EFFECT OF SMOKING AND BRUSHING FREQUENCY ON THE ORAL HEALTH STATUS IN THE POPULATION OF DISTRICT GHAZIABAD. Research Article

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1 EFFECT OF SMOKING AND BRUSHING FREQUENCY ON THE ORAL HEALTH STATUS IN THE POPULATION OF DISTRICT GHAZIABAD AnshuBlaggana, Pallak Arora, Vimal Kumar, Kapoor, NehaKoshal, VikramBlaggna 1 Professor and Head, Department of Periodontology, PDM Dental College and Research Institute, Bahadurgarh 2 Reader Department of Oral Medicine & Radiology, DJ College of Dental Sciences & Research, Modinagar University Journal of Dental Sciences Research Article 3 Reader Department of Periodontology, Kalka Dental College, Meerut 4 ReaderDepartment of Periodontology, SGT Dental College, Gurgaon 5 Consultant Oral Medicine & Radiology, New Delhi 6 Professor and Head, Inderprastha Dental College, Ghaziabad ABSTRACT: Context: Periodontitis, viewed for years as primarily the outcome from infection, is now seen as resulting from a complex interplay between bacterial infection and host response. The host response is now seen as a key factor in the clinical expression of periodontitis, with only some 20% of periodontal diseases now attributed to bacterial variance and more than 20% to smoking and tobacco use, although the role of tobacco has also been estimated as higher. Aims: To estimate effect of smoking and brushing frequency on the oral health status in the population of district Ghaziabad. Aims: To estimate effect of smoking and brushing frequency on the oral health status in the population of district Ghaziabad. Settings and Design: The study population consistedof 1290 subjects from total population of district Ghaziabad. 640 subjects were selected from rural area and 650 were from urban area. Study population subjects were further categorized into different smoking habits and brushing frequency. Methods and Material: A cross-sectional study was conducted with multi stage stratified random sampling techniques to select the sample population and the oral health assessment was made on the basis of, oral hygiene index simplified (OHI-S), and Community Periodontal Index of Treatment Needs (CPITN). Statistical analysis used: The statistical analysis was done using the CHI-Square test. Results: Significantly more number of females was found to be having good oral hygiene status than males. Periodontal disease was found to be highly prevalent in the study population and severity of disease increased with lack of oral hygiene and smoking habits. Conclusions: Significant association was observed between males and females having different scores of OHI-S, and CPITN index in different areas. KEYWORDS: CPITN; Ghaziabad; OHI-S; Periodontitis; Prevalence Source of Intrest: Nil Conflict of Intrest: None Key Messages Periodontal disease was found to be highly prevalent and severity of disease increased with lack of oral hygiene. Individuals, who brush twice, had good oral health in comparison to those who brushed once a day. Introduction: Population studies of the distribution and risk factors of periodontaldiseases offer a unique investigational model that provides power andgeneralization to observations made 1 among more limited populations. Periodontal diseases are multifactorial in origin having different forms and progression. The incidence and prevalence rates of periodontitis may be different in different areas depending on various risk factors. Although destructive forms of periodontal disease in are relatively uncommon, children and adolescentsmay manifest any form of periodontitis. However, it has beenshown that aggressive periodontitis may be more common inchildren and adolescents, while chronic periodontitis is morefrequent in University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 84

2 adults.prevalence estimates range widely in different geographicalregions, and demographic and ethnic groups. The estimatesof prevalence rates of early onset aggressive periodontitisin the general populations in different continentsare: % in North America, % in WesternEurope, 0.3 1% in South America, 0.5 5% in 2 Africa and0.4 1% in Asia. Many indices have been used by researchers and clinician to evaluate oral hygiene and periodontal status. Oral hygiene index simplified (OHI-S) is used to assess oral hygiene status of individuals by measuring debris and plaque on index teeth having well defined criteria and scoring system. Community periodontal index of treatment need estimate periodontal status and treatment needs by examining index teeth and having well defined criteria and scoring system. Thus in this epidemiological study an attempt has been made to estimate effect of smoking and brushing frequencyon the oral health status in subjects aged between years and above, in district Ghaziabad (Uttar Pradesh, India) using the Community Periodontal Index of Treatment Needs, along with the modified Oral Hygiene Index. Subjects and Methods: A cross-sectional study was conducted in which multi stage stratified random sampling techniques were used to select the sample population as under: Bhojpur, and Seven villages (Anwarpur, Abdullahpur Mori, Upada, kurana-kamalpur, Nizampur, Firozpur and Firozabad) from Hapur were selected by Fisher and Yates. 3 table of Random Number 4) FOURTH STAGE Full information was collected from the ward members and village Pradhans about the areas to be examined like the total number of residents, age group etc. The study population consisted of random sample of 1290 subjects from total population of district Ghaziabad. The selected subjects for the study were informed briefly about the study plans and were asked to sign a consent form. Valuable information from every patient was collected via structured questionnaire which consisted of questions of our interests like Age, Brushing Frequency, and Smoking or Chewing tobacco habit. Every individual, along with routine dental examination, was assessed for the periodontal disease status by using sterilized Mouth Mirror and Explorer (Shepherd's Crook) for the simplified oral hygiene index introduced in 1964 by John 4 C. Green and Jack R. Vermilion. and with WHO CPITN- C Probe for Community Periodontal Index of Treatment Needs introduced byjukkaainamo, Jean Martin and 5 Jennifer Sardo-Infirri in ) FIRST STAGE Out of four Tehseels of District Ghaziabad, two were selected by simple randomization (Modinagar and Hapur). 2) SECOND STAGE The selected Tehseels were further divided into three zones by the systemic randomization. (Modinagar, Bhojpur and Hapur). The statistical analysis was done using the CHI-Square test to determinesignificant association between males and females in rural and urban area having different brushing frequency and different smoking habits. The formula used for CHI- 2 square test was: 3) THIRD STAGE Six wards were selected (Multanipura, Fafranabasti, Adarshnagar, Modipone, Govindpuri, Modisteel Colony) from Modinagar, Ten villages (Sara, Yakutpurmavi, Kadrabad, Rori, Saidpur, Phaphrana, Sikrikhurd, Bhakharwa, Khanjarpur and Bhojpur) from Exclusion criteria 1. Those subjects who were using Datun, Mouth wash, and any other oral hygiene methods other than brushing. 2. Subjects less than 20 yrs of age. University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 85

3 Inclusion criteria 1. Subjects who Brushes their teeth either once or twice a day. 2. Subjects who Smokes one packet of Bidi/Cigarettes in a day was consider as a smoker in the study. 3. Subjects who Chew's more than 3 Packets of Tobacco were consider as a Tobacco chewer. Results: The study population had a total of 1290 subjects; 640 were from rural area and 650 were from urban area. In Table no.1 when we compare the C.P.I.T.N score on the basis of gender and dwelling areas it was found that 20.2% of rural males, 25.8% of rural females, 20.1% of urban males and 29.5% of urban females had C.P.I.T.N score 0. While score 1 was found in of rural male, 23.9% of rural female; 19.6% of urban male and 29.1% of urban female. Score 2 was there in 19.3% of rural male,19.1% of rural female ; 24.1% of urban male and 18.3% of urban female. But 19.3% of rural male 16.8% of rural female; and 20.1% of urban male 13.3% of urban female had score 3. Score 4 was noticed in 17.5% of rural male and 14.2% of rural female and 15.8% of urban male and 9.7% of urban female so from above results on comparing the C.P.I.T.N scores between the groups urban females were found to have the lowest C.P.I.T.N scores. On the other hand, rural males performed the worst in terms of C.P.I.T.N scores. On comparing the oral hygiene scores in Table no.2, 21.1% of rural males, 18.7% of rural females and 8.3% of urban males and 15.1% of urban females had good oral hygiene (OHI score 0-1.2) Fair oral hygiene scores (OHI score 1.3-3) were recorded in 36.25% of rural males, 35.9% of rural females, 31.7% of urban males and 39.3% of urban females. Poor oral hygiene (OHI score 3.1-6) was noticed in 42.6% of rural males, 45.3% of rural females, 59.9% of urban males and 44.9% of urban females. On analyzing the O.H.I-S scores, urban males were found to fare the worst between all the groups. Rural males and rural females however fared better than the urban populations. On analyzing the samples on the basis of smoking habit in Table no. 3, it was found that 32.3% of rural males, 17.8% of rural females, 49.46% of urban males and 7.5% of urban female were smokers. 53.7% of rural males, 70.5% of rural females, of urban males and 72.3% of urban females were non-smokers. 14.5% of rural males, 11.6% of rural females, 23.9% of urban males and 20.1% of urban females were tobacco chewers. On analyzing the data, significantly higher number of males, both from urban and rural areas were smoking tobacco. However a very high population of rural females was using smokeless tobacco. On comparing the brushing frequency (once / twice a day) in Table no. 4, it was found that 65% of rural males and 65% of rural females brushed their teeth once a day, while 34.4% of rural males, and 34.9% of rural females brushed twice a day. In the urban population 67.4% of males and 60% of females brushed once daily, while 32.5% of urban males and 39% of urban females brushed their teeth twice a day. There was not any appreciable difference between the groups based on brushing frequency was noticed. On evaluating the oral hygiene status with brushing frequency in Table no. 5, it was noticed that out of the 836 those who brushed once a day only 10.17% had good oral hygiene; and out of 454 subjects who brushed twice, 25.5% had good oral hygiene. 29.6% of the sample population who brushed once and 42.1% of those who brushed twice had fair oral hygiene. 60.1% of the subjects who brushed once and 27.3% of those who brushed twice had poor oral hygiene. Discussion: It was a cross-sectional survey done by using multi-stage sampling procedure. Sampling method is a critical issue in descriptive type of epidemiological surveys to assess the true University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 86

4 magnitude of the disease; sample population is expected to represent the whole population without any bias. The above data clearly indicates the huge percentage of population (approximately 46%) was smoker or using pan, tobacco etc. Approximately 80% of the smokers were males and 20% were females. Smoking prevalence was found to be more in urban males (49.6%). Again (23.9%) of urban males were tobacco chewers. Nearly 65% of the subjects brushes once a day, while only 35% twice a day. This shows a huge difference in brushing frequency among the subjects. who brushes once a day, and (25.5%) who brushes twice a day. But (60.16%) had poor oral hygiene who brushes once a day. This clearly shows that brushing frequency increases oral 7 hygiene status. (Berit Olsson et al. 1978). Smokers were found to be having worst score in OHI-S in rural male (74.8%), rural female (67.3%), urban male (77.7%) and urban female (71.4%) in comparison to non-smokers with values 22.7% (rural male), 36.2% (rural female), 16.3% (urban male) and 40.3% (urban female). In other category of oral habits the OHI-S score was better than smoker but poor than non-smoker with values in rural male (22.7%), rural female (36.2%), urban male (16.3%) and urban female (40.3%). When we compare subjects from both the areas on the basis of C.P.I.T.N coding it was observed that males from both rural and urban areas had code 1 & 2 only in approximately (20%) but females had (29.5%) this suggests females had good oral health rather than males. C.P.I.T.N score 3&4 were found to be nearly equal among males from both the areas. Again males and females from rural areas had good oral hygiene score (21.15% & 18.77%) respectively rather than urban male (8.3%) and urban female (15.11%). fair oral hygiene score (1.3-3) was noticed equally in subjects from both the areas. But poor oral hygiene score (3.1-6) was found to be more in urban males (59.9%) among rest of subjects from different areas. Habit of smoking and tobacco chewing was again found to be more in urban areas (49.9%) and (23.9%) rather than rural area (32.3%) and (14.5%) respectively. This suggests that habit of smoking and tobacco chewing is more common in urban areas than rural areas. Smokers were having poor oral hygiene status in comparison to non- smokers. (Jagadeesan et 6 al 2001). If we compare both the areas on the basis of brushing frequency only 65% subject's brushes once a day while 35% twice a day. On comparing O.H.I.S with brushing frequency good oral hygiene score (0-1.2) was found only in (10.17%) of subjects The pattern of observation was not consistent in CPITN Coding 3 and 4 in rural male. The highest percentage for same Coding was observed in smoker (43%). In rural female the highest percentage was in other habit category (44.4%). In urban male the maximum percentage was observed in other habit category (53%) and in urban female the maximum number was observed in smoker category (33.3%). The number of subjects in brushing twice category were observed to be more in OHI-S category scoring in all the study groups with values 29.3% (rural male), 28.8% (rural female), 17.4% (urban male) and 24.1% (urban female) in comparison to brushing oncecategory with values 9.3% (rural male), 13.8% (rural female), 4.4% (urban male) and 6.2% (urban female). More number of subjects was found in OHI-S score in brushing once category in comparison to brushing twice category indicating better oral hygiene performance in brushing twice group. These results are in 8,9 conformity with several studies reported. References: 1. Albandar JM. Epidemiology and Risk Factors of Periodontal Diseases. Dent ClinNorthAm 2005; 49(3): Camila P, Yndira C, Abel C. Generalized Aggressive Periodontitis In Preschoolers: Report Of A Case In A 3-1/2 Year old.journal of clinical pediatric dentistry 2008;33(2): Fisher, Ronald A, Yates F (1948) [1938]. Statistical tables for biological,agricultural and medical University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 87

5 research (3rd ed.). London: Oliver & Boyd. pp th edition. Tables in Numerical Orders 4. Greene JC, Vermillion JR. The Simplified Oral hygiene Index. J Am Dent Assoc 1964; 68:7 5. Ainao J, Barmes D, BeagrieG, et al.development of the World Health Organization (WHO) community index of treatment needs (CPITN) Int Dent J 32:281, Jagadeesan M, Rotli SB, Danabalan M. Oral Health Status and risk factors for dental and periodontal diseases among rural women in Pondicherry. Indian J of Community Medicine 2000; 25(1):31. The Chi- Square Statistic is The P- Value is < The Result is Significant at P<.05 Table No-1 7. Berit Olsson. Periodontal disease and oral hygiene in Arussi province, Ethopia.Community Dent Oral Epidemiol 1978; 6: The Chi- Square Statistic is The P- Value is < The Result is Significant at P<.05 Table No-2 8. Rahman B andkawas ALS. The relationship between dental health behavior, oral hygiene and gingival status of dental students in the United Arab Emirates. Eur J Dent. 2013; 7(1): Benigeri M, Brodeur JM, Payette M, Charbonneau A, Ismail A.L.CPITN and prevalence of periodontal conditions. J ClincPeriodontol 2000; 27: Corresponding Author: Dr. Pallak Arora, Reader Department of Oral Medicine & Radiology, DJ College of Dental Sciences & Research, Modinagar, arorapallak6@gmail.com The Chi- Square Statistic is The P- Value is < The Result is Significant at P<.05 Table No-3 The Chi- Square Statistic is The P- Value is The Result is not Significant at P<.05 Table No-4 University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 88

6 O.H.I.S Score OnceTwice (10.17%) 116 (25.5%) (29.6%) 214 (42.1%) (60.1%) 124 (27.3%) The Chi- Square Statistic is The P- Value is < The Result is Significant at P<.05 Table No-5 Table no 1 Table Legends CPITN scoring on the basis of area and gender Table no 2 OHIS scoring on the basis of area and gender Table no 3 Comparison of Smoking habits on the basis of area and gender Table no 4 Comparison of brushing frequency on the basis of area and gender Table no 5 OHIS scoring on the basis of brushing frequency University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 89