|Year : 2015 | Volume
| Issue : 4 | Page : 342-348
Oral hygiene practices and its relationship with periodontal status among police personnel of Bhopal city, Central India: An epidemiological study
Aishwarya Singh1, Ajay Bhambal1, Sudhanshu Saxena2, Vidhatri Tiwari3, Utkarsh Tiwari4, Ratika Shrivastava5
1 Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Public Health Dentistry, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
3 Department of Public Health Dentistry, People's Dental Academy, Bhopal, Madhya Pradesh, India
4 Department of Pedodontics and Preventive Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
5 Department of Periodontology, Rishiraj College of Dental Sciences, Bhopal, Madhya Pradesh, India
|Date of Web Publication||18-Sep-2015|
64, Vaishali, Kotra, Bhopal, Madhya Pradesh
Source of Support: Nil., Conflict of Interest: No.
Background: To assess the oral hygiene practices, oral health awareness, and oral health status of police personnel in Bhopal city and to suggest measures to improve the present oral health status. Materials and Methods: The cross-sectional study was conducted on 781 subjects, mean aged 40.5 years, who were selected by simple random sampling. Type-III examination of the subjects was conducted and along with questionnaire, community periodontal index (CPI), loss of attachment index and decayed, missing, filled teeth (DMFT) data was recorded on modified W.H.O format 1997. A value of P ≤ 0.05 was considered statistically significant. Results: Awareness related to oral health diseases, its cause, and prevention was low among police personnel. DMFT was significantly lower among this group. CPI score 2 was highest among the majority of subjects. Subjects brushing twice daily had significantly healthy periodontium than those brushing once daily. Conclusion: Most of the police personnel lack oral health awareness and suffer from periodontal diseases. Awareness should be created to maintain good oral hygiene, regular dental checkup and refrain from smoking among police personnel.
Keywords: Dental caries, oral health awareness, periodontal disease, police personnel
|How to cite this article:|
Singh A, Bhambal A, Saxena S, Tiwari V, Tiwari U, Shrivastava R. Oral hygiene practices and its relationship with periodontal status among police personnel of Bhopal city, Central India: An epidemiological study. CHRISMED J Health Res 2015;2:342-8
|How to cite this URL:|
Singh A, Bhambal A, Saxena S, Tiwari V, Tiwari U, Shrivastava R. Oral hygiene practices and its relationship with periodontal status among police personnel of Bhopal city, Central India: An epidemiological study. CHRISMED J Health Res [serial online] 2015 [cited 2019 Jun 18];2:342-8. Available from: http://www.cjhr.org/text.asp?2015/2/4/342/165733
| Introduction|| |
Oral health and general health are governed by various factors such as lifestyle, dietary habits, socioeconomic conditions, occupational environment;, etc. Oral health means more than healthy teeth. Oral health enables an individual to speak, eat and socialize without active disease, discomfort or embarrassment. Oral health contributes to personal well-being and quality of life. Oral diseases afflict humans of all ages and in all regions of the world. Practically no individual in the course of their lifetime escapes from dental diseases.
Occupational environment plays a major role on the health of the exposed. The health hazards get more severe with the difficulty of the job. Policing is a complex occupation. As, there is a wide range of activities involved in police work; there are many health and safety issues surrounding policing as an occupation.
The place that is occupied by the police in a state is similar to the place occupied by the military in a nation. Oral health of recruits is a subject of many epidemiological studies. A study conducted by Hopcraft et al. reported that caries experience in Australian army recruits aged 17–25 years increased between 2002–2003 and 2008 and the mean decayed, missing, filled teeth (DMFT) scores increased from 3.16 to 7.11 for recruits aged 17–35 years, respectively.
In India, a study conducted by Sohi et al. among police personnel demonstrated the prevalence of dental caries as 54.3%, and the mean DMFT was 3.05. Regarding highest community periodontal index (CPI) score, 61.3% had calculus. A distinct study done by Naveen and Reddy  among police personnel in Mysore city reported that the prevalence of periodontal disease as 99.7%, dental caries as 67.2% and total DMFT was 2.62.
It is the responsibility of the society to safeguard the general and oral health of their own defenders. Thus, is important that research be completed on the oral health issues of police officers in order to identify hazards and ways to reduce risk.
No epidemiological data have been reported on the oral health status of police personnel of Bhopal city. This information is important for establishing priorities and determining the type and quantity of prevention and treatment services required, as well as the type of personnel required to provide them.
Keeping this in mind this study was undertaken to assess the oral hygiene practices, knowledge and awareness among police personnel of Bhopal city, and to co-relate it with their caries and periodontal health status. The study also attempts to suggest measures for planning programs for the improvement of their oral health.
| Materials and Methods|| |
A descriptive cross-sectional study was conducted among all the active police personnel posted at various police stations of Bhopal city, Madhya Pradesh, Central India. The list of all the police stations and sanctioned strength of district executive force posted at various police stations in Bhopal city was obtained from police head Quarters. The total sanctioned strength was found to be 2109 which included inspectors, sub-inspectors, assistant sub-inspectors, head constables and constables, posted at 35 police stations. A pilot study was conducted to arrive at the sample size of 781.
On an average 35–40 policemen are available at one time in a police station. The police stations were selected on a random basis through lottery method and were visited till the sample size was achieved. A total of 22 police stations were visited. The Head of the selected police stations were contacted and informed about the schedule of the survey, so as to ensure maximum participation. Selected police stations were visited, and each policemen present on the day of examination were included in the final sample of the present study. Subjects who were absent on the day of the examination or were on external assignments were excluded from the study.
A predefined performa  was used to record information about demographic data, oral hygiene practices, dietary habits, adverse habits, systemic information, knowledge and experience of the dental problem, information about the dental visit. The proforma was filled by interviewing policemen prior to examination. The clinical examination was conducted using CPI, loss of attachment index (LOA) and WHO dentition status for dental caries from the WHO Oral Health Assessment form (1997).
The permission to carry out this study was obtained from institution's ethical committee. Furthermore, permission was taken from the senior superintendent of police before the examination. A schedule was prepared for data collection. One police station was to be examined per day. The study was to be conducted for a period of 3 months, from January 2014 to March 2014 across the police stations in Bhopal city.
Before conducting the survey, the training and calibration of the examiner were done. Intra-examiner reliability was assessed using kappa statistic that was in the range of 0.80–0.85.
The examination was done in premises of the respective police stations. Subjects were examined seated in a chair, under natural daylight. The subjects were positioned so as to receive maximum illumination while avoiding discomfort from direct sunlight.
The data obtained was subjected to statistical analysis with the consult of a statistician. The Chi-square test was used to analyze categorical variables. Mann–Whitney test was used to compare findings between two different groups and Kruskal–Wallis test was used to compare means between three or more groups. Statistical analysis was carried out using Statistical Package for Social Science (SPSS Version 17; Chicago Inc., USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons. The significance level was fixed at P ≤ 0.05.
| Results|| |
A total of 781 police personnel were examined, out of which 747 (95.6%) were males and 34 (4.4%) were females. The study sample comprised of 448 (57.4%) constables, 180 (23%) head constables and 153 (19.3%) officers. On further dividing, the population four age groups are observed. The age group 21–30 years comprises of 182 (23.3%) police personnel, 176 (22.5%) police personnel belong to 31–40 years of age, maximum that is 287 (36.7%) police personnel belong to the age group of 41–50 years, whereas minimum that is 136 (17.4%) subjects belong to the age group of 51–60 years. The mean age being 40.5 years [Table 1].
Out of 781 police personnel 645 (82.6%) used tooth brush, tooth paste was used by 717 (91.8%), 673 (86.1%) brushed their teeth once daily, 399 (51.1%) subjects brushed in horizontal motion. It was observed that 496 (63.5%) always rinsed their mouth after eating, and a total of 621 (79%) police personnel did not use any other oral hygiene aids. Out of the total population 387 (49.6%) subjects did not consume sugar in last 24 h [Table 2].
|Table 2: Distribution of subjects according to their oral hygiene practices|
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On putting together the reported awareness of oral health problems of police personnel it was found that 202 (25.8%) were unaware of oral health problem, 246 (31.4%) reported tooth decay, 273 (34.9%) gum diseases, 28 (3.5%) bad smell, 8 (1%) ulcers, and 24 (3%) reported stained teeth as oral health problems [Table 3].
|Table 3: Distribution of subjects according to their awareness related to oral diseases|
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On compiling the reported awareness of cause of oral health problems it was found that 356 (45.5%) were unaware of the cause of oral health problem, whereas, 74 (9.5%) reported eating sweets, 195 (25%) reported not brushing, 44 (5.6%) reported not rinsing, and 112 (14.3%) reported consuming tobacco causes oral health problem. Out of the total population 320 (40.9%) police personnel was unaware of the preventive measures. Among the rest 100 (12.8%) reported not consuming tobacco, 285 (36.5%) regular cleaning of teeth with brush, 30 (3.8%) visiting dentist regularly, 46 (5.9%) reported avoiding sweets, could prevent oral health problems [Table 4].
It was observed that 266 (34%) police personnel visited the dentist, out of which 224 suffered from an oral health problem, and 42 did not suffer from an oral health problem. Among the rest 515 (65.9%) subjects who did not visit the dentist 112 suffered from oral health problem, 391 did not suffer from oral health problem and 12 were not sure whether they suffered from oral health problem or not. Out of 266 police personnel who visited the dentist, 94 (35.3%) reasoned dental caries, 52 (19.5%) gum diseases, 26 (9.7%) checkup, 76 (28.5%) extraction and 18 (6.7%) reported prosthesis as the reason to visit the dentist. Among 515 police personnel who did not visit the dentist 116 (22.5%) reasoned lack of time, 313 (60.7%) felt there was no problem and 86 (16.6%) neglected the problem.
Out of 781 police personnel, 183 (23.43%) had healthy periodontium. bleeding was present in 119 (15.2%) subjects, calculus was present in 245 (31.3%) subjects, pocket of 4–5 mm was present in 220 (28.1%) subjects, pocket of 6 mm or more was recorded in 8 (1%) and in 4 (0.5%) subjects, it was excluded and not recorded in 2 (0.2%). Out of 781 police personnel, 418 (53.5%) had no loss of attachment. An attachment loss of 4–5 mm was present in 192 (24.5%) subjects, 6–8 mm attachment loss was present in 150 (19.2%%) subjects, 9–11 mm was present in 15 (1.9%%) subjects, in 4 (0.5%) subjects it was excluded and not recorded in 2 (0.2%). There exists a significant association of LOA scores with post (P = 0.00), age (P = 0.00) and education (0.00).
An association was established between oral hygiene practices and highest CPI score. It was found that the periodontal status presented a statistically significant association with the material used for cleaning of teeth (tooth brush or tooth paste) (P = 0.00). There also exists a significant association between rinsing of the mouth with water and periodontal status (P = 0.04) [Table 5].
| Discussion|| |
The study area Bhopal city, being the capital of the state Madhya Pradesh, possesses all the major administrative offices, the legislative assemblies, and political offices, thereby present a challenge to maintain law and order in the city. These factors keep policemen under constant workload and stress, which makes it common for them to neglect their general health including oral health.
A thorough literature search revealed very few studies related to oral health of police personnel. The present study to our knowledge is thefirst epidemiological study related to oral health among district police personnel of Bhopal city.
The study comprised of 747 (95.6%) males and 34 (4.4%) females. With 930 females against 1000 males  in Madhya Pradesh state more females should be recruited in police force to provide equal gender distribution.
Assessment of oral hygiene practices is thefirst step in analyzing oral health status. The oral hygiene practices of the police personnel revealed that 82.6% used tooth brush, 91.8% people used toothpaste, and 86.1% cleaned their teeth once daily. These parameters were also assessed in National Oral Health Survey and Fluoride Mapping 2002 (Madhya Pradesh) which reported only 54.7% respondents used tooth brush, 54.3% used tooth paste and 77.7% cleaned their tooth once daily. It was found that 51.1% subjects brushed in horizontal motion, 63.5% always rinsed their mouth after eating and 79% subjects did not use any other oral hygiene aids. Similar results were demonstrated in study conducted by Naveen and Reddy  among police personnel of Mysore city which reported that 96% of the study population used tooth brush and tooth paste, 66.6% brushed utilizing horizontal method and 81.4% brushed once daily.
The oral hygiene practices varied significantly across the age groups, posts and education level. Oral hygiene practices depend on a dynamic interplay of many factors, including individual's personal characteristics, behavior and perceptions. The findings concerning the oral hygiene practices are subjective and there may be a certain amount of error associated with self-reported behavior.
A dynamic relation exists between sugar consumption and oral health. An assessment of previous day (24 h) sugar intake recall was conducted and it was found that 49.6% subjects did not consume sugar in last 24 h; similar to 44.7% respondents who did not consume sugar as reported in National Oral Health Survey and Fluoride Mapping 2002 (Madhya Pradesh). This can be attributed to the usual dietary pattern of the Madhya Pradesh state.
Alike National Oral Health Survey and Fluoride Mapping 2002 (Madhya Pradesh) three questions were asked about awareness of dental health problems. Thefirst about common dental problems, the second about major factors responsible for the problems and the third how to prevent the problems. Overall 621 (79.5%) of police personnel were aware of the oral health problems. The awareness showed significant difference between the posts, age groups, and education. A similar result was reported in National Oral Health Survey and Fluoride Mapping 2002 (Madhya Pradesh) where 56.1% respondents reported gum disease and 27.1% reported tooth decay as a common oral problem. The survey highlighted an important gap in knowledge and awareness of police personnel regarding the cause and prevention of oral health problems. In contrast to National Oral Health Survey 2002 (Madhya Pradesh) where only 12.7% respondents were unaware of causative factors and 17.1% were unaware of preventive measures, in the present study 356 (45.5%) were unaware of causative factors and 320 (40.9%) were unaware of preventive measures related to oral health problems. One hundred ninety-five (25%) police personnel reported not brushing regularly as the major causative factor and 285 (36.5%) reported regular cleaning of teeth with brush as the chief preventive measure; similar to National Oral Health Survey 2002 (Madhya Pradesh). Such high level of unawareness may influence an oral health care seeking behavior.
In the present study, police personnel were asked if they had any oral health problem in last 1-year and whether they visited a dentist. Out of 781 police personnel, 336 reportedly suffered from dental health problem; mainly dental caries [94 (35.3%)] but only 224 visited the dentist. Lack of time was reported as an obstacle by 116 (22.5%) police personnel. In the DCI survey of 2002 (Madhya Pradesh) 25.9% subjects suffered from an oral health problem, and only 16.3% visited the dentist. This information suggests that the police personnel delayed the utilities of dental services unless they had problems such as pain and gum swellings. The results reflect that utilization of clinical facilities, although generated by a wide variety of factors, many of them psychosocial, is motivatedfirst and foremost by self-perception of illness.
Oral diseases, especially dental caries, and periodontal diseases are multifactorial and can be crippling in nature and hence require special attention. An assessment of periodontal status revealed that 75.8% subjects suffered from periodontal disease which is similar to the study conducted among police personnel of Ambala (75.9%) and Ghaziabad (82.2%), whereas higher prevalence was reported among police personnel of Mysore city (99.7%). The high prevalence of periodontal disease can be attributed to the irregular work shifts, high prevalence of adverse habits and lack of concentration on oral health in particular.
Calculus (31.3%) was found to be the most prevailing periodontal disease, being similar to study conducted by Naveen and Reddy  (31%) and Katz et al. (27%). Although the presence of calculus was the most common finding, yet the proportion of these subjects was less compared with that reported by Sohi et al. (61.3%). Whereas, in National Oral Health Survey 2002 (Madhya Pradesh) it is reported that bleeding was the most prevalent condition present, with or without calculus and pockets, except in the case of 65–74 years old subjects, where calculus or higher was the most prevalent. Pockets (4–5 mm) were present in about 5.7% and 11.3% subjects in the age groups of 35–44 years and 65–74 years.
Cultural factors are known to have an impact on patient's health behavior. On co-relating with oral hygiene practices method of cleaning of teeth (P = 0.00), frequency of changing toothbrush (P = 0.00) and rinsing of mouth with water after meals (P = 0.04) showed significant relation, with highest CPI score. Since oral hygiene remains to be a prime contributory factor in the maintenance of periodontal health, adequate oral hygiene measures are of prime importance, along with motivation and alleviation of local contributory factors.
Demonstration of the progression of periodontitis requires documentation of additional attachment loss. Naveen and Reddy  suggested that the reason for high number of subjects (65%) exhibiting no loss of attachment was because 70% of the population was below 45 years of age. This is further supported by our study where 64% of subjects were below 45 years of age. This may represent differences in health habits among younger subjects.
Investigation of caries profile revealed that 44.7% police personnel had dental caries, which is low as compared with National Oral Health Survey 2002 (Madhya Pradesh) which revealed that the percentage of subjects with caries experience at 35–44 years it was 84.8%. The caries experience is also low as compared to police personnel of Mysore (67.2%), Ghaziabad (67.37%) and Ambala (54.3%). The mean number of decayed teeth (1.27) was higher than that reported by Basavaraj et al.(2011) (0.87), whereas the mean number of missing teeth due to caries was 1.25 in the present study as compared to 2.25. Missing teeth due to caries was found to be increasing with age that is similar to study done in Ghaziabad. The police personnel lag in the utilization of dental services. This is demonstrated by the mean number of filled teeth which was as low as 0.13 (±0.84) comparable 0.10 (±0.39) of police personnel of Ghaziabad.
Though the study was conducted among police Personnel of one central Indian city, the sample size is fairly adequate and can reliably represent the overall pattern of oral hygiene practices in police personnel of India. Furthermore, the study results can be stated to have wider demographic applications as a whole because this sample represents various ethnic groups from different parts of India.
These findings present an opportunity to explore and understand what causes the neglect of oral health in particular. Police personnel is often busy and neglect their oral health. Understanding their pattern of oral hygiene practices and prevalence of oral diseases will help us to increase their efficiency for societal, economic, and readiness reasons. Health education and promotion, with its key concepts of equity and equality, empowerment and advocacy, offers an approach to improving both general and oral health. It shifts the responsibility for health from the formal health care system to individuals, communities and decision-makers at all levels of society. The professional examination and diagnosis should involve the felt and expressed dental needs. In both aspects, a crucial need for public health action is clearly evident.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]