|Year : 2022 | Volume
| Issue : 3 | Page : 172-177
Oral health status and treatment needs of chromium mine workers in India
Sandeep Kumar1, Priyaranjan1, Debashish Basak2, Barun Dasgupta3, Syeda S Nastaran Quazi4, Ashish Kumar5
1 Department of Public Health Dentistry, Dental Institute, RIMS, Ranchi, India
2 Department of Prosthodontics, Crown and Bridge, Hazaribagh College of Dental Sciences and Hospital, Rajasthan, India
3 Department of Pedodontics and Preventive Dentistry, Crown and Bridge, Hazaribagh College of Dental Sciences and Hospital, Rajasthan, India
4 Department of Oral Pathology, Jaipur Dental College, Rajasthan, India
5 Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
|Date of Submission||20-Jul-2021|
|Date of Decision||25-Mar-2022|
|Date of Acceptance||03-Apr-2022|
|Date of Web Publication||26-Sep-2022|
Dr. Sandeep Kumar
2B, Samvridhi Tower, Medical Chowk, Bariatu, Ranchi-09, Jharkhand
Source of Support: None, Conflict of Interest: None
Background: Several diseases are related to occupation. The workers in chromium mines may be exposed to hazardous environments. The objective of this research was to evaluate the oral health condition and treatment needs of chromium mine workers. Materials and Methods: This was a cross-sectional study conducted on workers in the chromium mines located in the Jajpur district, Odisha. The study included a total of 453 mine workers. The World Health Organization (WHO) oral health assessment proforma (1997) was used to assess the oral health status and treatment needs of the workers. Face-to-face interviews were conducted to acquire information on socio-demographic data, along with clinical examinations of type III. Frequency distribution analysis and independent-sample t-test were performed. Results: The majority of mineworkers demonstrated poor oral health status with high caries experience (Decayed Missing and Filled Tooth (DMFT) = 3.13 ± 1.82). The prevalence of tobacco consumption was very prevalent among them (74.8%). Leukoplakia (13.2%) was the most commonly noted oromucosal lesions. The buccal mucosa (16.8%) and commissures of the lips (3.3%) were the most common affected sites. Most workers demonstrated poor periodontal conditions. More than half of the mine workers (53.6%) showed malocclusion. Restoration, extraction, and pulp care were needed in most of the workers. Conclusion: A critical intervention should be provided to promote oral hygiene among Indian chromium mine workers. Dental health education and tobacco cessation programs are of utmost importance to improve the health conditions of these workers.
Keywords: Chromium, leukoplakia, mineworkers, tobacco
|How to cite this article:|
Kumar S, Priyaranjan, Basak D, Dasgupta B, Nastaran Quazi SS, Kumar A. Oral health status and treatment needs of chromium mine workers in India. Indian J Occup Environ Med 2022;26:172-7
|How to cite this URL:|
Kumar S, Priyaranjan, Basak D, Dasgupta B, Nastaran Quazi SS, Kumar A. Oral health status and treatment needs of chromium mine workers in India. Indian J Occup Environ Med [serial online] 2022 [cited 2022 Dec 3];26:172-7. Available from: https://www.ijoem.com/text.asp?2022/26/3/172/357019
| Introduction|| |
Oral health is an essential part of the overall health of an individual; moreover, it is a vital but sometimes overlooked element of general health. Several factors influence both general and oral health conditions, among which one of the most important factors is the environment, which not only includes the environment in which the individual lives but also the one in which he/she works.
In India, a large number of workers are employed in the mining industries. The mining industry is an integral part of many nations' economies and involves the consumption of a range of metallic and non-metallic minerals. Around the world, mineworkers are exposed to a hazardous environment due to multiple and recurrent injuries, as well as a variety of disabilities.,
In India, numerous workers are employed in chromium mines located in Sukinda situated in the Jajpur district of Odisha. Sukinda is the site of India's largest chrome ore deposits. However, very limited studies have been conducted in India to determine the magnitude and severity of oral health issues in chromium mine workers. Hence, this study sought to assess the oral health status and treatment needs of workers employed in chromium mines in the Jajpur district, Odisha. The study findings will enable policymakers to draft effective policies for the promotion of oral health among the workers.
| Methodology|| |
This cross-sectional study included mine workers who were employed in the chromium mines located in Sukinda Valley/taluka, Jajpur district, Odisha, and was conducted between April 2017 and October 2017 (approximately 6 months). The Kalinga Institute of Medical Sciences' Institutional Ethics Committee (IEC) in Bhubaneswar, Odisha, accorded the study ethical certification (KIMS/KIIT/IEC/133/2015). All participants' written informed consent was gathered in their native language.
A pilot research was conducted on 10 mine workers who were chosen at random. The study enrolled 453 chromium mine workers, in the age group of 18 to 54 years, using the WHO-recommended sample size calculation formula. The study participants were chosen using a convenience sampling technique.
A list of chromium mines situated in the Jajpur district, Odisha, and permission to conduct the research were sought from the competent authorities. A detailed schedule for the examination was prepared in consultation with the mine supervisors. All workers were informed about the study's objectives before conducting the study. The inclusion criteria for this study were individuals who were permanently employed in chromium mines, who signed the informed consent, and who were willing to participate in the study. The exclusion criteria were individuals who were uncooperative, who did not sign the informed consent, or who suffered from any chronic diseases that contradict oral examinations. No incentives were given by the principal investigator to mine workers to increase participation.
Before data collection, a training session was scheduled and both the examiners and recording clerks were trained in data collection. The training and calibration were conducted on day 1, day 7, and day 15 on randomly selected patients until good inter-examiner reliability (0.96) was obtained.
A questionnaire was prepared to gather data on socio-demographic variables, unfavorable oral behaviors, food habits, oral hygiene practices, and dental visits. The survey was translated into Odiya, the native language of Odisha. The validation of the questionnaire was conducted using back translation involving blind re-translation into English by an expert panel of public health dentists, periodontists, biostatisticians, and English and Odiya language school teachers. For the assessment of the oral health status and treatment needs, the WHO oral health proforma (1997) was used. The investigator preferred to employ a face-to-face interview method in the local language (Odiya) to avoid misinterpretation and maintain the universality of questionnaire responses.
Immediately after completing face-to-face interviews, a single trained examiner conducted clinical examinations on the same day using standardized protocols. Data collection and clinical examinations were conducted in a separate room allocated for the study purpose with permission from concerned authorities. The mine workers were sent in a group of 25 to 30 individuals for clinical examinations. All participants were examined following universal precautions, and all the used dental instruments were collected and sterilized in an autoclave before use. The collected data were checked for any missing data and entered into an Excel sheet for further statistical analysis on the same day.
Statistical analysis was conducted using SPSS V 20. Frequency distribution analysis, t-test, and analysis of variance (ANOVA) were performed. A P value < 0.05 was considered statistically significant.
| Results|| |
More than half (54.3%) of the mineworkers were in the age group of 25 to 34 years, were employed in the mines for 5 to 10 years, and consumed a mixed diet. The majority of them were literate (80.8%), with more than one-third (38.9%) having education levels up to high school or higher. Most of the mine workers (74.8%) had the habit of tobacco consumption [Table 1].
|Table 1: Distribution of study population according to sociodemographic characteristics, dietary habits, adverse oral habits and dental visit|
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Among the mine units, the transportation units had the highest mean decayed teeth component (DT), whereas the shifting units had the least; the transportation units had the highest mean missing teeth component (MT), whereas the maintenance units had the least; the administrative units had the highest mean filled teeth component (FT), whereas the transportation units had the least; and the excavation unit had the highest mean DMFT score, whereas the transportation unit had the least [Table 2].
|Table 2: Distribution of study population according to Mean caries experience|
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Among the chromium mine workers, very few (4%) had healthy periodontium, whereas all others (96.0%) had diseased periodontium. The workers in the administrative unit (7.9%) reported having healthy periodontium compared to those in the other units (p-value >0.05). The workers in the transportation (7.0%) and excavation unit (6.9%) showed a higher prevalence of diseased periodontium with deep pocket formation compared to shifting (0.8%) and maintenance unit (0.0%). Very few mine workers (3.4%) showed a loss of attachment score of ≥12 mm. The minimum (LOA 0-3 mm) and maximum (LOA ≥12 mm) scores for the loss of attachment were found in workers in the administrative unit [Table 3].
|Table 3: Distribution of study population according to Community Periodontal Index (CPI) Score and Loss of attachment (LOA) Score|
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The frequency of oral mucosal lesions was reported to be 25.8% among the mine workers. Leukoplakia (13.2%) was found to be the most prevalent oromucosal lesions. The workers in the maintenance unit had the highest prevalence of oromucosal lesions (34.3%), followed by transportation workers (28.6%). The buccal mucosa (16.8%) and lip commissures (3.3%) were the most common sites affected by oromucosal lesions [Table 4].
|Table 4: Distribution of study population according to types of Oro-mucosal lesions and their site of Occurrence|
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Dental fluorosis and TMJ disorders were present in 12.8% and 12% of the mineworkers, respectively. Very few of the workers were found to wear some sort of prosthesis in their upper (1.5%) or lower arch (2.9%). More than half (53.6%) of the workers exhibited some form of malocclusion [Table 5].
|Table 5: Distribution of study population according to other oral findings observed in study population|
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Among the mine workers, 38.9% needed restoration. The need for restoration was the highest among workers in the transportation unit (48.8%), followed by the shifting unit (37.2%). Among the mineworkers, 20.3% needed extraction. The need for extraction was the highest among workers in the transportation unit (34.1%), followed by the shifting (19%), excavation (17.7%), and administrative (2.6%) units. The proportion of workers who needed pulp care treatment was 21.0%, which was required in 31.0% of workers in the transportation unit, 22.3% of those in the shifting unit, 20% of those in the excavation unit, 2.6% of those in the administrative units, and 2.9% of those in the maintenance unit [Table 6].
|Table 6: Distribution of study population according to their treatment needs|
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| Discussion|| |
A total of 453 chromium mineworkers were evaluated, covering the administrative, maintenance, transportation, excavation, and shifting divisions of these mines. A very high proportion of the mineworkers reported tobacco consumption and nearly half of them had never visited any dentist before for any sort of dental treatment.
The mean decayed teeth (DT) of mineworkers was 2.88, which was similar to that reported in an Indian study conducted among green marble mine workers in Rajasthan, which was 2.79. The mean DT among workers in the shifting and transportation units was higher than those among workers in the other mine units. This may be attributed to dietary differences and oral hygiene practices.
The mean MT among the mineworkers was 2.34, with workers in the transportation and shifting units reporting a spike in the proportion of mean missing teeth, which may be because adverse oral habits such as tobacco consumption are very prevalent in the lower socioeconomic groups, resulting in early tooth loss.
The mean FT in mine workers was 1.60. It was found to be higher among workers in the administrative (2.1) and maintenance units (2.17). This might be due to differences in the socioeconomic status and higher utilization of dental services for restoration among the workers in the administrative and maintenance units than those in the other units. These findings are consistent with those reported in a study on the Danish industrial community.
The majority of the mineworkers showed a diseased periodontium on clinical examinations. The highest prevalence of periodontal diseases was seen among workers in the transportation unit compared to those in the other units. This might be due to a higher percentage of tobacco consumption, particularly gutkha and tobacco leaf chewing, among workers in the transportation unit compared to those in the other units. Concurrently, transportation workers had poor oral hygiene habits compared to those in the other units in our study. Our findings were similar to those reported in a recent study conducted among industrial employees in rural Norway.
Calculus was the most common finding in the mouth of mine workers. Similar results were found among the industrial workers of Davangere, where a 98.7% prevalence of periodontal disease was reported, with calculus being the commonest finding in the workers.
In our study, the bleeding score was seen in 17.7% of the workers, and 4–5 mm pockets were seen in 31.8% of the mine workers. A study among the mine workers of Romania reported similar findings as our study, where 21.49% had a bleeding score and 32.7% showed shallow pockets.
More than half of the mineworkers showed a loss of attachment to the periodontium. A study conducted among a randomized sample of the Swedish population stated that tobacco consumption habits were a significant risk factor for probing attachment loss.
In the present study, among the mine workers, 13.2% had leukoplakia and 3.3% had OSMF. Similar findings were reported by Dagli et al. (2008). The buccal mucosa was identified to be the most common site of mucosal lesions. Within the mine units, workers in the transportation, maintenance, and excavation units had a higher prevalence of leukoplakia than those in the other units. This may be due to the high intake of tobacco by workers in the transportation division.
The mine workers had a higher prevalence of dental fluorosis (12.8%) probably because 36.2% of the mineworkers were from Rajasthan, which is a high fluoride belt according to the national fluoride mapping (2002–2003).
Among the mineworkers, 2.6% of those in the administrative unit and 2.9% of those in the maintenance unit had upper prostheses compared to only 0.8% of those in the transportation and excavation units. Furthermore, 13.2% of workers in the administrative units and 8.6% of those in the maintenance unit had lower prosthetics compared to only 0.8% of those in the transportation unit and 1.5% of those in the excavation unit. This could be attributed to low literacy levels, low socioeconomic status, and a busy work schedule in the latter groups.
Malocclusion in the form of crowding, spacing, midline diastema, rotation of teeth, and others was present in nearly half of the mine workers in this study. The findings are suggestive of a lack of awareness and self-perceived esthetics among the mineworkers.
In the present study, workers in the transportation unit, followed by those in the shifting unit, were more in the need of extraction and pulp care than those in the other units. This difference might be due to more extensive lesions, which are not suitable for restorations, fewer dental visits, and lower socioeconomic status among the workers in these units. Our findings are consistent with those of a study conducted among the Danish industrial population, which found that dental extraction was the most common treatment requirement among manual laborers.
A higher proportion of decayed, missing, and filled teeth among the mineworkers are suggestive of the fact that oral care is neglected and their awareness of oral hygiene is poor. This warrants the need for drafting and conducting oral health awareness programs for mineworkers. The authors recommend that appointment of a public health dentist should be done to meet the dental care needs and instill a positive preventive attitude among the mineworkers. The poor periodontal conditions and presence of loss of attachment are probably sequelae of tobacco consumption and abnormal oral hygiene practices. The authors recommend setting up a tobacco cessation clinic on the premises, wherein behavioral and non-pharmacological counseling could be provided to quit the habit. The sale of tobacco in the nearby vicinity should be prohibited and administrative authorities should firmly enact and impose penalties on workers consuming tobacco on the premises.
Tobacco is a known associated risk factor for a number of oral diseases. A number of studies have reported a positive association of tobacco consumption with early tooth loss, halitosis, periodontal problems, oro-mucosal lesions, and others., Tobacco consumption habits were found to be very prevalent among the mineworkers. The long-term consumption of tobacco is responsible for depleted oral health in mineworkers. The abnormal oral findings reported in the present study are sequelae to adverse oral habits such as tobacco consumption rather than work-related disorders or long-term exposure to chromium ores.
The mineworkers had low literacy levels and poor oral hygiene awareness. A number of studies have reported that literacy level has a significant impact on oral health and oral health-related quality of life., Thus, efforts for the upliftment of oral health should be carried out. The present study suggests that tobacco consumption, low literacy level, and poor oral hygiene awareness are responsible for most of the oral findings. Working in chromite mines and exposure to chromium ores are not likely to be responsible for any abnormal oral findings or development of oro-mucosal lesions.
This study attempted to evaluate but did not find any oral health abnormality, which may be directly related to long-term exposure to chromium ores. The authors recommend conducting longitudinal studies to assess oral health disorders if any that may occur due to long-term exposure to chromium ores. Oral precancerous lesions, such as leukoplakia and OSMF, among the workers required tobacco cessation counseling, immediate referral, and care to prevent further progression of the disease. In the present study, almost all mineworkers and the general population needed improvement in oral hygiene maintenance and oral prophylaxis. Tobacco consumption along with low literacy levels and poor oral hygiene awareness was found to be significant contributors toward depleted oral health in mineworkers. The chromium ores were not found to have any direct effect on oral health status or the development of oromucosal lesions in mine workers.
| Conclusion|| |
The oral health status of mine employees, in particular, those working in the transportation, excavation, and shifting units, was relatively poor. Workers in the transportation, excavation and shifting units had a high prevalence of caries. It was found that low socioeconomic status, poor oral hygiene, and high tobacco consumption habits seemed to influence the oral health of the mineworkers rather than long-term exposure to chromium ores. Dental health education and tobacco cessation programs are of utmost importance to these workers. The industrial health care system in India should provide oral health care delivery to this population, and preventive and therapeutic oral health care should be undertaken for this group at the worksite. Further research on a wider group of chromium mines population can be conducted and the effectiveness of oral health promotion can be studied.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient connsent forms. In the form, the patient(s) has/have given their consent to voluntarility participate in the study and their clinical information to be reported in the journal. The patients understand their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]