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 Table of Contents  
Year : 2022  |  Volume : 14  |  Issue : 1  |  Page : 24-27

Oral health beahviour of the endangered toto tribe of North Bengal

1 Department of Periodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
2 Department of Periodontics, Burdwan Dental College and Hospital, Burdwan, West Bengal, India

Date of Submission29-Jan-2021
Date of Decision17-Apr-2021
Date of Acceptance20-May-2021
Date of Web Publication31-Dec-2021

Correspondence Address:
Sohini Banerjee
83/2, B.P. Lane, Kolkata - 700 035, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijds.ijds_15_21

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Introduction: The Toto tribe is a small tribal population who inhabit a tiny hamlet on the northern fringe of the state of West Bengal and is on the verge of extinction. They have their unique oral health behaviour and oral hygiene habits. Aims and Objectives: To study their unique oral health behaviours and traditional oral hygiene habits untouched by civilization. Material and Methods: A sum total of 515 adult Toto Populations were participated and observed for their oral health behaviour by means of door to door survey and OHI-S was recorded. Results: The prevalence of deleterious oral habits was found to be very high among this population with only 4.1% abstaining from any kind of oral habits. The most popular habit among this population was the chewing of betel nut(91.6%). Discussion: The study showed a unique blend of unchanged tribal habits and that of the practises and oral heath behaviour of primitive tribe.

Keywords: Oral habits, oral hygiene practises, toto tribe

How to cite this article:
Mukherjee S, Banerjee S, Biswas C, Bandopadhyay P K. Oral health beahviour of the endangered toto tribe of North Bengal. Indian J Dent Sci 2022;14:24-7

How to cite this URL:
Mukherjee S, Banerjee S, Biswas C, Bandopadhyay P K. Oral health beahviour of the endangered toto tribe of North Bengal. Indian J Dent Sci [serial online] 2022 [cited 2023 Oct 1];14:24-7. Available from: http://www.ijds.in/text.asp?2022/14/1/24/334519

  Introduction Top

The Toto tribe is a sub-Himalayan tribe of Indo-Bhutanese origin residing in a small hamlet called Totopara, adjoining the Indo-Bhutan border. The tribe has been declared as an endangered tribe with only 1360 members (Indian census report 2001), the adult population being a meagre 642.[1] The strict endogamous practises of the Toto people have been speculated to be the main reason for their dwindling numbers as several genetically they are homogeneous population several genetic disorders that usually run a recessive course are being manifested amongst these people, notably haemoglobinopathies.

A socio-economically backward community, the Toto people depends chiefly on cultivation and manual labour as their source of sustenance. This tribal community has unique customs and social practices and they are reluctant to accept any kind of change in this and fiercely guard their age old traditions and beliefs. Even their dietary habit is an exclusively coarse fibrous one with locally grown millet known as “marua” being the staple of every Toto household. The most remarkable feature of the Toto diet is the high consumption of betel nut in the raw unprocessed form which has surpassed being a habit; it is rather a natural trait of the Toto people with children as young as 10 years old chewing on the nut every day.

Several studies have been conducted till date amongst these people to get an insight not only into their social and anthropological aspects but also about the prevalence of psychiatric morbidity,[2] metabolic syndrome,[3] and haemoglobinopathies[4] but till date, to the best of our knowledge, no dental health survey has ever been under taken in this population. Therefore, the present study was conducted for these present years to obtain an overview regarding the oral health behaviour and oral hygiene status of this unique tribe which was a first of its kind in this population.

  Materials and Methods Top

The study was conducted after obtaining the ethical clearance from the Institution Ethics Committee, the registration number of the committee has been applied for. The present study was conducted on 515 adult Toto subjects of whom 243 were males and the remaining 272 were females. The study was conducted in two phases spanning over a period of 6 months for the last two tears. Regarding sample selection and sample size, the adult members of the tribe who were willing to participate in the study and were present at the locality during the all phases of the study were included. Informed consents were obtained from the participants. Door to door survey was conducted by means of a questionnaire which included information about the educational status, oral habits, brushing habits and tools used and any past history of dental illness and the treatment sought for the same. The oral hygiene status was noted according to the Oral Hygiene Index Simplified (OHI-S.) The help of an interpreter was taken for communicating with subjects who were only conversant in Toto language. The data obtained was subjected to statistical analysis.

  Results Top

The total study population in this study was 515 aged 15 years and above, comprising of 243 males and 272 females. The oral hygiene status of this study population was in general fair with 53.6% of the people surveyed demonstrating a Fair OHI-S score, 31.8% having Good OHI-S score and only 14.6% having a Poor score [Figure 1].
Figure 1: Comparison of Oral Hygiene Index Simplified between males and females of the study population

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The prevalence of deleterious oral habits was found to be very high among this population with only 4.1% abstaining from any kind of oral habits. The most popular habit among this population was the chewing of betel nut which was practised by 91.06% of the people surveyed of whom 69.9% chewed only betel nut whereas 12. 8% had a co-habit of chewing tobacco along with betel nut and 8.35% were smokers as well as betel nut users [Figure 2]. The prevalence of individuals who were only smokers or only used tobacco in the chewable form were low at 1.36% and 1.16% respectively. The co-existence of chewing tobacco and smoking was prevalent among 2.33% of the population studied. The prevalence of all the habits was consistently higher among the males except for betel nut chewing which was more prevalent among the females.
Figure 2: Distribution of the various oral habits among the study population

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Oral hygiene practises were reasonably good among the study population with 94.36% brushing their teeth once daily and 1.4% brushing twice daily. Only 4.3% were not practising any kind of oral hygiene methods on a daily basis [Figure 3].
Figure 3: Frequency of brushing among the study population

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Toothbrush and toothpaste was the most popular tool for oral hygiene practises, which was being used by 90.9% of the people surveyed. 9.12% however used other tools like herbal twigs and even charcoal. Females had better oral health habits as compared to the males. Chi-square test was performed to determine the association between the various study parameters. The OHI-S scores positively correlated with presence of deleterious oral habits, educational status, brushing habits and brushing tools.

  Discussion Top

India consists of one of the largest tribal population of the world. The present study population, the Toto tribe of North Bengal was unique in more ways than one. The Toto community is one of the most primitive tribes of India as well as the world which has been able to resist acculturation for ages until a very recent time. This community has a distinction of being a genetically homogenous community, which perhaps makes it one of its unique as well as rare kinds in the world. Living in seclusion, the Totos have limited awareness and access to oral health care, which was mostly restricted to treatment of dental caries with probably none of the members of the tribe having under gone any kind of periodontal treatment ever. Moreover, due to the acculturation and access to education that has gradually seeped into the Toto society over the past few decades, leading the community to a dichotomous variety so far as their socio-economic condition is concerned. Thus while interpreting the data from this study these facts should be borne in mind.

The oral hygiene practises of the Totos were unlike a primitive tribe that has been living in seclusion even a few decades ago. 94.36% of the people reported that they brush once daily and 1.4% was brushing twice daily. 90.9% of the population used a toothbrush and toothpaste for cleaning their teeth where as only 9.12% used other tools like herbal twigs and charcoal. This is in sharp contrast to other studies conducted by among other Indian tribes.[5],[6],[7],[8],[9],[10] This can be interpreted in light of the acculturation that has affected the tribe over the years. The permanent settlement of several Nepali, Bihari and Bengali households in the area, exposure to media in the form of newspaper, radio and television that has infiltrated the daily lives of the Toto community as well as increased access to education has definitely altered the life style of the Toto community and oral health behaviour is no exception to this. However this might also be a manifestation of an inherent human nature where one responds in a preconceived manner when questioned about their personal hygiene so as to present the most desirable behaviour. This has been observed by while studying the prevalence of caries and associated risk factors in Mexican school children.[6]

Regarding the oral health seeking behaviour only a meagre 1.5% reported a positive history of dental extraction. Although 3.1% had given a positive history of past dental pain, they did not seek any professional treatment for it. This reluctant for oral health seeking behaviour is understandable given the fact that the nearest dental treatment facility is almost 50 km away across difficult terrains.

The high prevalence of deleterious oral habits, as observed among the Toto people, was anticipated as such behaviour is widespread in any tribal community worldwide. Smoking, chewing of betel leaves and tobacco has been reported to be universally practised by several tribal populations in India.[7],[8],[9],[10] A vast majority of the population surveyed, 69.9%, reported the habit of chewing betel nut on a daily basis. The nut is chewed in the raw unprocessed form and is grown in abundance in the area. This has surpassed the status of a mere habit and is an essential part of Toto culture which even children as young as 7 and 8 year old indulging in it. The other habits prevalent were smoking and chewing tobacco in the form of “khaini” though the prevalence of such persons was low with 1.36% having a single habit of smoking and 1.16% having a sole habit of chewing tobacco. People having a combination of habits were more in numbers - 2.33% had habits of smoking and chewing tobacco, 12.8% were users of betel nut as well as tobacco and 8.35% were smokers and chewers of betel nut. The habit of smoking and chewing tobacco seems to have been imbibed from the settlers of the other communities since both were not very popular among the older members of the tribe. The prevalence of all the habits was significantly higher among the males except for the habit of chewing betel nut which was more popular among the females.

The other noteworthy habit practised by the Totos is the regular consumption of an alcoholic beverage produced in every household by fermenting the locally grown millet called “marua.” Known as “Eu,” this beverage is consumed by the adult men and women as a part of their daily diet as well as a part of their religious rituals.

The pattern of oral habits observed among the Toto tribes is comparable to those of the tribal communities inhabiting the Amazon basin where there is extensive use of alcohol, tobacco, locally grown coca and “ambil” which is a concentrated tobacco extract and is licked. As with the Totos, the prevalence of deleterious oral habits is more among the males in the Amazon basin than the females.[11]

As far as the oral hygiene status is concerned, a vast majority of the population, 53.6%, had a fair OHI-S and presence of debris was negligible. This is unexpected from a population, which has yet to be habituated with the dental health awareness of the modern world but can be explained by the fact that the higher OHI-S resulted due to the heavy deposits of stains which seemed to be a universal phenomenon among the Toto people due to the high prevalence of betel nut chewing in this tribe. Another possible reason for the different this could be due to the to poor lighting and difficult field conditions that are common during such epidemiological studies as noted by during their study of the indigenous population of the Amazon rain forests.[11] In this given population the OHI-S scores could be positively co-related with the educational status with more percentage of people showing a “good” OHI-S score with improving educational status, a trend universally prevalent. Brushing tools and brushing habits were also positively correlated with OHI-S scores with people brushing twice daily using toothbrush and toothpaste demonstrating the best OHI-S scores.

Due to influence of the other communities and access to media and education, the younger generations of the Toto tribe have switched from their traditional methods to more popular methods like brushing with toothpaste. Although, the some older members of the community have adapted to these methods yet majority of the older age group still use the traditional methods of using twigs or no oral hygiene aids at all.

  Conclusion Top

The aim of the present study was to get an overview into the oral heatlth behaviour and oral hygiene status of a primitive tribe that has been relatively untouched by the nuances of modernisation. The results obtained showed a unique blend of unchanged tribal habits and that of the practises of the more socio-economically developed populations. The reasons for such contradiction are many fold and calls for further exploration. Since this was a first of its kind amongst this population a future, more elaborate study, encompassing further parameters and including the Toto children is required to throw light on other aspects of the oral health of this tribe especially with respect to the prevalence of periodontal diseases and caries.

Ethical clearance

The study was done after obtaining ethical clearance from the Institution Ethics Committee of Dr.R.Ahmed Dental College and Hospital.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Census Report of Government of India, 2001, Office of the Registrar General and Census Commissioner, India Ministry of Home Affairs, Government of India.  Back to cited text no. 1
Ghosh AB, Banerjee G, Biswas D. Psychiatric morbidity in A Sub-Himalayan tribal community: An epidemiological study. Indian J Psychiatry 2004;46:324-32.  Back to cited text no. 2
[PUBMED]  [Full text]  
Sarkar S, Das M, Mukhopadhyay B, Chakrabarti CS, Majumder PP. High prevalence of metabolic syndrome and its correlates in two tribal populations of India and the impact of urbanization. Indian J Med Res 2006;123:679-86.  Back to cited text no. 3
Bhattacharyya D, Mukhopadhyay A, Chakraborty A, Dasgupta S, Mukhopadhyay S, Pal N, et al. Incidence of the Hb E [β26(B8) Glu → Lys, GAG>AAG] variant in Totos, one of the smallest primitive tribes in the world. Hemoglobin 2013;37:26-36.  Back to cited text no. 4
Bhat PK, Kadanakuppe S. Periodontal health status and oral hygiene practices of Iruliga tribal community residing at Ramanagar district, Karnataka, India. J Int Oral Health 2010;2:17-26.  Back to cited text no. 5
Cuéllar-González MA, Hernández-Gallardo I, Mondragón-Mojica M, Martínez-Herrera E, Rodríguez-López A. Prevalence of dental caries and associated factors in children at day care centers. Gac Med Me×2000;136:391-7.  Back to cited text no. 6
Philip B, Chithresan K, Vijayaragavan VS, Maradi A. Prevalence of periodontal diseases among the adult tribal population in Nilgiris-An epidemiological study. Int J Public Health Dent 2013;4:8-12.  Back to cited text no. 7
Vivek S, Jain J, Sequeira PS, Battur H, Tikara S, Mahuli A. Understanding oral health beliefs and behavior among Paniyan tribals in Kerala, India. J Int Oral Health 2012;4:23-8.  Back to cited text no. 8
Deepa KC, Maji J, Vishnudeva P. Ethnomedicinal practises for oral health and hygiene of tribal population of Wayanad, Kerela. Int J Res Ayurveda Pharm 2011;2:1246-50.  Back to cited text no. 9
Bhasin V. Oral health behaviour among bhils of Rajasthan. J Soc Sci 2004;8:1-5.  Back to cited text no. 10
Ronderos M, Pihlstrom BL, Hodges JS. Periodontal disease among indigenous people in the Amazon rain forest. J Clin Periodontol 2001;28:995-1003.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3]


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