Assessment of oral health status and treatment needs among TSRTC employees in Hyderabad City, Telangana, India

INTRODUCTION

Health is a basic human right and a vital asset not only for individuals but also for society as a whole.¹ A nation's progress may be accelerated if its citizens are healthier and live more productive lives.² The interplay and integration of two ecological facts those are internal environment of man and the external environment that surrounds him.³ As man progressed into the modern age, he was exposed to newer living styles, a lack of physical exercise, stressful working conditions, and harmful behaviors such as smoking, alcohol drinking, and dietary changes, all of which might have a negative impact on his overall and oral health.⁴ In these cases, the occupational environment is critical; it refers to the totality of external conditions and influences that exist in the workplace and have an impact on the health of the workforce.^2,5 Today's transport professionals labor in a very complex environment that is only getting more sophisticated as man's ingenuity grows.¹

Oral health is an important element of overall health and contributes to a higher quality of life.⁶ An individual with a problem-free mouth can eat, speak, and mingle without any active disease, symptoms, or embarrassment.⁷ Despite ongoing efforts around the world, oral health continues to be undervalued and neglected.⁸ Mouth disorders are multifactorial in nature, affecting people of all ages in all parts of the world; nearly no one can avoid oral difficulties over the course of their lives. Environmental factors play a role in poor oral health in many industries, as the oral cavity is a point of entry for many diseases and has numerous unique characteristics that make it particularly vulnerable to occupational disorders. Occupational exposure has been linked to an increased frequency of oral illnesses in studies.^6,9,10

Industrialization is a global trend that has resulted in a slew of occupational health issues and disorders among transportation workers.¹¹ Workers may be exposed to a hazardous workplace that includes various physical variables such as noise, vibration, and climatic conditions, all of which have been shown to have a negative impact on their health.^6,12 Because of the mechanical existence that they are compelled to live in metropolitan cities, the average man's life is exceedingly stressful. Several cities have different modes of public transportation. The state government will provide transportation services to the people in most metropolitan cities, and a local transportation network will operate with the support of government and private firms.

According to the 2011 national census, Hyderabad is the metropolitan capital of Telangana state, with a population of about 67 lakhs. Because the city is so large, encompassing over 650 square kilometers, travelling from one location to another is unavoidable for a variety of reasons, including work, school, and recreation.¹³ The public transportation system in Hyderabad is extremely important for the general public's transportation. Buses are the most often used public transit option, and many people favor them because of their cost effectiveness. The Telangana State Road Transport Corporation (TSRTC) is the organization in charge of Hyderabad's public transportation bus system.

Various issues like as work shifts, workplace environments, and lengthy working hours have a substantial negative impact on drivers' health. Drivers' job load is high in nerve psychological strain, and they are impacted by stress, mechanical vibration, shock, and fuel evaporation, the influence of high temperatures, noise, and pollution.¹⁴ Drivers and conductors travel hundreds of miles without stopping for food, relaxation, or sleep. The majority of drivers and conductors have their meals at mid-way dhabas or hotels. Due to their hectic schedules, people frequently use tobacco in the form of smoking and chewing to reduce tension and stay awake while traveling.¹²

As a result, in addition to general health, bus drivers' dental health suffers as a result of the lower priority paid to it. The usage of tobacco products and poor oral hygiene habits contribute to this population's oral disease burden.¹⁵ The current data on TSRTC employees' oral health is insufficient to plan appropriate dental care delivery to satisfy their oral health care needs. Since then, this study has been planned to analyse the oral health status and treatment needs of TSRTC employees in Hyderabad city of Telangana.

METHODS

A cross-sectional survey was conducted among employees working at Hyderabad's four major bus depots (Uppal, Tharnaka, Afzal Gunz, and Miyapur). Permission to conduct the study was received from the recognized Bus depot's Chief Medical Officer. Before clinical assessment, all study participants signed a written informed consent form. The Institutional Review Board of Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre (PMVIDS&RC/IEC/PHD/DN/0122-16) gave its approval. The research was carried out in line with the Helsinki Declaration.

A pilot study was conducted among 30 employees working in working in the TSRTC Corporation, Hyderabad. It was done to assess the feasibility, to estimate the sample size and to finalize the survey proforma.

n =Z²pq/d²

Z=Standard normal variant value (Z-value) =1.96

p=Proportion or prevalence of interest and q= 100-p (alternative prevalence)

d=clinically acceptable error (sample error – population proportion = 5%

With a confidence level of 95% and sampling error at 5%, the estimated sample size obtained was a minimum of 360 subjects required.

The study population consisted of 404 people, and oral health was examined using the World Health Organization (WHO) Oral Health Assessment form from 1997.¹⁶ Subjects who were completely edentulous, employees undergoing orthodontic treatment, underwent oral prophylaxis in the last 3 months and who did not give informed consent were eliminated from the study, with the exception of bus drivers and conductors. The poll was done throughout the working hours of the chief medical officer's personnel. The research was carried out during a three-month period, from March to June 2021.

Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyze the data. The Chi-square test, t-test, and Analysis of Variance were used to compare study population proportions and mean scores (ANOVA). The relationship between the risk factors and dental caries was determined using logistic regression analysis. Statistical significance was defined as p≤0.05.

RESULTS

The study population consisted of a total of 404 individuals, with 336 (83.2%) males and 68 (16.8%) females. The majority of the participants were between the ages of 30-45 (257; 63.6%) and about 82 subjects (20.3%) had a university education. The study population consisted of 395 (97.8%) married people, 205 (50.7%) of whom had previously seen a dentist, and 199 (49.3%) workers who had never visited one. In contrast to cigarette usage, more than half of the employees (261; 64.6%) had a negative history of alcohol intake; in contrast, more than half of the subjects (228; 56.4%) had an alcohol habit (Table 1).

*p value <0.005 statistically significant.

With regards to Oro-mucosal conditions, majority of the subjects had no abnormality; very few people among subjects aged 30-45 years (4.5%), females (3.3%) and those with high school education (2%) had shown presence of ulcerations in their mouth. On the other hand, males had significantly higher percentage of having leukoplakia (2.5%) when compared to other conditions. (p=0.000) (Table 2).

Similarly when observed for Oro mucosal locations, subjects aged 30-45 years, males and those with primary education had shown higher percentage for buccal mucosal lesions (4.2%, 3.2% and 2.5% respectively). However, only gender has shown statistically significant (P=0.00) relationship (Table 3).

*p value <0.005 statistically significant

*p value <0.005 statistically significant

*p value <0.005 statistically significant

With regards to Mean score comparison based on age had showed that, subjects belongs to the 30-45 years age group had significantly preponderance for code-0 (Healthy) (3.27±2.151) and bleeding gum on probing (code-1) (1.74±1.902) (p=0.005). Regarding gender, males had significantly dominant for calculus (code-2) (1.55±1.956), and shallow pockets (code-3) (0.42±1.133) than females. On the other hand, subjects with lower education level had significant higher mean CPI scores. (p=0.005) (Table 4).

In present study, 46-60 years had significantly (p=0.005*) higher mean scores for no attachment loss (code-0) (5.56±1.079) and Code-1 (0.44±1.079). Similarly, females and those with university education also had significantly (p<0.05*) higher mean score for no attachment loss (code-0) (5.99±0.121&5.98±0.155 respectively). However, males and subjects with primary education had loss of attachment of 4-5 mm (Code-1) (0.20±0.751&0.26±0.756 respectively). These differences were statistically significant. (p≤0.005) (Table 5).

With regards to age, 46-60 years hand significant (p<0.05) higher mean score for Missing Teeth (0.29±0.95), filled teeth (0.29±0.73) and overall DMFT (3.31±4.44) than subjects with age 30-45 years. However, males (2.11±3.33) and subjects with primary education (2.61±3.85) had significant (p=0.005) higher mean DMFT score than females and subjects with higher and university education. However, comparable means scores was observed for Decayed, Missing and Filled Teeth (p>0.05) (Table 6).

With regard to the treatment needs, among 30-45 years age group, majority of subjects required extraction(14.9%) followed by pulp care (13.1%). However significance difference was observed only for extraction (p=0.058). Likewise, with 45-60 years age group showed significantly (p<0.005) dominant for crowns for any reason (8.9%). Considering gender, higher percentage of males required extractions, followed by pulp care and two surface fillings (16.1%, 16.1% & 4.2% respectively) among this only two surface fillings showed significant difference (p<0.005). With respect education majority of the subjects with high school education required extractions, followed by pulp care and one surface fillings (8.2%, 8.1% & 4.7% respectively) and there was no statistical difference. (Table 7)

*p value <0.005 statistically significant

*p value <0.005 statistically significant

*p value <0.005 statistically significant OR- Odds Ratio

With regards to age, subjects age 30-45 years age group had significantly higher odds for root caries (1.3), CPI (1.6), LOA (1.4), and oral mucosal conditions.(p<0.05). Based on gender, it was noticed that even though males had higher odds for all the characters, significant association was observed only for CPI (2.5) and oral mucosal conditions (4.5). (p<0.005). Considering educational status, subjects with primary education were significantly greater risk of having CPI (2.6), LOA (2.8), oral mucosal conditions (1.8) and oral mucosal locations (1.5). (p<0.005). Nevertheless, those with high school education showed significantly higher prone for crown and root caries (1.9 and 2.1 respectively) (p<0.005) (Table 8).

DISCUSSION

There is significant evidence that occupation has an impact on health and well-being, and the impact of occupation on health has multiple aspects.^17,18 A "negative change in health state directly arising from more or less prolonged exposure to dangerous substances or situations directly related to the individual's work" is an occupational disease.¹⁹ As a result, it is critical to investigate the impact of occupation on health. Because the mouth cavity is a point of entry for many diseases6, environmental hazards contribute to poor oral health in many vocations.

The outcomes of this study show that TSRTC personnel had a high prevalence of dental caries and periodontal disease.²⁰ To achieve the study's goal, participants were asked to provide a history of oral mucosal disorders, their periodontal state was determined using the CPI and LOA index, and their dentition status and treatment needs were determined using WHO codes and criteria (1987).¹⁶ The study had a higher proportion of male employees and a lower proportion of female employees, most of whom were conductors; similarly, Zaitsu et al found that male employees outnumbered female employees. This could be related to the fact that driving is a difficult career with erratic hours and family obligations, making women less interested in it.²¹

According to the current report, the majority of them have completed high school. This is due to the fact that only government drivers who have completed their secondary school are eligible to work for TSRTC. It appears to play a significant impact in both knowledge and attitudes, as well as a movement in consumption criteria from basic necessities coverage to income disposal aimed at improving quality of life. In contrast, a research on professional truck drivers done by Aguilar-Zinser et al found that the majority of the study subjects had completed their primary school education.¹⁸

In the whole study population, 199 workers (49.3%) had never visited a dentist. This was in line with research conducted in Mysore by Reddy et al among Karnataka state road transport 55.6% of drivers visited the dentist.³ Other studies reveal that due to a lack of oral health awareness, dental neglect, and fear of dentists, as well as a lack of time due to a less flexible work schedule, the cost of treatment was too expensive, and people only visited dentists when they were in a serious condition.^22-24 Many studies among transportation workers revealed evidence of increased cigarette and alcohol consumption.^19,20 Similarly, more over half of the workers in the current study (56.4 percent) drank alcohol, but fewer workers smoked cigarettes (35.4%).

One probable explanation is that they operate under stressful conditions as a result of long hours and lack of sleep. As a result, they use alcohol as a sedative to cope with their stress.¹² Long hours of driving and infrequent shifts have been linked to a higher prevalence of leukoplakia (3.1%) in studies.^3,20,24 In contrast to previous research, we found a low prevalence of leukoplakia (2.5%) and ulcerations (5%), with the most afflicted sections of the oral cavity being the buccal mucosa (5.4%) and tongue (1.2%).

This could be because management provides frequent medical services to their staff. Nonetheless, it is a substantial public health issue that must be addressed. According to the Community Periodontal Index (CPI), bleeding after probing (27.8%) was the most common periodontal problem among study participants in both age groups, with males (52.2%) being affected more than females (13.8%). Their poor dental hygiene habits, such as infrequent and inadequate brushing and flossing, are most likely to blame for this problem.

A periodontal pocket of 4-5 mm was found in 19.4% of the participants in this investigation (code 3). This result was lower than that reported in other studies, such as Ahmed et al (72.67 percent) among Nellore bus drivers and Sanadhya et al (46.8 percent) among industrial population in Uttar Pradesh, India.^25,26 It's possible that this is attributable to their poorer educational attainment, longer driving experience, and regular use of alcohol and tobacco.¹⁹

The bulk of the participants (40.2%) in a research done by Chandra et al among bank employees in Bangalore exhibited with LOA 4-5 mm.²⁷ Plaque, supra-gingival, and sub-gingival calculus were all found to be significant correlates with the existence of LOA in this investigation. This is owing to the fact that the numerous forms of pressures experienced by bank personnel are linked to plaque formation, calculus, and attachment loss. In contrast to the data above, we discovered that roughly 27.6% of both age groups exhibited attachment loss of 6-8 mm (code-2) and 22.4 percent had 4-5mm attachment loss (code 1). Other investigations by Gambhir et al revealed that attachments 4-5 mm and 6-8 mm were lost at a rate of 11.9 percent and 5.9 percent, respectively, while Singh et al reported that the reason was the availability of regular medical and health insurance services to them (17.5 percent).^19,28

Male participants and those with a high school diploma had the highest prevalence of decaying crowns (34.4 percent and 17.9 percent respectively). Previous research by Reddy et al shown that the frequency of dental caries was higher than previously thought (45.7 percent).³ It was 63.1 percent in a research by John et al among drivers.⁸ This is because they spent the most of their time on wheels and practiced poor mouth hygiene at the time. Dental caries was found to be prevalent in 54.3 percent of police officers in Haryana, according to Sohi et al.²⁹

Workers in the current study who were 46-60 years old and had only a primary education had significantly higher mean DMFT scores (3.31±4.447, 2.61±3.856, respectively), which was in contrast to a study conducted by Aguilar-Zinser et al among Mexican drivers who had significantly higher mean DMFT scores (9.86±6.05), which could be due to smoking and 'poor' oral hygiene practices. Smoking caused 7.07 deaths among truck drivers in Chennai, according to Shalini et al. It was 3.23±2.89 among Nellore bus drivers, according to Ahmed et al.^15,17,25

The majority of the workers required extraction (20.3 percent), pulp care (20 percent), crowns (11.9 percent), and one surface filling (9.7%). Due to a lack of time for dental services, non-availability, and the high cost of treatment, 85.7 percent of Karnataka state road transport drivers needed extractions, 38.5 percent needed restorations, and 88.8 percent needed root canal treatment, according to a study conducted by Reddy et al among Karnataka state road transport drivers.³

Root caries was shown to be more prevalent in the 30-45 year old age group, according to a logistic regression study. The findings of Akrad et al and Peterson et al were similar.^30,31 This could be due to the accumulation of oral illness as people get older. It was also discovered that people with a high school education had a 1.9 times higher chance of rotting teeth than those with a primary school education. Education level has been found to have an impact on oral health and should be taken into account when assessing risk and planning suitable preventative measures.³²

Subjects with a primary education were more likely to have periodontal pockets and attachment loss; Craig et al discovered that unskilled and skilled employees in New York had more severe periodontal pockets and attachment levels than professionals.³³ According to a nationally representative cross-sectional survey in Japan, men in lower-status occupations, such as service, transportation, and labor, were significantly more likely to engage in health-risk behaviors, such as smoking, alcohol consumption, or physical inactivity, which are known risk factors for periodontal disease.³⁴

Limitations

Variables like oral hygiene practices, frequency of sugar consumption and duration of exposure which might have significant effect on oral health were not recorded. Also, relying on self-reported data for few parameters might possibly lead to bias. Moreover, being cross-sectional in nature, the study lacks the ability to draw inferences about causal relationships.

CONCLUSION

The current study's findings provide insight into the oral health of TSRTC employees in Hyderabad, India. Workers reported a high prevalence of dental caries, poor periodontal condition, substantial oro-mucosal lesions, and unmet dental treatment needs, according to the study. Oral health was found to be compromised, which could be related to long work hours, harmful oral practices such as smoking and alcohol intake, and a lack of understanding about the importance of oral health.

As a result, there is an urgent need to focus on these high-risk populations, with a particular emphasis on primary oral health care programs such as dental screening and oral education at regular intervals, which will assist to prevent the accumulation of employee health-care demands.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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