|Year : 2022 | Volume
| Issue : 3 | Page : 109-115
Association between dental health status and changing dietary and lifestyle patterns among selected population of Shimla (Himachal Pradesh, India)
Jagmahender Singh Sehrawat, Manisha Rana, Shubham Thakur
Department of Anthropology, Panjab University, Chandigarh, India
|Date of Submission||14-Aug-2021|
|Date of Acceptance||13-Oct-2021|
|Date of Web Publication||27-Aug-2022|
Jagmahender Singh Sehrawat
Department of Anthropology, Panjab University, Chandigarh
Source of Support: None, Conflict of Interest: None
Background: The change in food consumption patterns with greater reliance on junk and processed foods is more often related to lifestyle disorders nowadays. Dental health status is a clear indicator of lifestyle choices as well as major changes in the lifestyle. Aims and Objectives: The aim of the present study was to assess the dental health status of individuals of Shimla (Himachal Pradesh, India) on the basis of their primary dental check-up and the interview-based data. Materials and Methods: A total of 301 individuals (152 males and 149 females) were examined for dental caries, dental plaque, and periodontal diseases among them followed by an interview session inquiring about their dietary intake and lifestyle patterns. The frequency distribution for each state was calculated for each tooth type, and statistical analyses were done. Results: The number of decayed, missing, and filled teeth of each subject resulted in the calculation of average decayed-missing-filled teeth index as 1.5182. The calculated significant caries index and plaque index were found as 3.06 and 1.2872, respectively. The maxillary teeth (59.2% and 43.62% in males and females, respectively) were more affected than the mandibular teeth (37.5% and 47.5% in males and females, respectively). The survey showed that the most affected teeth by caries were first premolars and first molars (22.36% of males and 30.87% of females showed caries in their first premolars; 25% of males and 15.43% of females showed caries in their first molars). Conclusion: The overall dental health status revealed that females had more deteriorated dental health conditions than males, though the difference in the frequencies was not statistically significant. Dietary survey has revealed that their diet includes a high amount of sugar content along with carbonated drinks and junk food.
Keywords: Dental caries, dental hygiene, dental plaque and periodontosis
|How to cite this article:|
Sehrawat JS, Rana M, Thakur S. Association between dental health status and changing dietary and lifestyle patterns among selected population of Shimla (Himachal Pradesh, India). Indian J Dent Sci 2022;14:109-15
|How to cite this URL:|
Sehrawat JS, Rana M, Thakur S. Association between dental health status and changing dietary and lifestyle patterns among selected population of Shimla (Himachal Pradesh, India). Indian J Dent Sci [serial online] 2022 [cited 2022 Dec 9];14:109-15. Available from: http://www.ijds.in/text.asp?2022/14/3/109/354890
| Introduction|| |
Right from the hunter-gatherer groups to the modern complex industrial societies, everything has changed including the lifestyle. Apart from other things, food patterns have completely changed, right from the purest form of food consumption to almost processed food and junk food consumption. Earlier, people did not have any lifestyle-related disorders because of the simplicity of their lifestyle. But nowadays, lifestyle disorders such as type 2 diabetes, obesity, hypertension, atherosclerosis, heart disease, depression, and dental issues have increased manifold. Dental health status accurately shows the lifestyle. Due to the changed diet patterns and high consumption of sugary and starchy foods, dental issues such as dental caries, periodontitis, and dental erosion are commonly found., In the human body, dentition plays an important role both before and after death. Since, tooth structures are made of both soft and hard tissues, it practically makes them resilient to taphonomic damages, degradations and destructions and thus have longest postmortem longevity compared to bones. These hard tissues contain biological information during bio-archeological investigations. Enamel, dentin, and cementum are considered hard tissues, whereas pulp is considered soft tissue. The major bulk of tooth is dentin. Each tooth has a crown and root. The crown is covered with enamel. The root is covered with cementum, and they both join together at the cementoenamel junction (CEJ) or cervical line. Hence, tooth is a major part of body which also shows the effects of major lifestyle changes on them. For example, people from hunting-gathering societies hardly suffered from any dental caries, whereas such diseases are so much prevalent in our modern complex societies.
Dental caries are localized, progressive demineralization of the hard tissues of the crown and root surfaces of teeth which are generally initiated in the complex systems of fissures, fossae, and grooves of the occlusal surface of molar and premolar crown. The maxillary and the posterior teeth are more commonly affected with dental caries than the mandibular and anterior teeth, respectively.,, In modern industrialized societies, coronal caries are much more common than root or CEJ caries in adults.,
Gingivitis is a less severe form of periodontal disease and can be reversible in nature. It comprises gingiva induced by the presence of supragingival dental plaque. Periodontitis is considered an advanced stage of periodontal diseases which include the loss of tissue and bone. There are a number of bacteria along with the mucus in our mouth that constantly forms plaque on our teeth. The presence of dental plaque can be minimized by regular brushing and flossing but it cannot be eliminated completely. The remaining plaque can get hardened and form tartar which can only be cleaned by a dentist or a dental hygienist. Out of all the risk factors, smoking is the most significant factor for gum disease. It can even lower the treatment effect also. Some other risk factors are acquired immune deficiency syndrome, diabetes, hormonal changes, medications that decrease the saliva, and also genetic susceptibility.
The purpose of this study was to find out the effect of changing dietary patterns and lifestyle on the dental health status of population of Shimla. The study also aims to analyze the impact of diet on deterioration of teeth.
| Materials and Methods|| |
The present study was carried out in Shimla on total 301 subjects, of which 151 and 149 were males and females, respectively. The data were collected from various residential complexes, colleges, and villages. Precisely, fieldwork was conducted in locality near Annandale army area, police residential complex, Government Degree College Sanjauli, and Government Girls College and Kamyana village (Shimla, Himachal Pradesh). The data were collected through personal interviews and questionnaire administered through visits to home, colleges, and other institutions. The data collected were based on basic physical examination of the subjects done with proper precautions. The pro forma had two sections, former dealing with diagnosis of dental issues (dental caries, dental plaque, gingivitis, and periodontitis) and latter with general information regarding lifestyle. For physical checkup, dental mirror and probe were used as instruments. For basic demographic information, questions pertaining to their education level, annual income, occupation, marital status and family type were gathered. Besides, the subjects were also asked to specify about their food consumption habits, dental hygiene maintenance and other allied factors such as smoking, alcohol consumptions, etc. for answering the latter part of the proforma.
The most traditional measures of central tendencies are mean, median, and mode, which provide us the measure of the location of the distribution. The mean is the average of the given dataset. The median indicates the point which is in the middle of the given sample and mode is the most repeated value in that sample. To determine a population distribution, population values are estimated by these statistics. The standard deviation gives a measure of how spread out it is that how close each point is from the mean. Both standard deviation and variance measure the spread of the data in relation to the mean value. Standard deviation is the square root of variance where variance is often a large number because it is the square of the units. Standard deviation is in the same units and is more practical in most cases because it can be compared with the data easily with regard to observing how variable and spread out the given data are. Contingency tables also called two-way tables are used in statistics to calculate the relationship between several categorical variables. It is a special type of frequency distribution table, where two variables are shown synchronously. Chi-square test can be conducted on contingency tables to check whether there exists any relationship between the studied variables or not. If the Chi-square value is small that means there will be little relationship between categorical variables. If the Chi-square value comes to large that means there will be a definite correlation between two variables.
Three indices were also calculated based on the collected data, namely decayed-missing-filled teeth (DMFT) index, significant caries index (SiC), and plaque index (PI), using MS Excel. For DMFT index, number of decayed teeth, number of missing teeth, and number of filled teeth of a single subject were required. It was calculated for total 301 subjects and average is recorded.
DMFT Index = (number of decayed teeth + number of missing teeth + number of filled teeth)
Average DMFT = Total DMFT/Total number of persons
To calculate SiC, first, we have to calculate one-third of the total subjects. Second, we have to mark those one-third population with maximum number of caries. We will calculate the sum of these one-third individuals, and this sum is divided by the one-third individuals to calculate SiC.
For PI, separate data set was prepared covering the checking of plaque on total six spots in human dentition. For determining plaque sites on the maxillary dentition, three locations on different teeth i.e., first molar on the right side, left incisor on the right side and the first premolar on the left side were checked. Whereas for checking the presence of plaque in mandibular dentition three spots were looked into are first molar on the left, lateral incisor on the left side and the first molar on the right side. Total four surfaces on each tooth were monitored, namely buccal, lingual, mesial, and distal. To calculate the index, these four individual surfaces were scored from 0 to 3 indicating the presence of plaque as 0 (no plaque), 1(slight presence), 2(moderate presence) and 3 (abundant of soft matter within the gingival pocket). To calculate the PI for an individual, first, we have to calculate the average PI of an individual tooth and repeat it for all six teeth. Now, for a particular person, we have to add all six averages and divide it with six. This will be our PI.
Plaque index = 1M (right maxilla) + LI (right maxilla) + 1PM (left maxilla) + 1M (left mandible) + LI (left mandible) + 1PM (right mandible)/6.
If the score for PI comes 0, then the person is having excellent condition; score between 0.1 and 0.9 is considered good, 1.0–1.9 – fair; and 2.0–3.0 – poor.
| Results|| |
Out of the persons examined, 64.47% of males and 77.18% of females have shown the presence of dental caries. Parallel to this, 80.3% of subjects belonged to the age group of 15–30 years and 19.6% of subjects to the age group of 30–45 years. Responses to the questionnaire showed that 55.26% of males and 53.69% of females also showed a history of childhood caries. Among the subjects, the parents of 42.10% of males and 59.73% of females showed a history of caries. The Chi-square value for the presence of dental caries is 5.87 (P = 0.015), which is comparatively a small value that means there is little relationship between two. As shown in [Table 1], there is not much correlation of early childhood with the present dental health condition. The history of caries in parents showed a slight relationship between different categorical values.
|Table 1: Frequency, mean, standard deviation, variance, Chi-square value, and percentage distribution of subjects showing the presence of dental caries, early child caries record, and history of caries in their parents|
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[Table 2] shows the frequency and percentage of different tooth types and their percentage distribution. According to data, 35.52% of males and 22.81% of females were not affected at all. In 2.68% of females, canines were affected. Out of all the subjects, 22.36% of males and 30.87% of females showed caries in their first premolars. Only 3.28% of males and 13.42% of females showed caries in their second premolars. Apart from this, 25% of males and 15.43% of females showed caries in their first molars. And only 13.81% of males and 12.08% of females showed caries in their second molars. Out of all the respondents, only 2.68% of females showed caries in their third molar. [Table 2] shows that the maxillary teeth (59.2% and 43.62% in males and females, respectively) were more affected than the mandibular teeth (37.5% and 47.5% in males and females, respectively) collectively. The Chi-square value for type of teeth affected was 27.2 that means there is a definite correlation between two categories.
|Table 2: Frequency and percentage distribution for the affected tooth type|
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According to [Table 3], 53.2% of males and 57.7% of females showed decayed teeth. The Chi-square value for decayed teeth showed that there is a slight correlation between decayed tooth and dental health status (P = 0.026). Data show that 32.8% of males and 49.6% of females showed the missing tooth and the Chi-square value is 17.9. The Chi-square value for missing tooth is slightly larger which shows a correlation between two categories. For filled teeth, only 20.3% of males and 32.2% of females showed the status of filled teeth. The Chi-square value is also less that means there is not much correlation between them. Among all the subjects, 73.6% of males and 73.1% of females showed the presence of dental plaque. The Chi-square value for dental plaque shows an almost negligible correlation between two factors (P = 0.917). Among them, 39.4% of males and 50.3% of females had dental plaque-induced bleeding. The Chi-square value for this showed only slight correlation among them (P = 0.917). Data show that 48.6% of males and 74.4% of females showed inflammation of pulp or sensitivities. The Chi-square value shows that there is a definite correlation between inflammation of pulp and variables (P = 0.058). Among the subjects, 11.1% of males and 28.1% of females showed a less amount of saliva secretion that means they are at high risk of getting dental issues. The Chi-square value for saliva secretion shows a definite correlation between less saliva secretion and poor dental health. In [Table 4], there are three indices, namely DMFT index, SiC, and PI. As shown in [Table 4], the average DMFT index is 1.5182 which is derived from the status of decayed, missing, and filled tooth status on individual bases. The average value of SiC is 3.06 which was derived from one-third of the population having major issues. The average PI is 1.2872, which was derived from plaque status from six different teeth on different anatomical positions.
|Table 3: Frequency, mean, standard deviation, variance, Chi-square value, and percentage distribution of subjects showing status of decayed teeth, missing teeth, filled teeth, dental plaque, inflammation, and subjects with less saliva secretion|
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|Table 4: The averages of Decayed-Missing-Filled Teeth index, significant caries index, and plaque index|
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After calculating PI for 301 individuals, 47 subjects showed excellent dental condition (score = 0) with no dental plaque at all; 182 subjects showed slight (score = 1) results of plaque; 100 subjects showed moderate (score = 2) amount of plaque; only 19 subjects showed the abundance (score = 3) of soft matter within the gingival pocket.
[Table 5] shows the different factors about lifestyle of the subjects. As we can see, 88.6% of males and 90.5% of females among subjects were educated. The education status also showed high Chi-square value (12.0) that means it shows a definite correlation between lifestyle and dental health status. Among them, 84% of males and 81.1% of females showed the income more than 1 lakh and the Chi-square value (2.12) shows a slight correlation between two variables. Among the respondents, 26.9% of males and 28.1% of females were married although it did not show any relation between variables. Total 47.3% of males and 5.3% of females showed consumption of alcohol. The frequency of alcohol consumers is less, but the Chi-square value (68.0) shows a large correlation between variables. The same goes for smokers, they show less frequency, but the Chi-square value (59.6) depicts the definite correlation between variables. Among the respondents, 13.7% of males and 22.8% of females showed a history or signs of obesity. The Chi-square value (4.08) for obesity showed a slight correlation between lifestyle and dental health status. Apart from obesity, 17.1% of males and 11.4% of females showed signs of malnutrition also. However, their Chi-square value (1.99) did not depict much about correlation between variables. Among all the respondents, 31.5% of males and 42.2% of females showed a history of jaundice. The Chi-square value (3.70) for jaundice showed a slight correlation between variables. Talking about allergies, only 5.2% of males and 5.3% of females showed the presence of allergies; furthermore, their Chi-square value (0.168) could not depict much correlation between different variables. Among all the 301 subjects, only 3.2% of males and 4% of females showed regular visits to dentists. For maintaining dental hygiene, 62.4% of males and 69.1% of females showed brushing twice a day. The Chi-square value for brushing is 1.47 which shows a slight correlation between variables.
|Table 5: Frequency, mean, standard deviation, variance, Chi-square value, and percentage distribution of subjects showing various factors depicting lifestyle of subjects|
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As per [Table 6] data, 98.6% of males and 94.6% of females showed consumption of fast food in their diet, but their Chi-square value (3.85) did not show much correlation between variables. Among them, 94.6% of males and 97.2% of females consumed vegetables on a daily basis. Almost all of the subjects consumed pulses on a daily basis. As for sweets, 75.5% of males and 89.2% of females consumed them on a weekly basis leading to slightly high Chi-square value (9.60) showing a correlation between diet and dental health status. Among them, 65% of males and 78.5% of females consumed eggs on a daily basis leading to slightly high Chi-square value (6.66) showing a slight correlation between diet and dental health status. Talking about fruit consumption on a daily basis, 68.3% of males and 94.6% of females consumed them leading to a quite large Chi-square value (34.1) showing a definite correlation between diet and dental health status. Among total respondents, 67% of males and 62.4% of females consumed filtered water leading to the Chi-square value of 0.394 that means the correlation is not totally absent.
|Table 6: Frequency, mean, standard deviation, variance, Chi-square value, and percentage distribution of subjects showing consumption of various items depicting diet pattern of subjects|
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| Discussions|| |
The present study is based on data collected by a survey done in Shimla in October 2018, as part of the college project report working on total 301 subjects. This study was comprised of selecting random subjects to be examined and interviewed. In this project, data were collected primarily from physical examination followed by another set of questions. Interview method was applied for collection of second part as it helps in more interesting and more reliable data collection rather than self-filled questionnaire. Caselitz worked on historical evolution of caries in total 518 human populations of America, Asia, and Europe from the Paleolithic to the present, resulting in confirmation that during Paleolithic and Mesolithic periods, the hunter-gatherers had a less number of caries and lesion progression was slow. Caries have increased slowly from Neolithic period followed by high rates of caries prevalence today.
Weston Price,, worked on primitive and isolated people who did not use modern diet yet. His research shows that people did not have any degenerative diseases until the modern diet was introduced. He did research on total 14 remote areas of world during his 10-year travel. It included remote Swiss villages, isolated islands of coast of Scotland, Eskimos, Indian tribes in Canada, Australian aboriginals, islanders of South Sea, Maoris in New Zealand, Peruvian Indians, and Amazonian Indians and in some tribes of Africa. It was found that less than 1% of these populations had decayed permanent teeth. According to the present study in Shimla, 53.2% of males and 57.7% of females showed decayed permanent teeth. According to Price,,, those isolated groups did not have much dental issues because they were still eating their primitive food and their physical buildup was excellent. However, in the present study, along with proper diet, people consumed fast food heavily. 98.6% of males and 94.6% of females showed consumption of junk food. According to National Health and Nutrition Examination Survey (NHANES) related to diet consumption, more than one in three children and adolescents from the age group of 6–19 years are suspected to be overweight; more than two in three adults are suspected to be suffering from obesity. In the current study, out of 301 individuals, 13.7% of males and 22.8% of females were overweight.
Bernabé et al. and Evans et al. found in their cross-sectional study that children with the highest sugar-sweetened beverage intake were 2.0–4.6 times more likely to have severe early childhood caries compared with those with the lowest sugar-sweetened intake. In the current study, children were not examined, but history of early childhood carries was recorded. According to the current data, 55.26% of males and 53.69% of females showed a record of early childhood caries. According to NHANES estimate, 41% of children aged 2–11 years had dental caries in their deciduous teeth, 42% of children aged 2–11 years had dental caries in their permanent dentition, and 90% of adults had dental caries. As per the current data, 66.47% of males and 77.18% of females showed the presence of dental caries. Among them, 42.10% of males and 59.73% of females had a history of dental caries in parents also. Mariño et al., with their work on 603 older adults for assessment of oral health found that 46.7% of them had decayed teeth and 40.1% people had fillings in their teeth. According to their data, 33.3% had bleeding gums and 32.7% showed signs of dry mouth. Based on current data, 73.6% of males and 73.1% of females had dental plaque, and among them, 39.4% of males and 50.3% of females showed dental plaque-induced bleeding. Furthermore, 11.1% of males and 28.1% of females showed a less amount of saliva secretion.
The calculated PI from the current data is 1.2872. According to the paper published by the National Commission on Macroeconomics and Health, Ministry of Health and Family Welfare, Government of India, the occurrence of dental caries is estimated at the age groups of 5, 12, 15, 35–44, and 65–74 years of overall monitoring of trends and comparisons at international level. The occurrence of dental caries in India in these age groups is 56.72, 47.39, 49.59, 42.24, and 70.65, respectively. The calculated DMFT in the same age groups is 2.1, 1.6, 1.37, and 1.39 and it is not recorded for the 65–74 years. As per the current data, 64.47% of males and 77.18% of females showed the presence of dental caries. The calculated DMFT for overall subjects is 1.5182. From DMFT index, the calculated SiC is 3.06. According to the paper named Dental Requirements of the Hospitalized Alcoholic Patients conducted by Dunkley and Carson on 2694 individuals of the United States of America, alcohol consumers had a three times higher permanent tooth loss than national average. According to the current data, only 47.3% of males and 5.3% of females were alcohol consumers. Apart from alcohol, 41.3% of males and 4.0% of females were smokers.
| Conclusions|| |
Among all the subjects, most of the subjects were young adults, belonging to low- to medium-income households. Out of all the subjects, mostly had at least 12th-level education and only a few subjects were without proper education. Majority of the subjects were either students or job seekers and did not have any direct source of income. A large number of subjects showed the occurrence of caries and other dental issues and comparatively females showed more caries than males. Approximately slight more than half of the subjects also showed a history of dental caries in parents. Majority of the subjects had dental plaque and were also aware of the effects of dental plaque, but also the majority of the examined population did not use any measures to control dental plaque. A number of subjects showed the occurrence and history of jaundice, and it was because of water sanitation issues in Shimla. General water consumption was less and water supplied is mainly from government supply from main water tanker below mall road and hardly filtered.
Almost few less from total number of subjects were those who consumed junk food on a daily basis. Moreover, among them, most of the individuals are not living at their homes and they were either students or doing jobs in Shimla. A little talk with students showed that the case of smoking among young students was much greater than alcohol consumption. A very few subjects showed signs and history of obesity because of their daily lifestyle and some subjects also showed signs of malnutrition. According to this survey, only a few people go to dentists for routine checkups and treatments. Since the survey was done in colleges majorly, the examined group largely belonged to 16–18-year age groups, and among them, only a few subjects showed the eruption of wisdom tooth. Majority of the subjects were vegetarians and consumed enough amounts of green vegetables, pulses, fruits, sweets, milk, and its products. The consumption of milk was less in male subjects. More than half of the individuals were taking eggs with their vegetarian diet also. The national health authorities and decision-makers should formulate country-specific and community-specific goals for reducing the amount of free sugars and thus contributing toward preventing dental diseases such as caries.,
People who were nonvegetarian used to consume nonvegetarian diet only one or two times in a week. The largely consumed fruits were apple and banana. The frequency of having sweets and cold drinks or other soft drinks with or without alcohol was common. Talking about maintaining dental hygiene, approximately more than half of the subjects do brushing twice and none of the subjects were aware of flossing. When dealing with these surveys, it is important that the cross-sectional surveys are done for short periods of time and caries take time to develop, so all these measures might not actually give the exact reflection of caries. It is diet and other lifestyle factors which are the reasons for developing caries over time.
No ethical issues are associated with data collection for this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]