Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 2267

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 613
Impact of chikungunya virus infection on oral health status: An observational study


1 Consultant Public Health Dentist, Sai Dental Clinic, Ganeshpur, Karnataka, India
2 Department of Microbiology, BLDEAS, Shri BM Patil Medical College and Research Centre, Bijapur, India
3 Consultant Physician, Vatsalya Hospital, Bijapur, Karnataka, India

Click here for correspondence address and email

Date of Submission04-Aug-2010
Date of Decision24-Nov-2010
Date of Acceptance04-Mar-2011
Date of Web Publication26-Nov-2011
 

   Abstract 

Background and Objective: Chikungunya fever outbreak started in December 2005 in India when the country experienced more than 13 lakhs of Chikungunya infected cases. We undertook this study to describe the impact of Chikungunya virus infection on oral health.
Materials and Methods: The confirmed seropositive patients were included for the study (N = 97). Oral hygiene index simplified, gingival index, plaque index were recorded.
Results: Of the 181 tested, 97 were confirmed seropositive for chikungunya infection. Pain and bleeding gums were seen in 55% of the subjects. Of them, 29.1% had poor oral hygiene, 42.27% had severe gingivitis, and 27.84% had severe plaque deposits. Severe gingivitis was observed in patients with chronic disease, this association was statistically significant (χ2 = 6.417, P = 0.040).
Conclusion: Our findings showed that about more than half of the tested patients suffered severe pain and bleeding in the oral cavity thereby causing discomfort in chewing. About 1/3 patients had severe gingivitis and foul breath which caused discomfort in carrying out their day-to-day activities.

Keywords: Chikungunya fever, gingivitis, oral health

How to cite this article:
Katti R, Shahapur P R, Udapudi K L. Impact of chikungunya virus infection on oral health status: An observational study. Indian J Dent Res 2011;22:613

How to cite this URL:
Katti R, Shahapur P R, Udapudi K L. Impact of chikungunya virus infection on oral health status: An observational study. Indian J Dent Res [serial online] 2011 [cited 2019 Dec 13];22:613. Available from: http://www.ijdr.in/text.asp?2011/22/4/613/90325
Chikungunya fever is a mosquito borne illness of humans caused by Chikungunya virus (CHIKV). [1] This disease was first described in 1955, following an outbreak on the Makonde plateau along the border of Tanganyika and Mozambique. [2] Chikungunya virus is no stranger to the Indian subcontinent. Since its first isolation in Kolkata [3] in 1963, there had been reports from different parts of India viz, Vellore, [4] Chennai, [5] Nagpur, [6] Barsi. [7]

Since the last outbreak of chikungunya fever there had been very few reports of chikungunya virus infection in our country. However, since December 2005, cases of chikungunya were reported from several Indian states including Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, and Madhya Pradesh [8] suggestive of re-emergence of the virus.

Although there is abundance of literature explaining the detailed clinical profile and manifestations of chikungunya fever, few studies have addressed the oral health-related symptoms among patients suffering from chikungunya viral infection. Hence, this descriptive study was carried out to describe the oral health related symptoms among patients suffering from chikungunya virus infection.


   Materials and Methods Top


In this descriptive study, a total of 208 suspected cases of chikungunya fever during the epidemic period of June to Sep 2006 were enrolled consecutively. These patients visited a private outpatient clinic at Bijapur, Karnataka, India. Of the 208 cases, 27 were excluded as they suffered from concomitant systemic diseases or were on medication, which could affect the gingival health.

Blood samples were collected from each patient with their prior written informed consent for further studies. From all the patients, 5 ml of venous blood was collected in heparinized tubes and centrifuged at 1500× g for 15 min at 4°C. Plasma and pelleted RBC were separated and analysis was done immediately by using SD BIOLINE Chikungunya IgM Test Kit, a solid phase immunochromatographic assay for rapid, qualitative detection of IgM antibodies to chikungunya virus in human serum or plasma. Of the 181 cases tested, 97 were confirmed seropositive for chikungunya infection. Only the seropositive cases were further evaluated. Detailed history of the pertinent information like name, age, sex, location of residence, date of onset of illness, medical history was taken and clinical examination of the oral cavity was performed. Details of the measures taken by the patients for oral hygiene maintenance were recorded. Oral Hygiene Index Simplified (Green and Vermillion1964), [9] Gingival index (Loe and Silness1963), [10] Plaque index (Silness and Loe 1964) [11] were recorded among all the patients. Examination and recording of indices was performed by a single calibrated examiner (k ≥ 0.05). The findings were then subjected to statistical analysis using Chi square test and correlation coefficient.


   Results Top


There were 97 confirmed cases of chikungunya viral fever (n = 97). The mean age ±SD was 36.27 ± 11.36 years, age range 17-58 years, 53.35% of them were in the age range of 20-40 years. Female to male ratio was 1:0.9 (50 females and 47 males).

Pain (54.32%), bleeding, and burning sensation in the gums (54.32%), were predominant complaints, followed by inability to chew and swallow (29.1%), halitosis (21.34%), ulceration (17.46%) [Table 1].
Table 1: Clinical findings of patients with chikungunya

Click here to view


Pain was seen almost equally amongst younger (64.1%) and older age (67.85%) group individuals. Burning sensation in the gums was more common among younger age (71.79%) group whereas symptoms like bleeding gums (96.42%), inability to chew (39.28%), and halitosis (28.57%) were more pronounced in older age group subjects [Table 2].
Table 2: Comparisons of symptoms observed among different age group in chikungunya patients

Click here to view


Oral hygiene status among 70.1% of the patients was fair and 29.9% was poor. Gingival index revealed that 5.15% had mild, 52.58% had moderate, and 42.27% had severe gingivitis (r = 0.486, P ≤ 0.001). Among 19.58% of the patients, severe gingivitis was observed in spite of the low calculus scores (r = 0.207, P ≤ 0.001). Some 72.16% of the subjects had moderate amount of plaque, while only 27.84% had severe plaque deposits (r = 0.589, P ≤ 0.001).

Patients were compared for the oral hygiene status, gingival status, and plaque accumulation during different stages of the disease [12] [Table 3]. Statistically significant association was found in gingival index scores (χ2 = 6.417, P = 0.040). Severe gingivitis was observed in patients suffering from chronic disease while among patients with acute disease moderate gingivitis was observed. No significant association was seen with respect to oral hygiene status (χ2 = 2.116, P = 0.347) and plaque scores (χ2 = 4.125, P = 0.127).
Table 3: Comparison of oral hygiene status, gingival health and plaque accumulation among chikungunya patients

Click here to view


Patients were compared for the severity of pain during the various stages of the disease [Table 4]. Pain in gums was observed more commonly among the patients suffering from chronic disease, whereas pain while chewing was seen frequently in patients with acute disease. However, no statistically significant association was observed.
Table 4: Comparison of pain among patients with varying severity of pain

Click here to view



   Discussion Top


The present study was carried out among the confirmed cases of chikungunya virus infection. Many studies have focused on the classical symptomatology of chikungunya virus infection like a clinical triad of 'fever, rashes, and arthralgia', [2],[4],[5],[6],[7],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26] but few studies mention the effects of chikungunya virus infection on oral health.

There were about 53.53% of the patients in the age range of 20-40 years. Some authors have reported prevalence in age group between ≥15 and ≤30 years, [8],[14] while another reports majority of patients above age range >45 years. [15] The variation may be attributed to the differences in the herd immunity. [8],[13],[14]

We observed that females were slightly more affected as compared to males with the ratio of 1:0.9. Similar findings are reported in literature. [8],[16],[17],[18] In contradiction to the present findings, some authors have found female to male ratio as 1:2.3 [14] and 1:2.4. [15]

About 95% of the individuals suffered from mild and severe gingivitis, while 31% was reported by some. [14] Other studies have also reported cases of gingivitis in their study. [7] Since no index was used by these authors to measure gingivitis, it is likely that only the severe cases of gingivitis were recorded and severity of the disease was not emphasized. The underlying pathology in causation of gingivitis remains unclear. Perhaps the leucopenia [15] caused by the disease may be playing a role in this.

The study reporting the effect of chikungunya virus infection on connective tissue [19] states that there is an increased excretion of urinary proline and hydroxyproline in these cases, which is suggestive of high degree of turnover in connective tissue. Whether this affects the integrity of gingival tissue and the alveolar bone is not confirmed, and this may be causing the alterations in gingival and periodontal health. Further studies with radiographic examination may help to determine the effects on alveolar bone and the periodontal complex.

In the present study, about 55% of the subjects experienced bleeding from the gums. Similar reports are made by other authors. [3],[7],[14],[15],[20],[21] Mild thrombocytopenia observed [15] in the disease may be causing these episodes of bleeding.

Oral ulceration was observed in about 12% of individuals in this study. In other reports, 9% [14] and 2% [15] of the subjects were affected.

We observed Tempero Mandibular Joint pain in only 6% of the patients. Severe pain involving the other synovial joints has been reported by other authors. [2],[4],[5],[6],[7],[14],[15],[16],[17],[19],[20],[21],[22],[23],[24],[25],[26]

Though majority of the patients performed oral hygiene methods it was observed that oral hygiene among 70.9% of the patients was fair and 29.1% was poor. This may be because severe pain in the gums might have prevented the patients from performing meticulous brushing. No similar data is available for comparison of the same.

When the patients were compared for the oral hygiene status, gingival status and plaque accumulation during different stages of the disease, severe gingivitis was seen among patients with chronic disease, while mild to moderate gingivitis among patients with acute stage. The difference may probably be attributed to inability to clean the oral cavity properly for longer duration in chronic patients which is reflected in the higher plaque scores in these patients. This accumulated plaque might have caused the subsequent gingivitis.

Studies [14] have reported that following up of patients for a period of 90 days has shown that in half the proportion of patients suffering in the form of arthritis persisted. In another report [20] the symptoms persisted in 10% of the patients even after 3-5 yrs. Hence, a follow-up of patients to observe for resolution of oral symptoms must be taken into account in future studies. There are reports of functional and ambulatory limitations. [26] In this study, patients expressed their inability to chew varieties of food and so they had to limit their diet to soft, semisolid and liquids in severe cases.

Another area where attention is needed is the technique used by us for the confirmation of the disease. The sensitivity and specificity of the test kits varies based on many factors and manufacturers. Sensitivity varies from 22% to 83%. We used the kit from Standard Diagnostics, INC Korea, which has relative sensitivity of 97.1% and specificity of 98.9%; however; sensitivity of IgM (20%) detection was significantly lower for patients with acute infections (i.e., from day 1 to day 5 after infection) and Cross-reaction with other flavirus antibodies such as o'nyong nyong and Semliki Forest occur in the ELISA; but the latter viruses are relatively rare in South East Asia. [27] The gold standard for the diagnosis of chikungunya fever is viral culture, [28] but this is not routinely carried out because of lack of facilities in majority of centres. Recently, a reverse transcriptase, RT-PCR technique for diagnosing chikungunya virus has been developed using nested primer pairs amplifying specific components of three structural gene regions, Capsid (C), Envelope E-2, and part of Envelope E1. [27],[29] For sensitivity determination of the PCR protocols, the probe-based real time RT-PCR method was found to be 10 times more sensitive than one based on SYBR Green. [30] The practically feasible confirmatory test RT-PCR [20] method was not adopted because of inability to get the samples processed at NIV Pune, which is the only national referral centre in India for the chikungunya virus.

The patients included in this study represent a very small sample of the population that was affected by chikungunya during the outbreak. Though there are limitations of this study like a smaller sample size, absence of control group and convenient sampling technique, nevertheless it attempts to give an insight to understanding pain of the patients infected with chikungunya virus. This calls for further analytical studies with appropriate sample size.


   Conclusion Top


Several lessons can be drawn from the outbreaks of chikungunya infection in India. Patients may present with variety of symptoms and variable degree of severity. Oral symptoms are far distressing and severe to the patients than previously reported. The compartmentalization involved in viewing the mouth separately from the rest of the body must cease because oral health affects general health by causing considerable pain and suffering and by changing what people eat, their speech and their quality of life and well-being. Although it is a self limiting disease, palliative measures to ease the patient in distress due to oral pain should be employed.

 
   References Top

1.Brooks GF, Butel JS, Morse SA. Human arboviral infections. In: Jawetz, Melnick and Adelberg's, Editors. Medical microbiology. 23 rd ed. Singapore: Mc Graw Hill; 2004. p. 514-24.  Back to cited text no. 1
    
2.Robinson MC. An epidemic of virus disease in southern province, Tanganyika territory in 1952, 53. Clinical features. Trans R Soc Trop Med Hyg 1955;49:28-32.  Back to cited text no. 2
    
3.Shah KV, Gibbs CJ Jr, Banarjee G. Virological investigation of the epidemic of haemorragic fever in Calcutta; isolation of three strains of chikungunya virus. Indian J Med Res 1964;52:676-83.  Back to cited text no. 3
    
4.Jadhav M, Namboodripad M, Carman RH, Carey DE, Myers RM. Chikungunya disease in infants and children in vellore: A report of clinical and haematological features of virologically proved cases. Indian J Med Res 1965;53:764-76.  Back to cited text no. 4
    
5.Thiruvengadam KV, Kalyansundaram V, Rajgopal J. Clinical and pathological studies on chikungunya fever in madras city. Indian J Med Res 1965;53:729-44.  Back to cited text no. 5
    
6.Rodrigues FM, Patankar MR, Banarjee K, Bhatt PN, Goverdhn MK, Pavri KM, et al. Etiology of the 1965 epidemic of febrile illness in Nagpur city, Maharashtra State, India. Bull World Health Organ 1972;46:173-9.  Back to cited text no. 6
    
7.Padbidri VS, Gnaneshwar TT. Epidemilogical investigations of Chikungunya epidemic at Barsi, Maharashtra state, India. J Hyg Epidemiol Microbiol Immunol 1979;46:445-51.  Back to cited text no. 7
    
8.Kaur P, Ponniah M, Murhekar MV, Ramachandran V, Ramachandran R, Raju HK, et al. Chikungunya Outbreak, South India, 2006. Emerg Infect Dis 2008;14:1623-5.  Back to cited text no. 8
    
9.Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.  Back to cited text no. 9
    
10.Loe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.  Back to cited text no. 10
    
11.Silness J, Loe H, periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scan 1964;22:121-35.  Back to cited text no. 11
    
12.Management protocol for suspected cases of chikungunya. Prepared jointly by IMA Kerala state and Government Epidemic Cell, page3. Available from: http://www.imakerala.net/ecc/TPOCG.pdf. [Last Accessed on 2010 Nov 10]  Back to cited text no. 12
    
13.Lahariya C, Pradhan SK. Emergence of Chikungunya virus in Indian subcontinent after 32 years: a review. J Vect Borne Dis 2006;43:151-60.  Back to cited text no. 13
    
14.Suryawanshi SD, Dube AH, Khadse RK, Jalgaonkar SV, Sathe PS, Zawar SD. Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India. Indian J Med Res 2009;129:438-41.  Back to cited text no. 14
[PUBMED]  Medknow Journal  
15.Borgherini G, Poubeau P, Staikowsky F, Lory M, Moullec NL, Becquart JP, et al. Outbreak of chikungunya on reunion Island: Early clinical and laboratory features in 157 adult patients. Clin Infect Dis 2007;44:1401-7.  Back to cited text no. 15
    
16.Lam SK, Chua KB, Hooi PS, Rahimah MA, Kumari S, Tharrnaratnam M, et al. Chikungunya infection-an emerging disease in Ma­laysia. Southeast Asian J Trop Med Public Health 2001;32:447-51.  Back to cited text no. 16
    
17.Laras K, Sukri NC, Larasati RP, Bangs MJ, Kosim R, Djauzi S, et al. Tracking the re-emergence of epidemic chikungunya virus in Indo­nesia. Trans R Soc Trop Med Hyg 2005;99:128-41.  Back to cited text no. 17
    
18.Retuya RR, Ting DL, Dacula BD, Lanada JM, Roque VG, Hugo CT, et al. Chikungunya fever outbreak in an agricultural village in Indang, Cavite, Philippines. Philipp J Microbiol Infect Dis 1998;27:93-6.  Back to cited text no. 18
    
19.Lokireddy S, Vemula S, Vadde R. Connective tissue metabolism in chikungunya patients. Virol J 2008;5:31.  Back to cited text no. 19
    
20.Pialaux G, Gauzere BA, Jauréguiberry S, Strobel M. Chikungunya an epidemic arbovirosis. Lancet Infect Dis 2007;7:319-27.  Back to cited text no. 20
    
21.Sarkar JK, Chatterjee SN, Chakravarty SK. Haemorragic fever in Calcutta: Some epidemiological observations. Indian J Med Res 1964;52:651-9.  Back to cited text no. 21
    
22.Kennedy AC, Fleming J, Solomon I. Chikungunya viral arthropathy: A clinical description. J Rheumatol 1980;7:231-6.  Back to cited text no. 22
    
23.Thiruvengadam KV, Kalyanasundaram V, Rajgopal J. Clinical and path­ological studies on chikungunya fever in Madras City. Indian J Med Res 1965;53:729-44.  Back to cited text no. 23
    
24.De Ranitz CM, Myers RM, Varkey MI, Isaac ZH, Carey DE. Clinical impressions of chikungunya in Vellore gained from study of adult patients. Indian J Med Res 1965;53:756-63.  Back to cited text no. 24
    
25.Mackenzie JS, Smith DW. Mosquito-borne viruses and epidemic polyarthritis. Med J Aust 1996;164:90-3.  Back to cited text no. 25
    
26.Kennedy AC, Fleming J, Soloman L. Chikungunya viral arthropathy: A clinical description. J Rheumatol 1980; 7:231-6.  Back to cited text no. 26
    
27.World Health Organization, regional office for South-East Asia Guidelines for Prevention and Control of Chikungunya Fever. Available from: http://www.searo.who.int/Linkfiles/publication_SEA-CD-182.pdf [Last accessed on 2010 Oct 19].  Back to cited text no. 27
    
28.Mourya DT, Yadav P. Vector biology of dengue and chikungunya viruses. Indian J Med Res 2006;124: 475-80.  Back to cited text no. 28
[PUBMED]  Medknow Journal  
29.Kamath S, Das AK, Parikh FS. Chikungunya. J Assoc Physicians India 2006;54:725-6.  Back to cited text no. 29
    
30.Yap G, Pok KY, Lai LY, Hapuarachchi HC, Chow A, Leo YS, et al. Evaluation of Chikungunya Diagnostic Assays: Differences in Sensitivity of Serology Assays in Two Independent Outbreaks. PLoS Negl Trop Dis 2010;4: e753.  Back to cited text no. 30
    

Top
Correspondence Address:
P R Shahapur
Department of Microbiology, BLDEAS, Shri BM Patil Medical College and Research Centre, Bijapur
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.90325

Rights and Permissions



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

This article has been cited by
1 Chikungunya fever: General and oral healthcare implications
JC Leao,CDL Marques,ALBP Duarte,OP de Almeida,S Porter,LA Gueiros
Oral Diseases. 2018; 24(1-2): 233
[Pubmed] | [DOI]
2 Chikungunya fever: General and oral healthcare implications
JC Leao,CDL Marques,ALBP Duarte,OP de Almeida,S Porter,LA Gueiros
Oral Diseases. 2018; 24(1-2): 233
[Pubmed] | [DOI]
3 A novel species of torque teno mini virus (TTMV) in gingival tissue from chronic periodontitis patients
Yu Zhang,Fei Li,Tong-Ling Shan,Xutao Deng,Eric Delwart,Xi-Ping Feng
Scientific Reports. 2016; 6(1)
[Pubmed] | [DOI]
4 A novel species of torque teno mini virus (TTMV) in gingival tissue from chronic periodontitis patients
Yu Zhang,Fei Li,Tong-Ling Shan,Xutao Deng,Eric Delwart,Xi-Ping Feng
Scientific Reports. 2016; 6(1)
[Pubmed] | [DOI]
5 Infectious Chikungunya Virus in the Saliva of Mice, Monkeys and Humans
Joy Gardner,Penny A. Rudd,Natalie A. Prow,Essia Belarbi,Pierre Roques,Thibaut Larcher,Lionel Gresh,Angel Balmaseda,Eva Harris,Wayne A. Schroder,Andreas Suhrbier,Lisa F.P. Ng
PLOS ONE. 2015; 10(10): e0139481
[Pubmed] | [DOI]
6 Infectious Chikungunya Virus in the Saliva of Mice, Monkeys and Humans
Joy Gardner,Penny A. Rudd,Natalie A. Prow,Essia Belarbi,Pierre Roques,Thibaut Larcher,Lionel Gresh,Angel Balmaseda,Eva Harris,Wayne A. Schroder,Andreas Suhrbier,Lisa F.P. Ng
PLOS ONE. 2015; 10(10): e0139481
[Pubmed] | [DOI]
7 Assessment of Health and Nutritional Status in Children Based on School Screening Programs
Shahab Rezaeian,Jamal Ahmadzadeh,Nader Esmailnasab,Yousef Veisani,Mina Shayan,Noorollah Moradi
Health Scope. 2014; 3(1)
[Pubmed] | [DOI]
8 Assessment of Health and Nutritional Status in Children Based on School Screening Programs
Shahab Rezaeian,Jamal Ahmadzadeh,Nader Esmailnasab,Yousef Veisani,Mina Shayan,Noorollah Moradi
Health Scope. 2014; 3(1)
[Pubmed] | [DOI]
9 Viruses: are they really culprits for periodontal disease? A critical review
Ranjith Ambili,Chandran Preeja,Vilasan Archana,Krishnavilasam Jayakumary Nisha,Abraham Seba,Mohammed Khasim Reejamol
Journal of Investigative and Clinical Dentistry. 2013; : n/a
[Pubmed] | [DOI]



 

Top
 
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed5722    
    Printed127    
    Emailed1    
    PDF Downloaded174    
    Comments [Add]    
    Cited by others 9    

Recommend this journal