|Year : 2015 | Volume
| Issue : 3 | Page : 312-316
Periodontal health status of transport workers of a union territory in India: A cross-sectional study
Ramandeep Singh Gambhir1, Ashutosh Nirola2, Jagjit Singh3, Tegbir Sekhon4, Samir Anand5
1 Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
2 Department of Periodontics, Laxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India
3 Department of Periodontics, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
4 Department of Periodontics, Sarabha Dental College, Ludhiana, Punjab, India
5 Department of Periodontics, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India
|Date of Submission||29-Mar-2014|
|Date of Acceptance||19-Jan-2015|
|Date of Web Publication||26-Jun-2015|
Ramandeep Singh Gambhir
Department of Public Health Dentistry, Gian Sagar Dental College, Rajpura - 140 601, Punjab
Source of Support: Funding for the entire study was afforded by
the Honorable Chairman, M.M. University, Mullana, by giving us the
necessary manpower and “Community Dental Van”’ for conducting
the necessary treatments at the camp site., Conflict of Interest: None
| Abstract|| |
Background: Periodontal disease is one of the most prevalent dental diseases, which affects the adult population of the world, varying only in degree from mild to severe. Transport industry is considered an important pillar for socioeconomic development of any nation. The present study was carried out to assess the periodontal health status of transport workers working in Chandigarh Transport Undertaking (CTU) buses, Chandigarh (Union territory). Materials and Methods: A cross-sectional study was conducted on all available CTU workers at all three bus depots. The data were recorded on a modified WHO format (1997). A total of 998 subjects were included for community periodontal index (CPI) and attachment loss computations after doing necessary exclusions. Periodontal status was evaluated using CPI. Results: About 8.13% of the subjects had healthy periodontium while maximum subjects (73.2%) had a score 2 (calculus) as evaluated by CPI. 3.4% (12) of the subjects belonging to upper middle class had deep pockets as compared to 1.9% (10) of the subjects in the lower middle class. None of the subjects in the upper high, high, and upper middle socioeconomic status (SES) category had a loss of attachment score 4. 25.9% of the postgraduates had a CPI score of 0 whereas 0.7% high school subjects had a loss of attachment score 4. Conclusion: Advanced periodontal disease (CPI score, 4) affected small number of subjects with maximum subjects (73%) having a CPI score of 2. There was statistically significant association of SES and education level with the CPI score and loss of attachment level.
Keywords: Chandigarh Transport Undertaking, education, periodontal health, socioeconomic status, transport workers
|How to cite this article:|
Gambhir RS, Nirola A, Singh J, Sekhon T, Anand S. Periodontal health status of transport workers of a union territory in India: A cross-sectional study. J Indian Soc Periodontol 2015;19:312-6
|How to cite this URL:|
Gambhir RS, Nirola A, Singh J, Sekhon T, Anand S. Periodontal health status of transport workers of a union territory in India: A cross-sectional study. J Indian Soc Periodontol [serial online] 2015 [cited 2019 Dec 13];19:312-6. Available from: http://www.jisponline.com/text.asp?2015/19/3/312/153482
| Introduction|| |
Health continues to be a neglected entity despite continuous efforts for health promotion, worldwide. Health is often taken for granted, and its value is not fully understood, until it is lost.  The occupational environment is one of the major determinants for health. There are certain working classes who spend most of their time on wheels, traveling from one place to another, without regular food, rest, recreation, and even sleep. It is an environment over which they have no control whatsoever and is an environment that wrecks their schedules, disrupts their home life, makes social activities and regular breaks very hard to plan and supplies constant hassle. 
Chandigarh, a union territory, is the capital city of two states, Haryana and Punjab. Chandigarh has a great network of local bus transport system known as Chandigarh Transport Undertaking (CTU) with staff strength of 2100 people at three bus depots. CTU's staff ratio per bus is the lowest in the country: Just 5.54 employees per bus compared with Mumbai 10.99, Delhi's 9.16, Calcutta's 11.66 and Ahmedabad's 10.33. 
Oral health is an integral part of general health and a valuable asset for any individual. Periodontal diseases are a group of chronic, progressive bacterial infections resulting in inflammation and destruction of tooth-supporting tissues.  Its impact on individuals and communities in terms of pain and suffering, impairment of function, and reduced quality-of-life is considerable. Moreover, various demographic factors such as socioeconomic status (SES) and level of education can influence the development of periodontal disease.  Furthermore, periodontal disease and tooth loss are linked to chronic diseases like diabetes mellitus, hypertension, etc., 40-45% of the subjects in Chandigarh (35-44 years) reported oral health complaints in 1-year (2009).  20-25% of subjects (35-44 years) in Chandigarh used to smoke tobacco in the and 33% of subjects used to consume alcohol which deteriorated their periodontal health. , Even in other union territories like Puducherry, the prevalence of moderate periodontitis increased with age; the risk of being affected by periodontitis was 2.3 times for persons above 35 years of age than below.  The general trend observed for loss of attachment in the Indian population was that it was higher in the rural than in the urban population and was higher in males as compared to females. 
In this present period of evidence-based dentistry and oral health, foremost priority should be given to researches dealing with such a fundamental concept as very few researches dealing with the prevalence of dental disorders have been carried out among Indian population, especially among subjects in specific occupations. Literature on the periodontal health of transport employees is almost nonexistent. Therefore, the present study was conducted as an attempt to assess the periodontal health status in relation to socioeconomic and educational factors among the transport employees of CTU buses, Chandigarh.
| Materials and methods|| |
This study was conducted after obtaining ethical clearance from the Institutional Review Board of M.M. University, Mullana with prior permission from the director transport, CTU. A pilot study was conducted on 40 subjects to assess the feasibility of the study. Informed consent was taken from each subject prior to recording oral health. The study was conducted at all the three CTU bus depots of Chandigarh. The study was conducted from 9 a.m. to 4 p.m.; hence the subjects who were available during this time period comprised the study population. Initially, 1008 subjects were included in the study. Of the 1008 subjects, 10 (0.99%) were excluded from the community periodontal index (CPI) computations either because of edentulousness or because extractions indicated for remaining teeth would have rendered the subjects edentulous.
Recording and diagnosis criteria
On each visit, all the available drivers and conductors were interviewed, and a clinical examination was conducted and data regarding periodontal health status were recorded on WHO format.  Per-capita monthly income of the subjects was taken into consideration to determine SES. The SES was evaluated using modified B.G. Prasad's classification which was corrected by linking the original classification with the all India whole price index.  An expert opinion was also sought from the Department of Economics and Co-operation studies, Panjab University, Chandigarh and the concerned statistician to make the classification suit the income levels at the time of the study. On the basis of educational status, subjects were grouped in various categories ranging from illiterate to postgraduation. Periodontal status was assessed using the CPI, and it was expressed in terms of CPI score and loss of attachment score.  It was used in this study because it has proved to be a simple and effective method for measuring and monitoring the severity of periodontal disease at the community level.  The highest CPI score and loss of attachment score among the sextants examined in a person were taken as respective CPI and loss of attachment scores for the person. Data were also collected on other variables like age, presence of deleterious habits like alcoholism and tobacco smoking and self-reported systemic conditions like hypertension and diabetes mellitus. A subject was considered to be an alcoholic according to the criteria suggested by National Institute of Alcohol Abuse and Alcoholism. 
A single trained examiner ramandeep singh gambhir (RSG) who was calibrated in the department conducted all the examinations. Intra examiner calibration was undertaken by examining 40 subjects followed by their re-examination a week later which resulted in 87% of the diagnostic acceptability with a k = 0.84. A well-trained assistant was also taken for recording the data. Periodontal examination was conducted in the bus depot using additional artificial light.
Data were entered into a personal computer and were analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 13.0 for Windows). Qualitative data were summarized using frequencies and percentages. Parametric tests were used for comparisons involving continuous data. One-way analysis of variance used to determine differences at the 5% significance level (P < 0.05) whereas proportions were compared by the use of Chi-square test. P < 0.05 was selected to denote statistical significance. Multiple logistic regression analysis was conducted to assess the robustness of the association between periodontal health and independent variables like age, brushing habits, sort of job, etc., Regression permits the assessment of both the statistical significance and the direction of the association between the exogenous variable and the predictor variable of interest.
| Results|| |
Subjects' mean age was 45.3 ± 7.8 years. A total of 97% (978) males and 3% (30) females were interviewed and examined [Table 1]. As the number of female subjects was almost negligible as compared to their male counterparts, no attempt was made to relate gender to any of the findings of the study.
Majority of the subjects, 51.3% (518) belonged to lower middle class, and 55.4% (558) were educated till high school. Bus drivers constituted 45% (453) of the study population, 35% (352) were conductors and 20% (203) of the study population comprised of administrative and clerical staff. Among the self-reported systemic conditions, 12.5% reported to be suffering from hypertension and 4.9% with diabetes mellitus. 55.2% (556) of the subjects were alcoholics and 19.8% (187) of the subjects had a habit of using tobacco. 88.7% of the subjects used to clean their teeth at least once a day and 85.7% of the subjects used toothbrush and toothpaste to clean their teeth. Only 2.8% of the subjects used toothpaste and tooth powder [Figure 1].
Of the 1008 subjects, 10 (0.99%) were excluded from the CPI computations either because of edentulousness or because extractions indicated for remaining teeth would have rendered the subjects edentulous. [Figure 2] illustrates the periodontal status of the study population and shows a varied prevalence of periodontal disease in the study population. 50% of subjects in the upper high SES category and 9.5% of subjects in the poor SES category had a CPI score of 0 indicative of a healthy periodontium [Table 2]. On the contrary, none of the participants in the upper high SES category and only 2% of subjects in the high SES category had a CPI score of 4, indicating a periodontal pocket of 6 mm or more, whereas 4.7% of subjects in the poor SES category had this recording. This clearly suggests that more number of subjects in the upper class people had healthy periodontium whereas people having deep periodontal pockets were more in the lower class. Periodontal condition as measured by maximum CPI score per person showed that in the group studied there was statistically significant association of SES with the CPI score (P < 0.05). 85.7% of the subjects in the high and 80.8% of the subjects in the upper SES category had a loss of attachment score 0 (no loss of attachment or loss of attachment <3 mm). None of the subjects in the upper high, high, and upper middle SES category had a loss of attachment score 4 whereas 0.3% of the subjects in the lower middle SES category had a loss of attachment score 4. Here too, the percentage of subjects having loss of attachment score 0 was more in the upper classes and the percentage of population having loss of attachment score 4 was high in the lower classes. The results were statistically significant [Table 3].
|Figure 2: Distribution of study subjects on the basis of community periodontal index|
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|Table 2: Distribution of CPI score according to SES of study population |
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|Table 3: Distribution of loss of attachment scores in different SES categories |
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When education was compared with the health of the supporting structures, it was found that 25.9% of the postgraduates had a CPI score of 0 indicative of healthy periodontium as compared to only 5% of illiterate ones (P < 0.01) [Table 4]. In contrast, none of the subjects with the postgraduation had a CPI score of 4 indicating periodontal pocket of 6 mm or more. CPI score per person showed that in the group studied there were also statistically significant association of educational status with the CPI score (P < 0.05). 80.9% of the subjects who were graduates and 81.4% of the subjects who were postgraduates had a loss of attachment score 0 depictive of no loss of attachment or loss of attachment <3 mm [Table 5]. None of the postgraduate subjects had a loss of attachment score 4 (loss of attachment >12 mm) whereas 0.7% high school subjects had a loss of attachment score 4. The findings were statistically significant.
|Table 4: Distribution of maximum CPI score according to educational status |
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|Table 5: Distribution of loss of attachment scores in different educational categories |
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Multiple logistic regression analysis was also conducted to assess the effect of various independent variables like age, SES, brushing habits and sort (nature) of job of the subjects etc., on the periodontal health status using the information obtained from the subjects. Odds ratio was also generated [Table 6]. The odds of occurrence of periodontal disease were 2.23 times greater in subjects who were brushing less than once a day as compared to those who were brushing once and more than once a day. Subjects belonging to upper middle, lower middle, and poor SES were 3.13 times more at risk of developing periodontal disease than those who belonged to high and upper high category. The risk of developing periodontal disease also increased 3.13 times for those having education less than high school and 1.62 times for those using finger and toothpowder/paste for brushing their teeth.
| Discussion|| |
The present study was conducted to provide significant information on periodontal health of transport workers in a region that would aid in the future planning and evaluation of community oral health education and intervention programs. Moreover, previous data on the prevalence of periodontal disease in transport workers are not available; hence, the study was conducted to gather these baseline data for future comparisons. The basis for this comparison was to assess the impact of differences in occupation, lifestyle, and healthcare utilization on dental health. The comparison of the present study can be done with other workers like factory and industrial workers and general population as no previous comparable data are available.
In the present study, approximately 20% of the subjects used tobacco in some or the other form as compared to some other study in which nearly 50% of the subjects were using tobacco.  Moreover, a combined tobacco usage was observed among 49.4% of salt lake workers in India, which is much higher than the present study findings.  Furthermore, percentage of subjects who used tobacco and drink alcohol were comparatively less in the present study as compared to another study conducted on the public bus and trolleybus transport employees. 
Percentage of subjects free from any signs of periodontal disease was also similar with some other study.  More number of subjects in the study had disease confined to reversible gingivitis which is contrary to that reported by some other studies. , This could be due to the reason that a large percentage of subjects used to brush their teeth at least once a day. The most prevalent treatment need in the study was plaque control and scaling which was also in agreement with the results a study conducted by Roman and Pop.  Calculus and shallow pockets observed were same with the some other study also  but a lesser percentage of subjects in the study had deep pockets. The prevalence of shallow and deep pockets as depicted by the CPI score was much lower in the present study as compared to some other study. 
There is a strong correlation between SES and health.  Income level is positively correlated with health status: The lower the income, the lower the status of health. This situation is compounded by the fact that people on low income are less able to buy goods and services related to health and less able to pay the costs involved in accessing them. This could be explained on the basis of statistically significant association of SES with CPI score and attachment loss in the present study. This finding is similar to some other study findings. , Moreover, there is a statistically significant rise in the percentage of healthy sextants from low socioeconomic category to the higher one in the present study and some other study conducted in West Bengal in India. 
Education and SES are clearly shown to be risk factors that are inter-related and inter-dependent for causing periodontal disease.  Very often, meager earning capacity of people is a consequence of lesser educational attainment, and this predicament may lead to stress causing adverse periodontal conditions.  The risk of experiencing periodontal pockets and increased loss of attachment was more in case of subjects who were illiterate and subjects having education till middle of high school as compared to the subjects who were graduates and postgraduates in the present study. Similar findings with regard to the impact of less education level on periodontal conditions have been reported by other researchers also. ,, Reports of another study conducted on kota stone industry workers in India also revealed similar findings. 
| Conclusion|| |
The sample of transport workers provides a unique opportunity to study a population from diverse socioeconomic backgrounds. In the present study, advanced periodontal disease (CPI score, 4) affected small number of subjects with maximum subjects (73%) having a CPI score of 2. There was also statistically significant association of SES with the CPI score and attachment loss. Educational status of the workers was also found to have a significant association with the periodontal health as seen from the CPI score and loss of attachment level. Therefore, it is emphasized that during any dental program planning, priority should be given to people belonging to lower social-class and low educational status having higher prevalence of dental diseases.
| Acknowledgement|| |
The authors would like to thank Honorable Chairman, M.M. University, Mullana and Director, Chandigarh Transport for granting permission to conduct this study.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]