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Table of Contents   
ORIGINAL RESEARCH  
Year : 2014  |  Volume : 25  |  Issue : 2  |  Page : 174-177
Dental caries experience in high risk soft drinks factory workers of South India: A comparative study


1 Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
2 Department of Public Health Dentistry, Manipal College of Dental Science, Manipal, Karnataka, India
3 Department of Oral Medicine and Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
4 Department of Prosthodontics, RIMS, Imphal, Manipur, India

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Date of Submission19-Apr-2014
Date of Decision16-May-2014
Date of Acceptance12-Jun-2014
Date of Web Publication4-Jul-2014
 

   Abstract 

Background: The consumption of soft-drinks has been associated with dental caries development.
Objective: The aim was to evaluate dental caries experience amongst the workers working in soft-drink industries located in South India and compare it with other factory workers. To evaluate the validity of specific caries index (SCI), which is newer index for caries diagnosis.
Materials and Methods: This was a cross-sectional study carried out among 420 workers (210 in soft-drinks factory and 210 in other factories), in the age group of 20-45 years of Udupi district, Karnataka, India. Index used for clinical examination was decayed, missing, filled surfaces (DMFS) index and SCI.
Results: The mean and standard deviation (SD) of decayed surface (5.8 ± 1.8), missing surface (4.3 ± 2) and filled surface (1.94 ± 1.95) and total DMFS score (12.11 ± 3.8) in soft-drinks factory workers were found to be significantly higher than the other factory workers. The total SCI score (mean and SD) was found to be significantly higher in soft-drinks factory workers (5.83 ± 1.80) compared with other factory workers (4.56 ± 1.45). There was a high correlation obtained between SCI score and DMFS score. The regression equation given by DMFS = 1.178 + 1.866 (SCI scores).
Conclusion: The caries experience was higher in workers working in soft-drinks factory and this study also showed that specific caries index can be used as a valid index for assessing dental caries experience.

Keywords: Decayed, missing, filled surfaces, dental caries, factory workers, soft-drinks, specific caries index

How to cite this article:
Kumar S, Acharya S, Vasthare R, Singh SK, Gupta A, Debnath N. Dental caries experience in high risk soft drinks factory workers of South India: A comparative study. Indian J Dent Res 2014;25:174-7

How to cite this URL:
Kumar S, Acharya S, Vasthare R, Singh SK, Gupta A, Debnath N. Dental caries experience in high risk soft drinks factory workers of South India: A comparative study. Indian J Dent Res [serial online] 2014 [cited 2020 Aug 5];25:174-7. Available from: http://www.ijdr.in/text.asp?2014/25/2/174/135913
Dental caries (decay) occurs when bacteria living in dental plaque ferment dietary carbohydrate, producing acid that lowers plaque pH. Repeated exposure to reduced plaque pH results in softening of the enamel, and the lesion can progress to form a carious cavity. [1] Development of caries is influenced by host, agent and environmental factors. The environmental factor includes dietary habit, nutritional status and fluoride intake. The dietary factors include the amount of sugar consumed, sugar concentration of food, physical form of carbohydrate, oral retentiveness, frequency of eating, length of interval between eating and sequence of food consumption. [2]

Soft-drink consumption has been associated with risk factor for caries. [3],[4],[5],[6] Most soft-drink contains a high concentration of simple carbohydrates such as glucose, fructose, sucrose and other simple sugars. [5] Oral bacteria ferment carbohydrates and produce acid, which dissolves tooth enamel during the dental decay process; thus, sweetened drinks are likely to increase the risk of dental caries. The risk is greater if the frequency of consumption is high. [5]

Dental caries can be assessed through different indices. Specific caries index (SCI) is a new system for describing untreated dental caries experience in developing countries and it is based upon the GV Black's classification of cavity preparation. This classification was proposed specifically for cavity preparation; however the system has relevance to morphological classification of dental caries since Blacks Class 1 preparations are associated with Pit and fissure caries, while Class 2, 3, 4, 5 and 6 types are associated with a smooth surface lesions in different locations. This scoring pattern was also based on the assumption that sites of the carious lesions became less common with ascending order of weightage that is, Type 1 (pit and fissure caries) caries was the most common followed by Type 2 (proximal caries) and so on. The presence of higher values in individual tooth scores therefore suggested higher caries risk and caries susceptibility for the tooth and the individual. If more than one lesion was present on a tooth, the higher score was given. Similarly, a higher score was given when there were combined lesions. [7]

In recent years, in India, there has been increase consumption of soft-drink in all age groups. [8] Occupational acid exposure might also increase the risk of dental caries. Evidence for occupational acid exposure is limited to the battery and galvanizing (Zn-Al industry) workers, munitions manufacturers, soft-drink manufacturers and dyestuff container cleaners. [9] However, in these studies data is restricted to workers working in large scale industries only. To the best of author's knowledge, there has been no such study conducted in India, to assess dental caries as an occupational risk, in small scale soft-drinks factory workers. Hence, this study was conducted with the objective to assess dental caries experience among the workers working in small scale soft-drink industries located in South India and compare it with other factory workers. The secondary objective was to evaluate the validity of SCI, which is a newer index for caries diagnosis.


   Materials and methods Top


A cross-sectional study was carried out in industrial workers in South India in 2013. Prior to conduct of study, ethical clearance was taken from Institutional Review Board, Manipal University. 210 workers, working in various small scale soft-drink factories located in Udupi district, Karnataka, India were taken as a study group and 210 workers who were working in various other factories were taken as a comparison group. Hence, a total of 420 workers were included in this study. It was based on convenience sampling technique and all those workers who agreed to participate in the study were included. The workers who were suffering from any systemic diseases, or were unable to open their mouth for clinical examination, and not willing to participate were excluded from the study. The sample size estimation was done, based upon the findings of the pilot study done on 25 workers working in soft-drinks factory and other factories. The final sample size was calculated using the formula (WHO Survey). [10]



z = 1.96 for 95% confidence interval,

p = prevalence of disease in a population,

d = acceptable margin of error (0.05).

A dental caries prevalence of 90% was found among the workers in the pilot survey. Substituting the above values in the given formula, the minimum sample size was calculated to be 144 workers in each group. However, the final sample comprised of 210 workers in each groups.

Pilot survey assessments were utilized for sample size estimation, proper planning and execution of the main study and also to finalize the survey form to be used for collection of data. These subjects were not included in the study. The workers in both study and comparison group were in the age group of 20-45 years.

A questionnaire was prepared that dealt with the respondent's sociodemographic characters like age, gender, income and education. It also dealt with methods adopted for the oral health maintenance like the frequency of brushing and the materials used for maintaining oral hygiene. This was followed by clinical examination. Decayed, missing, filled surfaces (DMFS) index [11] and SCI [7] was used in this study.

The questionnaire was translated into Kannada language. The validity was checked by a back-translation method, involving blind re-translation into English. The validity of translation was verified by experts in both languages. This was also checked after wording modifications, in order to ensure the functional and conceptual equivalences of the questionnaire.

All the participants were briefed about the purpose of the study and all points of the questionnaire were clarified to them. The examination was carried out by a single examiner and the intra examiner reproducibility was found to be good (kappa value ranging 0.80-0.82) before, during and after the study. The participants were not permitted to confer with each other. Ethical approval was taken for the study from the Ethics Committee and informed consent was sought from the participants prior to the distribution of the questionnaire. The participants had the right to withdraw, at any point of time, from the study. No incentives were given to increase the number of participants.

Tools for clinical examination were mouth mirror, cotton roll and community periodontal index probe. The end of the probe was slided gently across a tooth surface to confirm the presence of a cavity or discontinuity. The clinical examination was done under natural light. The occlusal, buccal, palatal/lingual surfaces of all teeth were checked for the presence of dental caries. To eliminate interviewer's bias, data collection, questionnaire and visual examination were always carried out by the same examiner.

All the statistical analysis was carried out using the Statistical Package for Social Sciences software, (SPSS version 16.5). For the purpose of data analysis, age was dichotomized into ≤30 years and >30 years, income as ≤5000 Rs./month and >5000 Rs./month, education as primary or secondary and higher, frequency of brushing as once/day or twice or more/day. Chi-square test and independent sample t-test were performed. P < 0.05 was considered as statistically significant.


   Results Top


There was no significant difference observed in sociodemographic characteristics and oral hygiene practices between soft-drink factory workers and other factory workers. Majority of the workers in the study group and comparison group used toothpaste and toothbrush for oral hygiene maintenance [Table 1] and [Table 2].
Table 1: Sociodemographic characteristics of study group and comparison group


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Table 2: Oral hygiene practices of study group and comparison group


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The mean and standard deviation (SD) of decayed surface (5.8 ± 1.8), missing surface (4.3 ± 2) and filled surface (1.94 ± 1.95) and total DMFS score (12.11 ± 3.8) in the study group were found to be significantly higher than the comparison group [Table 3].
Table 3: Mean and SD of decayed surface, missing surface and filled surface between study group (n=210) and comparison group (n=210)


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The mean of SCI Type 1, Type 3 and Type 4 carious lesion was found to be significantly higher in the study group compared with the comparison group. No significant differences were found between SCI Type 2, Type 6 and Type 6A carious lesions between study and comparison group. The Total SCI score (mean and SD) was found to be significantly higher in the study group (5.83 ± 1.80) compared with the comparison group (4.56 ± 1.45) [Table 4].

On summarizing the data from SCI, it was seen that Type 1 caries was the most common of all the lesions with the mean being 1.79 followed by Type 2 with the mean being 1.16 [Table 5].
Table 4: Mean and SD of SCI score between study group (n=210) and comparison group (n=210)


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Table 5: A summary of the caries experience in the whole sample (n=420) according to SCI and DMFS index


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Scatter plot [Figure 1] shows a correlation between DMFS score and the SCI score. Pearson's coefficient of correlation was used to test the correlation between the SCI and DMFS score. There was a high correlation obtained between SCI score and DMFS score. The regression equation given by DMFS = 1.178 + 1.866 (SCI scores).
Figure 1: Scatter plot shows correlation between decayed, missing, filled surfaces score and the specific caries index scores

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   Discussion Top


The mean DS, MS, FS and DMFS score was significantly higher in soft-drink factory workers. According to American Dental Association (ADA) report [12] frequent exposure to sugar-sweetened soft-drink increases risk for dental caries (tooth decay). McIntyre, [13] stated that dental caries may result from a long-term high intake of soft-drink and deterioration in oral hygiene pattern. In other cases, slowly progressive caries may suddenly become rampant; this may result from frequent exposure to erosive acids. Bowen and Lawrence [14] stated that the most frequent source of dietary acid is soft-drinks like cola and the cariogenicity of cola is higher than milk and sucrose.

Specific caries index [7] is a new system for describing untreated dental caries experience in developing countries. The GV Black's [15] classification of cavity preparation was used to allot score for caries in different areas of the dentition as it covered almost all the possible areas where a carious lesion could occur. The total SCI score (mean and SD) was found to be significantly higher in the study group (5.83 ± 1.80) compared to the comparison group (4.56 ± 1.45). Data analysis showed that Type 1 carious lesion (occurring on the occlusal, buccal pits and fissures of molars and premolars and the lingual pits of the anterior teeth) was most common with mean value 1.79 followed by SCI Type 2 carious lesions with mean being 1.16.

In this study, scatter plot diagram shows a high correlation between SCI score and DMFS score suggesting that the SCI index can be used for assessing caries in place for DMFS Index.

Individual lifestyle, as it relates to the physical form of food and beverages consumed, individual susceptibility, and oral hygiene practice are considered the most important factors for development of dental caries.


   Conclusion Top


In this study, caries experience was found higher in soft-drink factory workers compared with other factory workers. Hence, effective measures to promote occupational health are required among small scale soft-drink factory workers. This study also showed that SCI can be used as a valid index for assessing dental caries experience due to high correlation obtained.

 
   References Top

1.Scottish Intercollegiate Guidelines Network. Preventing Dental Caries in Children at High Caries Risk: Targeted Prevention of Dental Caries in the Permanent Teeth of 6-16 Year Olds Presenting for Dental Care. SIGN Publication no. 47. Edinburgh: Scottish Intercollegiate Guidelines Network; 2000.  Back to cited text no. 1
    
2.Department of Health. Dietary Sugars and Human Disease. Report on Health And Social Subjects: 37. London: HMSO;1989.  Back to cited text no. 2
    
3.Forshee RA, Storey ML. Evaluation of the association of demographics and beverage consumption with dental caries. Food Chem Toxicol 2004;42:1805-16.  Back to cited text no. 3
    
4.Jensdottir T, Arnadottir IB, Thorsdottir I, Bardow A, Gudmundsson K, Theodors A, et al. Relationship between dental erosion, soft drink consumption, and gastroesophageal reflux among Icelanders. Clin Oral Investig 2004;8:91-6.  Back to cited text no. 4
    
5.Marshall TA, Levy SM, Broffitt B, Warren JJ, Eichenberger-Gilmore JM, Burns TL, et al. Dental caries and beverage consumption in young children. Pediatrics 2003;112:e184-91.  Back to cited text no. 5
    
6.Steinberg AD, Zimmerman SO, Bramer ML. The Lincoln dental caries study. II. The effect of acidulated carbonated beverages on the incidence of dental caries. J Am Dent Assoc 1972;85:81-9.  Back to cited text no. 6
    
7.Acharya S. Specific caries index: A new system for describing untreated dental caries experience in developing countries. J Public Health Dent 2006;66:285-7.  Back to cited text no. 7
[PUBMED]    
8.Soft drinks: Menace for your teeth-India PR wire. Available from: http://www.indiaprwire.com/pressrelease/health-care/20060903566.htm. [Last accessed on 2010 Dec 15].  Back to cited text no. 8
    
9.Wiegand A, Attin T. Occupational dental erosion from exposure to acids: A review. Occup Med (Lond) 2007;57:169-76.  Back to cited text no. 9
    
10.World Health Organization. Oral Health Surveys, Basic Methods. 4 th ed. Geneva: World Health Organization, AITBS Publishers;1999.  Back to cited text no. 10
    
11.Klein H, Palmer C. Studies on dental caries vs. familial resemblance in the caries experience of siblings. Public Health Rep 1938;53:1353-64.  Back to cited text no. 11
    
12.Purcell A. Prevalence and specifics of district-wide beverage contracts in California's largest school districts: Findings and recommendations; 2002.  Back to cited text no. 12
    
13.McIntyre JM. Erosion. Aust Prosthodont J 1992;6:17-25.  Back to cited text no. 13
[PUBMED]    
14.Bowen WH, Lawrence RA. Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics 2005;116:921-6.  Back to cited text no. 14
    
15.Black GV. A work on operative dentistry. The Technical Procedures in Filling Teeth. Vol. 2. Chicago: Medico-Dental Publishing Co.;1908.  Back to cited text no. 15
    

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Correspondence Address:
Sandeep Kumar
Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.135913

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