decalcification

Third degree

the dentin is complately exposed from impairment, which almost reaches the pulp or reaches the pulp itself. Approximately 50% of the crown has been impaired

Fourth degree

more than 2/3 of the crown has been impaired

using

•

To assess the Dental erosion by diagnostic criteria given in occupational dental health

•

Based on the findings in the study, to suggest possible recommendations that can be undertaken to improve the oral health of these group of population

Definition

RESULTS MATERIALS & METHOD

The present study is designed to assess the Degree of Dental erosion, Dental caries experience and periodontal status among 562 battery factory workers of Ghaziabad, working in 8 different factories. A total of 295 (52.5%) males and 267 (47.5%) females participated in the study. The overall prevalence of Dental caries was 62.5% (n=351). (Table 1) The overall prevalence of periodontal disease was 85.1% among the study group (Table 2) The results indicated that 38.1% subjects showed healthy periodontium for 1-5 years of service where as 36.2% of showed pockets with 4-5 mm with more than 10 years of service which is statistically significant P < 0.001 (Table 3) The overall degree of tooth erosion which is at 98.8%. (Table 4) Subjects with more than 10 years of experience 23.7% had 3rd degree and 7.9% had 4th degree of tooth erosion respectively. (P) < 0.001 (Table 5) Almost 25% of subjects with more than 55 years had 3rd degree of tooth erosion. (Table 6)

Ethical clearance was obtained from the ethical committee of I.T.S Centre for Dental Studies & Research, Ghaziabad, India before the start of the study. Prior permission from the concerned factory authorities was obtained. Sample Selection

Study was conducted in 8 randomly selected battery factories of Ghaziabad. All the subjects present in these factories on the days of examination were included. A total of 562 (Male – 386, Female – 176) aged between 25-58 yrs were examined. The Examination was carried out by one calibrated examiner in all the 8 battery factories of Ghaziabad with the subject seated on a chair, illuminated by a natural daylight. The examination was carried out by using a Mouth Mirror, Shepherd’s Crook Explorer No.23 and CPI probe. Dental Caries experience, periodontal status and Dental erosion were recorded using DMF index and CPI. Dental erosion was recorded using diagnostic criteria given in occupational dental health.8 Degree of Dental erosion

Table 1: Overall prevalence of Caries in the study population

Definition

Dental Caries

Number (%)

Mean ± SD

DT

323 (57.5%)

1.00 ( ± .86)

MT

330 (58.7%)

1.72 ( ± 1.67)

FT

64 (11.4%)

.15 ( ± 0.6)

First degree

Only tooth surface is impaired

Type1

The enamel is slightly opaque

Type2

Impairment is within the enamel, not reaching the dentin

DMFT

351 (62.5%)

2.55 ( ± 2.25)

Ds

323 (57.5%)

1.86 ( ± 1.47)

Second degree

impairment reaches the dentin, with exposure of the dentin showing characteristic yellow

Ms

330 (58.7%)

8.24 ( ± 5.38)

Fs

64 (11.4%)

.28 ( ± .16)

DMFS

351 (62.5%)

10.38 ( ± 9.06)

Type1

wedged shaped impairment is deepened

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JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. II Table 2: Overall Periodontal status in the study population Periodontal

Healthy

Bleeding on probing

Calculus

Pocket 4-5 mm

Pocket 6 mm

Total N = 562

84 (14.19%)

140 (24.9%)

182 (32.4%)

141 (25.1%)

15 (2.7%)

Table 3: Percent subject with their Periodontal status by Year of service Year of service

N

Healthy

Bleeding on probing

Calculus

Pocket 4-5 mm

Pocket 6 mm

1-5 Yrs

147

56 (38.1%)

21 (14.3%)

49 (33.3%)

21 (14.3%)

0 (.0%)

6-10 Yrs

238

28 (11.8%)

70 (29.4%)

84 (35.3%)

56 (23.5%)

0 (.0%)

> 10 Yrs

177

9 (.0%)

49 (14.5%)

49 (27.7%)

64 (36.2%)

15 (8.5%)

Table 4: Overall degree of Tooth erosion Toothwear

N

Not present Ist Degree

Oveall

562

7 (1.2%)

IInd Degree

154 (27.4%) 106 (18.9%) 92 (16.4%)

77 (13.7%)

IIIrd Degree IVth Degree 70 (12.5%)

42 (7.5%)

14 (2.5%)

Table 5: Percent subject with Tooth Wear by Year of Service Year of Service

N

1-5 Yrs

Ist Degree

IInd Degree

Not Present

Type 3

IIIrd Degree

IVth Degree

Type 1

Type 2

Type 1

Type 2

147

7 (4.8%)

49 (33.3%)

70 (47.6%)

14 (9.5%)

0 (.0%)

7 (4.8%)

0 (.0%)

0 (.0%)

6-10 Yrs

238

0 (.0%)

77 (32.4%)

21 (8.8%)

49 (20.6%)

35 (14.7%) 56 (23.5%)

> 10 Yrs

177

0 (.0%)

28 (15.8%)

15 (8.5%)

29 (16.4%)

42 (23.7%)

0 (.0%)

0 (.0%)

7 (4.0%)

42 (23.7%)

14 (7.9%)

Type 2

Type 3

IIIrd Degree

IVth Degree

0 (.0%)

0 (.0%)

Table 6: Percent subject with Tooth wear by Age Age

N

Ist Degree

IInd Degree

Not Present

Type 1

Type 2

Type 1

25-34 Yrs

168

7 (4.1%)

70 (41.7%)

70 (41.7%)

21 (12.5%)

0 (.0%)

0 (.0%)

35-44

196

0 (.0%)

56 (28.6%)

21 (10.7%)

42 (21.4%)

28 (14.3%) 35 (17.9%)

14 (7.1%)

0 (.0%)

45-54

142

0 (.0%)

21 (14.8%)

8 (5.6%)

29 (20.4%)

35 (24.7%) 28 (19.7%)

14 (9.9%)

7 (4.9%)

55+ Yrs

56

0 (.0%)

7 (12.5%)

7 (12.5%)

0 (.0%)

14 (25.0%)

14 (25.0%)

7 (12.5%)

DISCUSSION

7 (12.5%)

and found 67.2% of the study group with Dental caries and overall mean DMFT of 2.59.

The present study is done to assess the Degree of Dental erosion, Dental caries experience and periodontal status among 562 battery factory workers of Ghaziabad.

85.1% of the subjects showed some or the other signs of periodontal disease, this may be attributed to the exposure of acid mists in the working environment and the findings are similar to the study done by Ahlberg J et al (1996)10 who studied periodontal status among male industrial workers in southern Finland and found 20% of the population free from periodontal disease.

It was observed that oral hygiene practices most commonly seen among the factory workers is tooth brush & tooth paste. Only 7% of the workers were following other methods of oral hygiene practices.

In this study, health of periodontium in personnel is decreasing severely with the increasing age (pocket 4-5 mm, 25-34 years 12.5%, 35-44 years - 21.4%, 45-54 years - 35.2%, 55+ years - 50.0%) this is like in the study done by Tuominen M (1991)11 who studied the occurrence of periodontal pockets and oral soft

In our study it was found that Dental caries experience is 62.5% with overall mean DMFT of 2.87 and DMFS of 10.38 respectively. This is in agreement with the study done by Duraiswamy P et al (2008)9 who studied Dental caries experience and treatment needs on green marble mine laborers 829



oral hygiene and eating/drinking habits. When dental erosion is diagnosed, contributing factors should be identified as soon as possible. Rigorous history taking and a thorough oral examination should be performed. Photography, study casts, and tooth wear indexes should be used as diagnostic tools. Contributing factors should be weighed based on duration, intensity, and sequence of exposure(s). When a workplace (or other environmental) exposure is suspected, a workplace exposure assessment should be undertaken. A workplace survey may help capture new cases with early stage dental erosion.

tissue lesions in relation to sulfuric acid fumes in the working environment and found the presence of periodontal pockets increased with age significantly more among the acid-exposed workers (p less than 0.0001). The periodontal health deteriorated with increasing working experience of the workers 1-5 years - 14.3%, 6-10 years - 23.5%, 10+years 36.2% showed the pocket of 4-5 mm this is in agreement with the findings of Dini EL and Guimarães LO (1994)12 who studied periodontal conditions and treatment needs in a worker population in Araraquara, Brazil and found the increase in periodontal pockets as the experience increases.

RECOMMENDATIONS

98.8% showed some degree of dental erosion, this may be attributed to the working environment. Lead and sulfuric acid being used as one of the ingredients in the production. This findings is similar to that of Zabiñska O et al (1982)13, Lie T et al (1988)14. They found most of the workers with dental erosion (90%) 23.7% of the workers with more than 10 years of working experience showed 3rd degree of Dental erosion compared to 0% from 1-10 years and the difference is statistically significant P. This is in agreement with the study done by Amin WM et al (2001)15 studied dental erosion on workers of battery industries of Jordan and found significant increase (P) in the erosion among the study group according to their experience.

1. Efficient surveillance and routine monitoring of acid fumes in the workplace place environment

The present study shows slight difference in the degree of erosion with increasing age where 35-44 years showed 9.9% of 3rd degree and 25% with 55+years and the difference is not statistically significant. This is in agreement with the studies done by Paul (1961)16, Ten Bruggen Cate HJ(1968)17, Goto H (1996)18.

2. Amin WM, Al Omoush SA, Hattab FN (2001) Oral health status of workers exposed to acid fumes in phosphate and battery industries in Jordan. Int Dent J 51, 169-74

CONCLUSION

4. Imfeld T (1996) Dental erosion. Definition, classification and links Eur J Oral Sci 104, 151-55.

The present study revealed that chronic exposure in the working environment significantly affects oral health condition among exposed workers It can be concluded that the most common adverse effects on dental health of exposed workers were the significant increase in the prevalence of periodontal diseases, dental erosions and in the prevalence of decay. Dental erosion is a multi-factorial process. Several extrinsic and intrinsic sources of acids may be contributing simultaneously or consecutively. There are also modifying factors, such as salivary composition,

5. Jaeggi T, Schaffner M (2004) Prevention and minimally invasive treatment of erosions Oral Health Prev Dent 2, 321-5

2. Installation of efficient ventilation and exhaust system of the work sites 3. Implementation and mandatory use of protective masks, goggles and face guards 4. Set up of Dental and medical care services. REFERENCES 1. Kumar S, Dagli RJ, Chandrakant D, Prabu D, Suhas K (2008) Periodontal status of green marble mine labourers in Kesariyaji, Rajasthan, India. Oral Health Prev Dent 6, 217-21

3. Gamble J, Jones W, Hancock J, Meckstroth RL (1984) Epidemiological-environmental study of lead acid battery workers. III. Chronic effects of sulfuric acid on the respiratory system and teeth. Environ Res 35, 30-52.

6. Lussi A, Jaeggi T, Zero D (2004) The role of diet in the aetiology of dental erosion. Caries Res 38, 34-44. 7. Sivasithamparam K, Harbrow D, Vinczer E, Young WG (2003) Endodontic sequelae of dental erosion. Aust Dent J 48, 97-101. 8. Yuji suyama, Satoru Takaku, Yoshikazu Okawa, Takashi Matsulubo (2010) Dental erosion in workers exposed to sulfuric acid in lead storage battery 830


JOURNAL OF THE INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY Vol:2011 ISSUE:18 SUPPL. II manufacturing facility. Bull Tokyo Dent Coll 51, 77-83.

13. Zabiñska O, Jedrzejewska T, Ostrowska H, Ziemnowicz-G?owacka (1982) Requirements for periodontal disease treatment in workers in the printing industry in Lodz. Czas Stomatol 35, 713-7.

9. Duraiswamy P, Kumar TS, Dagli RJ, Chandrakant, Kulkarni S (2008) Dental caries experience and treatment needs of green marble mine laborers in Udaipur district, Rajasthan, India. Indian J Dent Res 19, 331-34.

14. Lie T, Due NA, Abrahamsen B, Böe OE (1988) Periodontal health in a group of industrial employees. Community Dent Oral Epidemiol 16, 42-6. 15. Amin WM, Al-Omoush SA, Hattab FN (2001) Oral health status of workers exposed to acid fumes in phosphate and battery industries in Jordan. Int Dent J 51, 169-74.

10. Ahlberg J, Tuominen R, Murtomaa H (1996) Periodontal status among male industrial workers in southern Finland with or without access to subsidized dental care. Acta Odontol Scand 54, 166-70.

16. Paul E (1968) Erosion of the teeth due to industrial sulphuric acid. Dent Mag Oral Top 79, 137-43

11. Tuominen M (1991) Occurrence of periodontal pockets and oral soft tissue lesions in relation to sulfuric acid fumes in the working environment. Acta Odontol Scand 49, 261-66.

17. Bruggen T, Cate HJ (1968) Dental erosion in industry. Br J Ind Med 25, 249-66. 18. Goto H, Kosaka M, Ueda T, Yoshida M, Hara I (1996) Association between dental erosion and exposure to acids in a chemical factory. Sangyo Eiseigaku Zasshi 38, 165-171.

12. Dini EL, Guimarães LO (1994) Periodontal conditions and treatment needs (CPITN) in a worker population in Araraquara, SP, Brazil. Int Dent J 44, 309-11.

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