|Year : 2012 | Volume
| Issue : 1 | Page : 20-24
Assessment of oral health status and treatment needs of police personnel in Shimla city, Himachal Pradesh: A cross-sectional study
Vinay Kumar Bhardwaj1, KR Sharma2, P Jhingta3, RP Luthra4, D Sharma3
1 Department of Public Health Dentistry, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Paedodontics, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
3 Department of Periodontology, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
4 Department of Prosthodontics, H. P. Govt. Dental College and Hospital, Shimla, Himachal Pradesh, India
|Date of Web Publication||21-May-2012|
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H.P. Govt. Dental College and Hospital, Shimla 1, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Objectives: To assess the oral health status and treatment needs of police personnel in Shimla city and to suggest measures to improve the present oral health status. Materials and Methods: The cross-sectional study was conducted on 371 subjects, aged 18-58 years who were selected by simple random sampling. Type-III examination of the subjects was conducted by a single investigator and data was recorded on modified W. H .O. format 1997. A value of P ≤ 0.05 and ≤ 0.001 was considered statistically significant and highly significant, respectively. Results: DMFT (decayed, missing, filled teeth) was significantly higher among older age group, males and constables. Subjects brushing once daily had higher DMFT 3.16 (S.D. = 3.29) than those brushing twice daily 2.8 (S.D. = 2.79) ( P < 0.05). CPI score-2 was highest among majority of subjects. Female employees were healthy in all their sextants to be examined in both arches than male employees (8.3% vs. 2.8%). Subjects brushing twice daily had significantly healthy periodontium than those brushing once daily. The percentage of healthy periodontium was higher in non-smokers (6.33%) than in smokers (1.31%). The difference was highly significant for score-3 and 4 ( P < 0.001). Prosthetic status and prosthetic needs was higher in mandible than maxilla and this difference was statistically significant ( P < 0.05). Conclusion: Most of the police personnel suffer from dental caries, periodontal diseases and edentulousness. Awareness should be created to maintain good oral hygiene, regular dental check up and abstain from smoking and alcohol among police personnel.
Keywords: Oral health status, police personnel, treatment needs
|How to cite this article:|
Bhardwaj VK, Sharma K R, Jhingta P, Luthra R P, Sharma D. Assessment of oral health status and treatment needs of police personnel in Shimla city, Himachal Pradesh: A cross-sectional study. Int J Health Allied Sci 2012;1:20-4
|How to cite this URL:|
Bhardwaj VK, Sharma K R, Jhingta P, Luthra R P, Sharma D. Assessment of oral health status and treatment needs of police personnel in Shimla city, Himachal Pradesh: A cross-sectional study. Int J Health Allied Sci [serial online] 2012 [cited 2019 Sep 16];1:20-4. Available from: http://www.ijhas.in/text.asp?2012/1/1/20/96415
| Introduction|| |
Health is a common theme in most cultures and is a fundamental human right without distinction of race, religion, and political belief, economic and social condition.  Oral health is an integral part of general health and is one of the determinants of quality of life.  Oral health is a standard of health of the oral and related tissues that enables an individual to eat, speak and socialize without active disease, discomfort, or embarrassment and contributes to the general well being. It is concerned with maintaining the health of craniofacial complex, the teeth and gums as well as the tissue of the face and head that surrounds the mouth.  Loss of teeth and deterioration of oral tissue substantially reduces the quality of life. 
As military is to defend the country from external threats, so is police for maintenance of internal peace of the community. The mission of police of a state is to help the common man, to provide him security and to create a peaceful and law abiding community with his cooperation.  The importance of health in general and oral health in particular entails particular considerations and repercussions from a police point of view because of the direct and indirect consequences for the service and deployment caused by a loss of oral health. Police personnel are state government employees who have access for free medical care at government hospitals and privileges for leave on medical grounds.  This warrants good general as well as oral health. But on the other hand, police personnel are a group of professionals who have all together a different working environment with round the clock busy work schedule. The nature of their job is such that they are subjected to physical, mental and emotional stress. The irregular shifts in their work schedule leads to neglecting or skipping of their regular diet and indulging into adverse habits.  The work shifts also deprive of their routine sleep pattern and social activities. This complicates their life and pulls down their level of living. 
It is the responsibility of the state government and society to safeguard the health of their defenders. However, no studies have been conducted in the state of Himachal Pradesh which assesses the oral health status of police personnel. Hence this study was taken up to assess oral health status and treatment needs of these employees in Shimla city. Outcome of this study will be important for establishing priorities and determining the type and quantity of preventive and curative services required with regards to oral health.
| Materials And Methods|| |
Shimla is the capital of the state of Himachal Pradesh in India with total area of 32.30 sq. km and with population of 1,42,535. It is situated at an altitude of 2400 m above sea level with a temperature range of 4-25°C. Being capital of the state, it harbors the head offices of all the departments.  Among all the employees, 3719 police personnel are employed in different police establishments in Shimla city.  371 subjects accounting 10% of the total police population were selected by simple random sampling for clinical examination. Age group of the study population was between 18 and 58 years. After getting ethical clearance, consent from concerned authorities and informed consent from subjects, a pilot study was done on 30 police personnel. Inclusion criteria were police personnel in Shimla city, who were present on the day of examination and willing to participate in the study. Exclusion criteria were employees not willing to participate in the study.
This cross-sectional study was conducted in the month of March 2009 as per prescheduled time and at the working place of the police personnel. Data regarding age, gender, oral hygiene practices, and adverse habits was recorded separately. The stress status was assessed as moderate (score-15) or severe (16-30), according to Dr. Hugh Sedgwick Criteria.  In order to ensure the reliability and validity of the results, the examiner was first calibrated against an experienced examiner, obtaining a 0.85 Kappa index and a percentage agreement of 99.4%. Type III examination as recommended by American Dental Association,  which includes inspection using a mirror and probe under good illumination was conducted. Oral health status of the study population was recorded on a modified W.H.O. format 1997.  Instruments were sterilized by autoclaving in the college before leaving to the field and chemical sterilization was done. The subjects were also educated regarding maintenance and benefits of good oral hygiene and harmful effects of consuming tobacco and alcohol. The needy were motivated to seek treatment. Data were analyzed using SPSS package -13. Depending on the type of variables to be compared, the measures of association employed the Mann-Whitney U test. The significance of the difference between the two proportions was assessed with Pearson's chi-square test. The precision was calculated for a 95% confidence level. A value of P ≤ 0.05 was considered statistically significant whereas ≤ 0.01 was considered as highly significant.
| Results|| |
A total of 371 subjects were examined out of which 347 (93.53%) were males and 24 (6.47%) were females. According to official status, 36 (9.7%) were officers and 335 (90.3%) were constables [Table 1]. All the subjects used tooth brush with tooth paste or tooth powder.A total of 326 (87.8%) of the study population used toothbrush and tooth paste, 45 (12.2%) used tooth brush and tooth powder. About 357 of the subjects brushed their teeth once (96.22%) and 14 subjects twice (3.78%) a day, respectively. Among the study population, 124 (33.42%) didnot have any adverse habits. Majority of them were smokers 142 (38.27%) followed by alcoholics 90 (24.25%), gutka and pan chewers 11 (2.96%) and 4 (1.07%), respectively.
|Table 1: Genderwise and official statuswise distribution of study population|
Click here to view
Among the self-reported medical conditions, hypertension, diabetes and thyroid problems were reported by 92 (24.79%), 16(4.31%) and 5 (1.34%) subjects, respectively. In the study population, 309 (83.28%) had moderate stress, while 62 (16.72%) had severe stress, which was highest in the age group of 35-44 years [Table 2].
Prevalence of dental caries was 48.24% among the whole sample. Mean DMFT was 2.98 (S.D. = 3.04). Prevalence of dental caries as well as DMFT had linearly increased from youngest age group 18-24 years to 55-58 years. Officers were having lower DMFT 2.78 (S.D. = 2.96) than constables 3.18 (S.D. = 3.12). Those subjects brushing twice daily had lower DMFT 2.8 (S.D. = 2.79) than those brushing once a day 3.16 (S.D. =3.29) [Table 3]. Of the 371 subjects, 4 (1.07%) were excluded from the CPI computation either because of edentulousness or because extractions indicated for remaining teeth would have rendered the subjects edentulous.CPI score 2 was maximum among 18-24, 25-34 and 35-44 years age group. Ages 45-54 and 55-58 years were reported with maximum scores, 3 and 4, respectively. Females were having higher CPI values for all the scores except scores-2 and 3. Among study population, the constables were having higher CPI scores 2 and 3 than officers, and this difference was statistically significant [Table 4].
Prosthetic status as well as need for mandibular arch was higher in all the age groups as compared to maxillary arch. Subjects in the age groups 55-58 years were reported with maximum need of prosthesis [Table 5].
| Discussion|| |
The intention of the present study was to provide systematic information of oral health status and treatment needs among police personnel in Shimla city, which would aid in planning and evaluation of oral health promotion program. Occupational environment plays a major impact on the health of the exposed. The severity of the health hazards increases when the duration of exposure increases. The fact becomes more important in the case of police personnel who are engaged in their 24-h duty quite often.
Subjects under study were aged between 18 and 58 years with a mean age of 42.16 ± 7.22 year. Females were having lower representation 24 (6.47%) than males 347 (93.53%) as police personnel in Shimla city. Hypertension was the most common self-reported systemic condition similar to the findings of study by Tharkar S.  This finding is based on the lifestyle in this occupation and mandates annual health screening of these personals. Smoking was the most common deleterious oral habit committed by this group of population, reason may be that this population is being dominated by males and because of cultural practices would have higher tendency to use tobacco. All the police personnel who were examined and questioned had perceived moderate to severe work stress which was significant (P < 0.05) and comparable to study by Gershon. 
Mean DMFT gradually increased from lowest age group 18-24 years (1.29, S.D. =1.32) to the highest age group 55-58 years (5.11, S.D. = 4.98). Increase in the mean DMFT may be due to cumulative effect of different diseases and also to the more missed teeth and removal of teeth in the older age groups. Mean DMFT irrespective of the gender was 2.98 (3.04). Similar findings were reported in studies. , Contrasting higher DMFT was reported by Vrbic et al. in their studies. Lower DMFT was reported by Ying et al. in China. This difference may be attributed to different geographical, ethnical and cultural variations, fluoride contents of drinking water. Comparison based on gender shows that males were having higher DMFT 3.16 (3.28) vs. 2.8 (2.94) and prevalence of dental caries 48.7% vs. 41.6% than females, and this difference was statistically significant which correlates with the study done by Nyyssonen V. 
Officers had shown lower DMFT 2.78 (S.D. = 2.96) than constables 3.18 (S.D. = 3.12) which was highly significant. Gaare et al.  in their study on a group of Indonesian soldiers and Satapathy  on police personnel reported similar findings. The reason may be that officers are well accustomed to the oral hygiene practices than constables.
Better oral hygiene practices were found to be associated with lower prevalence of dental caries similar to the findings of Doifode et al.  Frequency of tooth brushing had shown an inverse relationship with mean DMFT values. Those subjects who were brushing once daily had higher DMFT 3.16 (S.D. = 3.29) than those brushing twice daily 2.8 (S.D. = 2.79). The difference was significant (P < 0.05). This could be due to more cleansing of the teeth and better oral hygiene.CPI score-2 (presence of calculus) was highest among the age group 18-24 years, 25-34 years and 35-44 years. Score 3 was highest in the age group 45-54 whereas score-4 was highest in the age group 55-58 years, reason may be as the age advances periodontal diseases becomes more progressive and destructive. Similar trends were reported by Songpaisan  Female employees were healthy in all their sextants to be examined than male employees (8.3% vs. 2.8%). Statistically this difference was significant. The reason why gender affects periodontal health status may be attributed to the habit and conscious of females in maintaining a better oral hygiene practice. These results were in agreement to the results of the study.  Officers were having more healthy scores than constables (8.2% vs 2.1%) which could be due to more awareness among officers than subordinates. Frequency of tooth brushing has shown correlation with occurrence of periodontal disease. Subjects brushing twice daily had healthy periodontium than those brushing once daily and statistically this difference was significant. Idris FA  has reported similar results.
The percentage of healthy periodontium was significantly higher in non-smokers (6.33%) than in smokers (1.31%). The percentages of CPI scores (1, 2, 3 and 4) were higher in smokers than in non-smokers. The difference was highly significant for scores 3 and 4. Similar results were seen in the study by Zhonghua Z,  which has revealed that smoking is positively related to periodontitis.
Prosthetic status was higher in mandible than maxilla (4.85% vs 3.78%) and this difference was statistically significant. Prosthetic need for mandibular arch 138 (37.19%) was significantly higher in all the age groups as compared to maxillary arch 106 (28.57%).The need for one or more prosthesis was slightly less than the study conducted by Doughan et al. 
| Conclusion|| |
While dental health services are provided on concession to these police personnel, to date these services has been almost treatment oriented. Efforts need to be focused above all on raising this population's awareness of the importance of oral hygiene, harmful effect of tobacco and alcohol consumption, regular dental checkup for early diagnosis of oro-dental diseases and treatment at well-established dental care centers in government sector as well as authorized private clinics in Shimla city. To meet this objective, a preventive and curative oral health policy for the police personnel in the state of Himachal Pradesh, defining resources, objectives and priorities, needs to be planned and implemented. An added benefit is that provision of such care may constitute an incentive for these employees to maintain their commitment in their official work. Interventions that address modifiable stressors and promote effective coping and resiliency will probably be most beneficial in minimizing police stress and associated outcomes.
| Acknowledgment|| |
I thank all the police personnel who agreed to take part in this study, government dental college Shimla administration, statistician, and heads of the police establishments in Shimla city.
| References|| |
|1.||Park K. Man and medicine: Towards health for all. Park's text book of preventive and social medicine. 20 th ed. Jabalpur, India: M/S Banarsidas Bhanot publishers; 2009.p.1-11. |
|2.||Slade GD, Spencer AJ. Social impact of oral conditions among older adults. Aust Dent J 1994;39:358-64. |
|3.||Yewe- Dyer M. The definition of oral health. Br Dent J 1993; 174:224-5. |
|4.||WHO. The world oral health report 2003. Geneva: World health organization; 2003. |
|5.||Himachal Pradesh police. Available from: http://admis.hp.nic.in/himpol/ [Last accessed on 2011 July 26 th ]. |
|6.||Muthuswamy, Bindra. Swamy's Handbook 2009. Orders Based on Sixth Pay Commission Recommendation. 35 ed. Chennai : Swami Publishers(P) Ltd.; 2009. |
|7.||Silbert MH. Job stress and burnout of new police officers. Police Chief 2009;49:46-8. |
|8.||Dilip CL. Health status, treatment requirements and knowledge and attitudes towards oral health of police recruits in Karnataka. J Indian Assoc Pub Health Dent 2005;5:20-34. |
|9.||Chaudhary M. Himachal a complete guide to the land of gods.New Delhi: Rupa and Company Saurabh Printers Private Ltd.; 2006:12-9. |
|10.||51 st census of government employees in Himachal Pradesh as on 31.3.2008 department of economics and statistics, Government of Himachal Pradesh. |
|11.||Dunning JM. Principles of dental Public Health. 4 th ed.Cambridge Massachusetts:Harvard University Press; 1986. |
|12.||World Health Organisation, Oral health Surveys-Basic methods. 4th ed.Geneva: WHO;1997. |
|13.||Tarkar S, Kumpatla S, Muthukumaran P, Viswanathan V. High prevalence of metabolic syndrome and cardiovascular risk among police personnel compared to general population in India. J Assoc Physician India 2008; 56:845-9. |
|14.||RM. Mental, physical, and behavioral outcomes associated with perceived work stress in police officers. J Crim Justice Behav 2009; 16:275- 89. |
|15.|| Frencken JE, Rugarabamu P, Amuli JA. Oral health status of employees in sugar and sisal estates in Tanzania. Afr Dent J 1989; 3:9-16. |
|16.||Benoit V, Petersen PE, Seydou O. Oral health status of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J 2004; 54:83-9. |
|17.||Verbic B, Homan D, Zavrshik B. Oral Health in Slovania, Yugoslavia. Community Dent Oral Epidemiol 1991; 19:72-3. |
|18.||Ying WH, Petersen PE, You BJ. The second national survey of oral health status of adults in China. Int Dent J 2002; 52:283-90. |
|19.||Nyyssonen V, Paunio I, Rajala M, Vehkalahti M. Dental caries in the adult population in Finland. Int J Epidemiol 1984; 13:486-90. |
|20.||Gaare D, Joelimar FA, Ouderaa FV. A cross-sectional study of DMFT and CPITN scores in a group of Indonesian soldiers. Eur J Oral Sci 1989;97:20-4. |
|21.||Satapathy DM, Behera TR, Tripathi RM. Health status of traffic police personnel in Brahamapur city. Indian J Community Med 2009;34:71-2. |
|22.||Diofode VV, Ambadekar NN, Lanewar AG. Oral health status and its association with some epidemiological factors in population of Nagpur, India. Indian J Med Sci 2000;54:261-9. |
|23.||Songpaisan N. Periodontal status and treatment needs in the Chiangmai/Lamphun provinces of Thailand. Community Dent Oral Epidemiol 1989;17:196-9. |
|24.||Marker OT, Vigild M, Praetorius F. Oral health problems and treatment needs in Danish military personnel recruited for United Nations service. Mil Med 1997;162:416-21. |
|25.||Idris FA. Periodontal disease prevalence and some related factors among 15 years old school children in Khartoum State, Sudan. Sudan J Public Health 2010;5:187-92. |
|26.||Zhonghua Z. Effect of smoking on the periodontium and the level of aspartate aminotransferase in gingival cervical fluid. Chin J Prev Med 2003; 37:266- 9. |
|27.||Doughan B, Kassak K, Bourgeois DM. Oral health status and treatment needs of 35-44 years old adults in Lebanon. Int Dent J 2000;50:395- 9. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]