Original Article

Oral Health Status and Treatment Journal of Advanced Oral Research

10(1) 30–33, 2019
Needs of Soft Drink Factory Workers © 2019 Academy of Advanced
Dental Research
of Madurai City: A Cross-sectional Study Reprints and permissions:
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DOI: 10.1177/2320206819839811
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Vidhya G.1, Muthu Karuppaiah R.1, Bharath Kumar Garla1,

Umesh K.1, M. Taranath1, and Palanivel Pandian1

Abstract
Background: Oral health is an integral part of general health. Good oral health helps people to communicate and
enhances their dignity and personality. Oral health of soft drink factory workers depended on their working environment.
Aims and objectives: To assess the oral health status and treatment needs of soft drink factory workers in Madurai
city, Tamil Nadu, India.
Materials and methods: A cross-sectional survey was conducted on 175 soft drink factory workers. Informed consent
from the participants and ethical clearance were obtained. Data were collected by using WHO Oral Health Assessment
Form for Adults, 2013.
Results: The result shows higher prevalence of oral problems with 80% dental caries, 82.9% gingival bleeding, 13.7%
periodontal pockets, 15.4% loss of attachment, 54.9% fluorosis, and 50.9% dental erosion in soft drink factory workers.
Conclusion: The study suggests that the oral health status of these soft drink factory workers is poor and there is an
increased need for their dental treatment.

Keywords
Madurai, oral health status, soft drink factory workers, treatment needs

Introduction caries, periodontal disease, and dental erosion.4 India

contributes approximately 80% of the global burden of
Oral health is not only important to our appearance and occupational disease because of improper industrialization
sense of well-being but also to our overall health.1 Oral in our country.5
health is an integral part of general health. It is a state of In recent years, there has been an increase in the
being free from disease, disorder, pain, and infirmity of oral consumption of soft drink in all age group leading to
and perioral region. Good oral health helps people to mushrooming of soft drink factories. Oral health among the
communicate and enhance their dignity and personality, soft drink factory workers is severely affected. They suffer
thereby improving the quality of life.2 Poor oral hygiene, from dental caries, periodontal disease, gingivitis, and tooth
tobacco and alcohol consumption, unhealthy diet, and wear.6 Consumption of carbonated beverages is considered
working environment are considered as the risk factors for as the risk factor for the gastroesophageal reflux disease
the poor oral health. Working environment is the sum of (GERD) and regurgitation which leads to dental erosion.7
external conditions which influences the health of working Studies related to oral health of the soft drink factory
population. This environment is responsible for the exposure workers are limited. In this study, an attempt was made to
of the hazardous materials and accidents. Occupational
diseases are caused by a pathologic adaptation of the 1
Department of Public Health Dentistry, Best Dental Science College,
individual to his working environment.3 Occupational acid Madurai, Tamil Nadu, India.
exposure is limited to the battery and galvanizing (Zn–Al
Corresponding author:
industry) workers, soft drink manufacturers, and dyestuff
Vidhya G., Department of Public Health Dentistry, Best Dental
container cleaners. These factory workers are prone not only Science College, Madurai, Tamil Nadu 625104, India.
to health hazards but also to oral problems such as dental E-mail: [email protected]
Vidhya G. et al. 31

assess the oral health status and treatment needs of the soft number 4 plane dental mouth mirror, dental tweezers, and
drink factory workers in Madurai city. a specially designed lightweight CPITN-C probe (clinical).
The oral health status was assessed using WHO Oral
Health Assessment Form, 2013. All the examinations were
Materials and Methods carried out under aseptic condition.8

The present study is a cross-sectional study, conducted to

assess the oral health status and treatment needs of soft drink
Statistical Analysis
factory workers in Madurai city. Madurai city has many The collected data were compiled. Data analysis was done
small-scale soft drink factories among which Vadipatti with the help of computer using Statistical Package for
soft drink factory is considerably the bigger one. Hence,
Social Sciences (SPSS Inc., Chicago, IL, version 22.0 for
conveniently this factory has been selected for the study.
Windows). A p-value less than 0.05 denotes significant
This factory consisted of 175 workers. All the workers have
relationship. Since it is a descriptive data only, frequency
been included in the study after getting their consent.
distribution has been mentioned.
The study was conducted for a week in the month of
October 2017. The study was approved by the Institutional
Review Board, Best Dental Science College (Ethical no: Results
BDSC2772017). Written permission was obtained from the
head of the factory to conduct the study in their factory Majority of the workers in this study were in the age group
before commencing the study. Informed consent from of 31–40 years (44%). Most of the study participants
participants was obtained before starting the study. There belonged to upper-lower class (66.9%; Table 1). The study
were two inclusion criteria: (a) participants who were willing shows that 140 participants (80%) out of 175 were affected
to participate in the study; and (b) soft drink factory workers by caries. About 82% of the participants were affected by
who were above 18 years of old. The workers who had gingival bleeding. In regard to the periodontal pockets and
any systemic diseases, difficulty in mouth opening by any loss of attachment, 13.7% and 15.4% of the participants
reason, and those who were not willing to participate were were affected, respectively (Table 2). An assessment of
excluded from the study. dental fluorosis on the workers revealed that 45.1% (79)
A self-administered questionnaire was used to collect were affected by normal level of fluorosis, 1.1% (2) were
the demographic data such as age, educational qualification, affected by very mild level of fluorosis, 26.3% (46) were
socio-economic status, medical and dental history, and affected by mild level of fluorosis, 22.3% (39) were affected
oral hygiene practices. The level of health literacy among by moderate level of fluorosis, and 5.1% (9) were affected
factory workers was not measured, neither was there a by severe level of fluorosis (Table 3). About 50.9% (89) of
mention of educational level through frequency distribution. the participants were affected by enamel erosion (Table 4).
To avoid self-administered questionnaire misinterpretation A majority (80%) of the participants needed prompt
and to maintain universality of questionnaires response, treatment and scaling and the remaining (20%) required
the investigator asked questions to the participants in their preventive measures.
local language like an interview.
After questionnaires, clinical examination was conducted Table 1. Demographic Details Among Soft Drink Factory
by the investigator. The investigator was trained by a subject Workers in Madurai
expert. Intraexaminer reliability was done to standardize the Variable Frequency Percentage
clinical procedures and to minimize the error which can 175 175 100
occur during data collection. The intraexaminer reliability Up to 20 years 5 2.9
was 0.82 for caries diagnosis; 0.92, 0.9, and 1 were the 21–30 years 74 42.3
values attained for the diagnosis of plaque, calculus, and 31–40 years 77 44
bleeding on probing, respectively. The agreement for most Above 40 years 19 10.8
assessments was expected to be 90%. Gender
ADA Specification Type III examination was performed. Male 98 56
The subjects were seated comfortably on an ordinary chair Female 77 44
and examined using natural light. Oral examinations were Socio-economic status
conducted using a plain mouth mirror and a CPI-probe. (Kuppusamy Scale 2017)
The examinations were carried out without cleaning or Lower-middle class (Grade 3) 58 33.1
drying of the teeth and the instruments used consisted of a Upper-lower class (Grade 4) 117 66.9
32 Journal of Advanced Oral Research 10(1)

Table 2. Oral Health Status Among Soft Drink Factory world’s adult males and 30%–60% of the world’s adult
Workers in Madurai females.5
Factor Number Percentage Many occupations expose the workers to hazardous
Dental caries
working environments such as acids, chemicals among
Present 140 80
battery and galvanizing (Zn–Al industry) workers, muni-
Absent 35 20 tions manufacturers, soft drink manufacturers, and dyestuff
Gingival bleeding container cleaners. In recent years in India, there has been an
Present 145 82.90 increase in the consumption of soft drink in all age groups,
Absent 30 17.10 directly leading to increase in factories manufacturing soft
Periodontal pockets drinks. Occupational acid exposure in factories might also
Present 24 13.70 increase the risk of dental caries and dental erosion.6
Absent 151 86.30 The present study was undertaken as an attempt to
Loss of attachment describe the prevalence and nature of oral health problems
Present 27 15.40 among workers in soft drink factory in Madurai city.
Absent 148 84.60 Literature review revealed limited studies in this area, thus
comparison is limited. The survey comprised of all workers
in soft drink factory with a response rate of 100%.6
Table 3. Dental Fluorosis and Dental Erosion Among Soft In the present study, a total of 175 factory workers were
Drink Factory Workers in Madurai included. The sample consisted of 98 males (56%) and
77 females (44%) with age ranging from 20–45 years. This
Participants
distribution is similar to a study conducted by Sandeep
Number Percentage
Kumar et al6 which had 51% male and 49% females wherein
Fluorosis the majority belonged to low-income group with primary
Normal 79 45.1 education,9 which is in line with the current study where
Very mild 2 1.1 the majority (66.9%) belonged to lower-upper class. The
Mild 46 26.3 dentition status was recorded using WHO proforma (2013).
Moderate 39 22.3
According to it, the prevalence of dental caries in soft drink
Severe 9 5.1
factory of Madurai is 80%. In a study conducted in India by
Erosion
Rajkumar Maurya et al, the prevalence of caries was 67%
No sign of erosion 77 44
and the mean DMFT was 4.09. Decayed teeth had the
Enamel lesion 89 50.9
highest DMFT index of 67%.10 A previous study suggested
Dentinal lesion 9 5.1
high prevalence of caries which was probably due to frequent
Pulp involvement – –
exposure to sugar-sweetened soft drink and inadequate oral
hygiene practices. The present study result shows high
prevalence of periodontal disease among the study
Table 4. Intervention Urgency Among Soft Drink Factory
Workers in Madurai
population with gingival bleeding among 82.9%, periodontal
pockets among 13.7%, and loss of attachment among 15.4%,
Participants which could be as a result of inadequate oral hygiene
Intervention Urgency Number Percentage maintenance due to lower literacy rate.
Preventive/routine 35 20.0 Sudhashu Sanadhya et al shows that severe fluorosis
treatment needed was the most prevalent (n = 232; 23.7%) form of dental
Prompt treatment including 140 80.0 fluorosis observed among the study subjects. Only 5.5% of
scaling needed the participants had questionable fluorosis. A significant
relationship between dental fluorosis and gender was
Discussion evident (p = 0.001). Females had a significantly greater
prevalence of dental fluorosis (71.7%) as compared to
Workers or laborers form a major portion of population in males.11 In the present study, the dental fluorosis prevalence
any country. It was estimated by World Health Organization (n = 175) among the study participants was 54.9% among
in the year 2007 that the global labor force was half of the which 1.1% (2), 23.4% (41), 22.9% (40), and 5.7% (10)
world’s population (about 3,300 million). The officially had very mild, mild, moderate, and severe level of fluorosis,
registered working population includes 60%–70% of the respectively. The high prevalence of dental fluorosis and
Vidhya G. et al. 33

lower mean dental caries score can be attributed to the Funding

water fluoride concentration in the area which range from The authors received no financial support for the research,
0.28ppm to 3.6ppm. authorship, and/or publication of this article.
Kumar et al shows that workers working in these small-
scale soft drink industries were regularly consuming soft References
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