Year : 2008 | Volume
: 19 | Issue : 4 | Page : 331--334
Dental caries experience and treatment needs of green marble mine laborers in Udaipur district, Rajasthan, India
Prabu Duraiswamy, T Santhosh Kumar, Rushabh J Dagli, Chandrakant, Suhas Kulkarni
Department of Preventive and Community Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan - 313001, India
Department of Preventive and Community Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan - 313001
Background and Objectives: The study was undertaken at Kesariyaji, located in Udaipur district of Rajasthan. There are about 3 million workers who marble mine at Rajasthan. Living conditions of these workers are substandard and most of them are immigrant workers living in tiny shacks. Majority of them belong to lower socioeconomic status with poor educational background. The present study was carried out to estimate dental caries prevalence and treatment needs of laborers working in the green marble mines of Udaipur district.
Basic Research Design: The data was collected using the methods and standards recommended by the WHO. Dentition status and treatment needs along with decayed, missing, and filled teeth (DMFT) index, and decayed, missing, and filled surfaces score were recorded. Standard error of mean was calculated for all the mean values of treatment needs. There were three examiners, who were trained before the survey for inter-examiner variability, and the reliability was tested by means of weighted kappa statistics, which was 90%.
Participants: The study population comprised 513 men in four age groups of 18-25, 26-34, 35-44, and 45-54 years, respectively.
Results: The mean DMFT for all age groups was 3.13 with highest mean of 4.0 for the age group of 45-54 years. Mean decayed teeth were 2.60, 3.33, 1.46, and 1.5 for the age groups 15-24, 25-34, 35-44, and 45-54 years, respectively. Filled component was nil for all age groups. Most of the subjects required one surface filling with a very less proportion needing pulp care.
Conclusions: The missing component constituted the major part of DMFT index in the
45-54 years age group and the absence of filled component in the whole study population implies that the treatment needs of the study population are unmet. Thus, intervention in the form of oral health promotion and curative services are the need of the hour.
|How to cite this article:|
Duraiswamy P, Kumar T S, Dagli RJ, Chandrakant, Kulkarni S. Dental caries experience and treatment needs of green marble mine laborers in Udaipur district, Rajasthan, India.Indian J Dent Res 2008;19:331-334
|How to cite this URL:|
Duraiswamy P, Kumar T S, Dagli RJ, Chandrakant, Kulkarni S. Dental caries experience and treatment needs of green marble mine laborers in Udaipur district, Rajasthan, India. Indian J Dent Res [serial online] 2008 [cited 2019 Nov 15 ];19:331-334
Available from: http://www.ijdr.in/text.asp?2008/19/4/331/44537
It is believed that dental caries is a rapidly increasing oral health problem in developing countries,  with a decline in the western industrialized countries ,, due to change in dietary patterns. Mean decayed, missing, and filled teeth (DMFT) (3.13) of the study population was found to be slightly higher to that of the general population of India.  The study sample may not represent the general population, but it is widely accepted that a large proportion of dental caries experience can be found in small percentage of the population. It is well known that a close relation lies between dental caries experience and socioeconomic status  leading to the concentration of the disease in communities living in deprived conditions. Utilization of dental health services has been related to social class differences in caries experience. 
Marble mining is a major flourishing industry in Rajasthan. Kesariyaji in Rajastan is famous for green marble mines and it is one of the few places in India where green marble mining is done. Mining involves tedious physical work load, and this is the reason for the sample comprising only of men. Working in mines involves exposure to colloidal silica and particulate matter, and they are more prone to dental related injuries as their work area has slippery marble surfaces. A major part of this mining community is plagued by malnutrition, ill health, and physical impairment from accidents. Majority of people living in rural areas have limited access to essential oral healthcare due to geographic and economic barriers.  Hence, the intention of the present study was to assess dental caries prevalence and treatment needs of laborers working in green marble mines, who have poor access to healthcare especially oral healthcare due to geographical and economical restraints. All the study subjects belonged to the below poverty line (BPL) and were BPL card holders.
Oral healthcare in India has been neglected from a long time and oral disease problems are considered to be of least importance, even though India is considered as a fast developing nation. Public oral health services are limited and have always been a mirage for poor.
Materials and Methods
The study area was located in Udaipur district of Rajasthan and it is divided into four geographical zones namely: Masoron ki ovri, Rushabhdev, Khandiovri, and Kagdar bhatiya.
WHO sampling (stratified cluster sampling) procedure was used to collect the representative population. There were about 15,000 workers in 80 mines spread over the study area. Each zone was considered as a strata and a cluster of mines was selected from each zone randomly. All the mine workers in the selected clusters had prior information of the date of survey and those workers who were present on the days of survey were included in the study. Special leave was granted for the laborers, by marble mines owners' association authorities, who participated in the survey. The study was conducted between 3 rd and 12 th of February 2007.. It was a type I intraoral examination - examination done under natural day light - carried out by three trained examiners assisted by three recording clerks. All the examiners were trained at the Department of Preventive and Community Dentistry prior to the study by an expert examiner (Associate Professor in the Department of Preventive and Community Dentistry), to diminish inter-examiner variability and the agreement (weighted kappa statistics) was 90%. The training program lasted for a week.
The subjects were examined using a plane mouth mirror and curved sharp sickle probe (standard explorer) for DMFT and decayed, missing, and filled surfaces (DMFS). 
The study population comprised of 513 men categorized according to four age groups -15-24, 25-34, 35-44, and 45-54 years. Inclusion criterion comprised of subjects present on the days of survey. Those who were absent on the corresponding days of survey and subjects who reported systemic illnesses like hypertension and diabetes mellitus were excluded from the study. There were no women present in the study population because of the reason that strenuous physical work is involved in marble mining. Decayed, missing, and filled components were recorded for all age groups along with dentition status and treatment needs as recommended by the WHO oral health surveys.  Observations were recorded on a modified (Version WHO CC 02/DB, Malmo university caries recording form), and simplified WHO oral health assessment form.
DMFT and DMFS were used to record the caries status so that it would allow comparison with past studies as there is very modest literature of the dentition status.
Dentition status was recorded along with DMFT and DMFS as it was expected that a mass of sample population would present trauma or fractures, but no significant findings were observed. Hence, dentition status is not presented in the results section as it would duplicate the results. Preliminary pilot survey was done and the prevalence rate for dental caries was found to be 77%. Estimated sample size was 470, which was determined by the formula (Daniel, 1999), n = Z2P (1-P)/d2 , where n is the sample size, Z the statistic for a level of confidence, P the expected prevalence or proportion, and d the precision. (Z statistic and d precision (allowable error) were set at 95% confidence (Z = 1.98) and 5%, respectively)
Ethical clearance was obtained from the 'ethical committee for research' of Darshan Dental College, Udaipur prior to the survey along with the informed consent from each subject during the survey.
Data processing was carried out using SPSS/PC+ software package (11 01 English version), and standard error of mean was calculated for all the mean values of treatment needs.
[Table 1] illustrates the sample distribution according to age. Majority of the sample belonged to the youngest age group (15-24 years) and very few workers were under the age of 45-54 years, hence the small sample size. The oral health conditions among the 45-year-old age group were proportionate to the target population of that age group. In total, 513 subjects were examined, of which 135 (26.3%) subjects were caries free. In the age group 45-54 years, 40% of the individuals were caries free whereas only 21% were caries free among the age group 15-24 years. [Table 2] presents the percentage of caries-free subjects according to age groups
The mean caries index by age group is presented in [Table 3]. The DMF-T was 2.88 for the entire population. The largest component of the DMF-T was 'Decayed' accounting for a mean of 2.16 (71%), while missing and filled components were low. There was no filled component observed in the whole sample.
Missing teeth was the dominant expression of caries experience among the oldest age group.
[Table 4] displays DMF-S by age. The highest mean DMF-S was recorded for the oldest age group with missing surfaces being a major component. In the younger age groups, 15-24 and 25-34 years, decayed surfaces comprised a major part with the DMF-S scores of 3.15 and 4.22, respectively. Missing surfaces did not account for a major proportion in all the age groups, except for the oldest age group.
[Table 5] shows treatment needs in various age groups and was estimated according to WHO guidelines for the whole sample. One surface filling was needed for 44% of the 513 individuals examined, while 12% needed two surface fillings. In the age group 15-24 years, the need for pulp treatment was nil and most of the subjects (52%) required one surface filling. Teeth indicated for extraction accounted for a very less proportion, but a mean of 0.4 was recorded in the oldest age group. The proportion of subjects requiring crown was low, but significant. Treatment needs of preventive care and fissure sealant were not observed in the study population.
Geographically, Rajasthan is the largest state in India that is bestowed with marble and mineral mines. Kesariyaji is the only place in Udaipur district where green marble mines are found.
There are about 3 million workers who marble mine in Rajasthan. They work in the mines for at least 10 hours a day to earn anything between Rs 50-90 per day. The mineworkers work in deep open pits where the air is thick with dust from dry drilling, and safety equipments are nonexistent. Hence, mines are called 'pits of death'. It is estimated that half of the mineworkers develop lung diseases, such as silicosis due to the continuous exposure to dust and the lack of respiratory masks along with other precautionary measures. A mineworker, on an average, finishes his life at the age of 49.3 years (Mines and Geology Department, Rajasthan), 20 years earlier than that of general population of India.
Living conditions of the workers are also substandard. Most of them are immigrant workers, who live in tiny shacks without their families; Fifteen to twenty men share a single room.
There are hardly any studies done on general health of marble-mining population and seldom on oral-health status. The accumulation and comparison of data from different studies with comparative groups is difficult because of the paucity of literature on the oral health status of marble mining population.
The study revealed substantial unmet dental treatment needs, chiefly for the caries, among marble mine laborers, since only one-fourths of all participants were free from caries and none of them had filled teeth. This finding is of utmost importance as it indicates the unmet needs.
The present observation of dental caries prevalence and mean DMFT (3.13) of the study population is higher compared to the general population of India. 
For all the age groups, untreated dental caries constituted most of the caries experience that again gives an insight into unavailability of formal dental care; similar condition was observed in a study done by Poul Erik Petersen. 
Study done on Danish granite industry workers  observed a mean DMF-S score of 87.2 that is extremely greater than the in present study with a mere 5.37 DMF-S score, with a major portion contributed by the oldest age group. It was observed in the same study that about 51% of the subjects made regular visits to dentists in contrary to our study where no subject had been to a dentist in their lifetime.
The caries status of the study population with a mean DMFT of 3.13 and a caries prevalence of 73% is in agreement with a previous study among gold mine workers where DMFT and caries prevalence were 2.5 and 68%, respectively. 
Mean DMFT in a Danish industrial population increased with the age,  but no such trend has been encountered in our study.
Teeth requiring various types of treatment found that one or two surface fillings were maximum, followed by others in accordance to data from previous study,  where the sample comprised of general population.
Mean DMF-T for the age group of 35-44 years was only 3.2, which is extremely contradictory to other studies done on the general population of the same age group by Hescot et al.,  and Doughan et al.,  who have observed a mean DMF-T of 14.6 and 16.3, respectively.
Previous studies have observed that working in industries of mines,  metals,  and chemicals  may affect pattern of periodontal disease, whereas working in bakeries,  candy industries,  and chocolate factories , increases the prevalence of dental caries. No significant pattern of dental caries was observed in our study. Missing component accounted for a major proportion in the oldest age group. A small proportion of teeth were indicated for extraction for all ages including the age group 45-54 years.
One surface filling was a major dental treatment need that was found to decrease with increasing age; the same results were observed by Alvarez-arenakl A. 
Crown and veneer/laminates comprised of a significant proportion of treatment needs, but very less compared to other treatment needs, the rationale for the above treatment need is the trauma of anterior teeth due to slippery marble surfaces at work place.
In India, publicly funded oral healthcare service is very limited and primary oral healthcare service is based on private dental healthcare providers that cannot be afforded by the study group owing to their poor socioeconomic conditions. If not curative services, it is on the part of national health system to provide at least preventive services for the needy. The present study provides an insight into the poor lifestyle along with the healthcare accessibility of the study population. The government should take responsibility to improve their socioeconomic and health status by strengthening the existing legislations (Mines Act of 1952). Preventive and curative dental services apart from medical services should be provided to this needy group at free-of-cost through the establishment of rural health centers.
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