Chapter 1

INTRODUCTION

1.1 ENVIRONMENT

According to Webster dictionary Environment is defined as; “the complex

of physical, chemical, and biotic factors (as climate, soil, and living things) that
act upon an organism or an ecological community and ultimately determine its
form and survival” (Webster dictionary)

The word ‘Environment’ is derived from the French word ‘Environner’

which means to encircle, around or surround. Literary environment means the
surrounding external conditions influencing development or growth of people,
animal or plants; living or working conditions etc. In this meaning one can seek
the answer for what is surrounded, by what is surrounded and where it is
surrounded. For example an animal is surrounded by the air, soil, other animals
i.e. sum total of condition at that particular period of time and space on the earth.

However, other well-known definitions of others scientist are;

Boring: ‘A person’s environment consists of the sum total of the

stimulation which he receives from his conception until his death.’ It can be
concluded from the above definition that Environment comprises various types of
forces such as physical, intellectual, economic, political, cultural, social, moral
and emotional. Environment is the sum total of all the external forces, influences
and conditions, which affect the life, nature, behaviour and the growth,
development and maturation of living organisms.

Douglas and Holland: ‘The term environment is used to describe, in the

aggregate, all the external forces, influences and conditions, which affect the life,
nature, behaviour and the growth, development and maturity of living organisms.’

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1.2 ENVIRONMENTAL SCIENCES

The science of Environment studies is a multi-disciplinary science because

it comprises various branches of studies like chemistry, physics, medical science,
life science, agriculture, public health, sanitary engineering etc. It is the science of
physical phenomena in the environment. It studies of the sources, reactions,
transport, effect and fate of physical a biological species in the air, water and soil
and the effect of from human activity upon these.

According to Wikipedia, Environmental science is an interdisciplinary

academic field that integrates physical, biological and information sciences
(including ecology, biology, physics, chemistry, zoology, mineralogy,
oceanology, limnology, soil science, geology, atmospheric science, and geodesy)
to the study of the environment, and the solution of environmental problems.

1.3 ROLE OF ENVIRONMENT IN HUMAN LIFE IN TERMS OF

QUALITY OF LIFE

Human life cannot exist independently; it is actually an indispensable part

of environment constituting most important factors which decide the quality of
human life and existence. Environment plays predominant role in the life of all
organisms.

According to the Eurostar online publications, eighth dimension of the

'8+1' quality of life indicators framework is natural and living environment. The
environment, while usually discussed in the context of sustainability, is equally
important for the quality of life of individuals. Environmental conditions not only
affect human health and well-being directly, but also indirectly, through adverse
effects on ecosystems and biodiversity or even more drastically by causing natural
disasters or industrial accidents. This indirectly can affect the gross domestic
Product (GDP) too (http://ec.europa.eu).

1.4 DEFINITION OF HEALTH

Health in simple terminologies is the absence of disease. Nevertheless, the

classic definition which is given World health Organization is widely used and is

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as follows “health as a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.”(WHO’ formulated in 1948)

However, this definition is challenged by many of the new age scientist

owing to the increase in the number of chronic diseases. And they propose to
define health as the ability to adapt and to self-manage (WHO).

Environment is one among the many determinants of the human health.

The key to man’s health lies largely in his environment and the study of the
disease is really the study of man and his environment. Hippocrates was the first
person who related environment and the disease. Later the concept of disease and
environment association was revived by Pettenkofer (Park, 2007).

The macro or the external environment is all that which is external to the
individual human host. And the modern concept of the environment is not limited
to water, air and soil (physical environment), but also the social and economic
condition to which the host is exposed (Park, 2007).

1.5 DEFINITION OF ENVIRONMENTAL HEALTH

Environmental health has been defined in a 1999 document by the World

Health Organization (WHO) as:

Those aspects of the human health and disease that are determined by
factors in the environment. It also refers to the theory and practice of assessing
and controlling factors in the environment that can potentially and affect health.

Environmental health as used by the WHO Regional Office for Europe,

includes both the direct pathological effects of chemicals, radiation and some
biological agents, and the effects (often indirect) on health and well-being of the
broad physical, psychological, social and cultural environment, which includes
housing, urban development, land use and transport (Novice and Robert, 1999).

As of 2016 the WHO website on environmental health states

"Environmental health addresses all the physical, chemical, and biological factors
external to a person, and all the related factors impacting behaviours. It

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encompasses the assessment and control of those environmental factors that can
potentially affect health. It is targeted towards preventing disease and creating
health-supportive environments. This definition excludes behaviour not related to
environment, as well as behaviour related to the social and cultural environment,
as well as genetics (WHO).

1.6 OCCUPATIONAL ENVIRONMENT

‘Occupational Environment’ means the sum of external conditions and

influences which prevail at the place of work and which have a bearing on the
health of working population.7The interaction of the individual with the physical,
chemical and biological agents of the work place as great bearing on his physical
and the psychological health.

Every work place is really a ‘work environment’ where there are

interactions between people and the chemical and physical demands involved with
performing job. That is the health of workers in a large measure will be influenced
by conditions prevailing in their work place (WHO).

1.7 OCCUPATIONAL HEALTH

As defined by the World Health Organization (WHO) "occupational health

deals with all aspects of health and safety in the workplace and has a strong focus
on primary prevention of hazards”. Occupational health is a multidisciplinary
field of healthcare concerned with enabling an individual to undertake their
occupation, in the way that causes least harm to their health. Again this definition
was refined and a definition which was shared by both World health Organization
and the International Labour Organization was proposed for the Occupational
Health and is as follows;

"The main focus in occupational health is on three different objectives: (i)

the maintenance and promotion of workers’ health and working capacity; (ii) the
improvement of working environment and work to become conducive to safety
and health and (iii) development of work organizations and working cultures in a
direction which supports health and safety at work and in doing so also promotes

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a positive social climate and smooth operation and may enhance productivity of
the undertakings. The concept of working culture is intended in this context to
mean a reflection of the essential value systems adopted by the undertaking
concerned. Such a culture is reflected in practice in the managerial systems,
personnel policy, principles for participation, training policies and quality
management of the undertaking."- Joint ILO/WHO Committee on Occupational
Health (1995).

1.8 MINING AS AN OCCUPATION

Mining is an ancient occupation, long recognized as being arduous and

liable to injury and disease (Occupational Health Services and Practice, 2013).The
lifecycle of mining consists of exploration, mine development, mine operation,
decommissioning and land rehabilitation. Mining is a multi-disciplinary industry,
drawing on several professions and trades. To ensure precision in clinical and
epidemiological work, it is important to enquire about the details of tasks, as the
term ‘miner’ is relatively non-specific. Mining is traditionally classified as
metalliferous or coal, and as surface or underground. Metalliferous mining can
also be classified according to the commodity being mined. Some degree of
minerals processing is usually undertaken at mine sites. For metalliferous mining,
many of the occupational health hazards relate to these metallurgical processes
and for this reason I will include comments on metallurgical hazards
(Occupational Health Services and Practice, 2013).

Mining has always been among the most hazardous of occupations known
to human beings, but still the rapidly increase in demand of the metals and
minerals of all kind as greatly increased the demand of mining (Donoghue, 2004).

1.9 EFFECT OF MINING ON GENERAL HEALTH

The effects of mining can be of many categories, which include Physical

Hazards like the damage caused due to the heat, humidity, noise, vibration etc,
chemical hazards, biological hazards, psychosocial Hazards and the ergonomic
Hazards (Occupational Health Services and Practice, 2013).

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 The accident records of the industrialized countries during the Second
World War clearly reveal that the number of casualties resulting from industrial
accidents was almost as high as that of war casualties. The situation is worse in
developing countries with their low capital, less advanced technology, and
undertrained workers.

The mining industry has frequently appeared in the list of the most
dangerous trades in many countries. This is not surprising, because miners are
constantly facing new adverse conditions underground and their working
environments are maintained solely on an artificial basis. Underground mines
more dangerous than opencast mines. The following table summarizes the effect
of mining attributed to the different categories quoted above (Occupational Health
Services and Practice, 2013);

The major health hazards in mines (Occupational Health Services and

Practice, 2013)

Agents Hazards Conditions

Physical

High temperature Heatstroke; heat cramp; heat Deep underground

andhumidity exhaustion; lassitude; work
irritability; collapse; anxiety;
lowered morale
Cold Frostbite; trench foot; Ground work in
aggravated Raynaud'sdisease winter; high-altitude
mines
Sudden variation in Respiratory diseases; Moving from hot
temperature aggravated rheumatism working areas to
cold surface
conditions
Change of Bends (joint pain); chokes Work in deep
atmospheric (chest pain); air embolism; underground or high
pressure neuralgia toothache; paranasal altitude mines
sinusitis

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 Agents Hazards Conditions
Poor lighting Nystagmus (now rare); loss of Face work
visual acuity; giddiness

Noise Occupational deafness Rock drilling;

blasting
Vibration Raynaud's syndrome Rock drilling
Ionizing radiation Radiation hazards Working with
radioactive ore
Limited working Beat disease (cellulitis and Work in narrow
space bursitis of joints); displacement seams and in
and dislocation contorted positions
of joints
Accident Various Dangerous work
both in and out of
the pit
Chemical
Dusts Pneumoconiosis (silicosis, coal Working with
miner's lung, siderosis); mineral dust both in
induced and aggravated and out of the pit
respiratory disease; poisoning
by lead, arsenic, mercury,
manganese, etc
Poisonous gases; Gas poisoning (CO, C02, NOx, Blasting; inadequate
oxygen deficiency S02, methane); anoxia ventilation
(dyspnoea, dizziness)

Mine water Occupational dermatoses Underwater work in

Biological
Parasitic and fungal Ankylostomiasis;sporotrichosis;
infections tinea pedis and/or capitis;
leptospirosis
(Weil's disease)
the pit
Pit work where
parasites and fungi
grow easily owing to
high humidity and
poor sanitation

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1.10 EFFECT OF MINING ON ORAL HEALTH

According to the World Health Organization Oral health is a state of being

free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth
defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and
tooth loss, and other diseases and disorders that affect the oral cavity (Cho and
Lee, 1978).

The compartmentalization involved in viewing the mouth separately from

the rest of the body must cease because oral health affects general health by
causing considerable pain and suffering and by changing what people eat, their
speech and their quality of life and wellbeing. Oral health also has an effect on
other chronic diseases (WHO; oral health topics). Because of the failure to tackle
social and material determinants and incorporate oral health into general health
promotion, millions suffer intractable toothache and poor quality of life and end
up with few teeth.

Health policies should be reoriented to incorporate oral health using

sociodental approaches to assessing needs and the common risk factor approach
for health promotion (WHO; oral health topics; Petersen, 2003). Oral diseases are
the most common of the chronic diseases and are important public health
problems because of their prevalence, their impact on individuals and society, and
the expense of their treatment.

A thorough oral examination can detect signs of nutritional deficiencies as

well as a number of systemic diseases, including microbial infections, immune
disorders, injuries, and some cancers. Indeed, the phrase the mouth is a mirror has
been used to illustrate the wealth of information that can be derived from
examining oral tissues.

Recently, it has been recognized that oral infection, especially

periodontitis, may affect the course and pathogenesis of a number of systemic
diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus,
and low birth weight (Sheiham and Watt, 2000; Scannapieco, 1994; Xiaojing et

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al., 2000; Scannapieco, 1990). Three mechanisms or pathways linking oral
infections to secondary systemic effects have been proposed: (i) metastatic spread
of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic
injury from the effects of circulating oral microbial toxins, and (iii) metastatic
inflammation caused by immunological injury induced by oral microorganisms.
Periodontitis as a major oral infection may affect the host's susceptibility to
systemic disease in three ways: by shared risk factors; subgingival biofilms acting
as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir
of inflammatory mediators (Sheiham and Watt, 2000).The ignored signs and
symptoms of oral disease and dysfunction are detrimental (Xiaojing et al., 2000).
Consequently, oral health is integral to general health. You cannot be healthy
without oral health. Oral health and general health should not be interpreted as
separate entities. Oral health is a critical component of health and must be
included in the provision of health care and the design of community programs.

1.11 OCCUPATIONAL ORAL HEALTH HAZARDS

Oral health, as already mentioned is an integral part of general health and

plays an important role in improving the quality of life. The oral cavity is
vulnerable to external agents, and some occupational exposures are associated
with oral changes in both hard and soft tissues (Oshikohji et al., 2011).
Environmental hazards contribute to poor oral health in many occupations, as oral
cavity is a port of entry for many diseases and present several unique features,
which makes it especially prone to occupational diseases (Tatiana et al., 2008;
Schour and Sarnat, 1942). Oral cavity injuries which occur as a direct result of an
occupation are rather common. The injurious effect of occupational hazards may
manifest themselves in the teeth, jaw bones, periodontal tissues, tongue, lips, and
oral mucosa. The effects of the various etiologic agents responsible for oral
occupational disease depend on their specific chemical, physical and bacterial
nature, their physical state, and their mode of entry (Khurana et al., 2014).

The etiology of oral cavity diseases involves an array of environmental,

genetic, immunologic, and sociobehavioral factors including education, oral

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hygiene habits, and dental care access. As is mentioned earlier in this section the
location and multiple functions of the mouth make it particularly vulnerable to
external aggressions (Petersen and Henmar, 1988).

An occupational disease may be defined as a negative change in health

condition directly resulting from more or less prolonged exposure to harmful
substances or conditions immediately related to the individual's work. It should be
differentiated from an occupational accident, which is of sudden occurrence. The
injurious effect of occupational hazards may manifest themselves in the teeth, the
jaw bones, the periodontal tissues, tongue, lips, and oral mucosa. The effects of
the various etiologic agents responsible for oral occupational disease depend on
their specified chemical, physical, and bacterial nature, their physical state, and
their mode of entry (1), Injuries of the oral cavity which occur as a direct result of
the occupation are of rather common occurrence. In recent years industrial health
programs have recognized the necessity of maintaining oral health and have
emphasized the need for special precautions to prevent oral injuries (Vianna et al.,
2005).

The tissues of oral cavity may be affected by toxic agents either by direct
action as exposure to sulfuric acid fumes or through systemic exposure as
poisoning with heavy metals e.g. lead and mercury. Teeth, periodontal tissue, lips,
tongue, mucous membrane, salivary glands and jaw bones may be affected
depending on the type of exposure (Petersen, 1989). Sometimes, pathologic
changes in oral cavity may be the first sign that indicates absorption or toxicity
related to certain toxic agents, e.g. lead and mercury poisoning (Peterson and
Gorment, 1991). Due to the substantial increase in the use of chemical substances
that have adverse effects on oral health, industrial dentistry has become a subject
of major consideration and constituted a new branch in the field of dentistry.
Chronic Lead exposure favors the formation of cheilitis, fissures, ulcers and
epithelial desquamation of the tongue, palate and other parts of the oral mucous
membranes (Said et al., 2008).

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1.12 MINING AS AN OCCUPATION AND THE ORAL HEALTH

Every work place is really a work environment where there are interaction
between the people and the chemical and physical demands involved with
performing the job. It is considered that the industrialization is the sign of
progress and this can be proved by the fact that all the developed countries in the
world are the contributions of the industrialization. It also is the fact that industrial
progress and the growth of a nation go hand in hand. Alteration of the natural
existing physical environment by such kind of progress has made the man to live
in a complicated environment. By each day the complexity is increasing as man is
becoming more ingenious. If these trends persist, it is feared that the very
“Quality of Life” we cherish may soon be in danger (Park, 2007).

Mining is one of the major industries flourishing throughout the world. A

large number of labourers work in the stone crushing and mining industry in India
(Semple et al., 2007).In India, Rajasthan is the place where most of the marble,
zinc, copper and other mines are found. As part of general health of these
workers; their exposure to respirable crystalline silica and a number of other
particulate matter exposure metrics in occupational settings. Marble mining is
associated with environmental pollution along with this it also is associated with
the release of harmful chemicals like asbestos (Jehan and Ahmad, 2007). In the
long run all these respirable particulate matters and the consuming of chemically
contaminated water and food may affect the physical health as well as dental
health. It is worth a goal to explore the effect of the mining on the oral health of
the people working in such kind of environment.

Suspended particulate matter (SPM) refers to the mixture of solid and

liquid particles in air. In a broader sense the term applies to matter in the
atmosphere classed into particles having a lower size limit of the order of 10–3
mm and an upper limit of 100 mm. SPM, a complex mixture of organic and
inorganic substances, is a ubiquitous air pollutant, arising from both natural and
anthropogenic sources. Ever since the advent of the industrial era, anthropogenics
ources of PM have been increasing rapidly (Mohanraj and Azeez, 2004).

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 The dust swirling around in quarries is mineral powder that causes a
number of lung diseases, such as silicosis, tuberculosis (TB), silico-tuberculosis
and asthma. Exposure to chemical, physical, and biological agents in the
workplace can result in adverse effects on workers ranging from simple
discomfort and irritation to debilitating occupational diseases such as lung
fibrosis, neuropathy, deafness, organ damage, and cancers of various sites (Verma
et al., 2002).For the overall wellbeing of the person, dental health is as essential as
total body health. It is essential to know the prevalence and the treatment needs of
occupational disease related to oral health among labourers.

Besides, strenuous working hours of the mining labourers force them to

indulge in bad habits of tobacco smoking, chewing and alcohol drinking which
makes them prone to all types of oral ailment, some of which are known to be
fatal and life challenging too. Because of their long working hours, Social
boycott, lack of any other social activity in the mines and the absences of the
family and children makes them more attracted to the drugs which a very quick
habit forming and cause of the oral cancers, lung cancers, tuberculosis, black lung
and upper respiratory tract infections. These are chronic infections and are
expensive to treat without any chances of total cure or the recovery.

Thus, oral health is an integral part of the general health of the person and
it cannot and could not be ignored at any cost. As the saying goes that a healthy
mind dwells in a healthy body.

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 Chapter 2
AIMS AND OBJECTIVES

2.1 NEED FOR THE STUDY

There are extensive studies on the effect of mining and its environment
including the particulate matter on the general health of the human beings.
However, the effect of mining on the oral health of the human beings is not been
given any consideration at all and the literature per se is very negligible.
Assuming that particulate matter concentration will be more in the mining area
and the mining labourers will be performing strenuous labouring, which obviously
makes them oral breathers or else ora-nasal breathers, which makes them more
prone for the dental ill health due to the particulate matter concentration if any.
So, the present study was aimed to test the hypothesis whether the mining as an
occupation leads oral ill health and whether the particulate matter can be causative
factor for dental ill health in mining labourers.As factory/Mining workers
constitute well-defined population group, knowledge of factors affecting their oral
health in a work place allows oral health promotion measures to be appropriately
targeted, studies conducted on them also help in planning of preventive
programmes for the prevention of oral diseases and promotion of oral health in
industrial health care system.

2.1.1 What is aimed to be achieved by the study?

It is aimed to achieve the knowledge about the existing oral health

condition of the mining workers and the cause behind the same. The data of the
labourers will be compared with the normal non-mining population which will
give the idea of influencing factors in the work environment that can be
deleterious to the oral health of these mining workers. Evaluation of the oral
health will also help in detecting the presences of systemic disease if any and

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further we can advise for the advanced diagnostic aids for the need patients, which
will help in early detection and treatment of the systemic disease if any.

2.1.2 How is it likely to advance or add to the existing knowledge in relation

to human health?

The occupational environment and health related studies have been of

great importance worldwide. However, the data or the literature pertaining to the
occupational environment and oral disease is rather very scanty. Most of the
systemic and the deleterious human disease can be identified by the oral
conditions, which otherwise undergo undiagnosed. Thus oral health should be
given equal importance as the general health, which unfortunately is not the case
in the developing country like India. This neglect of oral health is even more in
the strenuous labouring/mining class who being exposed to the polluted
environment are at more risk of developing oral health problems and who are
ignorant of such condition because of their limited education. The study
pertaining to the oral health in mining workers so far in India are very minimal
and none which have compared the normal population with that of the mining
workers. It is the sole purpose of this paper to evaluate the oral health status of the
mining workers and to compare the same with normal population. The
investigation will also evaluate the influence of work environment on the oral
condition of the mining workers. The research will help in identifying the oral
health needs of the present population and will also try to propose the plan for
combating the conditions leading to such problems in these mining workers.

2.2 AIM

The study was done to evaluate oral health status of the mining workers in
the Udaipur City, Rajasthan, India.

2.3 OBJECTIVES

1. To review the literature of occupational Oral health related issues.

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2. To evaluate the demographic data of the mining workers in Udaipur city.

3. The effect of mining on the dental health among the labourers in Udaipur
city, Rajasthan, India.

4. To study the prevalence of oral cancerous and pre-cancerous lesions in the

mining labourers in Udaipur city, Rajasthan, India.

5. To study the dental health and the prevalence of oral cancerous and pre-
cancerous lesions in the non-mining population in Udaipur city, Rajasthan,
India.

6. To compare the oral health status of the mining labourers and normal
population of Udaipur city, Rajasthan, India.

7. To compare the difference in the level of particulate matter in the mining

area around the Udaipur city and in the Udaipur city proper.

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 Chapter 3

OVERVIEW ON THE MINING

3.1 OVERVIEW OF INDIAN STONE INDUSTRY PROFILE

India has major resources of marble, granite, sandstone, Kotah stone,

quartzite & slate. Granite resources are largely in South India and Marble deposits
are largely in Western India (Rajasthan & Gujarat).

The highest producer of stones

 Highest producer of dimensional stones in the world accounting for over

27% of the world stone production.

 16.16 million tons of stone production in the year 1997-98 out of a total
world production of 61 million tons.

 Over 2 million people are employed in stone sector.

Indian Stone Production (In Thousand tons)

1991-92 1992-93 1993-94 1994-95 1995-96 1996-97 1997-98

Marble 1966 2244 2086 2627 3186 3712 3622

Granite 989 3073 3618 4460 4555 4550 4950

Sandstone 4411 4435 3978 3304 4562 5501 5461

Flaggy 620 996 823 1407 1760 1710 2118

Limestone

Slate 3 5 4 9 7 11 8

Total 7989 10753 10509 11807 14070 15484 16159

(Source: State Department of Mines & Geology and All India Granites & Stones Association)

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Marching towards global leadership

 Export of Stones - US $ 301 million (Rs.13,000 million) in 1997--98

 India ranks 3rd in world stone exports with a 10.8% share in 1997 (in
terms of tonnage).

 India ranks 1st in Raw Siliceous product (Granite & Sandstone) exports.

 India ranks 5th in Raw Calcareous product (Marble & Flaggy Limestone)
exports.

 India ranks 9th in exports of finished stone products.

The bulk (90%) of the Indian stone exports is by way rough granite and
marble blocks and only about 10% is by way of value added or branded products.
Indian stone industry and the Government have set a target of raising this to 50%
over the next 5 years.

The bulk of the Indian stones are produced in the Indian states of
Rajasthan, Tamilnadu, Karnataka and Andhra Pradesh. Rajasthan accounts for
nearly 90% of all the marble produced and the other three states in Southern India
produce almost all the granite exported.

3.2 STATISTICAL OUTLOOK

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Major Importers

Marble the pride of India

 Practically inexhaustible marble deposits -over 1200 million tons

 Splendid varieties of white, green, black, grey, pink, yellow

 Physical and mechanical properties complying with international

standards

 Amongst the top 5 countries in marble exports

A Vibrant Industry

 Total Investment - over Rs.40,000 million (US $1,000 million)

 About 4,000 mining leases

 Block production 3.7 million tons in 1996-97

 About 1,100 modern gang saw units and 50 Automatic tiling plants

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  More than 5,000 trading companies

 Employing about 1 million people

 Fast developing modern mechanised quarries

 Over 300 quarries using diamond wiresaw& chainsaw cutter quarrying

technology

 Modern & well equipped factories with advanced Italian technology for
cutting, processing, polishing and handling

 Marble slab & tile production: 1300 million sq. ft per annum

Impressive Marble Export

 Increase of over 300% from US $ 9 million in 1992-93 to US $ 27 million

in 1996-97

 Excellent quality export varieties - Green, Onyx, Indo Italian, White and
Pink marble

 High quality polished marble tiles & slabs and green & white marble
blocks correspond to demand in the foreign market

 High export demand for marble handicrafts

 Key marble export markets - USA, Canada, Japan, Singapore, UAE, EC

countries

3.3 OVERVIEW ON THE MARBLE

The term "Marble" is derived from Latin word "Marmor" which itself
comes from the Greek root "Marmaros" meaning thereby a shining stone.
Technically marble is a recrystallised, compact variety of metamorphosed
limestone capable of taking polish. Commercially, marble is any crystalline rock

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composed predominantly of calcite, dolomite or serpentine, having 3-4 hardness,
which can be excavated as blocks and can be sawed and takes good polish.

3.4 PHYSICAL ORIGINS MARBLE

Marble is a rock resulting from metamorphism of sedimentary carbonate

rocks, most commonly limestone or dolomite rock. Metamorphism causes
variable recrystallization of the original carbonate mineral grains. The resulting
marble rock is typically composed of an interlocking mosaic of carbonate crystals.
Primary sedimentary textures and structures of the original carbonate rock
(protolith) have typically been modified or destroyed.

Pure white marble is the result of metamorphism of a very pure (silicate-

poor) limestone or dolomite protolith. The characteristic swirls and veins of many
colored marble varieties are usually due to various mineral impurities such as
clay, silt, sand, iron oxides, or chert which were originally present as grains or
layers in the limestone. Green coloration is often due to serpentine resulting from
originally high magnesium limestone or dolostone with silica impurities. These
various impurities have been mobilized and recrystallized by the intense pressure
and heat of the metamorphism. (Source: https://en.wikipedia.org/wiki/Marble)

3.5 MAJOR SITES OF MARBLE IN INDIA

Rajasthan is the richest state in the country with regards to marble deposits
both in quality and quantity. The state is most important centre (Mandi) of marble
processing in the country with about 95% of the total processing units. Rajasthan
possesses large reserves of about 1100 million tonnes (M.T) of good quality
marble. Rajasthan, the largest State in the country in terms of geographical area, is
located in the north-western part of the country. It has a geographical area of 3,
42,239 sq.km, which constitute 10.41 per cent area of the country. There are
2,849 mining leases for major minerals and 11,849 minor leases and 16,297
quarry licenses existing in the State. Mineral survey and prospecting on projects
have been taken up or are being carried out. Udaipur is one of the major producers
of marble. The important marble deposits are seen in Nagaur, Jaipur, Alwar,

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Dausa, Jaisalmer, Rajsamand, Pali, Banswara, Udaipur, Bundi, Sirohi, Dungarpur,
Ajmer, Sikar, Jodhpur, Bhilwara, Chittaurgarh, Churu

Figure 1. Udaipur Mining area Map

(Source: http://gis1.dmg-raj.org/website/DMGGIS/viewer.htm?Service=Marble)

3.6 CLASSIFICATION OF TYPES OF MARBLE

Marble has been classified into 10 groups by Bureau of Indian Standards

(Indian Standard Institute i.e. ISI) (IS 1130-1969) on the basis of colour, shade
and pattern. Rajasthan is the most fortunate state where all the 10 groups specified
below are occurring:

1. Plain White Marble 2. Panther Marble

3. White Veined Marble 4. Plain Black Marble
5. Black Zebra Marble 6. Green Marble
7. Pink Adanga Marble 8. Pink Marble
9. Grey Marble 10. Brown Marble

21
3.7 PROCESSING OF MARBLE

A large number of processing centres have been developed in the state at

Makarana, Jaipur, Alwar, Ajmer, Udaipur, Nathdwara, Rajsamand, Morchana,
Amet, Abu Road, Kishangarh, Banswara, Chittaurgarh, Sirohi etc. where more
than 1100 gangsaws and 50 automatic tiling plants are in operation. A large
number of tiny units are also working.

Chemical Properties of the Marble

Marble Area CaO MgO SiO2 Fe2O3 LOI

Jhiri, Alwar 26-33 21-25 0.01-3.18 0.73-1.01 40-47
Tripura 32 23-24 <=23.4 0.200.84 42-44
Sundari,
Banswara
Mandaldeh, 35.92 3.01 18.52 2.93 33.18
Chittaurgarh
Sandwa, 31-37 13-22.6 <=6.44 0.12-0.26 45-46
Churu
Dungarpur 48.18 2.04 10.75 1.13 35.55
Bhainslana, 48-54 2-4 1-3 1.5-3 35-45
Jaipur
Phalodi, 39.03 9.36 8.70 0.48 42.83
Jodhpur
Makrana, 50-56 0.8-1.8 0.33-1.20 0.10-0.28 34.8-43.2
Nagaur
Rajnagar 30-33 16-25 0.01-7.6 0.12-0.95 36-44
Sirohi 51.49 0.90 8.52 0.54 39.36
Keshariyaji, 18.56 21.29 31.51 5.33 21.82
Udaipur
Babarmal, 20.79 2.21 1
Udaipur

22
 TECHNICAL INFORMATIO N OF MARBLE

Technical Water Density, Modulus Compressive Abrassion Flexural

Details Absorption, bulk of rupture, strength resistance strength,
% by specific N/mm2 N/mm2 to wear N/mm2
weight gravity

ASTM/ C-97 C-97 C-99 C-170 IS 1237 IS 4860

Indian Guidelines Guidelines
Standard

Area Dry Wet Dry Wet Avg. Mxm.

Wear Wear
mm mm

Makrana 0.04 2.68 14 16 88 81 3.1 3.2 16

Andhi Indo 0.05 2.68 13 11 130 109 6.6 6.8 11

Andhi 0.08 2.68 14 17 94 114 3.8 4.1 16

Modern art

Jhiri Onyx 0.06 2.68 9.00 8 142 108 5.5 5.7 8

Agaria, 0.06 2.84 17 16 106 102 4.0 4.2 15

Rajnagar

Morwad, 0.04 2.84 12 13 111 80 3.1 3.2 13

Rajnagar

Keshariyaji 0.07 2.66 42 35 286 194 1.1 1.2 35

Green

Bidasar 2.38 - 2.43 2.55 - 19 - 13 - 138 83 - 1.45 1.6 12 - 20

2.47 24 20 - 81
114

Phalodi 0.64 2.62 15 21 212 116 2.0 2.2 20

3.7.1 How is Marble Formed?

Marble stone is formed due to metamorphism of sedimentary carbonate

rocks, most commonly known as dolomite rocks or limestone. Marble stone are
recrystallization of carbonate minerals. Today technology is growing very rapidly

23
and it’s being very useful to marble, making it more beautiful and has increased
availability across the world. Marble fabrication is the process which explains all
the steps in marble processing.

3.7.2 Marble processing steps

1. Quarrying The first step to finding the perfect slab is finding an optimal
deposit of material with desirable color, pattern, and composition. This
requires geologists to look for stone outcrops which are more easily
examined since the bedrock is exposed. Samples are then obtained by
boring into the earth to take core samples with expensive diamond-tipped
drill bits. These samples are then tested to determine if the stone is suitable
for use as dimensional building stone. Later they are polished so that their
color and pattern can be examined to determine marketability.

2. Extraction -After the quarry manager decides how to extract the blocks,
the drilling can begin. The process starts by taking down a “bench wall,” a
large dimensional chunk of rock that is then cut into smaller blocks which
will eventually be sent to the factory for processing. The bench walls are
cut using a combination of diamond wire cables, drills and even high
temperature torches that will melt the stone. Dirt is pushed up against the
base of the wall to cushion the fall, and small dynamite charges jar the
wall loose to bring it down to a horizontal position. The blocks can then be
drilled from the bench wall. Blocks of a given type of stone usually have a
fairly uniform size, due to the size of the processing equipment used.
Granite blocks usually weigh between 38-42,000 pounds, while lighter
marble and travertine blocks weigh between 15-25,000 pounds.

3. Gang Sawing - After the transportation of marble to their respective

location, they are taken to Fabrication area where marble are cut into more
fine pieces. The fabrication area is a big warehouse where the slabs of
marble are cut with steel blades with the help of hydraulic lifts. In this
process marble slabs are placed on an assembly line which are lifted by

24
 hydraulic pressured jacks and marble slabs are cut by giant sets of saw or
Gang saws which are just above the assembly, this saw's are connected to
crankshaft and pistons which are connected to engines moves this
crankshaft, resulting the saw's to move horizontally at a rapid speed.
Marbles slabs on assembly line are pushed by the hydraulic pressure and
the saw cuts the marble slabs. Then the marble small pieces are to taken
carefully to the finishing and polishing room for further processing.

4. Polishing and Sealing - Polishing and sealing is the main procedure in

marble fabrication as it defines the true value of marble. The slabs of
marble are placed on a platform where machine with artificial diamonds
smoothens the surface of the marble until partial reflection are visible on
the marble. This process is repeated on both sides and then cleaned
properly so that dust particles are removed. Polished marbles are then
taken for a uniform spray of epoxy sealer on the surface of the stone and
dried under heat lamps for 48 hours. Finished Marble are send to the
retailers and sellers to their respective location for further procedure and
selling.

5. Water jet Cutting and Wet Sawing - Retailer's sell the marble stone to
their customer as per their requirement, which includes the design,
quantity, and most important the size of marble stones. Customer demands
different sizes of stone which can fit there in their kitchen, bathroom,
countertops, floors etc. hence for this retailer themselves shape the size of
the marble, to do this they use wet sawing or water jet cutting. In wet
sawing the marble stone is being cut by the saws and water is kept flowing
over the marble to reduced heat from friction. Water jet cutting is a new
and unique method. In this process water with powdered minerals are
pressurized at 60000 psi and shot on the marble for clean and better cut.
This is very common today and almost all fabricator use water jet cutting.

(Source: http://www.selfgrowth.com/articles/marble-stone-fabrication-
process)

25
 Chapter 4
REVIEW OF LITERATURE

In-depth Reviews in this section are intended to cover the topics that
remain most important in the occupational oral health hazards.

Schour and Sarnat (1942) in a review on Oral Manifestations of Occupational

Origin, state that the oral cavity is a port of entry for many diseases and present several
unique features, which make it especially prone to occupational disease. It is more
usually exposed to injurious agents than any other organ or region of the body. The
problem of oral manifestations of occupational origin must be considered according to the
pathological process, structure, affected etiologic agent, and occupational distribution.
Dust of abrasive quality such as cement will collect on the occlusal surfaces of the teeth
and produce generalized abrasion. Prevention of oral occupational hazards must be
attained both by improving the working conditions and by establishing and maintaining
the oral health. In conclusion the authors stress oral hygiene is an essential part of
industrial hygiene.

Elsbury et al., (1951) studied the prevalence of erosion of the teeth of girls
working in an atmosphere containing dust composed of a mixture of tartaric acid,
sucrose, magnesium sulphate, and sodium bicarbonate. Gravimetric analysis of
the dust showed an average concentration in the shop of 15 mg/cu.m. They stated
that spending 30 hours per week in this concentration, which, it is estimated,
contained an average of 11l mg/cu.m of free tartaric acid, which produced a
clinical erosion of the teeth which may be detectable after an exposure of six
months.

Ten Bruggen Cate (1968) examined 555 acid workers between March
1962 and October 1964. One hundred and seventy-six (31.7%) were affected by
industrial dental erosion at the first examinations. In 33 cases (6.0%) the dentine
was affected. During the period of the survey, 66 (20.4%) of 324 workers

26
examined more than once showed evidence that erosion was progressing. The
prevalence and incidence of erosion were highest among battery formation
workers, lower among picklers, and least among other processes covered by the
survey. The age of workers did not appear to influence their susceptibility to
erosion. The habit of working with the lips slightly parted had little effect. Erosion
superimposed upon attrition predisposed to more severe loss of tooth structure
than either operating alone. Little inconvenience or functional disability was
suffered by acid workers due to erosion. Twenty-seven (27%) of 114 erosions
were considered to be disfiguring. Regular dental treatment was sought less by
acid workers than by controls, and the oral hygiene of the latter was superior.
They reported no evidence to show any difference between caries experience
among acid workers and controls. Calculus and periodontal disease were more
prevalent among acid workers than among controls, but they confirmed that it was
not possible to attribute this to the working environment. Black staining in iron
picklers was considered to be due to the working environment. They felt that the
use of closed acid containers or lip extraction on open acid vats prevented
significant atmospheric contamination and diminished the prevalence of erosion.
The use of wall fans and detergent foaming agents was also thought to be helpful.

Heloe and Kolberg (1974) did a questionnaire study to investigate dental

status and treatment pattern among 414 male industrial labourers living in a
Norwegian rural community approximately 100 Km away from their jobs. The
results revealed that median age of the labourers was 39 years; seventeen percent
of the labourers were edentulous, while 44% reported having 20 or more teeth
remaining. Fifteen percent had removable dentures in both jaws, 28% in one jaw
only and thirty eight percent reported having visited the dentist the previous year.
Seventy three percent of the study population stated that they were interested in
receiving low cost dental examination and treatment. The results of the study
showed that dental status and treatment pattern among male industrial labourers
was poor and definitely below the standards prevailing in the general population.
The authors concluded that situational factors such as working situation, little
leisure time, lack of time, lack of treatment facilities and difficulties in getting

27
dental appointments conceivably had interfered with seeking of treatment and thus
contributed to the neglect of dental care.

Gordon et al., (1974) conducted a study to compare oral health in 4

Canadian Indian communities. Oral examination was performed. OHIs,
periodontal index, and DMFT were recorded. They concluded that a correlation
might exist between dietary habits, especially the availability and frequency of
consumption of refined carbohydrates and the condition of dental structures.

Browne et al., (1977) carried out a retrospective survey of 75 patients with

oral squamous cell carcinoma (ICD Nos. 143, 144, 145) resident in the County
Borough of Stoke-on-Trent, England, and 150 controls has been carried out by
interview. The controls were matched for age, sex, occupation and place of
residence. There was no difference in the prevalence or duration of denture
wearing, although male controls had their dentures remade more frequently. Male
patients practiced oral hygiene procedures less frequently when they had their
own teeth than controls. Habitual beer-drinking was more common and greater
quantities were drunk by male patients than controls. Habitual cigarette smoking
was less and pipe smoking greater among male patients than controls. Tobacco
chewing, which was restricted to miners, was equally common (45%) in the two
groups. Among miners, the combined habit of tobacco chewing and pipe smoking
was more common among patients (100%) than among controls (25%).

Skogedal et al., (1977) checked the prevalence of dental erosion in 12

workers in a Norwegian factory using electrolytic methods to extract zinc. They
reported that there existed a relationship between degree of erosion, number of
teeth affected and the length of service. The prevalence of caries, abrasion and
attrition was not higher than in comparable population groups. They found that
the correlation between diagnosis of erosion based on clinical examination, and
diagnosis based on evaluation of colour slides was good.

Markkanen (1978) assessed the periodontal status among employees of a

paper mill in Finland and adapted the periodontal treatment needs system (PTNS)
to Finnish adult population; the estimates of Finnish periodontologists were used.

28
The mean estimate of periodontal treatment need was 97±58 (S.D) minute per
person and 32±18 minute per jaw segment. Periodontal treatment need increased
with age. No significant differences in periodontal treatment need by sex,
education, type of employment, regularity of working hours or frequency of
dental visits were observed. Adjusted family income and tooth brushing frequency
did not produce significant difference in periodontal treatment need, except in the
group having four dentulous jaw segments. The groups using sugar, other
sweetening agents or neither of these, mainly in coffee or tea, differed
significantly: the non-users of sugar had lowest treatment time and those who
used other sweetening agents than sugar had highest treatment time.

Reisine (1984) explored the feasibility of a social outcome measure, work

absence due to dental disability. 2600 employed people in the Hartford (CT) area
were interviewed by phone using Random Digit Dialing methodology. While
dental disability did not affect the majority (75%) of those workers interviewed,
25% reported an episode of work loss in the past 12 months related to dental
problems and dental treatment visits. Workers lost an average of 1. 7 hours. The
prevalence and magnitude of work loss were sensitive to several
sociodemographic, access, and health-related factors.

Gamble et al., (1984) evaluated the influence of acid exposure and the
pulmonary disease prevalence. Two hundred and twenty-five (225) workers in
five lead acid battery plants were administered a questionnaire containing work-
related symptoms, underwent spirometry, and had personal samples for Sulphuric
acid (H2SO4) taken over the shift. Most personal samples were less than 1 mg/m3
H2SO4. Mass median aerodynamic diameter of H2SO4 from area samples in the
formation areas was 2.6-10 micron. Workers with a higher exposure to acid did
not have an increased rate of acute work-related symptoms. Changes in
pulmonary function over the shift were not related to levels of airborne lead or
airborne acid, sex, age, or smoking status. In acclimated workers, there is no
evidence of acute symptoms or reductions in pulmonary function over the shift at
concentrations less than 1 mg/m3.

29
 The effects of long-term exposure to sulphuric acid mist on the teeth and
respiratory system were studied in 248 workers in five plants manufacturing lead
acid batteries was studied by Gamble et al. (1984). The prevalence of cough,
phlegm, dyspnoea, and wheezing as determined by questionnaire were not
associated with estimates of cumulative acid exposure. There was only one case
of irregular opacities seen on the chest radiographs. There was no statistically
significant association of reduced FEV1, peak flow, FEF50, and FEF75 with acid
exposure although the higher exposed group had lower mean values. FVC in the
high exposure group showed a statistically significant reduction compared to the
low exposure group, but there was no significant association when exposure was
analysed as a continuous variable. They reported that the ratio of observed to
expected prevalence of teeth etching and erosion was about four times greater in
the high acid-exposure group. The earliest case of etching occurred after 4 months
exposure to an estimated average exposure of 0.23 mg/m3 sulphuric acid.

Reisine and Miller (1984) analysed the effect of dental conditions on

social functioning by measuring the incidence of work loss days associated with
dental problems and treatments in 1 year. A longitudinal study of 1992 employed
adults in the Hartford, Conn area was conducted. Participants were interviewed at
baseline to collect data on socio demographic, health care and health status factors
and were followed for 1 year to assess the incidence of dental work loss days. The
results showed that 26.4% of the sample reported an episode of dentally – related
work loss, with a mean of 1.26 hours per person per year. The most important
predictors of having work loss were high number of dental visits, previously
having an episode of work loss, being young and being in the high social classes.
The most important variables explaining total hours of work loss were treatment
severity, previous work loss, low income and being non-white. The study suggests
that work loss days may be a useful population statistic in measuring oral health
status because of high prevalence of dental disease.

Janczuk et al., (1986) conducted a study on 347 workers (232 men and
115 women) aged 35-44 from four big industrial plants in the area of Szczecin.
Selected dental health indices and questionnaires filled by the workers have been

30
analyzed. The results were compared with the data obtained from the International
Collaborative Study of Dental Manpower Systems in relation to Oral Health
Status (so called "general population"). The study demonstrated differences in the
DMF and M data between the test and the general populations. No differences in
D and F numbers have been shown. Thus, the index of caries treatment
requirements was similar in both populations. The awareness of caries treatment
need was lower in the industrial than in the general population. The percentage of
workers in demand of dentures was higher in the industrial than in the general
population. The questionnaire study demonstrated that the test group more
frequently applied--within last year - for dental care. Also, the availability of
dental dispensaries was evaluated better by the workers as compared to controls.

Enbom et al., (1986) determined the degree of occlusal wear in two groups
of miners, one with an employment time of 5-7 years and one who had been
working in the mines for more than ten years. They were compared with two
matched groups of white collar workers. In the two groups of miners a statistically
significant higher degree of occlusal wear was found when comparisons were
made with the control groups. The older miners had a poorer dental health and a
higher degree of clinical signs of mandibular dysfunction than their control group,
but no differences were found in these respects between the two younger groups.
Because of this, they concluded that the most possible reason for the differences
found in occlusal wear between miners and white collar workers is differences in
working environment, probably abrasive components in the air.

Petersen and Henmer (1988) described the oral health situation of workers
in the Danish granite industry in the year 1986-1987, in particular to the
prevalence and severity of dental abrasion. Measurements of the work
environment showed that the workers were exposed to abrasive quartz dust. A
total of 39 workers (72%) completed a questionnaire on their dental health, work
environment and symptoms from the masticatory system. Consequently, the
clinical examinations revealed a high prevalence of dental caries (mean number of
decayed, missing, and filled surfaces 87.2). The worker’s periodontal conditions
were poor; the mean percentage of teeth with gingivitis, calculus and pockets

31
deeper than 5mm was 13.4. The prevalence of dental abrasion was 100%; in
particular, abrasion was observed on the front teeth. They stated that the severity
of abrasion and the affection ratio increased by duration of exposure to dust.

Lie et al., (1988) evaluated the dental health conditions of 181 male
employees (121 workers and 60 administrators) in a large aluminium factory in a
rural part of Norway. The study population was selected through random
sampling from the company’s employee’s list. Five percent of 181 examined
subjects aged between 25-60 years were edentulous. All dentate individuals had
some degree of periodontal disease. The percentage of sites with bleeding
increased from 40% in the lowest to about 60% in the highest age group. Teeth
with probing depths >4 mm increased from about 30% in the age group 25-29
years to about 45% in the age group of 30-34 years, after which it increased
gradually with increasing age. They also reported that the administrators had a
somewhat better oral hygiene, fewer retention factors, less bleeding, fewer
pockets and more marginal bone support than the workers.

A study was conducted by Majid et al., (1988) to assess the oral health
status of 198 factory workers (Antara Steel, Pasir Gudang Johar) in November
1986. The subjects were predominantly male (94%) and Malay (91%) with an
average age of 27.4 years. The results showed that the prevalence of caries was
87.4% with a mean DMFT of 7.15.4, regarding prosthetic status 3 subjects were
with full upper, lower dentures and 16 subjects were with partial dentures, two
subjects needed dentures but were not wearing them, treatment needs indicated
that thirty five (17.7%) needed extractions, and 8 needed fillings. Enamel
opacities were found in 141 subjects (75.6%) but only 9 were aware of these
defects, oral health was very poor among the workers with 72% examined needed
scaling, a total of 107 (54%) were smokers and heavy nicotine stains were found
in 41 (20.7%) of the population examined. Examination of the soft tissue showed
111 (56%) subjects with recurrent apthous ulcers while 15 (7.6%) suffered from
herpes labialis, five subjects (2.5%) suffered denture stomatitis while the
prevalence of other soft tissue lesions was very low.

32
 A cross-sectional was planned by Kovacevic (1989) to show how relevant
was the chronic professional exposure to noise in the occurrence of Para functions
of the stomatognathic region in textile workers. All investigations were carried out
on a sample of 72 textile workers (males and females), who worked in high noise
conditions. It was found that the level of noise ranged from 99 to 105 decibels,
with some extreme values to 130 decibels. In addition to family history, an
interview was carried out with each worker about his/her individual noise
sensitivity to bruxism. Their obtained result showed that the frequency of Para
function was 30.5% higher in workers working in high-noise environment.

The periodontal condition in 35-44 year old factory workers in Shanghai

was evaluated by Pilot et al., (1989).Study group consisted of 500 male and
female factory workers belonging to mining equipment factory, a cotton mill and
a factory of heavy machinery. The results showed that the differences between
groups appeared to be rather small. Calculus and shallow pockets (4 or 5 mm)
were most frequently observed; in 87% of all persons in 77% of all sextants. Deep
pockets (6 mm and over) were seldom found in 11% of all persons and only 3%
on all sextants. Excluded sextants (less than 2 teeth) were only infrequently
recorded and therefore not apparent in the tabulation. Edentulousness was not
seen in this survey and more than 99% of all persons investigated had still a
functioning dentition of at least 20 teeth. The mean number of missing teeth was
found to be 2.7 only.

Petersen (1989) developed and evaluated a preventive dental program at

two Danish chocolate factories. The program was undertaken within the setting of
an occupational health service in order to control oral occupational diseases.
Eighty-nine persons (80%), 19-61 years of age, participated in a 2-yr follow-up
study. Preventive care was offered to the workers by a dental hygienist. Clinical
prophylaxis was given at four visits the first year and two visits the second year.
Health education was based on active involvement of the participants and safety
committee or safety group members in order to stimulate self-care activities at the
factories. The outcome of the program was evaluated by clinical recordings of
visible plaque index (VPI), gingival bleeding (GB), calculus index (CI), and

33
DMFS. Data on dental conditions were recorded at baseline, after 12, and after 24
months. Questionnaires were completed by the workers each time in order to
obtain data on dental knowledge, attitudes, dental health behaviour, social
network activities, and perceptions of the process. The results showed
improvement in dental health in terms of stepwise reductions in VPI, GB, CI, and
DS, For example, mean GB decreased from 36% of the teeth scored at baseline to
9% at 24 months and mean DS decreased from 2, 3 to 0, 7, Positive developments
of dental health behaviour were observed. The proportion of workers reporting
daily tooth brushing at work increased from 6% to 24% during the program and
the proportion of workers using dental floss regularly increased from 24% to 47%.
However, the changes in dental knowledge and attitudes were rather diffuse. The
majority of the workers (73%-81%) were satisfied with scaling of their teeth,
fluoride treatment, instructions and advice in preventive care, and regular control
of dental health status. After 12 and 24 months, qualitative interviews were made
with the management, the workers of the safety committees, and the occupational
health personnel. Passive as well as active activities should he considered causal
with respect to the positive outcome of the program. The results of the authors
indicate the need of oral health education in the working labour class to improve
their oral health status.

Tuominen et al., (1989) verified the effect of inorganic acid fumes from
the work environment on the erosion of teeth blindly. A sample of 186 workers
was drawn from four factories. Among the 157 dentulous participants, 76 were
working in departments containing acid fumes, and 81 had never worked under
such conditions and were used as referents. Of the acid workers 18.4% had one or
more teeth with erosion, and the corresponding figure for the referents was 8.6%.
With a longer duration of exposure the proportion of subjects with erosion
increased. The acid workers had more teeth with erosion than the referents,
especially upper anterior teeth. The findings suggest that even today exposure to
inorganic acid fumes from the work environment may increase the erosion of
teeth, especially the upper anterior teeth, which are not continuously protected by
saliva and the lips.

34
 Koskela et al., (1990) undertook a retrospective cohort study to investigate
the cancer mortality of granite workers. The study comprised 1026 workers who
took up such work between 1940 and 1971. The number of person-years was
23,434, and the number of deaths was 296. During the total follow-up period, 59
tumours were observed as compared with 54.4 expected. An excess mortality
from tumours was observed in workers followed up for 20 years or more. Of the
59 tumours, 31 were lung cancers (expected 19.9), and 18 gastrointestinal cancers
(expected 11.6), nine of which were stomach cancers (expected 7.1). Mortality
from lung cancer was excessive for workers followed up for at least 15 years (28
observed, 12.7 expected). The results indicate that granite exposure per se may be
an etiological factor in the initiation or promotion of malignant neoplasms.

Masalin et al., (1990) investigated the association between type of work

and dental findings and the relevance of sugar dust as an occupational hazard to
dental health. Two hundred ninety eight (298) employees, 42 ± 11 years of age,
were investigated clinically and by means of chemical and microbiological tests
of their saliva. Mean total time of work on the production line in question was 10±
8.5 year. Periodontal treatment needs increased similarly with increasing age in all
subgroups. Subjects concerned with biscuit production had significantly higher
DMFS values. They also had significantly higher numbers of untreated cavities:
79.6% compared with 54.7% in those making sweets, 48.3% in bakery workers,
and 62.6% in the controls not exposed to sugar. High levels of lactobacilli and
Streptococcus mutants were found equally in all subgroups. Because work
hygiene measurements have previously shown that sugar and flour dust
concentrations were below accepted limits in the confectionery factory studied,
the results do not seem to support the hypothesis that airborne sugar is an
occupational dental health hazard. The authors felt that some other factors need
to be accounted for to explain the findings of the study.

Papapanou et al., (1990) performed a planned investigation to use a

decision making model in order to assess the periodontal treatment needs of a
random sample of employees in a large Swedish industrial corporation. The model
used provided data on critical bone loss limits for different tooth types and ages,

35
beyond which treatment must be initiated, in order to fulfil the goal of maintaining
all teeth in a functional state throughout life. A sample comprising 192 subjects
belonging to four age strata (31-35 years, 41-45 years, 51-55 years, and 61-65
years) was involved. From each subject, a full mouth series of intra-oral
radiographs were available. The radiographic bone height was assessed at the
mesial and distal aspect of all teeth by measuring the distance between the
cementoenamel junction and the bone crest. The clinical examination included
assessments of plaque, gingivitis, probing pocket depth, and probing attachment
level. The results revealed that (i) only 3.1% of all proximal tooth sites exhibited
radiographic bone loss exceeding the critical limits. (ii) all individuals and 70% of
the approximal tooth sites were in need of periodontal treatment when presence of
gingival inflammation (bleeding on probing) was employed as the single criterion
for therapeutic intervention, (iii) the proportion of individuals and tooth sites
requiring treatment amounted to 98% and 27%, respectively, when a probing
pocket depth of at least 4 mm was included as an additional criterion, and 54%
and 4.1%, respectively, if a probing depth threshold of ≥ 6 mm was used, while
(iv) the use of bleeding on probing in combination with radiographic bone loss
beyond the critical limits disclosed a need of treatment in 40% of the subjects and
2.5% of the approximal tooth sites.

Tuominen et al., (1991) explored the effect of inorganic and organic acid
fumes on teeth in a cross-sectional study using blind dental examinations. A
sample of 180 workers from two factories was randomly drawn. Among the 169
workers who participated in the survey, 88 were exposed to acid fumes and 81
were controls. The percentage of inorganic acid workers with tooth surface loss
was 63.2%, while that for the controls was 37.7% (P less than 0.005). The
corresponding figures in the organic acid company were 50.0% and 14.3% (P less
than 0.02). In both companies the acid workers had significantly more often teeth
with surface loss in the maxilla than their controls (P less than 0.02). Both
anteriors and posteriors were affected. On the basis of the findings it can be
concluded that acid fumes at work are strongly associated with tooth surface loss.

36
 Tuominen and Tuominen (1991) proposed a Cross-sectional study in
Tanga Cement Company, Tanga, Tanzania, to assess whether the occurrence of
tooth surface loss was more common and more severe in people having cement
and stone dust in their work environment than among controls. The study
population consisted of 36 workers who were exposed to cement and stone dust
and 62 randomly drawn control workers from the same factory. The study
conducted was double blind study in which the two examiners were unaware
whether each worker belonged to either the exposed or control group. Tooth
Surface loss was observed in 72.2% of the exposed workers and in 48.4% of the
controls.

Tuominen (1991) evaluated the effect of inorganic acid fumes from the
working environment on the occurrence of periodontal pockets and a soft oral
tissue was investigated in a cross-sectional, blind study. A sample of 186 workers
was drawn from 4 factories. Of the 170 participants, 82 were working in
departments containing acid fumes, and 88 controls had never worked under such
conditions. Of the workers exposed to acid fumes 36.9% and of the controls
30.9% had periodontal pockets. The presence of periodontal pockets increased
with age significantly more among the acid-exposed workers than among the
controls (P less than 0.0001). Oral mucous membrane lesions were observed
among 23.2% of the acid-exposed workers and 21.6% of the controls. The
findings suggest that acid fumes in the workplace air do not increase the
occurrence of oral mucous lesions but may lead to an increase in the prevalence of
periodontal pockets.

Petersen and Gormsen (1991) evaluated the oral health situation of

workers in a modern battery factory; in particular, to describe the prevalence and
the severity of dental erosion and attrition in relation to exposure of airborne
acids in the work environment. Measurements of the work environment at a
German battery factory showed that the workers were exposed to sulphuric acids
(0.4-4.1 mg/cm [SUP3]). All workers at the factory were included in the survey
and a total of 61 dentate individuals completed a questionnaire on their work
environment, dental health, and symptoms from the mouth, nose, and throat.

37
Information on oral health status, erosion, and attrition was collected by clinical
examinations. Nearly all workers reported exposure to etching substances in their
work environment; 56% complained of sharp and thin teeth and 29% of short
teeth. Poor dental health conditions were observed (e.g. mean D-T=3.8); the
mean number of teeth with crown restoration was 5.3. The prevalence of erosion
was 31% and 92% were affected by attrition. Erosion was found only in front
teeth while attrition also occurred in posterior teeth. Due to the high level of
crown restorations a rather moderate dose- effect relationship was observed. In
conclusion they state that the severe erosion and attrition due to sulphuric acid
mists should be recognized as an occupational disease.

Hohlfeld and Bernimoiilin (1993) assessed the periodontal status of 45-54

year-old patients and evaluated their treatment needs. Probing depths, bleeding on
probing and retentional elements (calculus and overhanging restorations) were
determined according to the community periodontal index of treatment needs
(CPITN). Additionally, loss of attachment was measured. Results indicated that
none of the subjects had a completely healthy periodontium; only 14.7%
presented with single sextants which were healthy or needed only improved oral
hygiene. Slightly less than half (46.1%) of the subjects were classified as
treatment need (TN) category 2 and the remainder (53.9%) as TN3. Of the
subjects classed as TN category 3, 14% had the requisite code 4 in one sextant,
18.2% in 2 sextants, 21.7% in half or more of the sextants and 4.2% in all
sextants. The mean loss of attachment was 3.8 mm. Anterior teeth showed less
loss of attachment than posterior teeth and buccal and lingual surfaces showed
less loss of attachment than mesial and distal surfaces. The data indicate that
although this group of 45-54-year-old subjects had high CPITN scores in total TN
categories, the codes for complex Treatment Needs (TN3) were re- corded only in
localized areas.

Kai et al., (1994) determined appropriate ways of promoting oral health in

places of work and factors affecting caries susceptibility were also studied.
Environmental hazards contribute to the poor oral health in many occupations.
Among the earliest occupations mentioned are those of the baker and

38
confectionery worker. Dental caries status, dietary and dental health behaviours,
and salivary microbiologic findings in 338 confectionery and 101 shipyard
workers were compared. A caries risk index based on salivary findings was used
in log-linear models where the effects of sex, diet, use of dental services, and
work environment were studied. Caries experience was found to be high in both
populations. Dietary habits were the most important factor affecting caries
occurrence and susceptibility. Similar dietary behaviours were found in both
groups. The confectionery industry did not seem to be an exceptionally hazardous
environment for dental health in general. However, the screening of high-risk
workers should be organized. Reimbursement of costs had no major effect on use
of dental services or caries risk. Oral health promotion should be integrated with
existing occupational health services to improve oral health in industrial
populations.

Ahlberg et al., (1996) planned a postal questionnaire survey of male

industrial workers of age 38-65 years to investigate knowledge and attitudes
concerning oral health care and whether access to an employer provided dental
belief scheme were associated with the utilization of dental services. The response
rate was 81 %( n=325) in subsidized group and 69% (n=1174) in control group. In
both the groups 60% had their last dental visit within a year but 915 of the
subsidized workers compared to 79% of the controls had visited a dentist in the
past 2 years (P<0.001).The subjects had similar attitudes towards the importance
of regular dental care and its implication for dental and general health.
Subsidization explained the disparity in the current dental visiting pattern between
the groups better than the possibility of using working hours for dental visits.
Backward stepwise logistic regression revealed that their probability of the dental
visit within the past two years was positively associated with access to an
employer-provided dental benefit scheme, tooth brushing to maintain dental
health and number of teeth, and negatively associated with number of carious
teeth. Results demonstrate a positive impact of subsidization on the utilization of
dental services.

39
 Goto et al., (1996) examined the dental erosion status in the acid factory
workers. They conducted a semi-quantitative assessment of exposure to acids on
134 workers in a chemical factory in Osaka Prefecture, and an association
between the dental erosion and the exposure to acids was discussed.

1) Percentage of workers with dental erosion of grade + or more among the

subjects was 30.6%.

2) Most of the erosion was observed in the front teeth.

3) There were more eroded teeth in the upper jaw than in the lower jaw.

The workers were divided into 4 groups according to job type at the time
of the examination: production, research, clerical work and others. The production
workers, those routinely handling a large amount of various kinds of acids, were
the highest proportion of workers with eroded teeth. Because some of the clerical
workers had previously handled acids, this group of workers included a larger
number of those with dental erosion than the other two groups. More than half of
the workers who had been engaged in production had eroded teeth including those
of grade +/- 5) the intensity of exposure to acids, as a semi-quantitative index for
cumulative exposure to acids, was calculated in each worker from a score for the
job type and its duration. The authors observed a significant association between
the intensity and the manifestation of dental erosion.

Petersen and Tanase (1997) analysed the oral health situation of an

industrial population in Romania. A total of 311 male and female employees (18–
62 years-of-age) were clinically examined according to the WHO Basic Methods
criteria and responded to an oral health questionnaire on dental knowledge and
health care habits. In the younger age groups, the amount of untreated dental
caries was high (18–24 years: DT=5.7, DMFT=8.9) whereas missing teeth were
prominent in older employees (45 years or more: MT=7.6, DMFT=11.9). At age
25–44, 72 percent had gingival bleeding and calculus. Dental knowledge was
relatively poor, and 28 percent of the participants indicated actual need for
treatment. Dental visits within the previous 12 months were reported by 24

40
percent of the employees, and 39 percent had had a tooth extracted at their most
recent visit. The study emphasises the need for reorientation of oral health care in
Romania, and the relevance of industrial dental services for the implementation of
oral health promotion and prevention is highlighted.

Zuskin et al., (1998) assessed the respiratory function and immunological

status of workers employed in the paper recycling industry. The mean age of the
101 studied workers was 41 years, and the mean duration of their exposure was 17
years. A group of 87 unexposed workers of similar age, duration of employment,
and smoking history was studied for the prevalence of chronic respiratory
symptoms. Lung function in the paper workers was measured by recording
maximum expiratory flow volume (MEFV) curves and recording forced vital
capacity (FVC), 1-second forced expiratory volume (FEV1), and maximum
expiratory flow rates at 50% and the last 25% of the FVC (FEF50, FEF25).
Immunological studies were performed in all 101 paper workers and in 37 control
workers (volunteers). These included skin-prick tests with paper-dust extracts and
other non-occupational allergens, as well as the measurement of total serum
immunoglobulin E. Significantly higher prevalence of all chronic respiratory
symptoms were found in paper compared with control workers (P < 0.01). The
highest prevalence was found for chronic cough (36.6%), chronic phlegm
(34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), and dyspnoea (18.8%).
Occupational asthma was diagnosed in four (4.0%) of the paper workers.

A logistic regression analysis performed on chronic respiratory symptoms

of paper workers indicated significant effects of smoking and exposure, with the
smoking effect being the most important. Multivariate analyses of lung-function
parameters indicated significant effects of exposure. For paper workers, the
measured FEF50 and FEF25 were significantly decreased, compared with
predicted values, suggesting obstructive changes located primarily in smaller
airways. Among 101 tested paper workers, 16 (15.8%) had positive skin-prick
tests to at least one of the paper extracts; none of the control workers reacted to
these extracts. Increased serum IgE levels were found in 21% of the paper
workers and in 5% of control workers (P < 0.05). Paper workers with positive

41
skin-prick tests to any of the paper and/or other tested extracts had higher
prevalence of chronic respiratory symptoms and lower measured lung-function
tests compared with predicted than did those with negative skin-prick tests, but
the differences were not statistically significant. The measured concentrations of
total and respirable dust in this industry were higher than those recommended by
Croatian standards. Their study suggests that work in the paper-recycling industry
is associated with respiratory impairment and that sensitive workers employed in
this industry may be at particular risk of developing chronic respiratory
abnormalities.

Chikte et al., (1998) did a Rapid Epidemiology Assessment (REA) of

industrial dental erosion with the aim of formulating a range of treatment
strategies that could be used to settle an industrial dispute. The dispute was
concerned with compensation for the group of adult male metal workers who had
complained of dental sensitivity and their teeth had been “eaten by the acid’ at
their workplace, an electroplating factory in springs near Johannesburg, South
Africa. The REA methods employed included a clinical examination, a structured
socio-demographic questionnaire and colour photographs each subject. Sixty
percent of the subjects reported pain and/or sensitivity to eating and/or drinking,
76% showed varying degrees of loss of tooth structure and 25% reported teeth had
been lost as a result of the industrial erosion. The project involved negotiating
with mine management and trade union representatives, each with conflicting
interest and with people’s oral health and large sums of money at stake. In this
context, the workers who were examined are being compensated and the
preventive measures were initiated in the factory. Presently the area has been
declared a respiratory zone, which made the wearing of respiratory masks
obligatory.

Fukayo et al., (1999) investigated the effect of occupational sulphuric acid

exposure and other factors on teeth using a cross-sectional study with blind dental
examinations. Among 350 male workers in a copper-smelter in Japan, 28 had mild
dental erosion with silky-glazed opaque appearance of the enamel and/or shallow
concavities on the enamel. While opaqueness was observed in 20 and concavities

42
found in 11 workers, only 3 had both signs, suggesting that the concave lesions
were often accompanied with enough remineralisation to keep the dental surface
gloss, possibly due to acid exposure at a low level. The cases had a history of
working in an electrolytic refining plant (36%), significantly more than in the
non-cases (14%, p < 0.05). Some significant differences were found between the
cases and the non-cases: the cases were older, had less dental plaque, less
gingivitis, and more frequent tooth brushing habits. No significant differences
were observed in possibly related dietary habits such as several types of acidic
drinks. It was concluded that the present cases with dental erosion were most
probably associated with occupational acid exposure. The risk ratio of cross-
sectional prevalence of dental erosion for those with a history of electrolytic
refining plant work was 3.0 (95% CI: 1.3-6.7) compared with those without a
history of acid exposure. They further added that future studies exploring whether
the present work environment can still develop new cases of dental erosion should
be done.

Recently, it has been recognized that oral infection, especially

periodontitis, may affect the course and pathogenesis of a number of systemic
diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus,
and low birth weight. With this in mind Xiaojing Li et al., (2000) reviewed to
evaluate the current status of oral infections, especially periodontitis, as a causal
factor for systemic diseases. Three mechanisms or pathways linking oral
infections to secondary systemic effects have been proposed: (i) metastatic spread
of infection from the oral cavity as a result of transient bacteraemia, (ii) metastatic
injury from the effects of circulating oral microbial toxins, and (iii) metastatic
inflammation caused by immunological injury induced by oral microorganisms.
Periodontitis as a major oral infection may affect the host's susceptibility to
systemic disease in three ways: by shared risk factors; subgingival biofilms acting
as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir
of inflammatory mediators.

Amin et al., (2001) determined the prevalence and nature of oral health
problems among workers exposed to acid fumes in two industries in Jordan. The

43
sample consisted of 68 subjects from the phosphate industry (37 acid workers and
31 controls) drawn as a sample of convenience and 39 subjects from a battery
factory (24 acid workers and 15 controls). Structured questionnaires on medical
and dental histories were completed by interview. Clinical examinations were
carried out to assess dental erosion, oral hygiene, and gingival health using the
appropriate indices. Differences in the erosion scores between acid workers in
both industries and their controls were highly significant (P < 0.05). In both
industries, acid workers showed significantly higher oral hygiene scores, obtained
by adding the debris and calculus scores, and gingival index scores than their
controls (P < 0.05). The single most common complaint was tooth
hypersensitivity (80%) followed by dry mouth (77%) on average. Exposure to
acid fumes in the work place was significantly associated with dental erosion and
deteriorated oral health status. Such exposure was also detrimental to general
health. Findings pointed to the need of establishing appropriate educational,
preventive and treatment measures coupled with efficient surveillance and
environmental monitoring for detection of acid fumes in the workplace
atmosphere.

Vianna and Santana (2001) reviewed the published research findings on

the oral effects of occupational exposure to acid mists. They conducted a literature
search on MEDLINE, LILACS, SciELO, BBO, and DEDALUS, identifying eight
articles and a doctoral dissertation focusing on this association. Findings were
consistent with a positive association between occupational exposure to acid mists
and dental erosion, according to the literature published since 1919. Studies on the
association between acid mist exposure in the workplace and periodontal disease,
or oral mucous lesions, were more recent and scarce, and their findings remain
controversial. Several methodological drawbacks were observed, such as small
sampling size and poorly developed analysis, as exemplified by little or no
attention to confounding variables. These findings support the relevance of this
research area and the need for improved research design. They also highlight the
importance of considering oral health as a component of workers' health in
effective preventive programs.

44
 Rekha and Hiremath (2002) undertook a scientific investigation to assess
the oral health status and treatment requirement of confectionery workers and also
to assess the influence of confectionery environment on their oral health. A total
of 502 confectioners were examined and studied under 4 groups, Biscuits group
[107], chocolate group [160], sweets group [144] and Bakery group [91]. Age and
sex matched 294 wheat flour workers served as controls. 60.36% of confectioners
exhibited caries experience with significantly higher DMFT compared to controls.
Among confectioners sweets and chocolate groups had higher caries experience.
Increase in caries experience with increase in duration of employment among
confectioners was observed. Also confectioners consuming confectionery
products more than 6 times/day had significantly higher caries experience than
those consuming 0 to 3 and 4 to 6 times/day. Periodontal diseases was
significantly higher among confectioners than controls more so in sweets and
biscuit groups. Further, they observed extensive unmet treatment needs like oral
prophylaxis, periodontal therapy, extractions and prosthetic rehabilitations among
confectioners.

Morishita et al., (2003) evaluated the effectiveness of an oral health

promotion programme that has been provided once a year among 1998 workers
(male – 1315, females – 683) of 43 companies in Japan at the work place, which
was voluntary and free of cost for all the employees. The programme consisted of
clinical examination followed by oral health guidance, oral hygiene instruction
and oral prophylaxis of anterior teeth. Oral health status was compared by the
times of participation in the programme. The results showed that subjects who
participated three times or more in the programme had fewer decayed, missing
and filled teeth (DMFT) and low percentage of Community Periodontal Index
(CPI). In conclusion the study showed that oral health promotion programme at
the work place was effective in keeping or maintaining good oral health among
workers and the programme should include education to motivate subjects to
receive regular check – ups.

Jahanbani (2003) evaluated the prevalence of oral precancerous lesions in

textile workers. A cross-sectional study was undertaken to assess a total of 1167

45
textile factory workers randomly selected from a total of 6947. An overall 97
women and 1070 men aged 18–69 years (mean = 31.8 years) were studied.
Regular smoking during the past 6 months was considered as the smoker group.
Leukoplakia lesions were classified in accordance to Axell criteria. The results
showed that 115 workers (9.9%) had red and white lesions. Among these 43
positive detections, 3.7% had leukoplakia and six cases (0.5%) had lichen planus.
The smoking habits of the workers were limited to cigarette smoking. There was a
statistically significant positive correlation between tobacco smoking and oral
leukoplakia (P < 0.001). There was a statistically significant positive correlation
between tobacco smoking and leukoplakia in this relatively young cohort with
generally mild tobacco use. The prevalence of leukoplakia had an inverse
relationship with the level of education.

Kim and Douglass (2003) aimed to evaluate the association between

occupational health behaviours and occupational dental erosion in the factory
workers. Using the data of 943 workers among 34 factories selected by stratified
cluster sampling from 888 factories using acids, two sets of modified case control
studies were performed. The cases were 242 workers with any dental erosion (G1-
5) and 78 with sever dental erosion (G3-5); the controls were 701 workers with no
erosion (G0) and 864 workers with no or mild erosion grades (G0-2) respectively.
The main explanatory variables in the study were behaviours such as wearing a
respiratory mask and gargling at work. They did a bivariate and multivariate
logistic regression analysis for comparing the data. The odds of overall
occupational dental erosion (G1-5) was 0.63 for respiratory mask wearers
compared to the non-wearers; the odds of sever occupational dental erosion (G3-
5) was not significantly less in respiratory mask wearers, gargling didn’t show a
significant association with occupational dental erosion. Among the occupational
health behaviours, wearing personal protective respiratory masks in work was
significantly associated with less overall occupational dental erosion.

Rao et al., (2004) analysed the expression of 10 genes implicated in

regulation of the inflammatory processes in the lung after exposure of alveolar
macrophages (AMs) to silica in vitro or in viva. Exposure of AMs to silica in vitro

46
up-regulated the messenger RNA (mRNA) levels of three genes [interleukin-6
(IL-6), monocyte chemoattractant protein-1 (MCP-1), and macrophage
inflammatory protein-2 (MIP-2)] without a concomitant increase in the protein
levels. AMs isolated after intratracheal instillation of silica up-regulated mRNA
levels of four additional genes [granulocyte/macrophage-colony stimulating factor
(GM-CSF), IL-1β, IL-10, and inducible nitric oxide synthase]. IL-6, MCP-1, and
MIP-2 protein levels were elevated in bronchoalveolar lavage fluid. Fibroblasts
under basal culture conditions express much higher levels of IL-6 and GM-CSF
compared with AMs. Coculture of AMs and alveolar type II cells, or coculture of
AMs and lung fibroblasts, in contact cultures or Transwell chambers, revealed no
synergistic effect. However, fibroblasts appear to be an important source of
inflammatory mediators in the lung.

Vianna et al., (2004) examined the hypothesis that acid mist or mixtures of
acid mists and acid gases are associated with ulcerative lesions of the oral mucosa.
All 665 active male workers of a metal processing factory were the study
population. Semi-quantitative measures of exposure were estimated from a job
exposure matrix constructed with industrial hygienist scoring and job titles.
Ulcerative lesions of the oral mucosa were identified with standardized clinical
dental exams. Past exposure to acid mists were positively associated with
ulcerative lesions of the oral mucosa but only among workers without lip sealing
(age- and alcohol consumption-adjusted prevalence ratio (PR), PR(adjusted) =
3.40; 90% CI: 1.48-7.85). Also in this worker group, the mixture of acid mists and
acid gases was associated with ulcerative lesions of the oral mucosa limited to
exposure in the past (PR (adjusted) = 2.83; 90% CI: 1.12-7.17). There is a positive
association between acid mist or mixtures of acid mists and acid gases and
ulcerative lesions of the oral mucosa only in the absence of lip sealing. Authors
state that evidence of a chronic rather than acute irritative process suggests a
possible step on the etiology of oral malignancies, which needs investigation. 65

Jokstad et al., (2005) performed a Cross-sectional study in Norwegian

west coast to clarify whether high tooth wear of employees in a mining industry
that extracts the mineral olivine could be associated with airborne dust exposure

47
in their working environment. The cumulative exposure to airborne mineral dust
for the workers in the company was calculated on the basis of their period of
employment multiplied by the air borne olivine dust concentrations, which have
been monitored continuously for the past 20 years for all divisions of the
company. Two groups of employees were compared with regard to tooth wear i.e.
the 30% with the highest (case) and the lowest (control) estimated dust exposure
levels. The differences were also apparent within three age subsets, although
statistical significance was reached only in the 34-44 years subset (p=0.002). They
noticed a considerable variation within three exposure groups.

Vianna et al., (2005) planned a cross-sectional study to investigate the

association between exposure to acid mists and periodontal changes and oral
mucosal lesions. The role of socio demographic factors, life style, and oral health
behaviour in relation to these outcomes were also examined. 665 active male
workers were examined. A job exposure matrix was constructed with industrial
hygienist scores and job titles to estimate years of exposure to acid mists. Oral
health outcomes were identified during standardized dental examinations.
Unconditional logistic regressions models were utilized in the analysis. Duration
of exposure to the acids mists exposure was positively associated with oral
mucosal lesions among workers without lip sealing. Only age, low salaries and
oral hygiene-related variables were associated with periodontal changes, and
estimates varied according to lip sealing. Results suggest that long term
occupational exposure to acid mists is associated with oral mucosal lesion and that
absence of lip sealing may increase the intensity of exposure.

Johansson et al., (2005) investigated whether the acetic acid released by

some silicone sealers during the curing process poses an increased risk for dental
erosion, thus constituting an occupational hazard to exposed individuals. The
material comprised 13 individuals (x=30 years, 10 men and 3 women) who had
been exposed to an average of 4.2 years' (range 0.6-10 years) of working with
silicone. Each had comprehensive medical and dental examinations carried out. A
sex and aged- matched group of 20 healthy, unexposed workers from the same
company served as controls for the medical examination, while study models from

48
randomly selected sex and age matched individuals were used as controls for
assessing the severity of erosion using a questionnaire, an assessment of the role
of various possible factors related to oral and general health, and to dental erosion
in particular, was made for each participant in the exposed group. Clinical
examination included recordings of severity of dental erosion, presence of
"cuppings", DMFT salivary secretion rate and buffer capacity, visible plaque
index and gingival bleeding index. In addition, bitewing radiographs, study casts
and intraoral colour transparencies were obtained for each individual. The severity
of dental erosion was significantly higher in those exposed to silicone compared
to controls. There was also a significant correlation between the period of
exposure to silicone in the workplace and severity of erosion. Medical problems,
especially with regard to upper respiratory tract symptoms, were significantly
more common among exposed individuals than controls. They concluded that a
relationship between occupational exposure to acetic acid vapours from silicone
sealers and development of dental erosion would appear to exist.

Barbour and Rees (2006) presented a review article which focused on the
physiochemical factors impacting tooth wear. There is increasing clinical
awareness of erosion of enamel and dentine by dietary acids and the consequent
increased susceptibility to physical wear. Enamel erosion is characterized by acid-
mediated surface softening that, if unchecked, will progress to irreversible loss of
surface tissue, potentially exposing the underlying dentine. In comparison, dentine
erosion is less well understood as the composition and microstructure are more
heterogeneous. Factors which affect the erosive potential of a solution include pH,
titratable acidity, common ion concentrations, and frequency and method of
exposure. Abrasion and attrition are sources of physical wear and are commonly
associated with tooth brushing and tooth-to-tooth contact, respectively. A
combination of erosion and abrasion or attrition exacerbates wear; however,
further research is required to understand the role of fluoride in protecting
mineralized tissues from such processes. Abrasive wear may be seen in a wide
range of patients, whereas attritive loss is usually seen in individuals with
bruxism. Wear processes are implicated in the development of dentine

49
hypersensitivity. Saliva confers the major protective function against wear due to
its role in pellicle formation, buffering, acid clearance, and hard tissue
remineralisation.

Kovacevic and Belojevic (2006) performed a Cross-sectional study on 225

textile workers from a wool production company in Montenegro to test the
hypothesis of a relationship between exposure to intense industrial noise and tooth
abrasion. The group exposed to intense noise (104 dB (A) Leq) consisted of 111
weavers (82 males and 29 females), while the control group (81 dB (A) Leq)
consisted of 114 blue-collar workers (32 males and 82 females) in preparation
departments. A specialist in dental prosthetics clinically examined all the subjects
and additionally analysed tooth statuses on hard plaster models. Gender, age,
socioeconomic status and tooth brushing habits of workers were controlled as
confounding factors. Significantly high adjusted odds ratios for tooth abrasion of
3.74 (95%CI=1.42–7.85; p<0.01) were found among female workers exposed to
intense noise in comparison with the control group. The analysis of the subclass of
male workers with severe tooth abrasion (grades III-IV) revealed significantly
high adjusted odds ratios for tooth abrasion of 5.48 (95%CI=1.76–14.50; p<0.01)
among the noise exposed group compared to the control group. This study
suggests that extremely high levels of occupational noise might be related to tooth
abrasion in exposed textile workers.

Kim et al., (2006) investigated the association between occupational acidic

chemicals (ACs) exposure and occupational dental erosion. A cross-sectional
study was conducted in which three Dentists surveyed 951 subjects from 42
factories using five types of ACs below Korean Threshold Limit Values (K-
TLVs). Subjects agreed to participate by a written consent; 519 were acid exposed
workers and 431 were non-exposed. The modified ten Bruggen Cate's criterion
was used to classify erosion. Length and type of exposure to ACs were assessed
using questionnaires. Logistic regression analysis including interaction terms was
applied. ACs exposure was associated with erosion severity. Multiple exposures
to ACs were found to be strongly associated with severe erosion. Interaction
between wearing masks and AC exposure was significant. The study showed a

50
clear association between AC exposure below K-TLVs and erosion. Hence, the
authors propose to lower K-TLVs of five types of ACs.

Chang et al., (2006)analysed the risk of hearing loss among workers

exposed to both toluene and noise. They recruited 58 workers at an adhesive
materials manufacturing plant who were exposed to both toluene and noise [78.6–
87.1 A-weighted decibels; dB(A)], 58 workers exposed to noise only [83.5–90.1
dB(A)], and 58 administrative clerks [67.9–72.6 dB(A)] at the same company.
Participants were interviewed to obtain sociodemographic and employment
information and performed physical examinations, including pure-tone
audiometry tests between 0.5 and 6 kHz. A contracted laboratory certified by the
Council of Labour in Taiwan conducted on-site toluene and noise exposure
measurements. The prevalence of hearing loss of ≥ 25 dB in the toluene plus noise
group (86.2%) was much greater than that in the noise-only group (44.8%) and
the administrative clerks (5.0%) (p < 0.001). The prevalence rates were 67.2, 32.8,
and 8.3% (p < 0.001), respectively, when 0.5 kHz was excluded from the
estimation. Multivariate logistic regression analysis showed that the toluene plus
noise group had an estimated risk for hearing loss ≥ 25 dB, 10.9 times higher than
that of the noise-only group. The risk ratio dropped to 5.8 when 0.5 kHz was
excluded from the risk estimation. Hearing impairment was greater for the pure-
tone frequency of 1 kHz than for that of 2 kHz. However, the mean hearing
threshold was the poorest for 6 kHz, and the least effect was observed for 2 kHz.
Their results suggest that toluene exacerbates hearing loss in a noisy environment,
with the main impact on the lower frequencies.

As the results of earlier studies connecting dental diseases to

cardiovascular diseases are inconsistent, Ylöstalo et al., (2006) did a cross-
sectional study to investigate whether there are associations of dental diseases
and diagnosed angina pectoris among the 1966 Northern Finland Birth Cohort. A
postal questionnaire was sent to all cohort members in 1997–1998. The number of
replies totalled 8690. Angina pectoris was determined by asking whether the
respondent had been diagnosed with angina pectoris. Gingivitis, dental caries and
tooth loss were determined on the basis of self-reported gingival bleeding,

51
presence of dental caries and six or more missing teeth. They found overall
associations of gingivitis (odds ratio (OR) 1.52, confidence interval (CI) 1.04–
2.22), dental caries (OR 1.50, CI 1.04–2.18) and tooth loss (OR 1.53, CI 0.69–
3.42) with the presence of angina pectoris. The associations were modified by
gender and socioeconomic status. In addition, gingivitis, dental caries and tooth
loss were also associated with several cardiovascular risk factors. They concluded
that there exists an association of self-reported gingivitis, dental caries and tooth
loss with angina pectoris.

Dülgergil et al., (2007) reported a case of uncommon occupational dental

erosion in an individual who had worked in the war industry for twenty years.
This occupation involved daily, at least 8 hours, inhalation of chromic acid being
used for cleaning of barrel of cannons. The erosion manifested as dental
sensitivity with excessive cervical erosion even with pulpal exposure in certain
teeth. Moreover, due to the adverse effect of the chemical against to gingival
and/or periodontal tissues, the lesions were extremely harmful with respect to the
exposed root-cementum. After proper periodontal therapy, cervical lesions were
treated conservatively with a compomer based restorative material without cavity
preparation. Although today it is not common due to the well-controlled working
conditions, occupational combined dental and medical problems via airborne
fumes and/or elements can be seen at workers in chemical factories. A cumulative
biohazardous effect is generally seen as not only medical but also dental
disorders.

Wiegand and Attin (2007) summarized and discussed the available

information concerning occupational dental erosion. Dental erosion is
characterized as a disorder with a multifactorial aetiology including
environmental acid exposure. Information from original scientific papers, case
reports and reviews with additional case reports listed in PubMed, Medline or
EMBASE [search term: (dental OR enamel OR dentin) and (erosion OR tooth
wear) and (occupational OR worker)] were included in the review. References
from the identified publications were manually searched to identify additional
relevant articles. Their systematic search resulted in 59 papers, of which 42 were

52
suitable for the review. Seventeen papers demonstrated evidence that battery,
galvanizing and associated workers exposed to sulphuric or hydrochloric acid
were at higher risk of dental erosion. According to them for other industrial
workers, wine tasters and competitive swimmers, only a few clinical studies exist
and these did not allow them to draw definitive conclusions. Occupational acid
exposure might increase the risk of dental erosion. They concluded that evidence
for occupational dental erosion is limited to battery and galvanizing workers,
while data for other occupational groups need to be confirmed by further studies.

Dagli et al., (2008) conducted a Cross-sectional study in Kesheriyaji,

Rajasthan, India on February 2007, to provide epidemiological data for planning
and evaluation of oral health care programme among green marble mine
labourers. The mean DMFT and DMFS scores were 2.79±2.44 and 5.47±5.40
respectively. The caries prevalence was 71.1% with higher prevalence of
periodontal disease was present, with only 1.75% having healthy gingival. Mean
number of sextant involved was maximum among 35-44 years. Alcohol and stress
due to physical load and noisy environment among labourers have shown highly
significant relationship with CPI scores (p<0.001). Fracture of tooth, mainly
maxillary central incisor was high (10.5%) as an occupational peril.

In continuation of the above study, Dagli et al., (2008) once again

performed a Cross-sectional study in Kesheriyaji, Rajasthan, India, among green
marble mine labourer to determine the prevalence of leukoplakia, oral sub mucous
fibrosis and papilloma among Green Marble Mines labourer and uncover its
relation with occupational stress. An overall elevated prevalence of all three oral-
mucosal lesions was found among mine workers (36.7%), mainly leukoplakia
affecting 171 mine workers (33.3%). The affected workers were having body
problems like headache, backache and stressed due to under-payment. Individuals
having papilloma have faced problem at work like noise, dust or fumes and poor
maintenance of equipment. Multiple logistic regression analysis model of oral-
mucosal lesion have shown highly significant relation (p<0.01) with increased
stress, age, alcohol habits and malnutrition. The prevalence of oral mucosal lesion

53
is higher, among marble mine labourers, and occupational stress can intensify the
disease condition.

Duraiswamy et al., (2008) carried out an investigation to estimate dental

caries prevalence and treatment needs of labourers working in the green marble
mines of Udaipur district. The data was collected using the methods and standards
recommended by the WHO on 513 men in four age groups of 18-25, 26-34, 35-
44, and 45-54 years, respectively. Dentition status and treatment needs along with
decayed, missing, and filled teeth (DMFT) index, and decayed, missing, and filled
surfaces score were recorded. The mean DMFT for all age groups was 3.13 with
highest mean of 4.0 for the age group of 45-54 years. Mean decayed teeth were
2.60, 3.33, 1.46, and 1.5 for the age groups 15-24, 25-34, 35-44, and 45-54 years,
respectively. Filled component was nil for all age groups. Most of the subjects
required one surface filling with a very less proportion needing pulp care. The
missing component constituted the major part of DMFT index in the 45-54 years
age group and the absence of filled component in the whole study population
implies that the treatment needs of the study population are unmet.

A large number of labourers work in the stone-crushing industry in India.

Many of these workers are also exposed to high levels of particulate matter in
their homes from the use of biomass fuels. With this rationale in mind, Semple et
al., (2008) examined the health of these workers characterising their exposure to
respirable crystalline silica and a number of other particulate matter exposure
metrics in both occupational and domestic settings. They used a combination of
direct reading and gravimetric sampling of respirable dust, total inhalable dust and
particulate matter <2.5 μm in diameter (PM2.5) at work (n = 19), within the
general environment (n = 6) and inside the home (n = 7). They used x-ray
diffraction to quantify the level of crystalline silica in the respirable dust samples.
Their real-time data showed peaks in exposure under certain environmental and/or
working conditions. General environmental and domestic PM2.5 exposures were
also high. Particulate matter exposures experienced by this group of workers and
their families are likely to produce impaired lung function within a short time-
frame.

54
 Psychosocial job stress has been associated with sleep disturbances, but its
association with sleep bruxism (SB), the stereotype movement disorder related to
sleep, is not well understood. Nakata et al. (2008) did an epidemiological study to
examine the relationship between psychosocial job stress and SB. 1944 male and
736 female factory workers participated in this study (response rate 78.1%).
Perceived job stress was evaluated with the Japanese version of the generic job
stress questionnaire, which covered 13 job stress variables. SB was assessed by
the question, ‘Do you grind or clench your teeth during your sleep or has anyone
in your family told you that you grind your teeth during your sleep?’ Response
options were ‘never’, ‘seldom’, ‘sometimes’ or ‘often’. SB was considered
present if the answer was ‘sometimes’ or ‘often’. Overall, 30.9% of males and
20.2% of females reported SB. In males, workers with low social support from
supervisors [odds ratio (OR) = 1.34, 95% confidence interval (CI) 1.08–1.68] or
from colleagues (OR 1.47, 95% CI 1.17–1.83), and high depressive symptoms
(OR 1.60, 95% CI 1.26–2.03) had a significantly increased risk of SB after
controlling for confounders. By contrast, no significant association was found in
females. They conclude that SB is weakly associated with some aspects of job
stress in men but not in women among the Japanese working population.

Kumar et al., (2008) did an investigation to determine the effect of tobacco

usage on the severity of periodontal disease in green marble mine labourers.
Marble mine labourers (n=585) aged 15–54 years were selected from four
geographic zones in green marble mines area using a stratified random sampling
procedure. A total of 517 (88%) labourers participated in the study. The sample
were classified as tobacco users, non-users, occasional users, ex users and the data
regarding form, duration and frequency of tobacco consumption was also
collected by personal interviews. Periodontal status was assessed by community
periodontal index. Nearly three fourth (71.9%) of the population was tobacco
users. Among the smokers, bleeding and calculus accounted to 33% each whereas
the prevalence of these periodontal indicators was 38% and 44% respectively
among smokeless tobacco users. Logistic regression analyses revealed that
smokeless tobacco users were more liable for presence of periodontal pockets

55
than smokers. Duration had a significant influence with users since more than 20
years being liable for presence of pockets at least twice (OR = 2.625, 95% CI
1.529 – 4.507) than the <5 years group. The odds ratio for presence of periodontal
pockets increased by 2.143 (95 % CI 1.060 – 4.333) and 5.596 (95 % CI 2.901 –
10.639) for users of 6 – 10 units/ day and more than 10 units/day than the 1-2
times/day category. They concluded that the Tobacco usage had a significant
impact on the severity of periodontal disease with users being more likely to
present periodontal pockets than non-users and the risk of periodontal pockets
increased as the duration and frequency of tobacco consumption increased.

Chronic Lead exposure favours the formation of cheilitis, fissures, ulcers

and epithelial desquamation of the tongue, palate and other parts of the oral
mucous membranes. The tissues of oral cavity may be affected by toxic agents
either by direct action as in exposure to sulfuric acid fumes or through systemic
exposure as in poisoning with heavy metals (e.g. lead). Said et al., (2008)
investigated the oral health condition of industrial workers exposed to lead in
Alexandria governorate. The samples included all workers chronically exposed to
lead fumes or dust in a storage battery plant (400 workers) and working in seven
departments where lead exposure was present. These departments were evaluated
environmentally for lead in air and their workers for lead in blood. Oral medical
examinations were carried out according to the items of WHO sheet designed for
oral health survey with some modifications. Results of the present study revealed
that chronic exposure to lead significantly affects oral health condition among
exposed workers and strongly correlates with increasing level of blood lead
among them. They concluded that the most common adverse effects of lead on
dental health of exposed workers were the significant increase in the prevalence of
periodontal diseases (gingivitis and periodontitis expressed as PI) and in the
prevalence of decay (caries), missed and filled teeth (expressed as DMFT index)
and dental abrasions. Moreover,these findings were found to be related to lead
concentration in air in the studied departments and to blood lead level. On the
other hand, exposure to lead was found to have insignificant effect on calculus

56
formation (expressed as CI-S) or oral debris (expressed as (DI-S)or both together
expressed as (OHI-S).

De Almeida et al., (2008) took up a study to investigate the hypotheses

that occupational exposure to acid mists is positively associated with periodontal
disease, assessed by periodontal attachment loss. The study sample included 530
male workers at a metal processing factory. Data were obtained from interviews
and oral examinations. Periodontal attachment loss was defined as > 4mm at
probing, in at least one tooth. A job exposure matrix was utilized for exposure
evaluation. Exposure to acid mists was positively associated with periodontal
attachment loss > 4mm at any time (prevalence ratio, PR adjusted = 2.17), past
(PR adjusted = 2.11), and over 6 years of exposure (PR adjusted = 1.77),
independently of age, alcohol consumption, and smoking, and these results were
limited to workers who did not use dental floss. The results showed that the
exposure to acid mists is a potential risk factor for periodontal attachment loss,
and further studies are needed, using longitudinal designs and more accurate
exposure measures.

Carvalho et al., (2009) critical reviewed the literature to demonstrate the

importance of the worker's oral health, by means of the studies of several
authors. This literature review draws attention to the importance of knowing the
dental problems that may affect workers, with the intention of analysing the
epidemiology, aetiology and pathology in addition to understanding the impact
they would cause on the quality of life, oral health promotion and prevention.
This goal stems from the dentist's importance to the Worker's Health, preventing
dental absenteeism, as orofacial pain may alter the conditions of life and work of
the individual to a greater extent than other systemic conditions such as diabetes
and high blood pressure do. Occupational Dentistry has collaborated with
worker's health both in the public and private spheres, because what really is
being sought is a worker with adequate oral health conditions for his/her work
activities and an improvement in the worker's quality of life.

57
 Prabu et al., (2009) determined the prevalence of oro-mucosal lesions
among Keshariyaji green marble mine labourers and to find its relation with
adverse tobacco habits. The study area was divided into four geographical zones,
and the participants were selected by stratified cluster sampling technique. A total
of 513 subjects were included in the final study, and they were divided among the
four age cohorts: 18–25, 26–34, 35–44 and ≥ 45 years. They were interviewed for
tobacco habits, and clinical examination of oral mucosa was done by one of the
three examiners with the aid of an artificial light source. An overall higher
prevalence of oro-mucosal lesion was found among mineworkers (36.7%), and
much higher value was found among those who were having tobacco habits
(40.6%). Non-users have shown less prevalence of leucoplakia 28%, compared
with that of users (regular users: 34.7%; occasional users: 40%; and ex-users:
50%). Among all age cohorts higher prevalence of leucoplakia was found among
the age group of 35–44 years (40%). Oro-mucosal lesions among mineworkers
were aggravated due to deleterious habits of tobacco consumption with increasing
age and bidi smoking habits.

Nandi et al., (2009) carried out an investigation in 12 different gypsum

mines in Rajasthan state to determine the health status of the miners. One hundred
and fifty workers engaged in mining activities were included in the study and their
health status was compared with that of 83 office staff of the same mines. The
health status of the employees was evaluated using a standardized medical
questionnaire and pulmonary function testing. The unpaired ‘t’ test was used to
determine whether there was any significant difference between the miners and
the controls and the chi-square test to compare the prevalence of various
respiratory impairments in workers with that in controls; they also examined the
differences between smokers and non-smokers. The findings showed that the
literacy rate is low (42%) among the miners. Pulmonary restrictive impairment
was significantly higher amongst smokers as compared to non-smokers in both
miners and controls. Hypertension (22.6%), diabetes (8.8%), and musculoskeletal
morbidity (8%) were the common diseases in miners. The study showed that there
is high morbidity amongst miners, thus indicating the need for regular health

58
check-ups, health education, use of personal protective devices, and engineering
measures for control of the workplace environment.

Kumar et al., (2009) did study with an intention to assess the relation
between Body Mass Index (BMI) and periodontal status among green marble
mine labourers of Kesariyaji, in the Udaipur district of Rajasthan, India. The study
sample comprised of 513 subjects aged 18-54 years, drawn using the stratified
cluster sampling procedure. BMI was calculated as the ratio of the subject’s body
weight (in kg) to the square of their height (in meters). Periodontal status was
recorded using the Community Periodontal Index (CPI). Binary multiple logistic
regression analysis was executed to assess the relation between body mass index
and periodontitis. The dependent variable for logistic regression analysis was
categorized into control group (scores 0 - 2 of the CPI) and periodontitis group
(scores 3 and 4 of the CPI). The overall prevalence of periodontal disease was
98.2%. Caries status and mean number of teeth present deteriorated with the poor
periodontal status. Subjects had an increased risk of periodontitis by 57% for each
1- kg/m2 increase in the body mass index, which means that a higher body mass
index could be a potential risk factor for periodontitis among the adults aged 18 to
54 years. They concluded that the evaluation of the body mass index could be
used in periodontal risk assessment.

Kaushik et al., (2009) did a study to evaluate the potential of aviation

related stress to induce bruxism and tooth wear leading to dental attrition among
Indian Air Force flying pilots. Subjects were 100 Indian Air Force (IAF) officers
of flying branch who were undergoing routine annual dental examinations at an
Air Force Dental Clinic during a 4 week period. One Dental officer using set
criteria examined each subject and estimated the tooth wear. Subjective evaluation
was based on questionnaire including conscious awareness of bruxism,
hypersensitivity and temporomandibular joint pain or discomfort. Awareness of
bruxism was also noted as to whether continuous and persistent, momentary while
undertaking flying tasks and manoeuvring or nocturnal while resting. Bruxism
was found in 51% of the overall group of pilots: 61% of the helicopter pilots, 57%
of fighter pilots and 32% of transport pilots. Of the total group, twelve subjects

59
had a score of over four and required immediate attention for the condition. 37%
of the subjects were aware of their parafunctional habit and resorted to the same
as a measure to overcome occupational stress. Air force aircrew maybe relatively
vulnerable to deleterious effect of bruxism as a consequence of chronic aviation
stress. The results of the study suggest that the accelerated rate of tooth attrition in
this young population calls for dental and psychological preventive efforts.

Kumar et al., (2010) assessed the dental prosthetic status and prosthetic
needs in a sample of green marble mine labourers of Udaipur, India. The study
population comprised of 513 green marble mine labourers who were divided into
four age groups (15-24, 25-34, 35-44 and 45-54). Prosthetic status and treatment
needs along with dentition status were recorded using WHO oral health
assessment form. The examination was done by two examiners who were
calibrated for inter examiner variability with kappa statistic of 86%. Chi-square
test was used to compare the proportions. The significance level was set at α=
0.05. Mean number of missing teeth due to any reason for the whole sample was
0.82. Approximately, 96.5% of the subjects were free from any kind of prosthesis
and only the rest of sample (3.5%) had single fixed prosthesis. The overall
prosthetic treatment needs was 15.5%. Prosthetic needs increased as the age
increased with the age group 45-54 showing the greatest. Prosthetic needs in the
lower arch were found to be greater than that of the upper arch. Single unit
prosthesis comprised a greater percentage of the whole prosthetic needs (41%).
Most of the prosthetic needs of the study population were unmet. The prosthetic
needs being four and half-fold greater than the status.

Dental erosion, and specifically its symptoms, has long been studied as an
occupational dental disease. However, in recent years, few studies have
investigated the development of this disease or labour hygiene management aimed
at its prevention. As a result, interest in dental erosion is comparatively low, even
among dental professionals. Suyama et al., (2010) investigated the prevalence of
dental erosion in lead storage battery factory. In 1991 the work environmental
sulphuric acid density was above the tolerable range (1.0mg/m) and that long-term
workers had dental erosion. Therefore, workers handling sulphuric acid were

60
given an oral examination and rates of dental erosion by tooth type, rates of
erosion by number of working years and rates of erosion by sulphuric acid density
in the work environment was also investigated. Where dental erosion was
diagnosed, degree of erosion was identified according to a diagnostic criterion. No
development of dental erosion was detected in the maxillary teeth, and erosion
was concentrated in the anterior mandibular teeth. Its prevalence was as high as
20%. Rates of dental erosion rose precipitously after 10 working years. The
percentages of workers with dental erosion were 42.9% for 10-14 years, 57.1%
for 15-19 years and 66.7% for over 20 years with 22.5% for total number of
workers. The percentages of workers with dental erosion rose in proportion to
work environmental sulphuric acid density: 17.9% at 0.5-1.0, 25.0% at 1.0-4.0
and 50.0% at 4.0-8.0mg/m. This suggests that it is necessary to evaluate not only
years of exposure to sulphuric acid but also sulphuric acid density in the air in
factory workers.

Ganss et al., (2011) addressed the methodological issues in the field of

tooth wear and erosion. Research including the epidemiological indices identifies
future work that is needed to improve knowledge about tooth wear and erosion.
Their paper was a result of the work done at the meetings of the Special Interest
Group "Tooth Surface Loss and Erosion" at the 2008, 2009 and 2010 conferences
of the European Association for Dental Public Health, and the Workshop "Current
Erosion indices- flawed or valid" which took place in Basel in 2007. Although
there is consensus about the definition and the diagnostic criteria of various forms
of tooth wear, gaps in research strategies have been identified. A basic problem is
that fundamental concepts of wear and erosion as an oral health problem have not
yet been sufficiently defined. To a certain extent, tooth wear is a physiological
condition, and there is no consensus as to whether it can be regarded as a disease.
Furthermore, the multitude of indices and flaws in existing indices, make
published data difficult to interpret. Topics for the research agenda are: the
initiation of a consensus process towards an internationally accepted index, and
the initiation of data collection on the prevalence of various forms of wear on a
population-based level. There should be an emphasis on promoting

61
communication between basic and clinical sciences, and the area of Public Health
Dentistry. Furthermore, they added that the question; whether tooth wear is a
public health problem remains open for debate.

Doaa et al., (2011) studied the possible effects of the industrial

environment in confectionery factory and flour Mills on the oral cavity of workers
in these factories, and assessed the current oral health status and treatment needs
among those workers. 300 workers from both factories were included in the
survey and they completed a questionnaire on their personal data, working years
in the Factory/Mills, personal habits, oral hygiene habits and dental visits within
last year. Information on oral health status was collected by clinical examinations;
Dentocult SM and Dentocult LB were used to measure Streptococcus Mutans and
Lactobacillus count. In both groups the working years is positively correlated with
the DMFT (p<0.001), furthermore in the Sweet factory workers there is a
statistically significant positive correlation between working years and the
increase of plaque index. Although the research results showed a relation between
working in Sweet factory and Flour Mills (as occupational hazardous
environment) and the worsened oral health condition among these workers. They
state that it is clear that there are other factors involved in their oral health status,
like their socio-economic status, oral health knowledge, attitudes and behaviour,
and the degree to which workers are restricted to using protective measures.

Sood et al., (2011) conducted a study on 1197 male Ceramic factory

workers (mean age- 33.29 yrs.) of Bahadurgarh, Haryana. The factory workers
had two major work environments (I) related to high temperature (N= 214) and
(II) related to abrasive dust (N= 983). The attrition was observed in (84.38%)
workers and abrasion was observed in (25.22%) workers. There were no
statistically significant differences based on work profile within the ceramic
factory workers. However attrition was relatively higher than reported in Haryana
population. They concluded that the work environment was related to pathologic
dental condition.

Mulic et al., (2011) assessed the prevalence and severity of dental erosive
wear among a group of professional wine tasters. Eighteen wine tasters employed

62
at AS Vinmonopolet, Norway (3 women, 15 men; mean age 39 years) and 30
comparison participants (9 women, 21 men; mean age 39 years) were included in
the study. The wine tasters were examined by four calibrated clinicians using the
Visual Erosion Dental Examination system. Data concerning medical and dietary
history, oral hygiene habits and occupational background were obtained from a
self-completed questionnaire. Nine (50%) of the wine tasters and six (20%) of the
comparison group showed clinical signs of dental erosion. Among the wine
tasters, 39% had dentine involvement, compared to just 7% of the comparison
group. The erosive lesions were mainly found on the occlusal surfaces of
mandibular first molars in the wine tasters, whereas for the controls, the palatal
surfaces of upper centrals were most often affected. They concluded that there
existed a significant difference in the prevalence of dental erosive wear between
the two groups, the wine tasters having a higher prevalence and more severely
affected surfaces than the comparison group. Half of the wine tasters had no
erosive wear and, for the other half, there was no relationship between the
duration of their professional life and the extent of erosive wear.

Dental caries and periodontal diseases are highly prevalent in the Japanese
adult population. Oral examination is an effective method to find various oral
health problems in their early stages. However, workplace oral health
examination, including oral health instruction, and oral health status in the
Japanese adult population is very scanty, that is why Ohikhoji et al., (2011)
performed a study to check the influence of oral health instruction on the oral
health status of the employees using data from 4,484 Japanese employees aged
35-74 years. The propotion of teeth with probing depth less then or equal to 4mm
and the number of decayed teeth were used for periodontal disease and dental
caries parameters. The subjects were asked through questionnarie about the past
experience of the work place oral health examination. The subjects who received
the who received oral health examination had better periodontal health status then
the subjects who were examined for the first time. On the other hand, no
significant relationship was found between workplace oral health exmination and
number of decayed teerh. These results suggest that workplace oral health

63
examination accompained by oral health instruction may be effective for
mantienance of periodontal health.

Since the mid-1990s, the focus of studies on tooth wear has steadily
shifted from the general condition towards the more specific area of dental
erosion; equally, a shift has occurred from studies in adults to those in children
and adolescents. During this time, understanding of the condition has increased
greatly. Johansson et al., (2012) attempted to provide a critical overview of the
development of this body of knowledge, from earlier perceptions to the present. It
is accepted that dental erosion has a multifactorial background, in which
individual and lifestyle factors have great significance. Notwithstanding
methodological differences across studies, data from many countries confirm that
dental erosion is common in children and young people, and that, when present, it
progresses rapidly. That the condition, and its ramifications, warrants serious
consideration in clinical dentistry is clear. They suggested that, it is important for
the oral healthcare team to be able to recognize its early signs and symptoms and
to understand its pathogenesis. Preventive strategies are essential ingredients in
the management of patients with dental erosion. When necessary, treatment aimed
at correcting or improving its effects might best be of a minimally invasive nature.
Further they suggest the need for future research to forge better understanding of
the subject.

Zelle and Mandola-Duncan (2012) discussed the oral hygiene

professionals' role in renal organ transplant. Health care professionals note that
renal failure patients undergoing dialysis have high risk of having oral conditions
including oral ulcers, jaw discomfort, and caries. It says that because of the lack
of defined guidelines for pre- or post-renal transplant treatment, oral health
professionals should use their professional judgment and medical experiences to
know the source of oral infection. This shows that oral cavity disease can be lead
to undiagnosed general health problems.

Salt workers are exposed to the adversities of environmental conditions

such as direct sunlight, salt dust and contact with brine, which have an impact on

64
the health of workers. Since oral health is an integral part of the general health,
Sanadhya et al., (2013) planned a study to determine the effect of salt industry
environment on the oral cavity among the workers of Sambhar Salts Limited at
Sambhar Lake, Jaipur, India. They conducted a cross sectional, descriptive survey
among 979 subjects (509 males; 470 females) who were aged between 19-68
years, who were the workers of Sambhar Salts Limited, Sambhar Lake, Jaipur,
India. An interview on the demographic profile followed a clinical examination
for recording the oral health status, based on the World Health Organization
guidelines. The Chi-square test, t-test, One way Analysis of Variance and a
Stepwise multiple linear regression analysis were used for the statistical analysis.
Females had a significantly greater prevalence of dental fluorosis (71.7%) and
periodontal disease (96.4%) as compared to males (p= 0.001). The mean number
of healthy sextants (0.71 ± 0.09) and the mean DMFT (5.19 ± 4.11) were also
significantly higher in females as compared to those in males (p=0.001). One
surface filling (78.2%), followed by pulp care and restoration (76.1%) were the
most prevalent treatment needs. The gender and oral hygiene practices for dental
caries and periodontal disease were respectively identified as the best predictors.
Considerable percentages of salt workers demonstrated a higher prevalence of oral
diseases. Higher unmet treatment needs suggest a poor accessibility and
availability of oral health care, in addition to a low utilization of preventive or
therapeutic oral health services.

Ever since the beginning of the universe mankind had struggled constantly
for their livelihood, Moradabad is branded as the “Brass city” of India, which
comprises of a large number of populations working in different industries. Tirth
et al., (2013) planned study to assess and compare the oral health status of
workers employed in brass industries with non-industrial workers of Moradabad
city. A total of 500 workers from each group aged 30-50 with 5 years working
experience were selected through random sampling. Type III examination was
performed by recording who oral health assessment form. To compare the
proportion chi-square test was used. Mean values were compared using students t-
test. SPSS version 15.0 was used for statistical analyses. The prevalence of dental

65
caries as Mean DMFT score was significantly higher in Non-Industrial Group i.e.
3.57±2.74 while it was 2.88±2.14 in brass workers. Periodontal diseases were
higher among production workers that belong to brass industries. The prevalence
of Oral Mucosal Lesions was significantly higher among Production Workers.
Bleeding was more pronounced in general population but calculus and pockets
were seen more in brass workers. The requirement of prosthetic status was also
more prevalent among industry subjects. The Oral health status of Brass Industry
Workers was relatively poor with poor periodontal health when compared to
General Population. Further studies of oral occupational disease should be
conducted in order to check or confirm previous reports and to discover possible
manifestations arising in new industries.

According to Khurana et al., (2014), the oral cavity is vulnerable to

external agents and some occupational exposures are associated with oral changes
in both hard and soft tissues. With this background they conducted a study to
assess oral health status in battery factory workers of Kanpur city and to describe
the prevalence and nature of oral health problems among workers. A total of 70
battery workers were enrolled and divided into study and control groups based on
acid exposure. The data was recorded on a modified World Health Organization
1997 proforma. The data was analyzed using Statistical Package for Social
Sciences version 15.0. The categorical variables were compared using Chi-square
test for proportions while the quantitative ordinal variables were compared using
Mann–Whitney U‑test. Quantitative continuous variables were compared using
Independent samples t-test. The mean age of all the workers surveyed was 36.24
years. Differences in the erosion, oral hygiene and gingival index scores among
the two groups were highly significant (P < 0.001). They concluded that the oral
health status of the battery factory workers was poor and significantly associated
with dental erosion.

Sudhanshu et al., (2014) in their review article tried to enlighten the oral
health status in acid factory industrial workers with available resources. They felt
that the occupational oral health hazards are omnipresent and there is no look out

66
for the oral health status of workers particularly for acid factory workers.
Therefore, it is desirable to impart oral health education to them, to apprise them
of the ill effects of work and teach remedial measures. Awareness programs and
local group discussions are essential for improving the oral health status of these
working communities. Accordingly they suggest that the well planned training
programme should be conducted for new recruited members. Guidelines to the
acid fumes industries are given like installing efficient ventilation and exhaust
systems at work sites, implementation and mandatory use of Personal protective
equipment should be provided like protective masks, goggles and face guards to
workers and provide medical and dental care services.

Sharma et al., (2014) planned a study to evaluate the oral health status of
cement factory workers. A cross- sectional study was carried out at Sirohi,
Rajasthan. A total of 90 study subjects were included. They were all males who
were in the age group of 20-58 years and are permanent employees of the cement
factory. For recording the oral hygiene status and dental caries status, The Oral
Hygiene Index Simplified (Greene and Vermillion, 1964) and The DMFT Index
(Henry T. Klein, Carrole E. Palmer, Knutson J. W., 1938) are used, respectively.
Wasting diseases were also recorded. Chi-square was used to find association of
dental caries, oral hygiene status, oral lesions and wasting diseases with age,
education, brushing habit, frequency of brushing and tobacco use. P < 0.05 was
considered statistically significant. Tooth wear was seen among 50% of the study
subjects. Forty percent of the subjects had adverse habit. Significant association of
wasting diseases was found with age (P = 0.004), education (P = 0.022) and
adverse habit (P = 0.014). Adverse habit was also significantly associated with
oral lesions (P = 0.000). Most of the factory workers had dental caries and poor
oral hygiene. Fifty percent had tooth wear. They concluded that there is a need of
oral health education and motivation for these workers along with oral health care
facilities in the premises.

Occupational injuries cause major health problems, which the developed,

developing, and underdeveloped nations worldwide are facing today. Solanki et
al., (2014) felt the need of assessing dental caries, periodontal health of stone

67
mine workers, and the relationship between wasting diseases and the years of
working experience. For this study, a population of 510 men were selected based
on the stratified cluster sampling. Clinical oral examinations were carried out, and
periodontal disease, dental caries, and wasting diseases were recorded. Workers
were in the age group of 17e56 years; the prevalence of dental caries in the
workers was found to be 74%, with a mean decayed, missing, filled teeth index of
2.89. A periodontal pocket of more than 6 mm was observed in 6% of the
workers. As the oral health of mine workers is in a poor state they recommended
to take steps to provide basic medical and dental care facilities.

Loss of tooth structure may be due to tooth to tooth contact and presence
of abrasive components in the work environment. To check the same Abdulla and
Al-Waheb (2014) planned a study to evaluate the occurrence of dental attrition
among Cement factory workers. The Sample included all workers chronically
exposed to cement dust in the EL-Kubaisa cement factory (95 workers). A
comparative group of workers (97) were non-exposed to cement dust was
selected. All workers were males in gender with age range (25-55) years. The
assessment of tooth wear was based on the criteria of smith and knight, 1984. The
maximum tooth wear score for exposed workers was 84.2% while non-exposed
workers was 38.1%, with statistical differences between two groups was highly
significant (P<0.01). The maximum tooth wear score among workers exposed to
cement dust according to duration (<10years), (10-20 years) and >20 years) was
(52.2 %), (92.3%) and (100%) respectively, with statistical differences was highly
significant (P< 0.001). While the maximum tooth wear score among workers
exposed to cement dust according to wearing mask was found to be statistically
not significant (P> 0.05). Work environment was related to dental wear.

Occupational factors may be considered responsible for dental erosion

among battery factory workers since they were exposed to sulfuric acid fumes
created by the harmful processes known as forming and charging. To evaluate the
same Agrawa et al., (2014) performed a study on a sample of 138 battery factory
workers (85 acid exposed workers and 53 controls) drawn as a convenient sample
from 3 different battery factories of Mandideep, India. A pre-tested proforma,

68
completed by interview, was used to collect information on medical and dental
histories. Clinical examination of battery factory workers was done to assess
dental erosion using tooth wear index given by Smith and Knight. Data related to
dental erosion score of acid worker and control group was compared using Mann
Whitney U test. Categorical data was analysed by chi-square test. The battery
factory workers showed a propensity for higher erosion scores. The result of
present survey showed a total of 74 percent of acid exposed workers had erosion
compared to 37.7 percent of the controls. Statistical difference in erosion scores
between acid exposed group and control group was found significant (p
value<0.05). Present study revealed that long term exposure of sulphuric acid
mists in the working environment significantly increased the chances of dental
erosion among exposed workers. There is urgent need for surveillance and routine
monitoring of acid fumes at workplace coupled with education about occupational
hazards, positive worksite oral health promotion and training for standardized
behaviours such as use of personal protective equipment to decrease occupational
erosion.
A seafarer is a person who navigates waterborne vessels or assists as a
crewmember in their operation and maintenance in all tough weather, but little
research has been done to identify conditions that may lead to assess seafarer
general health as well as oral health. So, Aapaliya et al., (2015) did a study to
assess oral diseases including dental caries and periodontal conditions among
seafarer's population arrived in Mundra Port, Kutch, Gujarat, India. A descriptive
cross-sectional survey was conducted to assess oral health condition of seafarer
community of Mundra Taluka of Kutch District, Gujarat, India, from July 2014 to
September 2014. Total of 385 subjects participated in the survey. Adverse habits
show the overall 72.3% prevalence among the study population. Occurrence rate
of caries, periodontal disease and prosthetic status were 88%, 75.1% and 6.5%,
respectively. The best predictors for Decayed Missing Filled Teeth (DMFT),
Community Periodontal Index (CPI) and prosthetic status were oral hygiene
practices, adverse habit and educational status. Findings of the present study
suggest that oral health condition of seafarer community was relatively poor, with

69
high caries prevalence and poor periodontal health. This epidemiological survey
has provided baseline information to underpin the implementation of oral health
programmes.

Standard of living and quality of life of people has been improved by the
expanding industrial activity, but at the other end it has created many occupational
hazards. Coal mining is one of the major age old industries throughout the world
and in India. Till date very less literature is available worldwide and in India
concerning the oral health status of labourers in this field. With this background
Abbas et al., (2016) undertook a study to assess the oral health status of
underground coal mine workers, oral hygiene practices, alcohol and tobacco
habits. A cross-sectional descriptive study was conducted among the underground
coal mine workers of a coal mine located in Adilabad district, Telangana,
according to the criteria described in the World Health Organization (WHO) Oral
Health Assessment form (2013). Descriptive statistics were done. A total of 356
workers participated in the study. Ninety percent of the subjects were with
tobacco and/or alcohol habits. Dental caries was prevalent in more than half
(55.6%) of the study subjects with a mean DMFT of 2.32±2.99. About 48.3%
study subjects were with untreated dental caries and 20.3% subjects were with
missing teeth. DMFT ≤=6 was seen in 45.5% of subjects and 10.1% have DMFT
scores ≥=7. Periodontal disease was the most prevalent condition seen in the
population with 94.4% subjects having unhealthy periodontium in terms of
gingival bleeding and/or periodontal pockets. About 186 (52.25%) and 145
(40.73%) of subjects were with 0-3mm and 4-5mm loss of attachment
respectively. Fourteen percent of population showed dental traumatic injuries. The
findings highlighted the high caries prevalence, higher periodontal disease,
traumatic injuries which requires immediate intervention.

70
 Chapter 5
MATERIALS & METHOD

The present study was carried out in the Department of Environmental

Sciences in collaboration with the Department of Physics, Mohanlal sukhadia
university, Udaipur.

5.1 STUDY DESIGN AND DURATION

A descriptive cross sectional study was conducted in and around the

Udaipur city, (Rajasthan, India) within the radius 150Kmfor evaluating the oral
health status and treatment needs of marble mining employees. The study was
conducted within the span of 2 years starting from 2012-2015.

5.2 ETHICAL CLEARANCE

The ethical clearance for the study was obtained from the Post Graduate
Research Board (PGRB) committee of the Mohanlal Sukhadia University held on
19.12 2012.

Informed consent

The purpose of the study was explained to all the individuals who were
examined and the oral consent was obtained for their willing participation in the
study.

Inclusion criteria

 Marble mining employees who were available at the time of the study

 Employees those who agreed to participate in the study.

 Only males among general population were included as comparative group

as only males were employed in the Granite factories.

71
Exclusion criteria

 Participants who had not given consent.

5.3 SELECTION OF MINING EMPLOYEES:

The list of all the mining factories situated in and around Udaipur city,
Rajasthan, India was obtained from the internet. The permission to carry out the
study was obtained from the Managing Directors (MD) of the factories. The
labourers will be divided into groups based on the type of the work they were
assigned (Figure 2, Figure 3, Figure 4 and Figure 5). There were five divisions of
employees in the marble mining based on the type of work assigned to them
namely;

1. Administrative unit.

2. Maintenance unit.

3. Transportation unit.

4. Cutting unit

5. Polishing unit.

A detailed schedule for the examination was prepared in consultation with

the mining supervisors (MS) of all the factories. All the employees were informed
in prior about the study as well as the date, time and the place of examination.

Based on the exclusion and inclusion criteria the survey was conducted on
mining employees that yielded final sample size of 500mining employees who
belonged to 15-54 years of age. The survey on marble mining employees was
conducted in the month of December 2012 to January 2015.

5.4 SELECTION OF GENERAL POPULATION: (COMPARATIVE/

CONTROL GROUP)

The comparative group comprised of individuals attending different dental

hospital camps for the routine checkup around the Udaipur city proper. The
Survey followed the simple random method for selecting the individuals. Only the

72
male population was included to make the comparison easy with the mining
employee group, where none of the group had female employees.

5.5 PILOT SURVEY

One marble mining was selected for pilot survey. Both questionnaire and
indices interpretation from Modified WHO oral health assessment form (1997)
was done on 15 mining employees. Necessary modifications were done to design
the final questionnaire and proforma.

5.6 QUESTIONNAIRE DESIGN

The study involved completion of an open and closed ended pre-designed

questionnaire that collected details of the demographic data, deleterious habits,
diet, sweet consumption, oral hygiene practices, medical / dental insurance
policies, visit to the dentist, working environment, and Personal Protective
Measures (PPM) used while working. (Annexure II)

5.7 TRAINING AND CALIBRATION

The investigator was trained about the diagnosis of oral diseases and the
interpretation of indices on 10 subjects under the supervision of the expert in the
Department of Public Health Dentistry, Darshan Dental College and Hospital,
Udaipur.

The data on the oral health status was recorded using Mouth mirror and
CPI probe (Figure 6 and Figure 7) and entered on a modified WHO oral health
assessment form 1997(Annexure III). Calibration was done by examining 20
subjects twice on two successive days and compared to know the diagnostic
variability. Agreement for assessment was 90 percent.

5.8 LIST OF MATERIALS NEEDED FOR THE STUDY ARE

 Plane mouth mirrors

 Periodontal probes confirming WHO criteria

 Several pairs of Tweezers

73
  Kidney trays

 Hand sanitizer

 Sterilization solution

 Cloth or paper hand towel

 Gauze

 Patient drape

 Gloves and mouth mirrors

 Cotton rolls

5.9 STERILIZATION

The instruments were sterilized using cold sterilization method at the site
of examination using Korsolex solution. (Active ingredients in 100 g:
(Ethylenedioxydimethanol 15.3 g, Glutaraldehyde 7.5 g, benzyl- C12-18 alkyl
dimethyl ammonium chlorides 1.0 g, didecyl dimethyl ammonium chlorides 1.0 g.
Other ingredients: Surfactants, solvents, corrosion inhibitors, foam inhibitors,
colorants, fragrances).

5.10 EXAMINATION AND COLLECTION OF DATA

ADA type III examination was done solely by the investigator. The
patients was either seated on a chair or laid on the table or bench depending upon
the availability of the furniture at the examination area (Figure 7). To do the
intraoral examination (Figure 8 to Figure 19) the natural light if feasible was used
or else a battery operated light was used. To enter the examined data, a standard
form for oral health assessment of WHO was used (Annexure II).

In the proforma tooth surface loss (Figure 10) of the study population was
registered and graded according to Eccles and Jenkins criteria (Eccles and
Jenkins, 1974).

74
 The grading used for the severity of tooth surface loss was as follows:

Grade 1 : Loss of surface features, the dentin is not involved

Grade 2 : Involvement of the dentin for less than one third of the area
of the tooth surface.

Grade 3 : Involvement of the dentin for more than one third of the
area of the tooth surface.

Score of the highest affected teeth in the upper and lower anterior sextants
were considered as the score for the sextant.

Oral examination was done and questionnaire was completed by the

investigator herself for each study subject by asking the questions in the
questionnaire to the subject to ensure uniformity in the data collection and to
avoid misinterpretation of the questions by the study subjects.

Socio economic status was recorded according to Modified

Kuppuswamy’s Socio economic status scale (Ravi Kumar et al., 2013) (Annexure
IV). This scale takes account of education, occupation and income of the family to
classify study groups in to upper, upper middle, middle, upper lower and lower
class. It is widely used in community based research and hence was used in this
study.

The clinical examination of the samples was done using a plane mouth
mirror and CPI probe where necessary according to WHO caries diagnostic
criteria (World Health Organization, 1997). Examinations was performed to
record the caries experience, decayed, missing, filled (DMF) teeth (Figure 8 and
Figure 9). Periodontal index was used to check the gingival and periodontal status
(Figure 12 and Figure 13); apart from that the oral cavity will be thoroughly
examined for the cancerous and precancerous lesions (Figure 16 to Figure 19)
according to WHO criteria.

75
Collection of particulate matter

The samples of particulate matter was obtained from the department of

physics, Mohanlal Sukhadia University. Sample collection was done for 24 hours
once in a week using High Volume Sampler with SPM Filter Manifold and Fine
Particulate Sampler/Dust Track Sampler.

5.11 STATISTICAL ANALYSIS

Data was entered in Microsoft excel 2010 for Windows. Frequencies,

percentages, mean, standard deviation (SD) of variables were calculated.
Categorical variables (frequencies, percentages) were analysed using Pearson’s
chi-square test and Cramer's V test. Shapiro-Wilk test showed that quantitative
data (mean and SD) did not follow normal distribution curve. Hence, non-
parametric tests such as Kruskal-Wallis test and Mann Whitney U tests were used
for further data analysis. P values <0.05 were accepted as statistically significant.
All analyses were performed using version 21.0 of the Statistical Package for
Social Sciences (IBM Corporation, Armonk, New York, USA).

Statistical formula used in the analysis

∑ 𝐱𝐢
Mean (𝐱̅):- 𝐱̅ = 𝐧

Where,
xi= value of each observation in sample

n = sample size

Standard Deviation (SD/σ):-

∑(𝐱𝐢 −𝐱̅)𝟐
𝝈=√ 𝐧−𝟏

Where,
xi= value of each observation in sample

(x̅) = Mean

n = sample size

76
Chi Square test:

The Chi Square (χ2) test is the most important and most used member of
the nonparametric family of statistical tests. Nonparametric statistical procedures
test hypotheses that do not require normal distribution or variance assumptions
about the populations from which the samples were drawn and are designed for
categorical (ordinal or nominal) data.

The properties Chi-square test was first investigated by Karl Pearson in

1900. This test is used to determine any significant association between
categorical data from two or more groups. It is a method of testing the significant
difference between two or more proportions.

(Observed value − Expected value)2

Chi − Square Test (χ2) = ∑
Expected value

Observed value= Obtained from the study (data collection)

Expected value = (Row Total x Column Total) / Grand Total

Degree of freedom for Chi-Square Test:

df = (r-1) x (c-1)

Where,

r= number of rows

c= number of columns

Cramer’s V:

Cramer’s V is a measure of association between two nominal variables,

giving a value between 0 (corresponding to no association between the variables)
and 1 (perfect relationship). It is based on Pearson’s chi-squared statistic and was
published by Harald Cramér in 1946.

Chi − square test value

Cramer ′ s V = √
𝑛𝑡

77
 n is the sample size,

t is the smaller of the number of rows minus one or the number of columns
minus one. If r is the number of rows, and c is the number of columns, then

t = Minimum (r − 1, c − 1)

Kruskal-Wallis Test:

The Kruskal Wallis test (named after William Kruskal and W. Allen
Wallis) is a non-parametric method for comparing differences between two or
more than two independent groups when the dependent variable is either ordinal
or continuous, but not normally distributed. Since it is a non-parametric method,
the Kruskal–Wallis test does not assume a normal distribution unlike the
analogous one-way analysis of variance (ANOVA).

𝑘
12 𝑅𝑖2
𝐻= ∑ − 3(𝑛 + 1)
𝑛(𝑛 + 1) 𝑛𝑖
𝑖=1

H = Kruskal-Wallis Test statistic

n = total number of observations in all samples

ni(i = 1, 2, ..., k) = Sample sizes for each of the k groups in the data.

Ri = the sum of the ranks.

Mann-Whitney U test:

The Mann-Whitney U test is used to compare differences between two

independent groups when the dependent variable is either ordinal or continuous,
but not normally distributed (contrary to Student’s t-test which has to be applied
only on normal distribution). The logic behind the Mann-Whitney test is to rank
the data for each condition, and then see how different the two rank totals are.

𝑛1 (𝑛1 + 1)
𝑈 = 𝑛1 𝑛2 + − 𝑅1
2

U is the Mann-Whitney statistic, n1 and n2 are the number of cases in

samples 1 and 2, respectively, and R1 is the sum of the ranks for the first sample.

78
 Figure 2. Marble Quarry

Figure 3. Marble Cutting Unit

79
Figure 4.Marble Polishing Unit

Figure 5.Transportation Unit

80
 Figure 6. Armamentarium

Figure 7. Examination of Patient

81
 Figure 8. Dental Caries Figure 9. Missing Teeth

Figure 10.Tooth Surface Loss Figure 11. Dental Flurosis

Figure 12. Poor oral Hygiene Figure 13.Periodontal Diseases

82
 Figure 14.Oral Ulcer Figure 15. Oral Abscess

Figure 16. Lichen Planus Lower

Figure 17. Lichen Planus Upper
buccal area
buccal area

Figure 18. Leukoplakia Figure 19. Oral Submucosal Fibrosis

83
Figure 20. Methodology Flow Chart

84
 Chapter 6
RESULTS

6.1 DISTRIBUTION OF STUDY POPULATION BASED ON GROUPS

A total of 980 subjects constituted the study population out of which 500
(51.2%) were marble mining employees and 480 (48.98%) were general
population constituting comparative group. (Table 1/Graph 1)

6.2 DISTRIBUTION OF MARBLE MINING EMPLOYEES BASED ON

WORK UNITS

A total of 500 Marble mining employees were segregated according to the

work assigned and the number of employees in each group were; 43 (8.60%)
administrative staff(A), 45 (9.0%) maintenance staff(M), 140 (28.0%)
transportation unit workers(T), 140 (28.0%) cutting unit workers(C) and
132(26.40%) polishing unit workers(P) ( Table 2/Graph 2).

6.3 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

AGE GROUPS IN YEARS

The age ranges of marble mining employees and the general population
was between 15-54 years.

The study population was categorized in to four age groups ranging from
15-24 years, 25-34 years, 35-44 years and 45-54 years.

The results reveal that a majority of the mining employees (52.40%) and
general population (47.92%) were between 25-34 years when compared to other
age groups. Comparison of distribution of study participants under different age
groups between mining employees and general population did not reveal
statistical significance (P=0.070).

85
 Among mining employees 46.51% of the employees in administrative
division, 60.0% in case of maintenance staff,61.43% of transportation unit,
42.86% of cutting unit and 52.27% of polishing unit were in between 25 – 34
years which formed the majority. Comparison of distribution of study participants
under different age groups between different mining employee units showed very
high statistical significance (P<0.000). (Table 3/Graph 3)

6.4 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

LITERACY LEVELS

Among the total study population 42.04% were illiterates, 11.12% had
primary level of education, 17.55% had high school level of education, 14.39%
had PUC level, 6.33% had diploma level, and 8.57% had degree qualification.

Among marble mining employees, about 62.60% of the subjects were

illiterates as against 20.63% of the general population. Among mining employees
and general population 11.20% and 24.17% respectively had high school level of
education which formed the majority compared to other levels of education in
both the groups. The differences of distribution between mining employees and
general population according to different education levels showed very high
statistical significance (P=0.000) (Table 4/Graph 4).

A significant association was observed between educational level and the

employment status among mining employees. Most of the transportation, cutting
and polishing unit workers had lower levels of education compared to other units
who had higher educational level which is evident from the frequency table. The
differences between mining units with regard to education level revealed very
high statistical significance (P =0.000)(Table 4/Graph 4).

6.5 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

SOCIO ECONOMIC STATUS (SES) –(Modified Kuppuswamy’s SES
classification scale)

According to Modified Kuppuswamy’s socioeconomic status (SES)

classification, the study population was sorted in to five SES classes namely
Upper class, Upper middle class, Middle class, Upper lower and Lower class.

86
 Similarly, among mining employees and general population about 39.0%
and 33.33% respectively belonged to middle class followed by 30.40% and
34.58% respectively belonged to lower middle class. Statistically significant
difference was observed between mining employees and general population in
regard to different SES classes (P=0.000)

Within the mining employees, a majority of administrative staff (60.47%)

belonged to higher SES class of upper middle class. Whereas, a majority of
maintenance staff (73.33%) cutting unit workers (51.43%) and polishing unit
workers (53.03%) belonged to middle class. While major portion of transportation
unit workers (67.86%) belonged to lower class. Comparison between mining units
according to different SES classes showed statistical significant difference (P <
0.001) (Table 5, Graph 5)

6.6 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

DIET

Forty odd percent of mining employees were vegetarians as against to

only 37.71% of vegetarians in general population and about 62.29% of mining
employees were on mixed diet when compared to 61.02% of general population
on mixed diet. The differences in prevalence of dietary habits between mining
employees and general population were statistically significant not significant
(P=0.424)

Within mining employees, a majority of administrative group (69.77%)

belonged to vegetarian diet whereas a major portion of transportation unit
(77.14%), cutting unit (58.57%), and polishing unit (56.82%) belonged to mixed
group. The differences in prevalence of dietary habits between different mining
units were statistically significant (P=0.001). (Table 6/ graph 6)

6.7 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

SWEET CONSUMPTION

About 56.20% of the marble mining employees were consuming sweets

occasionally as against 42.50% of general population. However, 10.51% of

87
general population was consuming sweets daily in contrast to 11.40% of subjects
among mining employees. The difference in frequency of sweet consumption
between mining employees and general population was found to be statistically
significant (P=0.001).

A majority of administrative staff (46.51%), maintenance staff (46.67%),

transportation employees(42.29%), cutting (63.57%) and polishing (62.12%) units
were consuming sweets at the rate of 2-3 times/ week. But prevalence of daily
sweet consumption was higher in transportation (18.57%) and Maintenance staff
(11.11%) when compared to administrative staff (6.98%). The difference in
frequency of sweet consumption between the various mining units was
statistically significant (P=0.000). (Table 7/Graph 7)

6.8 DISTRIBUTION OF STUDY POPULATION ACCORDING TO USE

OF TOBACCO PRODUCTS

It is found that the 79.40% (339) and 61.67% (303) of marble mining
employees and general population respectively were found to be tobacco users.
The difference in prevalence of tobacco habit between mining employees and
general population showed high statistical significance (P=0.000).

Within mining employees highest prevalence of tobacco habit was found

in transportation unit workers (85.71%) compared to other units but the difference
was not statistically significant (P=0.211). (Table 8A/graph 8A)

6.9 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

THE TYPE OF TOBACCO PRODUCTS AND ALCOHOL USE

The results revealed that the commonly used tobacco products among the
study population were cigarette, bidi, tobacco leaf, pan, and gutkha.

Among mining employees a majority were using gutkha (38.60%)

followed by tobacco chewing (19.20%) and bidi smoking (16.0%). Whereas
among general population a majority were bidi smokers (13.75%) followed by
tobacco chewing (15.42%) and gutkha chewing (22.08%). Comparison of

88
prevalence of various tobacco habits between mining employees and general
population yielded statistically significant differences in the prevalence of pan
chewing (P=0.004), and gutkha chewing (P=0.000).

Within mining employees highest prevalence of gutkha (52.14%) was

seen among of transportation unit workers. While highest prevalence of bidi
smoking was seen among polishing unit workers (28.79%) compared to other
units. Whereas prevalence of cigarette smoking and pan chewing was highest
among administrative unit. The differences in use of tobacco products among
mining employees were statistically significant for all the tobacco products
(P<0.001) except for the tobacco leaf.

Overall 70.82% of the study population had alcohol habit. Whereas among
mining employees 80.80% and among general population 60.42% had alcohol
consuming habit respectively. The difference in the prevalence was statistically
significant (P= 0.000). (Table 8B/Graph 8B)

Within mining employees there was statistically significant difference in

the prevalence of alcohol habit between various mining units (P=0.004) with
89.29% of cutting unit employees consuming the alcohol.

6.10 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

THEIR ORAL HYGIENE HABITS

6.10.1 Frequency of cleaning the teeth

Among marble mining employees 97.73% had once frequency of brushing

and rest (2.27%) had twice brushing habit. Among general population 98.84% had
once brushing habit and 1.16% had twice brushing habit and none of the
participants was brushing after every meal. On comparison the difference in the
frequency of brushing between mining employees and general population was
found to be statistically significant (P=0.005). (Table 9/Graph 9)

Within mining employees 100% all the units had once brushing habit. The
difference in frequencies of brushing between various mining units was not

89
applicable as frequency of cleaning in all the sub-groups is “once”(Table 9/Graph
9)

6.10.2 Mechanical aids for cleaning the teeth

Among marble mining workers 68.74% (288) were using brush, 21.0%
(88) were using finger, and 10.26% (43) were using other materials for cleaning
their teeth. Among general population 85.68% (377) were using brush, 11.59%
(51) were using finger and 2.73% (12) using other aids for cleaning their teeth.
The prevalence of various aids used for cleaning teeth among mining employees
and general population showed statistically significant difference (P=0.000).
(Table 9/Graph 9)

Among mining employees highest prevalence of use of brush was seen

among of Administrative (95.35%) compared to other units. Whereas prevalence
of using finger and other materials to clean the teeth was high among
transportation workers 30.23% (29) and 23.26% (20) compared to other units. The
prevalence of use of various aids for cleaning teeth between different units yielded
statistically very high significant difference (P=0.000). (Table 9/Graph 9)

6.10.3 Materials used for cleaning teeth

Tooth paste was used by 72.08% (302) of mining employees and 75.0%
(330) of general population. Whereas 10.74% (45) and 15.0% (66) of mining
employees and general population were using tooth powder respectively and
8.59% (36) and 8.64% (38) of mining employees and general population
respectively were using other materials. Whereas 8.59% of mining employees did
not use any material to clean their teeth as against to only 1.36% of general
population. The differences showed high statistical significant (P=0.001). (Table
9/Graph 9)

Among the mining employees 13.95% of transportation workers were not

using any cleaning material and 10.85% were using other materials to clean their
teeth whose prevalence was higher compared to other units. Tooth paste
prevalence was highest among administrative staff (88.37%) compared to other

90
units. The differences between the mining units in the prevalence of various
materials to clean the teeth was statistically not significant (P=0.243).(Table
9/Graph 9)

6.11 DISTRIBUTION OF THE MARBLE MINING EMPLOYEES

ACCORDING TO USE OF PERSONAL PROTECTIVE
MEASURES (PPM)

Except for the administrative and maintenance staff all other mining units
are continuously exposed to dust and noise in their work environment and tend to
use personal protective measures.

Face cloth and Ear Plugs

Overall among the mining employees a majority of 93.40% (467) and

94.60% (473) were not using face cloth/mask and earplug respectively.

Within the mining unit relatively higher percentage of maintenance

(13.33%, 17.78%) and polishing unit workers (7.58%, 4.55%) were utilizing face
cloth and ear plugs respectively compared to other units. But the differences were
not statistically significant for the usage of face cloth, whereas for the usage of ear
plug among the mining employees there was statistically significant difference
(Table 10/Graph 10).

6.12 DISTRIBUTION OF THE MARBLE MINING EMPLOYEES

ACCORDING TO DURATION OF EMPLOYMENT IN THE
MINING

The duration of employment of the marble mining employees in the

factories were grouped in to five categories including less than 5 years, 5-10
years, 11-15 years, 16-20 years, more than 20 years.

Overall a majority of 40.60% of the mining employees belonged to 5-10

years duration group compared to other groups.

Further analysis revealed a similar trend among all the mining units where
a larger proportion of administrative staff (36.8%), transportation workers

91
(53.5%), cutting unit workers (50.0%) and polishing unit workers (53.7%) were in
5-10yearsgroup except for the maintenance group (31.11%) which had most of the
employees in the less than five year experience category (Table 11/ Graph 11).

6.13 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

DENTAL VISIT

Among mining employees 37.20% (186) visited dentist compared to

47.50% (228) of general population and the differences was highly significant
(P=0.001).

Among mining units, prevalence of dental visits was relatively higher for
administrative staff (60.4%) and maintenance staff (53.3%) compared to other
units and revealed very high statistically significant difference (Table 12/ Graph
12).

6.14 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

REASONS FOR DENTAL VISIT

Dental extractions was the most commonest reason for visiting the dentist
and 64.52% (185) and 57.02% (150) of mining workers and general population
respectively had visited dentists for the same and the differences were statistically
significant (P=0.020). Replacement of teeth was got done by 6.99% (13) and
9.65% (22) of mining employees and general population respectively. Whereas
14.52% (27) of mining employees and 28.51% (65) of general population had
undergone restorative procedures. While 1.32% of mining employees and 5.07%
of general population visited dentist for oral prophylaxis which showed no
statistically significant difference (P<0.001). (Table 13, Graph 13)

Within mining employees large percentage of maintenance (41.6%),

transportation (90.3%), cutting (70.18%) and polishing unit workers (68.75%)
visited dentists for extraction of teeth, compared to only 34.62% of administrative
staff and the differences revealed statistical very high significance (P=0.192).
Whereas 19.2% and 19.2% of administrative staff had visited dentist for
replacement of teeth and restoration of teeth respectively which was higher
compared to other units but the results did not revealed statistical significance
(P=0.625). (Table 13, Graph 13)

92
6.15 DISTRIBUTION OF STUDY POPULATION ACCORDING TO
REASONS FOR NOT VISITING THE DENTIST

Among marble mining employees a majority of 31.85% gave the response

of ‘no problem in their teeth’ as a reason for not visiting dentist, where as 23.81%
stated high cost of dental treatment, while 23.42% (59) responded fear as the
cause of not visiting the dentist. Among general population 23.02% felt that they
don’t have problem in their teeth, which is followed by reason of high cost of
dental treatment (23.81%). While 23.41% answered fear as the reason for not
visiting the dentist. The differences in response rate of various reasons between
mining employees and general population revealed statistical significance
(P<0.05) except for no dentist nearby and the lack of time or permission (Table
14/Graph 14)

Between different units of mining employees no problem with my teeth

remains the reason for not visiting the dentist. However 26.51% of cutting unit
responded that they had no interest in visiting the dentist and No dentist nearby
remained the second commonest choice for not visiting the dentist and the
differences for these two showed statistical significance (P=0.023 and P=0.008)
(Table 14/Graph 14).

6.16 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

SYSTEMIC DISEASES

Among marble mining employees most common systemic disease was

respiratory diseases with 23.39% prevalence which was followed by
diabetes(21.05%) and heart problem (11.7%). Whereas, in general population, eye
problem was the most prevalent systemic disease with 27.78%, followed by
diabetes in 22.22% examined population. The differences in prevalence of various
systemic diseases on comparison between mining employees and general
population revealed no statistical significant difference (P=0.412).

93
 Within mining employees 38.46% of Administrative unit reported diabetes
and which was higher compared to other units. While 32.79% of polishing unit
reported respiratory diseases which was more than other units. But the Intra group
comparison of prevalence of systemic diseases yielded no statistically significant
difference (P=0.738) (Table 15/Graph 15).

6.17 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

PREVALENCE OF TMJ DISORDERS:

There was statistically significant difference in the prevalence of TMJ

disorder between Mining employees (16.40%) and general population (10.42%)
(P= 0.006).

Within the mining employees there was higher prevalence of TMJ disorder
among maintenance workers (20.93%) compared to administrative unit(20.93%),
transportation unit(14.29%), cutting unit (15%) though there was no statistically
significant difference (P=0.659) between the different units (Table 16/Graph 16).

6.18 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

ORAL MUCOSAL LESIONS:

Among mining employees the prevalence of oral mucosal lesions was

31.6% and among general population it was 17.8%. The differences were
statistically significant (P<0.001).

The prevalence of ulcer among mining employees was 6.00% followed by

oral submucous fibrosis (OSMF) (5.20%) and abscess (3.60%). Whereas among
general population the prevalence of ulcers was 3.54% followed by oral
submucous fibrosis (3.75%) and abscess (2.08%).

Within mining employees leukoplakia had the highest prevalence

compared to other lesions among all the units and it was highest among
transportation staff (20.0%) followed by cutting unit workers (19.29%) and
maintenance unit workers (17.78%) than compared to administrative unit
(11.63%) and polishing unit (11.36%) though the differences were statistically
significant insignificant. (P=0.649). (Table 17/Graph17).

94
6.19 DISTRIBUTION OF ORAL MUCOSAL LESIONS ACCORDING
TO LOCATION IN ORAL CAVITY AMONG STUDY
POPULATION

Among marble mining employees 67.09% of all the lesions appeared in

buccal mucosa followed by 15.82% in commissures and 5.6% in alveolar ridges.
Among general population, 56.0% of lesions were seen in buccal mucosa and 16.0
% occurred on the tongue. The difference in the site wise prevalence of oral
mucosal lesions between the general population and the mining employees was
statistically significant (P=0.017) (Table 18/Graph 18).

6.20 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

PREVALENCE OF LEUKOPLAKIA:

Out of the various oral mucosal lesions among mining employees,

leukoplakia had the highest prevalence of about 16.60% against only 7.71% of
general population with leukoplakia. The differences were statistically significant
(P=0.000), however the difference in between the different mining employees was
statistically insignificant (P=0.255) (Table 19/Graph 19)

6.21 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

PREVALENCE OF DENTAL FLUOROSIS AND ENAMEL
OPACITIES

Among mining employees 74.40% (372) had dental fluorosis, whereas

only 52.08% (250) of general population showed dental fluorosis. The differences
were statistically significant (P=0.000). Within mining employees 78.57 % of
transportation unit, 77.14% of cutting unit, 73.48% of polishing unit, 66.67% of
Maintenance staff, and 62.79% of administrative staff workers were showing
dental fluorosis. Difference in prevalence was statistically insignificant (P=0.175).
(Table 20/Graph 20).

95
6.22 DISTRIBUTION OF STUDY POPULATION ACCORDING TO
COMMUNITY PERIODONTAL INDEX (CPI) SCORES

Among marble mining employees only 7.60% (38) had healthy

periodontium while 17.80% (89) and 39.0% (195) had bleeding and calculus
scores respectively, while 29.20% (146) and 6.4% (32) had 4-5 mm and 6 mm or
more pocket depth respectively. Among general population 10.425 (50) had
healthy periodontium, 24.17% (116) and 35.63% (171) showed bleeding and
calculus scores. Whereas, only 26.04% (125) and 3.75% (18) showed 4-5 mm and
6 mm pocket depths respectively. On comparison the difference in prevalence of
various CPI scores between mining employees and general population was
statistically significant (P=0.018).

Within mining employees, the prevalence of higher CPI score of 4-5 mm

pocket depth was higher in cutting unit workers (39.2%) and transportation unit
workers (32.86%) compared to other units, whereas healthy periodontium had
higher prevalence among administrative unit (23.26%) compared to other units.
The differencein prevalence showed statistical significance (P=0.001). (Table
21/Graph 21)

6.23 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

LOSS OF ATTACHMENT (LOA) SCORES

Among marble mining employees 23.20% (116) showed 0-3 mm LOA as

against to 30.83% of general population. 29.40% (147) and 27.00% (135) of
mining employees showed 4-5 mm and 6-8 mm LOA scores respectively as
compared to 29.58% and 28.33% of 4-5 mm and 6-8 mm LOA scores respectively
among general population. 13% and 7.40% showed higher LOA scores of 9-11
mm and 12 mm or more respectively among mining employees when compared to
9.17% (44) and 2.08% (10) among general population respectively. The
intergroup comparison between mining employees and general population did not
reveal any statistical significance (P=0.000).

96
 Within mining employees higher LOA scores of 9-11mm and 12mm or
more, had high prevalence among administrative unit (20.93% and 11.63%) and
transportation unit workers (16.43%, 7.86%) compared to other units. The intra
group comparison between mining units in regard to prevalence of various LOA
scores revealed statistically insignificant difference (P=0.733). (Table 22/
Graph 22)

6.24 DISTRIBUTION OF CPI SCORES AMONG USER AND NON-

USER OF TOBACCO PRODUCTS AMONG STUDY
POPULATION

Among marble mining employees it was found that the prevalence of

higher CPI scores of 4-5 mm and 6 mm or more deep pockets were more among
the tobacco users which was 33.0% and 7.30% respectively when compared to the
tobacco non-users which was 14.56% and 2.91% respectively. Whereas the
prevalence of healthy periodontium was higher among the tobacco non-users
(29.13%) compared to the tobacco users (2.02%). The differences revealed
statistical significance (P=0.000). A Similar trend was seen among the individual
mining units.

Similar trend was seen among the general population where the prevalence
of higher CPI scores of 4-5 mm and 6 mm or more deep pockets was more among
the tobacco users which was 38.18% and 4.05% respectively when compared to
the tobacco non-users which was 4.1% and 0% respectively. Whereas the
prevalence of healthy periodontium was higher among the tobacco non-users
(23.91%) compared to the tobacco users (2.03%). The differences in prevalence
between tobacco users and tobacco non-users yielded statistical significance
(P=0.000) (Table 23/Graph 23).

6.25 DISTRIBUTION OF LOA SCORES AMONG USER AND NON-

USER OF TOBACCO PRODUCTS AMONG STUDY
POPULATION

97
 Among marble mining employees it was found that the prevalence of
higher LOA scores of 6-8 mm , 9-11 mm, 12mm or more was more among the
tobacco users which was 33.75%, 14.61% and 6.30% respectively when compared
to the tobacco non-users which was 14.56%, 8.75% and 4.85% respectively.
Whereas the prevalence of lower LOA scores of 0-3mm was higher among the
tobacco non-users (44.66%) compared to the tobacco users (14.11%). The
differences revealed statistical significance (P=0.000). A similar trend was seen
among the individual mining units.

Similar trend was seen among the general population where the prevalence
of higher LOA scores of 6-8 mm, 9-11 mm, 12mm or more was more among the
tobacco users which was 42.23%, 14.19% and 2.03% respectively when compared
to the tobacco non-users which was 1.4%, 0% and 0% respectively. Whereas the
prevalence of lower LOA scores of 0-3mm was more among the tobacco non-
users (53.26%) compared to the tobacco users (11.82%). The differences in
prevalence between tobacco users and non-users yielded statistical significance
(P=0.000) (Table 24/Graph 24).

6.26 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

DECAYED, MISSING & FILLED TEETH

6.26.1 Decay Component (D)

D component had prevalence of 58.33% (280) among general population

compared to only 41.20% (206) among mining employees which was found to be
statistically significant (P=0.000).

Within mining employees highest prevalence of D component was among

transportation unit which was 55.0% followed by maintenance unit (37.7%) and
polishing units (37.8%). Whereas, administrative unit had the least prevalence of
decay which was 27.9%. On comparison between mining units, the differences in
the prevalence of decay was statistically significant (P=0.002). (Table 25/Graph
25)

6.26.2 Missing Component (M)

98
 34.0 % (170) and 29.58% (142) of mining employees and general
population respectively had missing component. But the differences did not show
any statistical significance (P=0.138).

Within mining units, transportation unit (39.2%) had a higher prevalence

of missing component followed by maintenance unit (33.3%) and polishing unit
(32.5%). The differences between the mining units did not reveal statistical
significance (P=0.592). (Table 25/Graph 25)

6.26.3 Filled Component (F)

Among mining employees 13.80% had filled component as compared to

17.71% of general population. The differences were not statistically significant.
(P=0.093)

Within mining units, administrative (27.9%) and maintenance units

(31.1%) showed higher prevalence of filled component compared to other units
which was statistically significant (P=0.000). (Table 25/Graph 25)

6.27 AGE WISE DISTRIBUTION OF MEAN NUMBER OF DECAYED

TEETH AMONG THE STUDY POPULATION

It was found that mean decay was higher among the older age groups
compared to the younger age groups in both mining employees and general
population which was statistically significant (P=0.005). The difference noted in
between the mining employees and the general population for the decayed tooth
were statistically significant for the age group 25-3 years and for the rest of the
age group the difference remained insignificant. However, in between the mining
employees there existed a statistically significant difference between the
administrative unit workers and the cutting, polishing and the transportation unit
employees for the age group less than 25 years (P<0.05) and in between the
maintenance unit and the cutting unit, between the transportation and cutting unit
there existed a highly significant difference (P<0.01) for the age group more than
45 years (Table 26, Graph 26).

99
6.28 PREVALENCE AND MEAN OF DENTAL CARIES IN STUDY
POPULATION ACCORDING TO SWEET FREQUENCY

The mean decay of mining employees and general population in daily

sweet consuming group was 6.07±1.66 and 5.67±1.30 respectively whereas in
occasional sweet consuming group it was 1.99±1.24 and 1.55±0.83 respectively.
The differences in mean decay noted was statistically highly significant in both
Mining employees (P<0.01) and general population (P<0.01) for daily and 2 to 3
times a week sweet consuming units (Table 27/Graph 27)).

6.29 PREVALENCE OF DENTAL CARIES IN STUDY POPULATION

ACCORDING TO SOCIOECONOMIC STATUS

Prevalence of caries was more in the upper class mining employees with
50%, followed by upper lower (46.05%) and lower (68.57%) and the difference
was statistically significant (P=0.000) (Table 28/Graph 28).

In general population, dental caries was more prevalent in 71.43% and

was least prevalent in upper class with 45.0%. However, the difference noted was
statistically insignificant (P=0.133)(Table 28/Graph 28).

6.30 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

TREATMENT NEEDS

6.30.1 Restoration of Teeth

Among mining employees 29.20% needed restoration as against to

43.75% among general population. The difference in prevalence was statistically
significant (P=0.000).

Within mining employees, the need for restoration was highest in

transportation unit (39.29%) followed by of maintenance unit (31.11%). The
difference between mining units was significant (P=0.033). (Table 29/Graph 29)

6.30.2 Extraction of Teeth

100
 Among mining employees 12.00% needed extraction as against to 14.58%
among general population. The differences were not statistically significant
(P=0.233)

The need for extraction was highest among the transportation unit workers
which was 15.71% followed by 13.64% of polishing unit and 10.71% of cutting
units and it was least required among the administrative unit(4.65%). The
difference between individual units were statistically significant (P=0.215). (Table
29/Graph 29)

6.30.3 Pulp Care Treatment

Among mining employees 12.60% needed pulp care treatment as against

to 18.75% among general population. The differences were statistically significant
(P=0.008)

Among marble mining employees, pulp care was required in 17.86% of

transportation unit workers followed by 12.86% of polishing unit and 11.11% of
maintenance unit employees. Whereas pulp care was least required among the
administrative (6.98%).The difference was found to be statistically insignificant
(P=0.176). (Table 29/Graph 29)

6.31 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

PROSTHETIC NEEDS AND PROSTHETIC STATUS

6.31.1 Prosthetic Needs

Only 29.58% of the general population needed upper prosthesis as

compared to 34.0% of mining employees. The difference was statistically
insignificant (P=0.138).

Within the marble mining employees 39.29% of Transportation unit

followed by 33.33% of maintenance unit workers needed prosthesis whereas only
27.91% of the administrative unit was requiring prosthesis. But the difference

101
between units did not show statistically significant (P=0.592). (Table 30/Graph
30)

6.31.2 Prosthetic Status

7.29% of general population had prosthesis compared to 6.20% of mining

employees. The differences were not statistically significant (P=0.495).

Among mining employees, 7.14% of transportation unit, 6.67% of

maintenance unit, 6.06% of cutting unit had prosthesis as compared to only 4.65
% of administrative unit. The difference was statistically insignificant (P=0.495).
(Table 30/Graph 30)

6.32 MEAN TREATMENT NEEDS OF STUDY POPULATION

Mean restoration needed in the mining workers was 2.14±0.79 and the
mean restoration need in the general population was 2.13±0.60 and the difference
found was statistically non-significant.

The mean extraction need was 1.72±0.69 and 1.64±0.76 in mining

population and general population respectively. The difference noted was
statistically insignificant.

The difference in the mean pulp care need was statistically insignificant.
The mean pulp care need of the mining population was 1.70±0.78 and in the
general population was 1.59±0.76. (Table 31/Graph 31)

6.33 DISTRIBUTION OF STUDY POPULATION ACCORDING TO DAI

(DENTAL AESTHETIC INDEX) SCORE

There was no statistically significant difference in DAI score between

general population and mining employees (P=0.122) (Table 32/Graph 32).

6.34 DISTRIBUTION OF STUDY POPULATION ACCORDING TO

GRADES OF TOOTH SURFACE LOSS IN ANTERIOR TEETH
(Eccle’s and Jenkin’s criteria)

102
 Marble mining employees had 33.8% of tooth surface loss when compared
to only 11.46% of general population. The difference was statistically significant
(P=0.000).

Within mining employees highest prevalence of Grade 1 tooth surface loss

was observed among polishing unit (30.30%) followed by cutting unit (25.00 %)
compared to administrative unit (13.95%), maintenance unit (22.22%) and
transportation unit (15.71%) which was found to be statistically significant
(P=0.002).

Grade 2 and Grade 3 tooth surface loss was also highly prevalent in case
of polishing unit compared to other units which was statistically significant.
(P=0.002) (Table 33/Graph 33)

6.34.1 Comparison of Mean Grades of Anterior Teeth Surface Loss

According to the Mean Duration of Employment among Mining
Employees

It was seen that the mean loss of tooth surface was 1.81±1.02 in the 20
years of work experience group and in the group of 15 to 20 years of work
experience the mean tooth surface loss was 1.40±0.80. The difference noted was
statistically very highly significant for the different employee groups. The high
mean of 2.60±0.89 was noted for polishing unit employees than the administration
employees who had the mean tooth loss of 0.80±0.45. This trend of increased
tooth surface loss as the work experience increased was noted for the polishing
unit employees followed by the cleaning unit employees (Table 34/Graph 34)

6.34.2 Mean Grades of Anterior Teeth Surface Loss According to the Mean
Duration of Employment among Mining Employees

When the trend of tooth loss with respect to the years of experience was
checked it was seen that as the years of experience increased the anterior tooth
loss increased. This increase in the tooth loss is statistically very highly significant
with P value less than 0.001. The tooth wear was seen more in the group of more
than 20 years of experience in all the mining employees unit, however it was

103
greater in polishing (2.60±0.89) and cutting unit employees (2.11±1.05) (Table
35, 36/Graph 35, 36)

6.35. COMPARISON OF PARTICULATE MATTER VALUES IN

DIFFERENT AREAS OF UDAIPUR CITY

The particulate matter level obtained in different parts of the Udaipur

showed that the PM level was more in the mining areas (254.00) and the regional
office of Madri industrial area (212.00). The difference noted in different regions
is statistically significant with P=0.000.

104
 Table 1: Distribution of study population based on groups

Study Population No %
Marble Mining employees (Study group) 500 51.02
General Population (Comparative group) 480 48.98
Total 980 100

Table 2: Distribution of marble mining labourers based on work units

Mining employees (M.E) No %

Administrative unit (A) 43 8.60
Maintenance unit (M) 45 9.00
Transportation unit (T) 140 28.00
Cutting unit (C) 140 28.00
Polishing unit (P) 132 26.40
Total 500 100

Table 3: Distribution of study population according to age groups in years

Age group Mining employees (M.E) M.E -

G.P Total
(in yrs) A M T C P Total
No 5 8 26 22 26 87 68 155
15-24
% 11.63 17.78 18.57 15.71 19.70 17.40 14.17 15.82
No 20 27 86 60 69 262 230 492
25-34
% 46.51 60.00 61.43 42.86 52.27 52.40 47.92 50.20
No 13 7 24 38 37 119 140 259
35-44
% 30.23 15.56 17.14 27.14 28.03 23.80 29.17 26.43
No 5 3 4 20 0 32 42 74
45 -54
% 11.63 6.67 2.86 14.29 0.00 6.40 8.75 7.55
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Intra group - M.E: χ2 = 39.886, df = 12, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.163
Inter group (M.E. Vs G.P.): χ2 = 7.059, df = 3, P = 0.070 (> 0.05) (Not Sig.)
Cramer's V= 0.085
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit; M.E –Mining employees; G.P-General
Population

105
 Table 4: Distribution of study population according to literacy levels

Mining employees
M.E -
Literacy G.P Total
A M T C P Total
Levels

No 2 6 105 100 100 313 99 412

Illiteracy
% 4.65 13.33 75.00 71.43 75.76 62.60 20.63 42.04

No 4 7 25 5 8 49 60 109
Primary
% 9.30 15.56 17.86 3.57 6.06 9.80 12.50 11.12

High No 8 8 5 20 15 56 116 172

school % 18.60 17.78 3.57 14.29 11.36 11.20 24.17 17.55

No 10 12 5 15 9 51 90 141
PUC
% 23.26 26.67 3.57 10.71 6.82 10.20 18.75 14.39

No 10 12 0 0 0 22 40 62
Diploma
% 23.26 26.67 0.00 0.00 0.00 4.40 8.33 6.33

No 9 0 0 0 0 9 75 84
Degree
% 20.93 0.00 0.00 0.00 0.00 1.80 15.63 8.57

No 43 45 140 140 132 500 480 980

Total
% 100 100 100 100 100 100 100 100

Intra group - M.E: χ2 = 269.79, df = 20, P = 0.000 (<0.001) (VHS)

Cramer's V = 0.367

Inter group (M.E. Vs G.P.): χ2 = 200.741, df = 5, P = 0.000 (<0.001) (VHS)

Cramer's V= 0.453

*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-

Cutting unit; P-Polishing unit; M.E –Mining employees; G.P-General
Population

106
 Table 5: Distribution of study population according to socio economic status (SES) –
(Modified Kuppuswamy’s SES Classification Scale)

SES Mining employees M.E –

G.P Total
Classification A M T C P Total
No 2 0 0 0 0 2 20 22
Upper
% 4.65 0.00 0.00 0.00 0.00 0.40 4.17 2.24
Upper No 26 12 0 8 0 46 64 110
middle % 60.47 26.67 0.00 5.71 0.00 9.20 13.33 11.22
No 15 33 5 72 70 195 160 355
Middle
% 34.88 73.33 3.57 51.43 53.03 39.00 33.33 36.22
Upper No 0 0 40 56 56 152 166 318
lower % 0.00 0.00 28.57 40.00 42.42 30.40 34.58 32.45
No 0 0 95 4 6 105 70 175
Lower
% 0.00 0.00 67.86 2.86 4.55 21.00 14.58 17.86
No 43 45 140 140 132 500 480 980
Total 100.0 100.0 100.0
% 100.00 100.00 100.00 100.00 100.00
0 0 0
Intra group - M.E: χ = 467.054, df = 16, P = 0.000 (<0.001) (VHS)
2

Cramer's V = 0.483
Inter group (M.E. Vs G.P.): χ2 = 28.343, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.170
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

Table 6: Distribution of study population according to diet

Mining employees M.E –

Diet G.P Total
A M T C P Total
No 30 24 32 58 57 201 181 382
Veg
% 69.77 53.33 22.86 41.43 43.18 40.20 37.71 38.98
No 13 21 108 82 75 299 299 598
Mixed
% 30.23 46.67 77.14 58.57 56.82 59.80 62.29 61.02
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Intra group - M.E: χ2 = 36.959, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.272
Inter group (M.E. Vs G.P.): χ2 = 0.639, df = 1, P = 0.424 (>0.05) (Not Sig.)
Cramer's V= 0.026
*A - Administrative; M-Maintenance unit; T-Transportation unit; C-Cutting unit;
P-Polishing unit; M.E –Mining employees; G.P-General Population

107
 Table 7: Distribution of study population according to sweet consumption

Sweet Mining employees M.E -

G.P Total
consumption A M T C P Total
No 10 9 15 10 12 56 50 106
No sweet
% 23.26 20.00 10.71 7.14 9.09 11.20 10.42 10.82
No 3 5 26 11 12 57 46 103
Daily
% 6.98 11.11 18.57 7.86 9.09 11.40 9.58 10.51
2-3 times No 10 10 30 30 26 106 180 286
/week % 23.26 22.22 21.43 21.43 19.70 21.20 37.50 29.18
No 20 21 69 89 82 281 204 485
Occasionally
% 46.51 46.67 49.29 63.57 62.12 56.20 42.50 49.49
No 43 45 140 140 132 500 480 980
Total 100.0 100.0 100.0 100.0 100.0 100.0
% 100.00 100.00
0 0 0 0 0 0
Intra group - M.E: χ = 25.588, df = 12, P = 0.012 (<0.05) (S)
2

Cramer's V = 0.131
Inter group (M.E. Vs G.P.): χ2 = 32.491, df = 3, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.182
*A - Administrative; M-Maintenance unit; T-Transportation unit; C-Cutting unit;
P-Polishing unit; M.E –Mining employees; G.P-General Population

Table 8A: Distribution of study population according to use of tobacco products

Mining employees(M.E) M.E -

Tobacco use G.P Total
A M T C P Total
No 33 37 120 105 102 397 296 693
User
% 76.74 82.22 85.71 75.00 77.27 79.40 61.67 70.71
No 10 8 20 35 30 103 184 287
Non-user
% 23.26 17.78 14.29 25.00 22.73 20.60 38.33 29.29
No 43 45 140 140 132 500 480 980
Total 100.0 100.0 100.0 100.0 100.0
% 100.00 100.00 100.00
0 0 0 0 0
Intra group - M.E: χ2 = 5.839, df = 4, P = 0.211 (>0.05) (Not Sig)
Cramer's V = 0.108
Inter group (M.E. Vs G.P.): χ2 = 37.188, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.195
*A - Administrative; M-Maintenance unit; T-Transportation unit; C-Cutting unit;
P-Polishing unit; M.E –Mining employees; G.P-General Population

108
Table 8B: Distribution of study population according to type of tobacco products
and alcohol use

Mining employees M.E -

Tobacco use G.P Total
A M T C P Total
No 08 04 10 00 00 22 30 52
Cigarette
% 18.60 8.89 7.14 0.00 0.00 4.40 6.25 5.31
No 01 08 08 25 38 80 66 146
Bidi
% 2.33 17.78 5.71 17.86 28.79 16.00 13.75 14.90
Tobacco No 08 10 28 25 25 96 74 170
leaf % 18.60 22.22 20.00 17.86 18.94 19.20 15.42 17.35
No 04 00 01 00 01 06 20 26
Pan
% 9.30 0.00 0.71 0.00 0.76 1.20 4.17 2.65
No 12 15 73 55 38 193 106 299
Gutkha
% 27.91 33.33 52.14 39.29 28.79 38.60 22.08 30.51
No 28 33 110 125 108 404 290 694
Alcohol
% 65.12 73.33 78.57 89.29 81.82 80.80 60.42 70.82
Cigarette:
Intra group - M.E: χ2 = 37.805, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.275
Inter group (M.E. Vs G.P.): χ2 = 1.668, df = 1, P = 0.197 (>0.05) (Not Sig.)
Cramer's V= 0.041
Bidi:
Intra group - M.E: χ2 = 33.529, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.259
Inter group (M.E. Vs G.P.): χ2 = 0.978, df = 1, P = 0.323 (>0.05) (Not Sig.)
Cramer's V= 0.032
Tobacco leaf:
Intra group - M.E: χ2 = 0.501, df = 4, P = 0.973 (>0.05) (Not Sig.)
Cramer's V= 0.032
Inter group (M.E. Vs G.P.): χ2 = 2.445, df = 1, P = 0.118 (>0.05) (Not Sig.)
Cramer's V= 0.050
Pan:
Intra group - M.E: χ2 = 26.553, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.230
Inter group (M.E. Vs G.P.): χ2 = 8.346, df = 1, P = 0.004 (<0.01) (HS)
Cramer's V= 0.092
Gutkha:
Intra group - M.E: χ2 = 18.825, df = 4, P = 0.001 (<0.01) (HS)
Cramer's V= 0.194
Inter group (M.E. Vs G.P.): χ2 = 31.511, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.179
Alcohol:
Intra group - M.E: χ2 = 15.470, df = 4, P = 0.004 (<0.01) (HS)
Cramer's V= 0.176
Inter group (M.E. Vs G.P.): χ2 = 49.234, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.224

109
 Table 9: Distribution of study population according to their oral hygiene
habits
Mining employees M.E –
G.P Total
A M T C P Total
Frequency of cleaning
No 43 45 129 102 100 419 430 849
Once
% 100.00 100.00 92.1 72.8 75.7 100.00 97.73 98.84
No 0 0 0 0 0 0 10 10
Twice
% 0.00 0.00 0.00 0.00 0.00 0.00 2.27 1.16
After No 0 0 0 0 0 0 0 0
every
% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
meal
No 43 45 129 102 100 419 440 859
Total
% 100.00 100.00 92.1 72.8 75.7 100.00 100.00 100.00
Mechanical aids used for cleaning
No 41 37 60 70 80 288 377 665
Brush
% 95.35 82.22 46.51 68.63 80.00 68.74 85.68 77.42
No 2 7 39 23 17 88 51 139
Finger
% 4.65 15.56 30.23 22.55 17.00 21.00 11.59 16.18
No 0 1 30 9 3 43 12 55
Others
% 0.00 2.22 23.26 8.82 3.00 10.26 2.73 6.40
No 43 45 129 102 100 419 440 859
Total
% 100 100 100 100 100 100 100 100
Material used for cleaning
No 0 0 18 10 8 36 6 35
Nil
% 0.00 0.00 13.95 9.80 8.00 8.59 1.36 4.89
No 38 37 81 72 74 302 330 685
Paste
% 88.37 82.22 62.79 70.59 74.00 72.08 75.00 73.57
No 4 5 16 10 10 45 66 109
Powder
% 9.30 11.11 12.40 9.80 10.00 10.74 15.00 12.92
No 1 3 14 10 8 36 38 72
Others
% 2.33 6.67 10.85 9.80 8.00 8.59 8.64 8.61
No 43 45 129 102 100 419 440 980
Total
% 100 100 100 100 100 100 100 100
Frequency of cleaning:
Intra group - M.E: χ2 = Not applicable as frequency of cleaning in all the sub-groups is
“once”
Cramer's V = Not applicable
Inter group (M.E. Vs G.P.): χ2 = 7.761, df = 1, P = 0.005 (<0.01) (HS)
Cramer's V= 0.095
Mechanical aids used for cleaning:
Intra group - M.E: χ2 = 62.773, df = 8, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.274
Inter group (M.E. Vs G.P.): χ2 = 38.743, df = 2, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.212
Material used for cleaning:
Intra group - M.E: χ2 = 14.979, df = 12, P = 0.243 (>0.05) (Not Sig.)
Cramer's V = 0.109
Inter group (M.E. Vs G.P.): χ2 = 26.198, df = 3, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.175
*A – Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

110
 Table 10: Distribution of the Marble Mining employees according to use of
personal protective measures (PPM)
Mining employees
PPM Total
A M T C P
Face cloth
Using Face No 0 6 8 9 10 33
cloth % 0.00 13.33 5.71 6.43 7.58 6.60
Not using No 43 39 132 131 122 467
Face
%
cloth/mask 100.00 86.67 94.29 93.57 92.42 93.40
No 43 45 140 140 132 500
Total
% 100 100 100 100 100 100
Ear plug
Using Ear No 0 8 5 8 6 27
plugs % 0.00 17.78 3.57 5.71 4.55 5.40
Not using No 43 37 135 132 126 473
Ear plugs % 100.00 82.22 96.43 94.29 95.45 94.60
No 43 45 140 140 132 500
Total
% 100 100 100 100 100 100
Face cloth: χ = 6.737, df = 4, P = 0.150 (>0.05) (Not Sig.)
2

Cramer's V = 0.116
Ear plug oth: χ2 = 17.083, df = 4, P = 0.002 (<0.01) (HS)
Cramer's V = 0.185
*A – Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit

Table 11: Distribution of the Marble Mining employees according to

duration of employment in the Mining.
Duration of Mining employees
Employment Total
A M T C P
In Years
No 10 14 48 40 38 150
<5
% 23.26 31.11 34.29 28.57 28.79 30.00
No 16 12 63 59 53 203
5-10
% 37.21 26.67 45.00 42.14 40.15 40.60
No 10 8 8 25 28 79
11-15
% 23.26 17.78 5.71 17.86 21.21 15.80
No 2 6 19 7 8 42
16-20
% 4.65 13.33 13.57 5.00 6.06 8.40
No 5 5 2 9 5 26
>20
% 11.63 11.11 1.43 6.43 3.79 5.20
No 43 45 140 140 132 500
Total
% 100 100 100 100 100 100
χ2 = 38.627, df = 16, P = 0.001 (<0.01) (HS)
Cramer's V = 0.139
*A - Administrative; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit

111
 Table 12: Distribution of study population according to dental visit
Mining employees M.E
Dental visit – G.P Total
A M T C P Total
No 26 24 31 57 48 186 228 414
Yes
% 60.47 53.33 22.14 40.71 36.36 37.20 47.50 42.24
No 17 21 109 83 84 314 252 566
No
% 39.53 46.67 77.86 59.29 63.64 62.80 52.50 57.76
No 43 45 140 140 132 500 480 980
Total
% 100 100 100 100 100 100 100 100
Intra group - M.E: χ2 = 29.343, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.242
Inter group (M.E. Vs G.P.): χ2 = 10.649, df = 1, P = 0.001 (<0.01) (HS)
Cramer's V = 0.104
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit; M.E –Mining employees; G.P-General
Population

Table 13: Distribution of study population according to reasons for dental visit

Reasons for Mining employees M.E –

G.P Total
dental visit A M T C P Total
No 9 10 28 40 33 120 130 250
Extraction
% 34.62 41.67 90.32 70.18 68.75 64.52 57.02 60.39
Replacement No 5 3 1 2 2 13 22 35
of teeth % 19.23 12.50 3.23 3.51 4.17 6.99 9.65 8.45
No 5 6 2 8 6 27 65 92
Restoration
% 19.23 25.00 6.45 14.04 12.50 14.52 28.51 22.22
No 4 3 0 5 6 18 3 21
Cleaning
% 15.38 12.50 0.00 8.77 12.50 9.68 1.32 5.07
No 3 2 0 2 1 8 8 16
Others
% 11.54 8.33 0.00 3.51 2.08 4.30 3.51 3.86
No 26 24 31 57 48 186 228 414
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Within Mining Employees: Between Mining employees and General Population:
Extraction -
χ2 = 25.819, df = 4, P = 0.000 (<0.001) (VHS) χ2 = 2.408, df = 1, P = 0.121 (>0.05) (Not Sig.)
Cramer's V = 0.372 Cramer's V = 0.076
Replacement-
χ2 = 5.741, df = 4, P = 0.219 (>0.05) (Not Sig.) χ2 = 0.936, df = 1, P = 0.333 (>0.05) (Not Sig.)
Cramer's V = 0.176 Cramer's V = 0.048
Restoration -
χ2 = 11.604, df = 1, P = 0.001 (<0.01) (HS)
χ2 = 2.612, df = 4, P = 0.625 (>0.05) (Not Sig.)
Cramer's V = 0.167
Cramer's V = 0.119
Cleaning -
χ2 = 14.874, df = 1, P = 0.000 (<0.001) (VHS)
χ2 = 2.922, df = 4, P = 0.571 (>0.05) (Not Sig.)
Cramer's V = 0.190
Cramer's V = 0.125
Others -
χ2 = 0.173, df = 1, P = 0.677 (>0.05) (Not Sig.)
χ2 = 2.712, df = 4, P = 0.607 (>0.05) (Not Sig.)
Cramer's V = 0.020
Cramer's V = 0.121
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting unit;
P-Polishing unit; M.E –Mining employees; G.P-General Population

112
 Table 14: Distribution of study population according to reasons for not
visiting the dentist

Reasons for not Mining employees M.E -

G.P Total
visiting dentist A M T C P Total
No Problem No 8 10 35 24 23 100 58 158
with my teeth % 47.06 47.62 32.11 28.92 27.38 31.85 23.02 27.92
No dentists No 4 6 8 7 10 35 30 65
nearby % 23.53 28.57 7.34 8.43 11.90 11.15 11.90 11.48
Lack of No 0 2 18 8 15 43 45 88
time/Permission % 0.00 9.52 16.51 9.64 17.86 13.69 17.86 15.55
High cost of No 3 1 15 7 17 43 60 103
Treatment % 17.65 4.76 13.76 8.43 20.24 13.69 23.81 18.20
No 1 2 12 15 10 40 59 99
Fear
% 5.88 9.52 11.01 18.07 11.90 12.74 23.41 17.49
No 1 0 21 22 9 53 0 53
Not interested
% 5.88 0.00 19.27 26.51 10.71 16.88 0.00 9.36
No 17 21 109 83 84 314 252 566
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Within Mining employees: Between Mining employees and General Population:
No Problem with my teeth -
χ2 = 5.323, df = 4, P = 0.256 (>0.05) (Not Sig.) χ2 = 5.418, df = 1, P = 0.020 (<0.05) (Sig.)
Cramer's V = 0.130 Cramer's V = 0.147
No dentists nearby-
χ2 = 11.331, df = 4, P = 0.023 (<0.05) (Sig.) χ2 = 0.079, df = 1, P = 0.779 (>0.05) (Not Sig.)
Cramer's V = 0.190 Cramer's V = 0.018
Lack of time/Permission -
χ2 = 1.845, df = 1, P = 0.174 (>0.05) (Not Sig.)
χ2 = 6.126, df = 4, P = 0.190 (>0.05) (Not Sig.)
Cramer's V = 0.086
Cramer's V = 0.140
High cost of Treatment -
χ2 = 9.609, df = 1, P = 0.002 (<0.01) (HS)
χ2 = 6.630, df = 4, P = 0.157 (>0.05) (Not Sig.)
Cramer's V = 0.195
Cramer's V = 0.145
Fear -
χ2 = 11.037, df = 1, P = 0.001 (<0.01) (HS)
χ2 = 3.384, df = 4, P = 0.496 (>0.05) (Not Sig.)
Cramer's V = 0.209
Cramer's V = 0.104
Not interested -
χ2 = 46.929, df = 1, P = 0.000 (<0.001) (VHS)
χ2 = 13.930, df = 4, P = 0.008 (<0.01) (HS)
Cramer's V = 0.432
Cramer's V = 0.211

*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting unit;

P-Polishing unit; M.E –Mining employees; G.P-General Population

113
 Table 15: Distribution of study population according to systemic diseases
Mining employees M.E -
Systemic Diseases G.P Total
A M T C P Total
No 5 3 15 8 5 36 24 60
Diabetes
% 38.46 37.50 26.79 24.24 8.20 21.05 22.22 21.51
No 3 0 5 5 4 17 9 26
Hypertension
% 23.08 0.00 8.93 15.15 6.56 9.94 8.33 9.32
Eye No 4 3 6 6 10 29 30 59
Problems % 30.77 37.50 10.71 18.18 16.39 16.96 27.78 21.15
Respiratory No 0 2 13 5 20 40 17 57
diseases % 0.00 25.00 23.21 15.15 32.79 23.39 15.74 20.43
No 0 0 6 3 4 13 8 21
Skin
% 0.00 0.00 10.71 9.09 6.56 7.60 7.41 7.53
No 1 0 7 2 10 20 12 32
Heart
% 7.69 0.00 12.50 6.06 16.39 11.70 11.11 11.47
No 0 0 4 4 8 16 8 24
Hearing
% 0.00 0.00 7.14 12.12 13.11 9.36 7.41 8.60
No 13 8 56 33 61 171 108 279
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Intra group - M.E: χ2 = 19.251, df = 24, P = 0.738 (>0.05) (Not Sig.)
Cramer's V = 0.168
Inter group (M.E. Vs G.P.): χ2 = 6.102, df = 6, P = 0.412 (>0.05) (Not Sig.)
Cramer's V= 0.148
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting unit;
P-Polishing unit; M.E –Mining employees; G.P-General Population

Table 16: Distribution of study population according to prevalence of TMJ disorders

TMJ Mining employees M.E -

G.P Total
Disorder A M T C P Total
No 9 10 20 21 22 82 50 132
Yes
% 20.93 22.22 14.29 15.00 16.67 16.40 10.42 13.47
No 34 35 120 119 110 418 430 848
No
% 79.07 77.78 85.71 85.00 83.33 83.60 89.58 86.53
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Intra group - M.E: χ2 = 2.420, df = 4, P = 0.659 (>0.05) (Not Sig.)
Cramer's V = 0.070
Inter group (M.E. Vs G.P.): χ2 = 7.522, df = 1, P = 0.006 (<0.01) (HS)
Cramer's V= 0.088
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit; M.E –Mining employees; G.P-General
Population

114
 Table 17: Distribution of study population according to oral mucosal lesions (OML)

Oral mucosal Mining employees M.E -

G.P Total
lesions A M T C P Total

No 32 28 92 100 90 342 398 740

No OML
% 74.42 62.22 65.71 71.43 68.18 68.40 82.92 75.51

No 5 8 28 27 15 83 37 120
Leukoplakia
% 11.63 17.78 20.00 19.29 11.36 16.60 7.71 12.24

Lichen No 0 0 0 0 1 1 0 1
Planus % 0.00 0.00 0.00 0.00 0.76 0.20 0.00 0.10

No 3 3 5 5 14 30 17 47
Ulcer
% 6.98 6.67 3.57 3.57 10.61 6.00 3.54 4.80

No 0 3 6 4 5 18 10 28
Abscess
% 0.00 6.67 4.29 2.86 3.79 3.60 2.08 2.86

No 3 3 9 4 7 26 18 44
OSMF
% 6.98 6.67 6.43 2.86 5.30 5.20 3.75 4.49

No 43 45 140 140 132 500 480 980

Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00

Intra group - M.E: χ2 = 17.062, df = 20, P = 0.649 (>0.05) (Not Sig.)

Cramer's V = 0.092

Inter group (M.E. Vs G.P.): χ2 = 26.657, df = 5, P = 0.000 (<0.001) (VHS)

Cramer's V= 0.165

115
 Table 18: Distribution of oral mucosal lesions according to location in oral cavity
among study population
Mining employees M.E -
Oral mucosal lesions G.P Total
A M T C P Total
No 1 3 9 7 5 25 3 28
Commissures
% 9.09 17.65 18.75 17.50 11.90 15.82 6.00 13.46
No 1 2 2 2 0 7 0 7
Lips
% 9.09 11.76 4.17 5.00 0.00 4.43 0.00 3.37
No 0 0 0 0 5 5 2 7
Sulci
% 0.00 0.00 0.00 0.00 11.90 3.16 4.00 3.37
Buccal No 8 11 29 30 28 106 28 134
mucosa % 72.73 64.71 60.42 75.00 66.67 67.09 56.00 64.42
No 0 0 2 0 4 6 8 14
Tongue
% 0.00 0.00 4.17 0.00 9.52 3.80 16.00 6.73
No 1 0 0 0 0 1 3 4
Palate
% 9.09 0.00 0.00 0.00 0.00 0.63 6.00 1.92
Alveolar No 0 1 6 1 0 8 6 14
ridges % 0.00 5.88 12.50 2.50 0.00 5.06 12.00 6.73
No 11 17 48 40 42 158 50 208
Total
% 100 100 100 100 100 100 100 100
Intra group - M.E: χ = 24.623, df = 24, P = 0.426 (>0.05) (Not Sig.)
2

Cramer's V = 0.197
Inter group (M.E. Vs G.P.): χ2 = 15.435, df = 6, P = 0.017 (<0.05) (Sig.)
Cramer's V= 0.272
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

Table 19: Prevalence of leukoplakia among Mining employees and general

population
Mining employees M.E -
Leukoplakia G.P Total
A M T C P Total
No 38 37 112 113 117 417 443 860
Absent
% 88.37 82.22 80.00 80.71 88.64 83.40 92.29 87.76
No 5 8 28 27 15 83 37 120
Present
% 11.63 17.78 20.00 19.29 11.36 16.60 7.71 12.24
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Intra group - M.E: χ2 = 5.326, df = 4, P = 0.255 (>0.05) (Not Sig.)
Cramer's V = 0.103
Inter group (M.E. Vs G.P.): χ2 = 18.019, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.136
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

116
 Table 20: Distribution of study population according to prevalence of dental
fluorosis

Dental Mining employees M.E -

G.P Total
Fluorosis A M T C P Total
No 16 15 30 32 35 128 230 358
No
% 37.21 33.33 21.43 22.86 26.52 25.60 47.92 36.53
No 27 30 110 108 97 372 250 622
Yes
% 62.79 66.67 78.57 77.14 73.48 74.40 52.08 63.47
No 43 45 140 140 132 500 480 980
Total
% 100 100 100 100 100 100 100 100
Intra group - M.E: χ = 6.346, df = 4, P = 0.175 (>0.05) (Not Sig.)
2

Cramer's V = 0.113
Inter group (M.E. Vs G.P.): χ2 = 52.604, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.232
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting unit; P-
Polishing unit; M.E –Mining employees; G.P-General Population

Table 21: Distribution of study population according to community periodontal

index (CPI) scores.

Mining employees M.E -

CPI G.P Total
A M T C P Total
No 10 8 5 8 7 38 50 88
Healthy
% 23.26 17.78 3.57 5.71 5.30 7.60 10.42 8.98
No 5 10 20 26 28 89 116 205
Bleeding
% 11.63 22.22 14.29 18.57 21.21 17.80 24.17 20.92
No 15 16 60 44 60 195 171 366
Calculus
% 34.88 35.56 42.86 31.43 45.45 39.00 35.63 37.35
No 11 8 46 51 30 146 125 271
4 -5 mm
% 25.58 17.78 32.86 36.43 22.73 29.20 26.04 27.65
6mm or No 2 3 9 11 7 32 18 50
more % 4.65 6.67 6.43 7.86 5.30 6.40 3.75 5.10
Total No 43 45 140 140 132 500 480 980
% 100 100 100 100 100 100 100 100
Intra group - M.E: χ = 40.351, df = 16, P = 0.001 (<0.01) (HS)
2

Cramer's V = 0.142
Inter group (M.E. Vs G.P.): χ2 = 11.910, df = 4, P = 0.018 (<0.05) (S)
Cramer's V= 0.110
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit; M.E –Mining employees; G.P-General
Population

117
Table 22: Distribution of study population according to loss of attachment (LOA) scores

Mining employees M.E -

LOA G.P Total
A M T C P Total
No 10 11 28 33 34 116 148 264
0-3mm
% 23.26 24.44 20.00 23.57 25.76 23.20 30.83 26.94
No 08 12 41 40 46 147 142 289
4-5mm
% 18.60 26.67 29.29 28.57 34.85 29.40 29.58 29.49
No 11 13 37 42 32 135 136 271
6-8mm
% 25.58 28.89 26.43 30.00 24.24 27.00 28.33 27.65
No 09 05 23 16 12 65 44 109
9-11mm
% 20.93 11.11 16.43 11.43 9.09 13.00 9.17 11.12
12mm or No 05 04 11 09 08 37 10 47
more % 11.63 8.89 7.86 6.43 6.06 7.40 2.08 4.80
Total No 43 45 140 140 132 500 480 980
% 100 100 100 100 100 100 100 100
Intra group - M.E: χ = 12.159, df = 16, P = 0.733 (>0.05) (Not Sig.)
2

Cramer's V = 0.078
Inter group (M.E. Vs G.P.): χ2 = 23.127, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.154
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting unit; P-
Polishing unit; M.E –Mining employees; G.P-General Population

Table 23: Distribution of CPI scores among user and non-user of tobacco products
among study population
Mining employees General Population
CPI scores
Non- users Users Non-users Users
No 30 8 44 6
Healthy
% 29.13 2.02 23.91 2.03
No 15 74 44 72
Bleeding
% 14.56 18.64 23.91 24.32
No 40 155 78 93
Calculus
% 38.83 39.04 42.39 31.42
No 15 131 12 113
4 – 5 mm
% 14.56 33.00 6.52 38.18
6mm or No 3 29 6 12
more % 2.91 7.30 3.26 4.05
No 103 397 184 296
Total
% 100 100 100 100
Mining employees: χ2 = 91.840, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.429
General Population: χ2 = 99.866, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.456

118
Table 24: Distribution of LOA scores among user and non-user of tobacco products
among study population.

Mining employees General Population

LOA scores
Non-User User Non-User User

No 46 56 98 35
0-3mm
% 44.66 14.11 53.26 11.82

No 28 124 68 88
4-5mm
% 27.18 31.23 36.96 29.73

No 15 134 11 125
6-8mm
% 14.56 33.75 5.98 42.23

No 09 58 05 42
9-11mm
% 8.74 14.61 2.72 14.19

12mm or No 05 25 02 06

more % 4.85 6.30 1.09 2.03

No 103 397 184 296

Total
% 100 100 100 100

Mining employees: χ2 = 50.362, df = 4, P = 0.000 (<0.001) (VHS)

Cramer's V= 0.317

General Population: χ2 = 140.615, df = 4, P = 0.000 (<0.001) (VHS)

Cramer's V = 0.541

119
Table 25: Distribution of study population according to Decayed (D), Missing
(M) & Filled (F) teeth

Mining employees M.E –

DMF G.P Total
A M T C P Total
Decayed
No 12 17 77 50 50 206 280 486
Yes
% 27.91 37.78 55.00 35.71 37.88 41.20 58.33 49.59
No 31 28 63 90 82 294 200 494
No
% 72.09 62.22 45.00 64.29 62.12 58.80 41.67 50.41
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Missing
No 12 15 55 45 43 170 142 312
Yes
% 27.91 33.33 39.29 32.14 32.58 34.00 29.58 31.84
No 31 30 85 95 89 330 338 668
No
% 72.09 66.67 60.71 67.86 67.42 66.00 70.42 68.16
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Filled
No 12 14 15 18 10 69 85 154
Yes
% 27.91 31.11 10.71 12.86 7.58 13.80 17.71 15.71
No 31 31 125 122 122 431 395 826
No
% 72.09 68.89 89.29 87.14 92.42 86.20 82.29 84.29
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Decayed:
Intra group - M.E: χ2 = 16.700, df = 4, P = 0.002 (<0.01) (HS)
Cramer's V = 0.183
Inter group (M.E. Vs G.P.): χ2 = 28.758, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.171
Missing:
Intra group - M.E: χ2 = 2.798, df = 4, P = 0.592 (>0.05) (Not Sig.)
Cramer's V = 0.075
Inter group (M.E. Vs G.P.): χ2 = 2.201, df = 1, P = 0.138 (>0.05) (Not Sig.)
Cramer's V= 0.047
Filled:
Intra group - M.E: χ2 = 24.054, df = 4, P = 0.000 (<0.001) (VHS)
Cramer's V = 0.219
Inter group (M.E. Vs G.P.): χ2 = 2.824, df = 1, P = 0.093 (>0.05) (Not Sig.)
Cramer's V= 0.054
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

120
Table 26: Age wise distribution of mean number of decayed teeth among the
study population
Age Mean Mining employees F.E -
G.P
Group Decay A M T C P Total
Mean 0.60 1.00 2.31 2.32 2.27 2.08 1.81
<25 years
S.D 0.55 1.07 1.91 1.67 1.19 1.59 1.46
25-34 Mean 2.05 2.44 2.94 2.33 3.58 2.85 2.50
years S.D 2.26 2.50 2.45 1.58 1.83 2.16 1.57
35-44 Mean 2.77 2.00 3.42 3.18 3.92 3.34 3.56
years S.D 2.20 1.41 2.24 1.81 2.31 2.12 2.29
Mean 3.00 0.00 0.00 3.10 NA 2.41 3.00
>45 years
S.D 1.87 0.00 0.00 1.48 NA 1.86 1.86
Age group: < 25 years:
Intra group FE:- Kruskal Wallis test = 11.685, df = 4, P =0.020 (<0.05) (Sig.)
Mann Whitney U test:
A & M: MW = 16.500, P = 0.622 (>0.05) (Not Sig.)
A & T: MW = 23.000, P = 0.022 (<0.05) (Sig.)
A & C: MW = 20.500, P = 0.028 (<0.05) (Sig.)
A & P: MW = 16.500, P = 0.006 (<0.01) (Sig.)
M & T: MW = 56.500, P = 0.053 (>0.05) (Not Sig.)
M & C: MW = 46.500, P = 0.051 (>0.05) (Not Sig.)
M & P: MW = 45.500, P = 0.015 (<0.05) (Sig.)
T & C: MW = 270.500, P = 0.742 (>0.05) (Not Sig.)
T & P: MW = 304.500, P = 0.525 (>0.05) (Not Sig.)
C & P: MW = 282.500, P = 0.941 (>0.05) (Not Sig.)
Inter group (F.E. Vs G.P.): MW = 2586.000, P = 0.169 (>0.05) Not Sig.
Age group: 25-34 years:
Intra group FE:- Kruskal Wallis test = 17.846, df = 4, P =0.001 (<0.01) (HS)
Mann Whitney U test:
A & M: MW = 243.500, P = 0.558 (>0.05) Not Sig.
A & T: MW = 682.000, P = 0.143 (>0.05) Not Sig.
A & C: MW = 523.500, P = 0.387 (>0.05) Not Sig.
A & P: MW = 425.500, P = 0.008 (<0.01) (Sig.)
M & T: MW = 1024.500, P = 0.350 (>0.05) Not Sig.
M & C: MW = 764.500, P = 0.671 (>0.05) Not Sig.
M & P: MW = 615.500, P = 0.009 (<0.01) (Sig.)
T & C: MW = 2304.000, P = 0.265 (>0.05) Not Sig.
T & P: MW = 2367.500, P = 0.029 (<0.05) (Sig.)
C & P: MW = 1218.500, P = 0.000 (<0.001) (Sig.)
Inter group (F.E. Vs G.P.): MW = 26967.500, P = 0.041 (<0.05) (Sig.)
Age group: 35-44 years:
Intra group FE: - Kruskal Wallis test = 7.108, df = 4, P =0.130 (>0.05) (Not Sig.)
Mann Whitney U test: Not applicable
Inter group (F.E. Vs G.P.): MW = 7484.500, P = 0.152 (>0.05) (Not Sig.)
Age group: > 45 years:
Intra group FE:- Kruskal Wallis test = 13.078, df = 3, P =0.004 (<0.01) (HS)
Mann Whitney U test:
A & M: MW = 1.500, P = 0.071 (>0.05) (Not Sig.)
A & T: MW = 2.000, P = 0.063 (>0.05) (Not Sig.)
A & C: MW = 49.000, P = 0.974 (>0.05) (Not Sig.)
M & T: MW = 6.000, P = 1.000 (>0.05) (Not Sig.)
M & C: MW = 3.000, P = 0.008 (<0.01) (HS)
T & C: MW = 4.000, P = 0.002 (<0.01) (HS)
Inter group (F.E. Vs G.P.): MW = 547.500, P = 0.169 (>0.05) Not Sig.
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; F.E –Mining employees; G.P-General Population

121
 Table 27: Mean decay among the study population according to the sweet
intake among the study population

Mann-
Mean Mining General
Whitney U P value
Decay employees Population
test value
No sweet
Mean 0.64 0.54 0.929 (>0.05),
1391.500
S.D 1.81 1.52 Not Significant
Daily
Mean 6.07 5.67 0.003 (<0.01),
973.500
S.D 1.66 1.30 HS
2-3 times/week
Mean 4.37 3.99 0.002 (<0.01),
7519.500
S.D 0.87 1.07 HS
Occasionally
Mean 1.99 1.55 0.000 (<0.001),
21262.500
S.D 1.24 0.83 VHS

Table 28: Prevalence of dental caries among study population according to

socioeconomic status
Upper Upper Upper
Dental Caries Middle Lower Total
class middle lower
Mining employees
No 1 12 51 70 72 206
Yes 50.00 26.09 26.15 46.05 68.57 41.20
%
No 1 34 144 82 33 294
No
% 50.00 73.91 73.85 53.95 31.43 58.80
Total No 2 46 195 152 105 500
% 100.00 100.00 100.00 100.00 100.00 100.00
General Population
No 9 35 90 96 50 280
Yes
% 45.00 54.69 56.25 57.83 71.43 58.33
No 11 29 70 70 20 200
No
% 55.00 45.31 43.75 42.17 28.57 41.67
Total No 20 64 160 166 70 480
% 100.00 100.00 100.00 100.00 100.00 100.00
Mining employees:
χ2 = 54.195, df = 4, P = 0.000 (<0.001) (VHS); Cramer's V = 0.329
General Population:
χ2 = 7.055, df = 4, P = 0.133 (>0.05) (Not Sig.); Cramer's V = 0.121

122
Table 29: Distribution of study population according to treatment needs

Treatment Mining employees M.E –

G.P Total
needs A M T C P Total
Restoration
No 10 14 55 35 32 146 210 356
Yes 23.26 31.11 39.29 25.00 24.24 29.20 43.75 36.33
%
No 33 31 85 105 100 354 270 624
No 76.74 68.89 60.71 75.00 75.76 70.80 56.25 63.67
%
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Extraction
No 2 3 22 15 18 60 70 130
Yes 4.65 6.67 15.71 10.71 13.64 12.00 14.58 13.27
%
No 41 42 118 125 114 440 410 850
No 95.35 93.33 84.29 89.29 86.36 88.00 85.42 86.73
%
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Pulp care
No 3 5 25 18 12 63 90 153
Yes 6.98 11.11 17.86 12.86 9.09 12.60 18.75 15.61
%
No 40 40 115 122 120 437 390 827
No 93.02 88.89 82.14 87.14 90.91 87.40 81.25 84.39
%
No 43 45 140 140 132 500 480 980
Total
% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00
Restoration:
Intra group - M.E: χ2 = 10.467, df = 4, P = 0.033 (<0.05) (S)
Cramer's V = 0.145
Inter group (M.E. Vs G.P.): χ2 = 22.414, df = 1, P = 0.000 (<0.001) (VHS)
Cramer's V= 0.151
Extraction:
Intra group - M.E: χ2 = 5.794, df = 4, P = 0.215 (>0.05) (Not Sig.)
Cramer's V = 0.108
Inter group (M.E. Vs G.P.): χ2 = 1.420, df = 1, P = 0.233 (>0.05) (Not Sig.)
Cramer's V= 0.038
Pulp care:
Intra group - M.E: χ2 = 6.323, df = 4, P = 0.176 (>0.05) (Not Sig.)
Cramer's V = 0.112
Inter group (M.E. Vs G.P.): χ2 = 7.031, df = 1, P = 0.008 (<0.01) (HS)
Cramer's V= 0.085
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

123
 Table 30: Distribution of study population according to prosthetic needs and
prosthetic status

Prosthetic Mining employees

needs and M.E - General
Total
Prosthetic A M T C P Total Population
status
Prosthetic needs
Yes No 12 15 55 45 43 170 142 312

% 27.91 33.33 39.29 32.14 32.58 34.00 29.58 31.84

No No 31 30 85 95 89 330 338 668

% 72.09 66.67 60.71 67.86 67.42 66.00 70.42 68.16

Total No 43 45 140 140 132 500 480 980

% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00

Prosthetic status
Yes No 2 3 10 8 8 31 35 66

% 4.65 6.67 7.14 5.71 6.06 6.20 7.29 6.73

No No 41 42 130 132 124 469 445 914

% 95.35 93.33 92.86 94.29 93.94 93.80 92.71 93.27

Total No 43 45 140 140 132 500 480 980

% 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00

Prosthetic needs:
Intra group - M.E: χ2 = 2.798, df = 4, P = 0.592 (>0.05) (Not Sig.)
Cramer's V = 0.075
Inter group (M.E. Vs G.P.): χ2 = 2.201, df = 1, P = 0.138 (>0.05) (Not Sig.)
Cramer's V= 0.047

Prosthetic status:

Intra group - M.E: χ2 = 0.469, df = 4, P = 0.976 (>0.05) (Not Sig.)

Cramer's V = 0.031
Inter group (M.E. Vs G.P.): χ2 = 0.465, df = 1, P = 0.495 (>0.05) (Not Sig.)
Cramer's V= 0.022

124
 Table 31: Mean treatment needs of study population

Mining employees F.E -

Mean Treatment needs G.P
A M T C P Total
Restoration Mean 2.40 2.29 2.04 1.97 2.34 2.14 2.13
S.D 1.08 1.33 0.43 0.82 0.79 0.79 0.60
Extraction Mean 2.00 1.00 1.77 1.87 1.61 1.72 1.64
S.D 0.00 0.00 0.69 0.74 0.70 0.69 0.76
Pulp Care Mean 1.00 2.00 1.68 1.83 1.58 1.70 1.59
S.D 0.00 0.00 0.75 0.92 0.79 0.78 0.76
Restoration:
Intra group - F.E: Kruskal Wallis test = 6.047, df = 4, P = 0.196 (>0.05) (Not Sig.)
Inter group (F.E. Vs G.P.):
Mann Whitney U test = 15013.000, P = 0.706 (>0.05) (Not Sig.)
Extraction:
Intra group - F.E: Kruskal Wallis test = 5.889, df = 4, P = 0.208 (>0.05) (Not Sig.)
Inter group (F.E. Vs G.P.):
Mann Whitney U test = 1941.000, P = 0.416 (>0.05) (Not Sig.)
Pulp care:
Intra group - F.E: Kruskal Wallis test = 4.899, df = 4, P = 0.298 (>0.05) (Not Sig.)
Inter group (F.E. Vs G.P.):
Mann Whitney U test = 2604.000, P = 0.342 (>0.05) (Not Sig.)
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit; F.E –Mining employees; G.P-General
Population

Table 32: Distribution of study population according to DAI (Dental

Aesthetic Index) score
DAI Grades M.E G.P Total
No 248 218 466
No
% 49.60 45.42 47.55
No 120 128 248
Grade 1
% 24.00 26.67 25.31
No 62 74 136
Grade 2
% 12.40 15.42 13.88
No 55 38 93
Grade 3
% 11.00 7.92 9.49
No 15 22 37
Grade 4
% 3.00 4.58 3.78
No 500 480 980
Total
% 100.00 100.00 100.00
Inter group (M.E. Vs G.P.): χ = 7.275, df = 4, P = 0.122 (>0.05) (Not Sig.)
2

Cramer's V= 0.086

125
Table 33: Distribution of study population according to grades of tooth surface loss
in anterior teeth (Eccle’s and Jenkin’s criteria)
Mining employees
Tooth surface loss M.E – G.P Total
A M T C P
Total
No tooth No 37 30 110 85 69 331 425 756
surface
%
loss 86.05 66.67 78.57 60.71 52.27 66.20 88.54 77.14
No 06 10 22 35 40 113 45 158
Grade 1
% 13.95 22.22 15.71 25.00 30.30 22.60 9.38 16.12
No 00 05 08 15 15 43 09 52
Grade 2
% 0.00 11.11 5.71 10.71 11.36 8.60 1.88 5.31
No 00 00 00 05 08 13 01 14
Grade 3
% 0.00 0.00 0.00 3.57 6.06 2.60 0.21 1.43
No 43 45 140 140 132 500 480 980
Total
% 100 100 100 100 100 100 100 100
Intra group - M.E: χ2 = 30.391, df = 12, P = 0.002 (<0.01) (Sig.)
Cramer's V = 0.142
Inter group (M.E. Vs G.P.): χ2 = 73.092, df = 3, P = 0.000 (<0.001) (Sig.)
Cramer's V= 0.273
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit; M.E –Mining employees; G.P-General Population

Table 34: Comparison of Mean grades of anterior teeth surface loss

according to duration of employment among Mining employees
Mean Mining employees Mann
teeth Kruskal Wallis Whitney U
Total
surface A M T C P Test test
loss
Duration of employment < 5 years
Mean 0.00 0.14 0.08 0.00 0.13 0.07 KW= 6.171, Not
df=4, P= 0.187 applicable
S.D 0.00 0.36 0.35 0.00 0.41 0.31
(>0.05) Not Sig
Duration of employment 5-10 years
Mean 0.00 0.17 0.02 0.27 0.40 0.20 KW= 29.079, A=M=T,
df=4, P= 0.000 M=C=P,
S.D 0.00 0.58 0.13 0.49 0.60 0.46
(<0.001) VHS C,P> A,T
Duration of employment 11-15 years
Mean 0.10 0.38 0.88 1.28 1.36 1.03 KW= 40.705, C=P>T>
df=4, P= 0.000 A=M
S.D 0.32 0.52 0.35 0.54 0.49 0.66
(<0.001) VHS
Duration of employment 15-20 years
Mean 0.50 0.83 1.21 1.86 2.12 1.40 KW= 16.579, C=P>
df=4, P= 0.002 A=M=T
S.D 0.71 0.41 0.63 0.38 0.99 0.80
(<0.01) VHS
Duration of employment >20 years
Mean 0.80 1.60 1.50 2.11 2.60 1.81 KW= 9.838, A=M=T,
df=4, P= 0.043 M=T=C=P,
S.D 0.45 0.89 0.71 1.05 0.89 1.02
(<0.05) Sig C=P >A
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-Cutting
unit; P-Polishing unit

126
Table 35: Mean grades of anterior teeth surface loss according to duration of
employment among Mining employees

Duration of Mean Mining employees

employment teeth
Total
surface A M T C P
loss
< 5 years (a) Mean 0.00 0.14 0.08 0.00 0.13 0.07
S.D 0.00 0.36 0.35 0.00 0.41 0.31
5-10 years Mean 0.00 0.17 0.02 0.27 0.40 0.20
(b) S.D 0.00 0.58 0.13 0.49 0.60 0.46
11-15 years Mean 0.10 0.38 0.88 1.28 1.36 1.03
(c) S.D 0.32 0.52 0.35 0.54 0.49 0.66
16-20 years Mean 0.50 0.83 1.21 1.86 2.12 1.40
(d) S.D 0.71 0.41 0.63 0.38 0.99 0.80
>20 years Mean 0.80 1.60 1.50 2.11 2.60 1.81
(e) S.D 0.45 0.89 0.71 1.05 0.89 1.02
KW= KW= KW= KW= KW= KW=
24.103, 18.293, 100.320, 95.216, 75.349, 259.049,
df=4, df=4, df=4, df=4, df=4, df=4,
Kruskal Wallis Test P= P= P= P= P= P=
0.000 0.001 0.000 0.000 0.000 0.000
(<0.001) (<0.01) (<0.001) (<0.001) (<0.001) (<0.001)
VHS HS VHS VHS VHS VHS
a=b=c
a=b=c
c=d
c=d c=d= d=e> d=e> d=e>
Mann Whitney U d=e
d=e e>a= c>b> c>b> c>b>
test# d,e >
d,e > a,b b a a a
a,b
e>c
e>c
#a= < 5 years, b = 5-10 years, c = 11-15 years, d = 16-20 years, e = > 20 years
*A - Administrative unit; M-Maintenance unit; T-Transportation unit; C-
Cutting unit; P-Polishing unit

Table 36: Comparison of PM values in different areas of Udaipur city

Area PM Value (µg/m3) (Mean ± SD)

Udaipur Ambamata (1) 119.00 ± 42
Udaipur Town Hall (2) 134.00 ± 48
Udaipur Regional Office, MIA (3) 212.00 ± 95
Mining area (4) 254.00 ± 64
Kruskal Wallis Test KW= 36.70, df=3,
P= 0.000 (<0.001) VHS
Mann Whitney U test 4>3>2>1
*1= Udaipur Ambamata, 2 = Udaipur Town Hall,
3 = Udaipur Regional Office, MIA, 4 = Mining area

127
 Graph 1:Distribution of study population (in percentage) based on groups

Groups
Marble mining employees (Study group)
General Population (Comparative group)

48.98
51.02

Graph 2: Distribution of marble mining labourers based on work units

Mining employees (M. E.)

Administrative unit Maintenance unit Transportation unit
Cutting unit Polishing unit

8.6
26.4 9

28

28

128
Graph 3: Distribution of study population according to age groups in years

Age groups (years)

45 -54 35-44 25-34 15-24

7.55
26.43
Grand Total 50.20
15.82

8.75
29.17
General Population 47.92
14.17

6.40
23.80
Mining employees-Total 52.40
17.40

0.00
28.03
Polishing unit 52.27
19.70

14.29
27.14
Cutting unit 42.86
15.71

2.86
17.14
Transportation unit 61.43
18.57

6.67
15.56
Maintenance unit 60.00
17.78

11.63
30.23
Administrative unit 46.51
11.63

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00

Percentage of subjects

129
 Graph 4: Distribution of study population according to literacy levels

Literacy Levels
Illiteracy Primary High school PUC Diploma Degree

Grand Total

General Population

Mining employees-Total

Polishing unit

Cutting unit

Transportation unit

Maintenance unit

Administrative unit

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

130
Graph 5: Distribution of study population according to socio economic status (SES)
–(Modified Kuppuswamy’s SES Classification Scale)

SES Classification
Upper Upper middle Middle Upper lower Lower

Grand Total

General Population

Mining employees-Total

Polishing unit

Cutting unit

Transportation unit

Maintenance unit

Administrative unit

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

131
 Graph 6: Distribution of study population according to diet

Diet
Veg Mixed

77.14
80.00
69.77
70.00
62.29 61.02
58.57 59.80
60.00 56.82
53.33
Percentage of subjects

50.00 46.67
41.43 43.18
40.20 38.98
37.71
40.00
30.23
30.00
22.86
20.00

10.00

0.00
Administrative Maintenance Transportation Cutting unit Polishing unit Mining General Grand Total
unit unit unit employees-Total Population

131
 Graph 7: Distribution of study population according to sweet consumption

Sweet consumption
Occasionally 2-3 times /week Daily No sweet

49.49
29.18
Grand Total 10.51
10.82

42.50
37.50
General Population 9.58
10.42

56.20
21.20
Mining employees-Total 11.40
11.20

62.12
19.70
Polishing unit 9.09
9.09

63.57
21.43
Cutting unit 7.86
7.14

49.29
21.43
Transportation unit 18.57
10.71

46.67
22.22
Maintenance unit 11.11
20.00

46.51
23.26
Administrative unit 6.98
23.26

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00

Percentage of subjects

132
 Graph 8A: Distribution of study population according to use of tobacco products

Tobacco use
User Non-user

90.00 85.71
82.22
76.74 77.27 79.40
80.00 75.00
70.71
70.00
61.67
Percentage of subjects

60.00

50.00
38.33
40.00
29.29
30.00 23.26 25.00 22.73 20.60
17.78
20.00 14.29

10.00

0.00
Administrative Maintenance Transportation Cutting unit Polishing unit Mining General Grand Total
unit unit unit employees-Total Population

133
Graph 8B: Distribution of study population according to type of tobacco products
and alcohol use.

Tobacco use
Alcohol Gutkha Pan Tobacco leaf Bidi Cigarette

Grand Total

General Population

Factory employees-Total

Polishing unit

Cutting unit

Transportation unit

Maintenance unit

Administrative unit

0 20 40 60 80 100
Percentage of subjects

134
 Graph 9: Distribution of study population according to their oral
hygiene habits

Grand Total General Population Polishing unit

Cutting unit Transportation unit Maintenance unit
Administrative unit

Others
Material used for cleaning

Powder

Paste

Nil
Mechanical aids used for

Others
cleaning

Finger

Brush
Frequency of cleaning

After every meal

Twice

Once

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

135
Graph 10: Distribution of the marble Mining employees according to use of
personal protective measures (PPM)

Administrative unit Maintenance unit Transportation unit

Cutting unit Polishing unit Total

100.00
90.00
Percentage of subjects

80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
Using Not using Using Not using
Face cloth Ear plug

Graph 11: Distribution of the marble Mining employees according to

duration of employment in the Mining

Duration of Employment
<5 yrs 5-10 yrs 11-15 yrs 16-20 yrs >20 yrs
Percentage of subjects

100.00
80.00
60.00
40.00
20.00
0.00

136
 Graph 12: Distribution of study population according to dental visit

Dental visit
Yes No

80.00

70.00

60.00
Percentage of subjects

50.00

40.00

30.00

20.00

10.00

0.00
Administrative Maintenance Transportation Cutting unit Polishing unit Mining General Grand Total
unit unit unit employees-Total Population

137
 Graph 13: Distribution of study population according to reasons
for dental visit

Reasons for dental visit

Others Cleaning Restoration Replacement Extraction

Grand Total

General Population

Mining employees-Total

Polishing unit

Cutting unit

Transportation unit

Maintenance unit

Administrative unit

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

138
Graph 14: Distribution of study population according to reasons for not
visiting the dentist

Reasons for not visiting dentist

Not interested Fear
High cost of Treatment Lack of time/Permission
No dentists nearby No Problem with my teeth

Grand Total

General Population

Mining employees-Total

Polishing unit

Cutting unit

Transportation unit

Maintenance unit

Administrative unit

0.00 10.00 20.00 30.00 40.00 50.00

Percentage of subjects

139
 Graph 15: Distribution of study population according to systemic diseases

Systemic Diseases
Diabetes Hypertension Eye Problems
Respiratory diseases Skin Heart
Hearing
Percentage of subjects

100.00
80.00
60.00
40.00
20.00
0.00

Graph 16: Distribution of study population according to prevalence of TMJ

disorders

TMJ Disorder
Yes No

90.00
80.00
Percentage of subjects

70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00

140
 Graph 17: Distribution of study population according to oral mucosal lesions
(OML)

Oral mucosal lesions

OSMF Abscess Ulcer
Lichen Planus Leukoplakia No OML

Grand Total

General Population

Mining employees-Total

Polishing unit

Cutting unit

Transportation unit

Maintenance unit

Administrative unit

0.00 10.00 20.00 30.00 40.00 50.00

Percentage of subjects

141
Graph 18: Distribution of oral mucosal lesions according to location in oral cavity
among study population

Location of oral mucosal lesions

Commissures Lips Sulci Buccal mucosa
Tongue Palate Alveolar ridges

100.00
Percentage of subjects

80.00
60.00
40.00
20.00
0.00

Graph19: Prevalence of leukoplakia among Mining employees and general

population

Leukoplakia
Absent Present

100.00
90.00
Percentage of subjects

80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00

142
 Graph 20: Distribution of study population according to prevalence of dental
fluorosis

Dental Fluorosis
No Yes

80.00
Percentage of subjects

70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00

Graph21: Distribution of study population according to community periodontal

index (CPI) scores.

CPI
Healthy Bleeding Calculus 4 -5 mm 6mm or more
Percentage of subjects

100.00

50.00

0.00

143
Graph 22: Distribution of study population according to loss of attachment (LOA)
scores

LOA
0-3mm 4-5mm 6-8mm 9-11mm 12mm or more

100.00
Percentage of subjects

90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00

Graph 23: Distribution of CPI scores among user and non-user of tobacco products
among study population

CPI scores
Healthy Bleeding Calculus 4 – 5 mm 6mm or more

45.00
40.00
Percentage of subjects

35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
Non- users Users Non-users Users
Mining employees General Population

144
Graph 24: Distribution of LOA scores among user and non-user of tobacco products
among study population.

LOA
0-3mm 4-5mm 6-8mm 9-11mm 12mm or more

60.00

50.00
Percentage of subjects

40.00

30.00

20.00

10.00

0.00
Non- users Users Non-users Users
Mining employees General Population

145
Graph 25: Distribution of Study Population According to Decayed, Missing &
Filled Teeth

Grand Total General Population

Mining employees-Total Polishing unit
Cutting unit Transportation unit
Maintenance unit Administrative unit

No
Filled

Yes

No
Missing

Yes

No
Deacyed

Yes

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

146
Graph 26: Age wise distribution of mean number of decayed teeth among the
study population.

Groups
General Population Mining employees-Total
Polishing unit Cutting unit
Transportation unit Maintenance unit
Administrative unit

3
2.41
0
>45 years 3.1
0
0
3

3.56
3.34
3.92
35-44 years 3.18
3.42
2
Age groups

2.77

2.5
2.85
3.58
25-34 years 2.33
2.94
2.44
2.05

1.81
2.08
2.27
<25 years 2.32
2.31
1
0.6

0 1 2 3 4
Mean number of decayed teeth

147
Graph 27: Prevalence of dental caries among study population according to
socioeconomic status

Upper class Upper middle Middle Upper lower Lower Total

80.00
70.00
Percentage of subjects

60.00
50.00
40.00
30.00
20.00
10.00
0.00
Dental Caries Dental Caries Dental Caries Dental Caries
Yes No Yes No
Mining employees General Population

Graph 28: Mean decay among the study population according to the sweet
intake among the study population

Groups
Mining employees-Total General Population
Mean number of decayed teeth

7 6.07
5.67
6
5 4.37
3.99
4
3 1.99
1.55
2
0.64 0.54
1
0
No sweet Daily 2-3 Occasionally
times/week
Sweet intake

148
Graph 29: Distribution of Study Population According to Treatment Needs

Grand Total General Population

Mining employees-Total Polishing unit
Cutting unit Transportation unit
Maintenance unit Administrative unit

No
Pulp care

Yes

No
Extraction

Yes

No
Restoration

Yes

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

149
 Graph 30: Mean treatment needs of study population

Groups
General Population Mining employees-Total
Polishing unit Cutting unit
Transportation unit Maintenance unit
Administrative unit

1.59
1.7
1.58
Pulp Care 1.83
1.68
2
1

1.64
1.72
Treatments

1.61
Extraction 1.87
1.77
1
2

2.13
2.14
2.34
Restoration 1.97
2.04
2.29
2.4

0 0.5 1 1.5 2 2.5

Mean treatment needs

150
Graph 31:Distribution of Study Population According to Prosthetic Needs
and Prosthetic Status

Grand Total General Population

Mining employees-Total Polishing unit
Cutting unit Transportation unit
Maintenance unit Administrative unit

No
Prosthetic status

Yes

No
Prosthetic needs

Yes

0.00 20.00 40.00 60.00 80.00 100.00

Percentage of subjects

151
Graph 32: Distribution of study population according to DAI (Dental

DAI Grades
No Grade 1 Grade 2 Grade 3 Grade 4

100.00
Percentage of subjects

80.00

60.00

40.00

20.00

0.00
Mining General Total
employees Population

Graph 33: Distribution of study population according to grades of tooth surface loss
in anterior teeth (Eccle’s and Jenkin’s criteria)

Tooth surface loss

No tooth surface loss Grade 1 Grade 2 Grade 3

100.00
Percentage of subjects

80.00

60.00

40.00

20.00

0.00

152
Graph 34: Mean grades of anterior teeth surface loss according to duration
of employment among Mining employees

Groups
Total Polishing unit Cutting unit
Transportation unit Maintenance unit Administrative unit

1.81

2.11
> 20 years 1.5
1.6
0.8

1.4

1.86
16-20 years 1.21
0.83
0.5
Duration of employment

1.03

1.28
11-15 years 0.88
0.38
0.1

0.2

0.27
5-10 years 0.02
0.17
0

0.07

0
< 5 years 0.08
0.14
0

0 0.5 1 1.5 2 2.5 3

Mean teeth surface loss

153
Graph 35: Mean grades of anterior teeth surface loss according to duration
of employment among Mining employees

Duration of employment
> 20 years 16-20 years 11-15 years 5-10 years < 5 years

1.81
1.4
Total 1.03
0.2
0.07

2.6
2.12
Polishing unit 1.36
0.4
0.13

2.11
1.86
Cutting unit 1.28
0.27
0
Groups

1.5
1.21
Transportation unit 0.88
0.02
0.08

1.6
0.83
Maintenance unit 0.38
0.17
0.14

0.8
0.5
Administrative unit 0.1
0
0

0 0.5 1 1.5 2 2.5 3

Mean teeth surface loss

154
Graph 36: Comparison of PM values in different areas of Udaipur city

300 254µg/m3
212µg/m3
250
Mean PM values

200
134µg/m3
150 119µg/m3
100

50

0
Udaipur Udaipur Udaipur Mining area
Ambamata Town Hall Regional
Office, MIA
Areas of Udaipur city

155
 Chapter 7
DISCUSSION

7.1 INDUSTRIAL HYGIENE

Ramazzini, “the father of industrial hygiene”, who was the first to

advocate the inclusion of patient’s occupation inmedical history and to point out a
number of oral symptoms (Schour and Sarnat, 1942) “as injurious effects of
occupational hazards also manifest themselves in the teeth, jaw bones, periodontal
tissues, tongue, lips and oral mucosa” (Peterson and Henmer, 1988). “Exposure to
chemical, physical and biological agents in the work place can result in adverse
effects on workers ranging from simple discomfort and irritation to debilitating
occupational diseases” (Dagli et al., 2008). “In addition, the health of industrial
workers often goes uncared due to their stressful working conditions, busy
schedules and poor economic conditions” (Patil et al., 2012).

Rajasthan is the geographically largest state and has the second highest
amount of mineral deposits in India. Amid the ancient forts and stunning palaces
of Rajasthan is a less alluring sight: hundreds of workers in stone quarries, many
dying of silicosis from cutting and polishing the sandstone tiles that adorn gardens
and patios here and abroad. Much of the sandstone used in kitchen counter tops
and as cobblestones comes from the state's Kota and Bundi districts, where
workers toil under extreme conditions, with hardly any protective gear and for
very little money. About half the state's 2 million mine workers suffer from
silicosis or other respiratory diseases, according to labour rights campaigners.
Although there is no comprehensive data, hundreds, possibly thousands, have died
of silicosis, an incurable lung disease caused by long-term exposure to silica dust
given off in the mining and processing of sandstone and limestone. Rajasthan's
human rights commission last year asked the state government to modernize

156
mining and conduct regular medical tests to contain the disease. Activists say the
state must also do more to ensure there are no child workers, whose vulnerable
bodies are even more susceptible to silicosis. India is one of the largest producers
of raw stone, accounting for more than a quarter of stones mined worldwide.

About a fifth of India's mine workers are children. Many work for more
than 10 hours a day in dangerous and filthy conditions. In the quarry, where
chemicals are used to pulverize the earth to reveal the stone, workers often cut and
chisel without goggles, masks or other protective gears. The industry's working
conditions "fall far short" of national or international standards, and there are
"alarming levels" of child labour, according to a 2013 UNICEF report. Child
workers make up a fifth of Bundi district's mining workforce of more than 50,000,
it said. "The industry has complex social, economic and political challenges due
to the multifaceted supply chain and interwoven network of middlemen, which
makes it very difficult to trace the exact source of the stones," the UNICEF report
said.

Rajasthan is India's largest sandstone-producing state, and the industry is

the only source of livelihood for generations of rural workers trapped in poverty
and in debt bondage to the 'maliks', or owners of the quarries, many of them
illegal. Migrant workers from neighbouring Madhya Pradesh and Bihar and
Odisha, are also tricked by agents into coming to the quarries with promises of
well-paying jobs. This kind of exploitation is especially common in India's
construction sector, particularly in the unregulated areas of brick making and
stone quarrying, experts say Aravali, a public-private development agency that
surveyed mine workers in the state, found that silicosis is caused by inhaling silica
dust for 10 years or longer. Rajasthan is one of the poorest states in the country,
with among the lowest literacy rates and a deeply entrenched caste system.
Workers in the quarries are mostly from Dalit and other lower-caste and tribal
communities. The sandstone industry has come under attack from
environmentalists as well, who say the mining and dumping of chemicals have led
to significant land degradation, deforestation and contamination of groundwater.

157
7.2 DEMOGRAPHIC DATA

Totally 980 individuals were examined for the oral health status in the
current study. Out of 980 samples 500 individuals were mining employees and the
rest 480 individuals belonged to the general population category. The 500 mining
employees were again segregated into different groups depending upon the work
they undertook in the mining industries. The categories included were
Administrative unit (A), Maintenance unit (M), Transportation unit (T), Cutting
unit (C), Polishing unit (P). As none of the mining workers belong to feminine
gender, the general population was also devoid of the female sample.

7.2.1 Age

Maximum (52.40%) of the mining employees fell in the age group of 25-
34 years with the least number found in the age group of 45-54 years. There were
around 19.70% of employees were in the age range of 15-24 years indicating the
presence of child laborers in the current mining population. Similar to our
findings there were around 32.22% of the cement mining workers(Sharma et al.,
2014) and 36.6% stone mining workers of Jodhpur city were in the age group of
21-36 years (Solanki et al., 2014). Similar age group i.e from 21- 40 years were
seen in maximum number in the battery workers of the Kanpur city (Khurana et
al., 2014) and same was true for the metal plant workers of the Brazil (Vianna et
al., 2005).In analogues to this finding the, coal mining workers were more
prevalent in age group of 50-54 years (39.38%) (Abbas et al., 2016).

7.2.2 Literacy

In the present study it is noted that the maximum number of mining

employees i.e. 62.60% were illiterate. Similar high percentage illiteracy was noted
in the coal mining workers of Telangana (Abbas et al., 2016). The highest level of
education noted was for the high school level with 11.20% in the mining
employees. Similar level of literacy was seen in the Brazillian metal plant
workers, where 15.5% of the workers had high school level education (Vianna et
al., 2005). However in case of general population only 20.63% were illiterate and

158
rest all were literate with around 15.63% individuals having the degree level
education. When compare this data with the other studies we can see that the only
10% of the cement mining workers in Sirohi district of Rajasthan completed their
high school level education (Sharma et al., 2014). Contrastingly in the stone
mining employees of the Jodhpur city the percentage of illiteracy was only 34.9%
which is way too low in comparison to the present study findings (Solanki et al.,
2014). Contrastingly, around 67.7% of the sea farer had the secondary level
education (Aapaliya et al., 2015).

7.2.3 Socioeconomic status

When the socioeconomic status of the mining employees and the general
population was compared, it was seen that most of that the most of mining
workers fell under the middle class level and most of the general population feel
under the upper lower category. The difference notes between the two groups was
statistically significant. Whereas, in between the mining workers most of the
transportation, cutting and polishing unit employees belonged to the lower
socioeconomic category.

7.3 PERSONAL HABITS

7.3.1 Food Habits

The eating preference of both general and the mining employees remained
mixed with 62.29% and 59.80% respectively. However, most of the
administrative unit employees (69.77%) were of vegetarian category. There
existed significant difference in the food habits of the mining employees.

In the food habits, the consumption of the sweet by the mining employees
occasionally was noted in greater number than the daily or 2-3 times a week
category. The results remained same for the general population also but the
percentage was lesser i.e 42.50% and the difference noted between the two groups
was statistically significant. Whereas, among the mining workers occasional
sweet consumption was most commonly noted in all the groups.

159
7.3.2 Oral Adverse Habits

Usage of the tobacco products in the present mining employees (79.40%)

was high in comparison to the general population (61.67%) and the difference
noted was statistically significant. However, the battery mining workers of
Kanpur city consumed showed greater prevalence for the consumption of the
tobacco products with 85.71% consuming the same (Khurana et al.,
2014).Contrastingly, less consumption (58%) of the tobacco products was seen in
the Jordanian battery industries workers (Amin et al., 2001), similar trend of
lesser percentage of adverse oral habits was seen in the brass mining workers of
Moradabad city (Tirth et al., 2013) with 53.8% consumption and the salt workers
(49.4%) of the Jaipur city (Sakthi et al., 2011). Such reports of decreased
consumption in the foreign countries have been reported by (Knutsson and
Nilsson, 1998). It was estimated in 2004 that there will be 930 million of worlds
1.1 billion tobacco users will be from the developing countries. This global shift
in tobacco consumption may have around 182 million consumers in India alone
(Subramanian et al., 2004). Transportation unit workers consumed more tobacco
products then the rest of the employees but the difference noted was statistically
insignificant.

Among the tobacco products gutkha was most commonly used by both the
mining employees (38.60%) and the general population (22.08%) in the present
study group, this was followed by the habit of tobacco leaf consumption in both
the groups. Greater consumption of chewable tobacco was reported in the coal
mining workers by 84% (Abbas et al., 2016). Bidi consumption was greater in the
mining workers (16.00%) than the general population (13.75%). However, the
difference noted for the tobacco consumption habit between the two groups is
statistically insignificant for the cigarette and bidi but was significant for tobacco
leaf, pan and gutkha.

Nevertheless, the difference in the tobacco consumption in between the

mining employees showed statistically significant difference with 52.14% of
transportation workers consuming gutkha. Tobacco leafs were consumed more by

160
the maintenance workers (22.22%) but the difference noted for bidi was
statistically insignificant.

Alcohol was consumed by 80.80% of the mining workers, which is way

higher in comparison to the general population (60.42%). The difference is
statistically highly significant. However in the study by Khurana et al., (2014), it
is seen that the working population consumed less alcohol then the control group
or the general population. In disagreement to this finding less consumption (2.3%)
of the Alcohol was reported in the coal mining workers of Telangana (Abbas et
al., 2016).

In between the mining workers, alcohol consumption remained greater in

transportation unit (89.29%), cutting (81.82%) and polishing (80.80%). Highly
significant statistical difference was appreciated for the same.

According to the earlier literature, physically tedious work drives people

to consume alcohol and tobacco which further deteriorate their oral health (Sakthi
et al., 2011). Kiran Kumar et al., (2011) also found in his study that nicotine
dependence is the major diagnosis (27.7%) followed by alcohol abuse (12.3%).
Same was true in case of the present study. Another reason which can quoted for
the high prevalence of adverse Oral habit practice in these mining workers is the
peer influence, as most of the task which they have to perform in the team (Abbas
et al., 2016), they might acquire these habits in influence of their peers.

7.3.3 Oral hygiene Habits

When the data pertaining the oral hygiene practice of the current
population is analyzed it is seen that the 81 individuals in the mining study
population did not brush their teeth at all. Similar poor oral hygiene practice was
reported by Amin et al., (2001). In the remaining population it is seen that the
maximum of them had a habit of brushing their teeth once daily (100%) i.e 419
members using tooth brush (68.74%) and tooth paste (72.08%). Similar high
percentage of brushing once in a day in brass mining workers was reported by
Tirth et al., (2013) and Abbas et al., (2001) and the same trend is noticed in the

161
construction workers (76.9%) of Chennai city (Sakthi et al., 2011).Few of the
individuals used their finger to clean their teeth and in the materials few used
tooth powder, neem twigs also. High prevalence (43.1%) of use chew sticks for
cleaning the teeth was reported in the salt workers of Jaipur city (Sanadhya et al.,
2013). Interestingly, in the sea farer community, around 59.2% used sea weed to
clean their teeth (Aapaliya et al., 2015), this may be due to the non-availability of
the other mechanical aids during the long sea voyages. Other than this it’s been
proven that the sea weeds are more effective cleansing material then the tooth
paste (News, 2012). There was statistically significant difference in the usage of
the mechanical aid for cleaning in between the different units of mining
employees. Contrastingly, in the earlier reports on the battery mining workers it is
seen that 70.2% used toothpowder and finger (Khurana et al., 2014).

The difference in oral hygiene maintenance between the mining workers

and the general population was significant for frequency of brushing, mechanical
aid used for cleaning and for the material used for the cleaning. In general
population three was around 2.2% of individuals who are used to brushing twice.

7.3.4 Usage of Protective Measures

The negligence in protecting themselves was seen the current mining

employees as 92.42% of the population did not use in protective measures cover
their face and 95.45% of the individuals did not use any ear plugs to cover the
ears in noise environment. There existed no significant difference in the usage of
the face cloth or the face mask in between the mining employees, however, for the
usage of ear plugs there was a statistically significant difference as the
maintenance unit (17.78%) staff used the ear plugs in more number than the rest
of the staff.

7.4 YEARS OF EXPERIENCE

The years of experience adds to the proportionality of the health damage

caused by the work environment. In the present study group most of the
employees (40.60%) were having the experience range of 5 to 10 years. Less than

162
10 years of experience was noted in almost 30% of the population. There existed
significant difference in the duration of the employment in between the different
mining workers. It is noticed that the individuals who are working in these type
industries tend to have experience of greater than 5 years and same was depicted
in the earlier studies by Khurana et al., (2014).

7.5 DENTAL DECAY, MISSING AND FILLED TEETH

High caries index is one of commonest oral findings in the mining workers
(Peterson and Henmer, 1988; Dagli et al., 2008; Kumar et al., 2008; Petersen and
Tanase, 1997; Duraiswamy et al., 2008). The literature shows that the workers
working in sweet food industries are more prone to have higher caries index
(Anaise et al., 1980; Rekha and Hiremath, 2002). Nevertheless, Massiln et al,.
(1994) through their study discards the hypothesis that airborne sugar is an
occupational dental health hazard and same was supported by the statement that
the confectionery industry did not seem to be an exceptionally hazardous
environment for dental health in general. Studies do claim that the proper oral
hygiene instructions followed by periodic dental evaluation improved the workers
oral health condition (Kumar et al., 2008). There are less chances of caries
development with high income/high occupational status individuals then with
individuals of the low status occupation, thus proving the influence of social
inequalities playing the role in the prevalence of caries (Krustrup et al., 2008).

The reports of decrease in the prevalence of dental caries are cited in the
literature, but the findings of the present study doesn’t support this finding as the
more than half of the general population and more than 40% of the mining
workers had the decayed tooth. In agreement to this finding a total of 44.4% of the
coal mining workers had caries teeth (Abbas et al., 2016). The results were in
contradiction to the earlier study done on the stone mining workers in the Jodhpur
city, where the prevalence of caries was reported to be 70% (Mandal et al.,
2001).Similarly Gambhir et al., (2001) also reported the prevalence of dental
caries 71%. Even in the transport workers the prevalence rate of caries was noted
to be 64%(Tuominen and Murtomaa, 1996). Increase in the prevalence of dental

163
caries was also noted in the earlier studies on the different population groups
(Bachanek et al., 2001; Tomita et al., 2005; Athanassouli et al., 1990; Bali et al.,
2004).

In the present group of population the difference in the prevalence of

caries in between the mining workers and the general population was found to be
statistically significant. The discrepancy that existed between the mining workers
and the general population might be due to the habits of the employees. It is
known that the individual who had tobacco chewing habit, had low prevalence of
caries and probable reason for the discrepancy noticed in the prevalence of caries
can be attributed to this. In the earlier studies on the mining workers it was found
that more than 90% of the workers had the habit chewing the tobacco (Mandal et
al., 2001). Apart from this the mining workers were exposed to fine particulate
matter, which might have caused the attrition of the dentition leading to the
formation of secondary dentine which makes the teeth more resistant to caries.
The intergroup difference for the caries in the mining workers showed statistically
significant difference with the higher prevalence for the employees involved in
the transportation group and the least prevalence was seen for the administrative
workers. This finding is clear indicator that the literacy plays a major role in
prevention of occurrence of caries.

The prevalence of missing teeth was greater in the mining workers than in
the general population and the difference was not statistically significant. There
existed no significant difference between the different groups of mining workers.

The filled teeth in case of general population (17.71%) was greater than
the mining workers (13.80%). The difference noted was statistically significant.
Contrastingly, none of the participant had filled teeth in the study of Duraiswamy
et al., (2008) on the green marble mining workers and in the study of Abbas et
al.,(2016) where, out of 356 only 10 of the coal mining workers had the filled.

There existed no significant difference in the presence of filled teeth in

between the different groups of the mining workers. Here again the emphasis of
literacy and the oral habits is clearer seen. Greater the literacy of the population,

164
greater is awareness related to oral hygiene practices and the incidences of the
dental checkups.

The study though reports the prevalence of decayed, missing and the filled
teeth, it didn’t explore the co relation between the literacy rates and the oral habits
of the population with the incidence of the DMFT prevalence. Thus, the scope to
establish the correlation between the literacy rate and the DMFT prevalence still
exists.

7.5.1 Age wise distribution of mean number of decayed teeth among the
study population

The mean decay was greater in the age group of 35 to 44 years in both the
mining employees (3.34±2.12) and the general population (3.56±2.29). But the
difference found between the mining employees and the general population and
amongst the mining employees was statically insignificant. Mean prevalence of
caries experienced was greater in the transportation, cutting and the polishing unit
employees. This again emphasizes the lack of oral hygiene in these employees,
which may be due to the lack of the education or the oral hygiene negligence.

7.5.2 Dental Caries and Sweet Consumption

The mean decay was higher in the daily sweet consuming group with
6.07±1.66 when compared to occasional sweet consuming group with 1.99±1.24
in general population and 4.49±3.99 and 2.13±0.81 in the daily consuming group
and occasional sweet consuming group respectively among mining employees.
Higher mean decay can be attributed to the frequency of sweet consumption.

The results were in agreement with the previous study conducted among
Lebanese adults that concluded that the poor dietary habits including high
consumption of sugar containing products were associated with dental caries
(Doughan et al., 2000).

The results were also in agreement with the previous study conducted
among Canadian Indian communities that concluded that a correlation might exist

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between dietary habits, especially the availability and frequency of consumption
of refined carbohydrates and the condition of dental structures (Myers and Lee,
1974).

7.5.3 Dental Caries and Socioeconomic Status

In both mining employees and general population the upper lower class
(46.05%, 57.83%), lower class (68.57%, 71.43%) and middle class (26.15%,
56.25%) respectively had higher decay prevalence compared to other higher SES
groups. This might be because of the poor oral hygiene habits seen in lower SES
groups compared to upper classes.

A similar trend was seen in a study among building construction workers

in Brazil.59

It is in contrast to a study in Nagpur where higher SES showed higher

prevalence of caries due to higher sweet consumption in the higher SES groups
(Doifode et al., 2000).

7.6 DENTAL VISITS AMONG STUDY POPULATION

In the present study there was statistically significant difference in dental

visits between mining employees (37.20%) and general population (47.50%).
Same was true for the Sea farers, only 22.3% of them visited dentist earlier in
their entire life as no oral check-up was done except at some port (Aapaliya et al.,
2015).In our study among mining workers dental visits among administrative unit
(60.47%) and maintenance unit (53.33%) was higher compared to transportation,
polishing and cutting unit workers and the difference noted was very highly
significant.

Similar results were seen in Danish industrial population where regular

dental visits were seen in clerical staff compared to other employees (Petersen and
Henmer, 1988).

In our study when the barriers to dental visits were questioned, in case of
mining employees, no problem in my teeth remained the most common reason

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quoted by all the categories of the employees. ‘No dentist nearby’ as reason was
quoted as the second most commonest reason by the administrative and the
maintenance staff (25.53% and 28.57% respectively) followed by the reasons
such as high cost of treatment’ and ‘fear’. Whereas, none of the administrative
unit had the problem of ‘lack of permission’ in the mining.

Similar to our study in a study among South Australian employees and

among male industrial employees majority perceived that they had no problem in
their teeth and hence did not visit a dentist (Srikanth et al., 1983; Ahlberg et al.,
1996).

Our study correlates with a study conducted among Japanese employees

that reported 44% of their study population did not visit the dentist due to lack of
time (Kawamura and Iwamoto, 1999). In a study among commuting labourers in
Norway working situation, little leisure time, lack of treatment facilities were
common reason for reduced dental attendance which is similar to our study (Heloe
and Kolberg, 1974).

In our study among general population the underutilization of dental

services was mainly due to no problem with the teeth, high cost of treatment and
the fear.In India majority of dental services are financed on a fee for service basis
and hence the fee barrier could hinder the utilization of dental services among
general population also.

In our study the majority of mining employees (64.52%) and general

population (57.02%) visited the dentist mainly for extractions. Within mining
units visit to dentist for replacement of teeth was higher in administrative unit
(19.23%) compared to other units and for extraction of teeth was least (34.6%)
compared to other units. The reasons might be due to differences in socio
economic status (SES) and literacy levels.

The results of our study were correlating with the previous study
conducted on Jordanian adults which stated that people gave dental health a low
priority in their lives, especially for the more expensive dental treatment thus

167
extraction of teeth was the most common treatment modality among poor
societies (Hamasha et al., 2000).

In contrast to our study insurance schemes and subsidized rates increased

the dental utilization in a study among Danish industrial population (Peterson,
1983). In a previous study among South Australian employees regular dental
visits were only by those in higher SES group which is similar to our study
(Srikanth et al., 1983).

7.7 ORAL MUCOSAL LESIONS

Prevalence of oral mucosal lesions was mainly related to the occupational

stress to which the mining workers will be exposed. Noise, dust or fumes and poor
maintenance of equipment added to the predisposing factor; the stress (Dagli et
al., 2008). The exposure of the air borne dust particles in the mining or the
working atmosphere will lead to the cancerous lesion which can be mortal to the
workers. Even the workers who were exposed to acidic fumes were at risk of
developing in oral mucosal lesions (Vianna et al., 2005; Vianna et al., 2004) and
this was more so with the workers without lip seal (Koskela et al., 1990).
However, contrastingly it was reported that occupational acid air fumes didn’t
increase the occurrence of oral mucosal lesions but they lead to increase in the
periodontal pocket depth (Tuominen, 1991). Same was true for the cancer
prevalence when the duration is taken into consideration. Longer the exposure
more is the chance of cancer occurrence. The granite exposure when pertaining to
the general health may be the etiological factor for the initiation and promotion of
the malignant neoplasms (Prabhu et al., 2009). The habits like tobacco chewing
and pipe smoking apart from mining environment can act as triggering factors in
causing the oral mucosal lesions (Browne et al., 1977; Jahanbani, 2003; Prabhu et
al., 2009). But there were studies which reported occupation has little effect on
the occurrence of oral mucosal lesions (Jahanbani et al., 2009). Vianna et
al.,(2004) in their study conclude that the evidence of a chronic rather than acute
irritative process suggests a possible step on the etiology of oral malignancies,
which needs investigation.

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 In the present study a significant difference was observed in the
prevalence of oral mucosal lesions between mining employees (31.6%) and
general population (17.08%). Among mining employees 16.60% had leukoplakia,
and 5.20% had OSMF, whereas among general population the prevalence was
only 7.71% and 3.75% respectively.

A similar result was obtained in a study in Rajasthan among green marble

mine labourers where almost 33.3% of workers had leukoplakia which was related
to high use of tobacco, stress and malnutrition that was prevalent in the
population. It was also postulated in their study that stresses in their work
environment drives the workers to use tobacco (Dagli et al., 2008).

The findings of the present study can be attributed to the high prevalence
of chewing tobacco habits like tobacco leaf chewing and gutkha chewing (19.7%,
38.60% respectively) among mining employees compared to general population (
15.42%, 22.08% respectively), however the difference in consumption of the
different tobacco products was statistically insignificant.

In this study regarding the location of the oral mucosal lesions, Buccal
mucosa was found as the commonest site affected in both mining employees
(67.09%) & general population (56.2%) compared to other sites.

Our results are in agreement with the previous study conducted among
Iranian textile mining workers that showed a statistically significant positive
correlation between tobacco use and oral pre-cancerous lesion (Jahanbani, 2003).

Similar to our study, previous study reported that in rural inhabitants of

Maharashtra state the prevalence of leukoplakic lesions was highest among people
with mixed tobacco habits (Deshmukh et al., 1995). It was also found that OSMF
was exclusively seen in pan chewers in both mining employees and general
population which contains slices of areca nut with slaked lime.

Our present study is also in agreement with a previous study conducted in

Xiangatan city, China where the prevalence rate of OSMF was 3.03%, which was
due to heavy use of areca nut chewing along with hot pepper among them. Areca

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nut chewing has been suggested to be involved in the pathogenesis of this
condition (Tang et al., 1997).Within mining units Transportation (20%), cutting
(19.29%) and maintenance units (17.78%) had higher prevalence of leukoplakia
compared to other units which was statistically significant. This can be due to
high tobacco use like gutkha and tobacco chewing among transportation unit
(52.14%, 20.00%) compared to other units.

7.8 DENTAL FLUOROSIS

The prevalence of dental fluorosis was higher in mining employees

(74.40%) compared to general population (52.08%) which was statistically
significant. This might be because of the fact that the most of the examined
mining employees and the general population belonged to Rajasthan which is high
fluoride belt according to the National fluoride mapping 2002-2003(Bali et al.,
2004).

Even in the salt lake workers of the Jaipur city the dental fluorosis seen
was around 59.9% which was high owing to the high fluoride level in the drinking
water. High water fluoride level (1.5 ppm) was reported by Sinha (1997) in 19
villages of the Sambhar district, Jaipur.

7.9 PERIODONTAL STATUS OF THE STUDY POPULATION

ACCORDING TO CPI SCORES

Overall periodontal status of the industrial or the mining workers remained

poor (Peterson and Henmer, 1988; Lie et al., 1988; Panos et al., 1990; Petersen
and Tanase, 1997; Amin et al., 2001; Dagli et al., 2008). But the amount of sugar
intake and the sweeting agent use along with sugar increased the risk of
periodontal diseases (Jahanbani et al., 2009).Age of the worker was directly
proportional to the poor periodontal health and the probing depth (Lie et al., 1988;
Kumar et al., 2008).Apart from this the habits had their own share of adding the
burden to the prevalence of periodontal diseases (Kumar et al., 2008). However,
the white collar group or the administration workers had better periodontal health
then the mining workers (Lie et al., 1988). But in the survey by pilot et

170
al.,(1989)it was reported that there existed no significant difference in the
periodontal status of three group of mining worker; mining equipment mining, a
cotton mill and a mining of heavy machinery. There was increase in the
periodontal pocket and attachment loss prevalence and it was positively associated
with age of the acid mining workers (Tuominen, 1991; Hohlfeld and Bernimoiilin,
1993) than the control group.

Periodontal diseases are caused due to multiple factors and one of the most
important factors among them is the environment in which the person is living
and that constitute the occupational environment as well. The occupations like
mining industries are highly strenuous in nature and most of the employees owing
to this strain revert to the habits like ghutka chewing, alcohol consumption, bidi
and cigarette smoking. These habits are not kind to the oral cavity proper, gingival
and periodontal problems ensure with this. The current paper aimed to evaluate
the periodontal status of the mining employees of the Udaipur city.

Total of 92.4% population had gingival and the periodontal problems,

which is low in comparison to the results obtained for the salt lake workers in
Jaipur and the stone mining workers of Jodhpur(Sanadhya et al., 2013; Solanki et
al., 2014).However, the results coincided with the National Oral Health Survey
and Fluoride Mapping, 2002-03, of India and Rajasthan, the survey conducted by
Dagli et al., (2008) on the stone mining workers and the survey conducted by
Abbas et al., (2016) on the underground coal mining workers. Similar prevalence
as also been noted by the earlier studies in the different industrial workers
(Dharmashree et al., 2006; Dini and Guimaraes, 1994; Tirth et al., 2013). It is
noted in the earlier studies that an individual if manages to have lip seal during the
working hours will tend to have lesser chances of periodontal health risks than in
the non-lip sealed individuals (Vianna et al., 2005). In the other study on the
Finnish industrial population, 97±58 of mean estimated periodontal treatment
need was reported. This is backed by the study on the Chinese mining workers,
were the periodontal status was poor and the amount calculus, shallow and the
deep pockets noted was very high (Pilot et al., 1989). The trend discussed here

171
shows that the periodontal health status of the mining or the mining workers is
poor in all over the world. Thus, the role of the working or the occupational
environment seems to be the major factor which triggers the unhealthy changes
related to periodontium. In German mining workers the prevalence of periodontal
disease was 100%, which is way higher than the statistics of the present study
(Dagli et al., 2008).In comparison to the present study results lesser prevalence of
periodontal diseases was noted in sea farers of Gujarat with only 75% of them
reporting to be having poor periodontal status (Aapaliya et al., 2015).Still lesser
incidence of periodontal disease i.e 40.2% was reported in the migrant mining
workers of South Africa (Van Der Merwe and Maat, 2010). This study was done
on archeological remnants where periodontitis was assessed based on alveolar
resorption of jaw bones, which might be the reason for such lesser periodontal
disease observed.

The reports also appreciate the difference in the periodontal health status
between the mining workers and the control group and the difference was
statistically significant. Even the results of our study show the significant
difference between the mining workers and the general population for the
periodontal health (Amin et al., 2001). The deep pockets of more than 6mm were
found in 6% of the current mining population and similar prevalence rate was
noted for the marble stone mining workers of the Jodhpur city (Solanki et al.,
2014).Higher prevalence (9.6%) of 6mm pockets were noted in coal mining
workers of Telangana (Abbas et al., 2016).

When we considered the different categories of the mining workers, poor

periodontal status was noted for the transportation, cleaning and the polishing unit
workers. The periodontal health was far better in the administrative group than the
other mining workers. The intra group difference noted was statistically
significant. Similar reports were published by Lie et al, where the periodontal
health status was evaluated in the aluminum mining workers and there also the
administration unit employees had less problematic periodontal health (Lie et al.,
1988).

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 Loss of attachment of 4-5 mm was noted in 29.40% of the mining
employees and the similar statics were applicable to the general population for the
attachment loss of 4-5mm. coinciding reports were published for the Brazilian
metal processing plant workers, where the loss attachment 4-5 mm was noted only
in 25.3% of the workers (De Almeida et al., 2008). However, a higher percentage
(40.7%) of attachment loss had been reported by the Abbas et al., (2016) in the
coal mining workers (16%) and in the sea farers (30.9%) by Aapaliya et
al.,(2015). Contrastingly they reported 7.02% of 6-8mm attachment loss in the
coal mining workers (Abbas et al., 2016) and the current mining population it was
increased and the percentage noted was 27%. The difference noted between the
mining population and the control group was statistically significant. However,
the difference existed in between the mining employees was statistically
insignificant.

Further, the study carries the scope to establish the correlation between the
years of experience of the employees and the oral habits they indulged with the
periodontal health status.

In the present study a statistically significant difference was observed in

the prevalence of periodontal disease between mining employees (92.4%) and
general population (89.58%). This might be due to higher prevalence of tobacco
use and poor oral hygiene practices, among mining employees than general
population.

Among mining employees highest prevalence of periodontal disease was

seen amongst the transportation workers (96.44%) compared to other units. This
might be due to higher percentage of tobacco use (85.71%), in particular gutkha
chewing (52.14%) and tobacco leaf chewing (20.0%) among transportation
workers compared to other units. Concurrently transportation workers had poor
oral hygiene habits compared to other units in our study.

The results in present study were in agreement with the study conducted
among cement mining workers at Chelm, in Poland where the prevalence of

173
periodontal disease among workers was 94.43% while in local inhabitants it was
64.94% (Bozyk and Owczarek, 1990).

The finding in our present study was in agreement with the study
conducted among industrial workers in Davangere city, Karnataka where
periodontal disease prevalence reported among industrial workers was higher
compared to general population (Dharmashree et al., 2006).

Our study results was also similar to the study among green marble mine
labourers in Rajasthan where prevalence of periodontal disease was about 98.2%
with bleeding and calculus as the commonest scores(Dagli et al., 2008).

The findings of our study were analogous with the previous study
conducted among industrial employees in rural part of Norway which concluded
that periodontal disease was higher among manual workers compared to
administrators (Lie et al., 1988).

Our findings were in agreement with the previous study conducted among
Japanese mining workers which states that poor lifestyles were related to high
prevalence of periodontal pocketing and gingival symptoms in these population
(Shizukuishi and Hayashi, 1998).

A previous study conducted among citizens of Oulu in Finland was in

agreement with the present study which concluded that periodontal disease
increase with poor standard of oral hygiene and unhealthy lifestyle practices
(Sakki et al., 1995).

Calculus is the commonest score in our study in both mining employees

(41.9%) and general population (38.0%) compared to other scores.

Similar results were found among industrial workers of Davangere where

98.7% prevalence of periodontal disease was reported with calculus being the
commonest score (61%) (Dharmashree et al., 2006).

The results in our present study are analogous with the studies done on
mining workers in Shangai, China with only 1.75% having healthy periodontium
with calculus score as commonest (Pilot et al., 1989).

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 A study on worker population Araraquara, in Brazil also reported that
calculus was the most frequently observed periodontal condition(Dini and
Guimaraes, 1994).Similar results were also seen in a study among green marble
mine labourers in India(Dagli et al., 2008).

In our study bleeding score was seen in 7.60% and 4-5 mm pocket was
seen in 29.20% of mining employees. A study among mining workers of Romania
was similar to ours where 21.49% had bleeding score and 32.7% showed shallow
pockets (Roman and Pop, 1998).

In a study from Danish granite industries bleeding score was the

commonest score among the study population that was contrasting our study
results which is evident from the higher prevalence of twice brushing habit among
the workers in their study (70%) (Peterson and Henmer, 1988).

7.9.1 CPI Scores and Tobacco Use

A statistically significant difference was observed in the present study in

the prevalence of periodontal disease between tobacco users and non-users in both
mining employees and general population.

In both groups prevalence of healthy periodontium was more among non-

smokers compared to smokers.

Overall, the prevalence of healthy periodontium was higher among mining

employees (29.13%) compared general population to (23.91%), this contrast may
be due to the unequal sample size of the study population.

Transportation unit and cutting units had higher prevalence of increasing

CPI scores of 4-5mm and 6mm or more deep pockets.

This can be due to high tobacco use like gutkha and tobacco chewing
among these units compared to other units.

In a study from Nagpur, generally lower SES, high tobacco use and
increasing age were considered as risk factors for periodontal diseases which*h is
similar to our study (Doifode et al., 2000).

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 Our study findings were also in accordance with the previous study
conducted among Northern Jordanian adults that suggested a positive correlation
between smoking and periodontal disease which might be due to greater presence
of plaque and calculus deposits in smokers but there was no significant difference
between smokers and non-smokers in regard to bleeding and probing depths this
might be because of the other influencing factors like oral hygiene habits and age
(Taani, 1997).

Similar results were also seen in a study among Japanese mining workers
which showed significant association of poor periodontal health among
tobacco users (Imaki et al., 1997).

Negative life style practices were associated with poor periodontal health
in a study conducted in Oulu, Finland (Sakki et al., 1995).

A recent study in 2008 by Palmar et al., (2008) concluded that the

occurrence of periodontal pockets was more among tobacco quid chewers which
is similar to our study.

A recent study in 2009 indicated in all age groups there was a significant
difference in periodontal health between smokers and non-smokers where
calculus was observed more among smokers than non-smokers (Pucau et al.,
2009).

7.9.2 CPI Scores and Oral Hygiene Habits

Oral hygiene habits were better in general population than mining

employees where twice brushing was about 2.27% among general population
whereas, only 0.0% among mining employees. Brush and paste was used by
85.68% and 75.0% respectively by general population whereas only 68.74% and
72.0% were using brush and paste among mining employees which could have led
to poor periodontal status in this group.

These findings were in conformity with a previous study conducted among

Japanese mining workers in Osaka that concluded that in a group with a poor state

176
of oral hygiene, the negative effects of smoking were evident faster resulting in
unhealthy periodontal tissues (Shizukuishi and Hayashi, 1998).

Our findings were also in conformity with the earlier study done on
citizens of Oulu in Finland which concluded that periodontal pocketing increased
with diminishing tooth brushing frequency and an unhealthier life style (Sakki et
al., 1995).

Among Danish Granite industrial workers there was 70% prevalence of

twice a day brushing habit and hence revealed better periodontal health which was
contrasting our study (Sakki et al., 1995).

7.9.3 Prevalence of Loss of Attachment among the Study Population

In the present study there was less prevalence of loss of attachment among
the general population compared to mining employees and the difference was
statistically significant. This might be because of high prevalence of tobacco
habits and poor oral hygiene habits among mining employees as compared to
general population.

A study conducted among randomized sample of Swedish population

stated that tobacco habits were a significant risk factor for probing attachment loss
(Axelsson et al., 1998).

7.10 PROSTHETIC STATUS

Total of 34% of mining employees and 29.58% of general population

needed the prosthetic replacement. However, the difference noted between the
two groups was statistically insignificant. Similar need of the prosthetic
rehabilitation (37%) was noticed in the brass industry workers of Moradabad city
(Tirth et al., 2013). Within the mining employees the prosthetic need was more in
cutting unit employees and in transportation unit employee’s highest number of
prosthesis were found.

Among the general population 7.29% had prosthesis in comparison to

6.20% of the mining employees. Higher prosthetic rehabilitation was reported for

177
the brass industry workers with 37.2% of them having the prosthesis (Tirth et al.,
2013).

This difference among the two groups could be attributed to the low
literacy levels, socio economic status and lack of permission in the mining among
the transportation, cutting and polishing unit workers.

7.11 Tooth Surface Loss

Dental erosion has been defined as a progressive irreversible loss of dental

hard tissue by a chemical process, usually by acids other than those produced by
plaque bacteria (Meurman and Ten Cate, 1996). The erosion of teeth was most
commonly seen in the individuals who worked in acid factories (Gamble et al.,
1984; Tuominen, 1991; Erik and Charlotte, 1991; Tuominen et al., 1991; Fukayo
et al., 1999; Amin et al., 2001; Vianna and Santana, 2001; Kim et al., 2003; Kim
and Douglass, 2003; Ann-Katrin et al., 2005; Suyama et al., 2010).It is a common
oral finding in professional wine tasters. There existed significant difference for
the erosion between the wine tasters and the non-wine tasters (Mulic et al., 2011).
Nevertheless, in a review article by Wiegand and Attin, (2007) claim that the
literature evidence show that the occupational dental erosion is limited to the
battery and galvanizing workers. They also claim that the data available for the
other occupations needs to be confirmed by further studies(Wiegand and Attin,
2007).The fumes produced in the industries like phosphate, battery (sulfuric acid,
lead acid), silicone sealers (acetic acid release), copper smelters (sulfuric acid),
zinc extraction by electrolytic methods, war industry are deleterious to oral hard
and soft tissues (Gamble et al., 1984; Tuominen, 1991; Erik and Charlotte, 1991;
Tuominen et al., 1991; Fukayo et al., 1999; Amin et al., 2001; Vianna and
Santana, 2001; Kim et al., 2003; Kim and Douglass, 2003; Ann-Katrin et al.,
2005; Wiegand and Attin, 2007; Suyama et al., 2010; Mulic et al., 2011). There
existed a highly significant difference for the prevalence of dental erosion
between the control group and the acid mining workers (Gamble et al., 1984;
Tuominen et al., 1991; Fukayo et al., 1999; Amin et al., 2001; Ann-Katrin et al.,
2005). The medical problems like upper respiratory tract symptoms persisted

178
commonly in these workers (Ann-Katrin et al., 2005). In battery workers the
incidence of erosion was more common in the anterior region (Erik and Charlotte,
1991; Goto et al., 1996) and the posterior region showed incidence of attrition
(Ann-Katrin et al., 2005).However, in another study in organic and inorganic acid
factories, showed the prevalence of erosion to be more in maxillary teeth
(Tuominen et al., 1991; Goto et al., 1996). Contrasting results were reported in
the recent study where the erosion was seen in the mandibular anterior teeth
(Wiegand and Attin, 2007). But, Mullic et al., (2011) noted that the erosion was
most commonly seen on the occlusal surface of the mandibular molar toothin the
wine tasters.

By wearing the protective respiratory mask one can reduce the overall
occupational dental erosion (Kim et al., 2003; Kim and Douglass, 2003). Dental
erosion was noticed even in the female food industry workers, owing to the
inhalation of the dust containing Tartaric acid, sucrose, magnesium sulphate and
sodium bicarbonate. It also noted that the Longer the duration of exposure more
the chances of dental erosion (Goto et al., 1996; Suyama et al., 2010). In the
recent study on dental erosion they have measured the density of acid in the
working environment and have found out a significant relationship between the
density of the acid and erosion rate (Suyama et al., 2010).

It is one of the common dental problems noticed in the miners (Enbom et

al., 1986). The duration of the working has definite influence on the enamel wear,
longer the person has worked in the mining field greater are the chances of the
enamel wear. Same has been proved in earliest study to the latest study on the
dental wear and the working environment (Enbom et al., 1986; Peterson and
Henmer, 1988; Jokstad et al., 2005). Few studies took control group-the non-
miners for comparing the extent of wear between the two groups, they found that
white collar workers or the non-miners showed less prevalent dental wear.
(Peterson and Henmer, 1988; Tuominen and Tuominen, 1991; Jokstad et al.,
2005).This observation can be attributed to the mining environment, especially the
abrasive component of the air which they breathed. 100% abrasion was observed

179
by Peterson and Henmer (1988) in the granite mining workers and was
particularly severe in the anterior teeth. So, far the occupational related abrasion
studies were conducted on cement mining workers, granite mining workers,
olivine mining workers. Even the noise pollution in the industrial set up has
bearing on the dental abrasion rate and same was proven in the study by
Kovacevic and Belojevic (2006), they found female workers exposed to noise
showed more prevalent abrasion.

In the present study the presence of tooth surface loss of the anteriors was
recorded and its severity was graded according to Eccles and Jenkins criteria
(Eccles and Jenkins, 1974). Statistically significant difference was observed in the
prevalence of tooth surface loss in the anterior teeth between mining employees
(33.8%) and general population (11.46%).This might be due to continuous
exposure to airborne stone dust particles in the employees working environment
that might cause friction and result in tooth surface loss(Tuominen and Tuominen,
1991).

The prevalence of anterior tooth surface loss was higher among polishing
unit (47.72%) and cutting unit (39.28%) compared to administrative staff,
maintenance staff and the difference was found to be statistically significant.This
might be due to heavy and continuous dust exposure and less use of personal
protective measures (PPM) among polishing unit (7.58%) and cutting unit
(6.43%) workers.

The results of our present study is in agreement with the previous study
conducted at Tanza cement company Tanzania, that also found higher prevalence
of tooth surface loss among workers (72.2%) compared to staff employees
(48.4%). This very high prevalence of tooth surface loss compared to our study
might be due to inclusion of both anterior and posterior tooth surface loss in their
study (Tuominen and Tuominen, 1991).

Similarly, among Danish Granite industrial workers, 100% abrasion was

found in the oral cavity in particular in the front teeth (Peterson and Henmer,
1988).

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 The results of the current study reveal that the severity and prevalence of
tooth surface loss increased with the duration of employment in the mining
employees. Similar finding was reported in a previous study conducted at Tanza
cement company Tanzania and in Danish Granite industries in which there was an
increased severity of tooth surface loss with length of service of the workers in the
mining (Peterson and Henmer, 1988; Tuominen and Tuominen, 1991).

Our study results are also similar to a study among workers exposed to
olivine dust in Norway (Jokstad et al., 2005).

A longitudinal study design is needed to observe the association between

tooth surface loss and dust exposure in these factories because tooth surface loss
can be attributable to other causes also.

7.11.1 Noise and Teeth Grinding Habits

Interestingly it seen that teeth grinding habit during work time had direct
relationship with the noise produced during the working. This probably is the
reason why the tooth loss was most prevalent in polishing and cutting unit
employees.

Similar results were seen in other studies, which hypothesized that there
was an increased masticatory muscle reflex and eventual tooth grinding habit in
workers exposed to high decibel of noise in the work environment which was seen
in our study also(Kovacevic, 2006; Kovacevic and Belojevic, 2006).

Moreover the workers using earplugs as a personal protective measure

were also very scarce with only about 5.71% and 4.55% of cutting and polishing
unit respectively who are exposed to continuous noise in the work environment in
the present study.

7.12 TREATMENT NEEDS

7.12.1 Prosthetic rehabilitation Needs

There was a difference between mining employees and general population

in terms of prosthetic need but the difference was statistically non-significant. The

181
difference may be due to the higher prevalence of dental visit among general
population for prosthetic rehabilitation (7.29%) than mining employees (6.20%)
which could be due to poor access to the dentist and lack of permission in the
mining to visit dentist in the working hours.

In the present study a non-significant difference was found within the

mining units though there was a higher prosthetic need among the transportation
unit, polishing and cutting unit which might be because of lack of permission in
the mining, lower socio economic conditions and lower literacy levels of these
workers as seen in our study.

An earlier study conducted among Lebanese adults was in agreement with

the present study that concluded low SES subjects were in greater need of
dentures (Doughan et al., 2000).

7.12.2 Restoration, extraction and pulp care need

A statistically significant difference was observed between mining

employees (29.20%) and general population (43.75%) in the need for restoration
of teeth.

There was no statistically significant difference between mining

employees and general population in extraction needs. Nevertheless, there was
statistically significant difference for the pulp care treatment between the mining
employees and the general population with general population showing more need
of pulp care.

In the present study within the mining employees the transportation unit
(15.71%, 17.86%) followed by polishing unit (10.71%, 12.86%) were more in
need of extraction and pulp care compared to other units. This difference might be
due to more extensive lesions, which are not suitable for restorations, less dental
visits and lower socio-economic status among these units. There was no
statistically significant difference for the mean restoration, extraction and pulp
care therapy between general population and the mining population.

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 The results in our present study were in conformity with the study
conducted among Danish industrial population that concluded that dental
extraction was the most frequent treatment need among manual workers (Peterson
and Henmer, 1988).

7.13 TMJ DISORDERS

Temporomandibular Disorders are again multifactorial in origin and not

one factor can be attributed to its presence. Nevertheless, the psychosomatic
disorders are considered as the major etiological factors. In the mining employees
the day to day strenuous work and the stress involved due to this can be the major
players in the causation of this disorder and to prove this the prevalence of TMJ
disorder was greater in the mining employees in the current study.

Temporomandibular Disorders were more in the mining employees then

the control group by 6.0%. Reports of the current study show the prevalence of
16.40% of Temporomandibular disorders in the mining employee group and in the
control group the prevalence was 10.42%. The difference noted between the two
groups was statistically significant. In the previous studies on the prevalence of
the TMJ disorder in the general population it is seen that almost 40 to 60 % of the
subjects suffer from one or the other signs and symptoms of the TMJ (Nassif and
Hilsen, 1992; Chuang, 2002). These findings are contrasting to our results as the
TMJ disorders were seen in only 10.42% of the general population. Similar low
prevalence of TMJ disorders were reported by Johansson et al., (2000) on the
Swedish population and by Pow et al., (2002) on the adult Chinese population.

In between the mining employees, greater prevalence of TMJ Disorders

were noted in the maintenance group (22.22%) and it was least prevalent in
transportation unit employees. However the difference noted was not statistically
significant.

The literature pertaining to the prevalence of the occupational related TMJ

disorder is scanty to nil, so the scope to discuss and compare our results with the
other occupational groups was not possible. However, the increased prevalence of
TMJ disorder in mining employees may be due to the development of the

183
parafunctional habits like grinding of the teeth and clenching of the teeth during
the strenuous physical labor. Pertaining to this, in the Nigerian population who
suffered from TMJ disorders, it was found that maximum number (89.7%) of
them had one or the other parafunctional habit which triggered the signs and
symptoms of TMJ disorder (Saheeb, 2005). Same may be applicable to present
mining employees.

7.14 DENTAL AESTHETIC INDEX SCORE

Maximum number of the mining workers and the control group population
judged their dentition as satisfactory. Twenty four percent of the mining workers
judged their dentition in grade 1 category, however, 26.67% of the general
population judged their dentition to be belonging to the grade 1 category. In rest
of the grading also the similar higher prevalence of judgment was seen in the
general population. However, the difference noted was statistically insignificant.

This difference in judgement might be due to the increase in the awareness

in the general population regarding their esthetic need of their dentition than the
mining workers. Again the increase in awareness can be attributed to the
increased literacy level of the general population then the mining employees.

7.15 SYSTEMIC DISEASES

Respiratory disease were the most common finding in the mining

employees (23.3%), which is followed diabetes (21.0%) and the eye problem
(16.9%). This high prevalence for the respiratory disease could be attributable to
the working conditions and the higher prevalence of the smoking habit. In the
control group the main prevalent systemic problem was related to eyes (27.7%).
This was followed by the diabetes (22.22%) and respiratory diseases (15.74%).
However, the difference found between the mining workers and the general
population. It is cited that the Lung function impairment was relatively higher in
miners than in controls in the previous study on the Gypsum mining workers
(Nandi et al., 2009). It is noted that diabetes was seen in 8% of the miners in the
same study, which way lower (21%) than the findings of our study (Nandi et al.,

184
2009).Similarly, in health survey study of the lime stone workers 15% of
impairment in the pulmonary function was noted and in agreement to this two
more reports were also cited(Chatterjee et al., 2008; Dhatrak et al., 2014; Oliveira
et al., 2014).

Hypertension was seen in 9.9% of the mining workers and in 8.33% of the
control group. This increase in the percentage of hypertensive individuals in
mining group again reflects their unhealthy work environment, including the
adverse habit which they indulged themselves in. in accordance to this finding
few studies previously on different occupational groups have reported in an
increased hypertension prevalence by 5.92%, 8.3% and 22.6% in lime stone
workers, iron ore workers and gypsum mining workers respectively (Nandi et al.,
2009; Dhatrak et al., 2014; Oliveira et al., 2014).

In between the mining workers respiratory diseases were most common in

the polishing workers (32.79%), eye problems were most common in maintenance
unit (37.50%) and diabetes was the most common problem in administration unit
workers (38.46%). Hearing problem was once again more prevalent in polishing
unit (13.11%). However, the difference noted was statistically not significant.

7.16 COMPARISON OF PM VALUES IN DIFFERENT AREAS OF

UDAIPUR CITY

The particulate matter level seen in the Udaipur Ambamata (119.00) and
Udaipur Town hall region (134.00) were low in comparison to the Udaipur
industrial area (212.00) and the mining area (254.00). The difference found
between the different regions was statistically significant with the P=0.000. This
increase in the PM level might be the reason for the tooth loss seen in the mining
employees. However, when we talk about the air quality, in all the regions the air
quality was critical.

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 Chapter 8

SUMMARY & CONCLUSION

8.1 SUMMARY

Mining workers represent a special population group or community who

deserve to be attended both on their oral and general health due to the various
occupational and environmental hazards they encounter in their daily life. The study
was conducted with the aim to evaluate the oral health status of the mining
employees in and around the Udaipur city. In turn the results of the study can be
utilized to plan the preventive dental care programmes and it is noted in the
previous studies also that the preventive dental care programmes at the workplace
were reported to effectively improve oral hygiene, periodontal status and
restorative care (Heloe and Kolberg, 1974; Petersen, 1989; Ahlberg et al., 1996).

A total of 500 mining employees, that includes 43 Administrative unit (A), 45

Maintenance unit (M), 140 Transportation unit (T), 140 Cutting unit (C), 132 Polishing
unit (P) workers and a comparative group of 480 subjects from general population were
examined. A modified WHO oral health assessment form (1997) and a questionnaire was
used to assess the oral health status and treatment needs.

The findings of the study are summarized here

1. The transportation, cutting and polishing unit workers had lower levels of
education and income compared to other employees who had higher educational
and income levels.

2. The transportation, cutting and polishing unit workers had poor oral hygiene
practices when compared to administrative, maintenance staff and general
population

186
 3. Two to three times a week consumption of sweets was
higher among the general population (37.50%) than Mining
employees (21.20%). The majority of administrative unit (43%)
transportation (49.29%), cutting (63.57%) and polishing unit
(62.12%) employees consumed sweets occasionally.

4. The transportation workers had higher percentage of

pernicious habits like tobacco use (84.5%) compared to other
Mining units and general population.

5. Significantly higher proportions of administrative and maintenance staff (60.4%

and 53.3% respectively) visited the dentist compared to other units and general
population.

6. Higher proportions of maintenance, transportation, cutting and polishing unit

workers (>40%) visited dentist mainly for extraction compared to administrative
unit staff (34.62%). Whereas 19.23% of administrative staff and 25.00% of
maintenance staff had visited dentist for restorative procedures which was
highest when compared to other units.

7. ‘No problem in the teeth’, ‘high cost of treatment’ and ‘lack of permission’ were
the most common reason among the Mining employees for not visiting dentist.
Whereas lack of time (and no nearby dentists were the complaints among general
population.

8. Mining employees had a higher prevalence of oral mucosal lesions with 16.60%
showing leukoplakia which was higher compared to general population (7.71%).
Within Mining units maintenance, transportation and cutting unit showed higher
prevalence of leukoplakia compared to other units with buccal mucosa being the
most affected site.

9. The prevalence of periodontal disease was higher among the Mining employees
(92.40%) compared to general population (90.58%). Within Mining units,

187
 transportation, cutting and polishing unit workers had shown higher prevalence of
periodontal disease compared to administrative unit.

10. Higher CPI scores were seen among tobacco users than among non-tobacco users
in both mining employees and general population. A similar trend was seen in LOA
scores also.

12. Regarding the prevalence of dental caries higher prevalence was among the
general population (58.33%) than Mining employees (41.20%). Among mining
employees transportation unit (55.0%), cutting unit (35.7%) and polishing unit
(37.8%) exhibited higher dental caries experience while the corresponding
prevalence among administrative staff was 27.9%, maintenance staff was 37.7%.

13. The mean decay component increased with age in both Mining employees and
general population.

14. Daily sweet consuming group had more prevalence and mean decay compared to
occasional sweet consuming group in both Mining employees and general
population.

15. The prevalence of tooth surface loss in the anteriors was higher among the
polishing unit workers (47.73%) followed by cutting unit (39.22%) as compared to
administrative (7.9%), maintenance staff (14.3%) and transportation unit (9.3%)
and general population (9.6%). The severity of tooth surface loss increased with
duration of employment in the mining and it seems to have direct connection with
the level of the particulate matter which was detected in the mining area.

17. Prosthetic rehabilitation was required more in the case of Mining employees than
general population. Whereas general population had better prosthetic status
compared to Mining employees.

16. Assessment of treatment needs revealed that higher proportion of transportation,

cutting and polishing workers required more restorations, extractions and pulp
care needs than for other units. Almost all Mining workers and general population
required oral prophylaxis.

17. The Particulate matter level seen in the mining areas was greater in comparison
with the other areas of the city.

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8.2 CONCLUSION

It is clear from the discussion that despite numerous advancements,

occupational oral health hazards are omnipresent and there is no look out for the oral
health status of workers particularly for mining workers. Therefore, it is desirable to
impart oral health education to them, to apprise them of the ill effects of work and
teach remedial measures. Awareness programs and local group discussions are essential
for improving the oral health status of these working communities. Health promotion
among the industrial workers requires coordinated action by all concerned including the
dental profession, local factory authorities, social and economic sectors and voluntary
organizations. Mass media could also play a significant role by providing systematic
updates regarding native and contiguous working conditions as to how it can be
improved. Well Planned training programme should be conducted for new recruited
members. Guidelines like mandatory use of Personal protective equipment should be
provided like protective masks, goggles and face guards to workers and provide medical
and dental care services. Government must take suitable measures and a strict law for
the rights of workers regarding health should be formulated along with regular
inspections and follow up.

Oral manifestations of occupational origin are readily predisposed and

aggravated by neglect of oral health, and the problem of prevention of oral occupational
hazards must be attacked both by improving the working conditions and by establishing
and maintaining oral health. The oral occupational diseases observed in this study
present a challenge to the authorities in industrial and public health to provide adequate
measures for the prevention, early recognition and treatment of oral occupational
disease.

In continuation with the current research, further there exists a scope to pursue
a longitudinal research to establish the correlation between the particulate matter level
and the tooth surface loss and the cancerous and precancerous oral lesions.

8.3 LIMITATIONS OF THE STUDY

189
1. Oral health status and treatment needs of employees in other mining factories
and those working in similar type of work environments in the entire state could
not be taken due to economic and time constraints.

2. Though marble mining employees had high prevalence of tooth surface loss
other etiological factors that might increase individual susceptibility to tooth
surface loss could not be assessed in our study which requires a longitudinal
study design.

3. The employers and the employee’s reluctance to oblige for the oral hygiene
checkup was the biggest drawback, as the sample size could have been
increased if this factor was favorable.

4. Collection of the particulate matter over a period of 5 years or more can yield
the definitive results for the increase in tooth surface loss noticed in these
mining employees, which the current study lacked to do due to the time
constraint.

190
 Chapter 9

RECOMMENDATIONS

Following recommendation are made in line with the results of this study;

1. Oral health related educational programmes have to be conducted amongst the

mining population.

2. Demonstration camps related to oral hygiene practice need to be organized

frequently by the mining owners.

3. Periodic general and oral health check-up is the necessity of the day and
accordingly six monthly treatment camps need to be organised by the
government or the mining owners.

4. The employees should be registered under the medical insurance and dental
insurance policies for the futuristic benefit.

5. The employees need to be educated regarding the adverse oral habits like the
pan and ghutka chewing, bidi and cigarette smoking etc and the adverse ill
effect they can possible produce.

6. In continuation to previous recommendation ‘Tobacco cessation programmes’

in integration with local medical and dental colleges have to be encouraged
regularly.

7. Use and sales of tobacco products can be banned in and around the mining
area.

8. Oral cancer screening programmes should be instilled periodically in the

industrial areas.

191
9. It should become a compulsion to wear the face mask, the ear plugs and the
googles to prevent damage.

10. The marble mining owners association may establish a dental clinic within the
mining area to deliver comprehensive oral health care to its employees and the
dental manpower may be sought from the local dental college.

11. Such dental clinics should also provide the subsidized treatment charges for the
mining employees.

192
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 LIST OF PUBLICATIONS

1. Publications related to thesis work

A. Referred journals

1. Tarulatha R. Shyagali, Nidhi Rai. “Occupational Dental Health

Hazards-A Review”. International Journal of Contemporary Dental and
Medical Reviews 2014:1-5.

2. Nidhi Rai., Tarulatha R. Shyagali, Deepak P. Bhayya. “Prevalence of

Caries in the Marble Mining Workers of the Udaipur City, Rajasthan,
India.” European Journal of Biomedical and Pharmaceutical sciences
EJBPS, 2016, Volume 3, Issue 4, 230-233.

3. Nidhi Rai, Tarulatha R. Shyagali, Deepak PB, Sudhanshu Sexana.

“Periodontal health in the marble mining workers of Udaipur city, India.”
European Journal of Pharmaceutical and Medical Research 2016, 3(6),
300-303.

2. Other publications

1. Tarulatha R. Shyagali,B. Chandralekha, Deepak P. Bhayya, Santhosh

Kumar, Goutham Balasubramanyam. “Are ratings of dentofacial
attractiveness influenced by dentofacial discrepancies?’ Australian
Journal of Orthodontics, Volume 24, No 2, November 2008, 91-95.
IM.F- 1.496

2. Jigar R. Doshi, Kalyani Trivedi, TarulathaShyagali. “Management of

Partially Impacted Mandibular Second Molars with an Australian
Uprighting Spring.” The Orthodontic CYBER Journal, November
2009.

3. D.P. Bhayya, T.R. Shyagali. “Prevalence of oral habits in 11-13 year old
school children in Gulbarga city, India.” Virtual journal of
orthodontics, 2009 January 10; 8(3):1-4.

211
4. Deepak P Bhayya, Tarulatha R Shyagali. “Dentigerous Cysts of
Inflammatory Origin-A case report.” The Internet Journal of Dental
Science,2009 Volume 7 Number 2.

5. KalyaniTrevedi, Tarulatha R Shyagali, Varun Jain. “Reliability of

investigating Vertical skeletal growth pattern using OPG and Lateral
Cephalogram – A comparative Study.”JIndian Orthodontic Society,
April - June 2010, Vol. 44: No. 2, page No:59.

6. Tapan Shah, Kalyani Trivedi, Tarulatha R Shyagali. “Assessment of

acceptability of smile esthetics with different level of gingival display by
Orthodontists and general public — A comparative study.”JIndian
Orthodontic Society, April - June 2010, Vol. 44: No. 2, Page No. 3-9.

7. Tarulatha R. Shyagali, Deepak P. Bhayya, Mallikarjun k.“Study of oral

hygiene status and prevalence of gingival diseases in 10-12 year school
children in Maharashtra, India.” J.Int Oral Health, October 2010 Vol. 2:
Issue 3.

8. Prabhuraj B Kambalyal, Arvind M, Tarulatha R Shyagali, Rani Hamsa.

“Clinical evaluation of the effects of retraction forces applied at varying
levels on maxillary anterior segment using implants” J. Adv Dental
Research, 2010; I (I): October: 27-32.

9. Tarulatha R Shyagali,Deepak. P. Bhayya. “Cephalometric evaluation of

treatment effect of twin block appliance in class II div 1
malocclusion”J.Int Oral Health, December 2010 Vol. 2: Issue 4, Page
No.57-64.

10. YagneshRajpara, Tarulatha R Shyagali, Kalyani Trivedi. “Evaluation of

skeletal asymmetry in aesthetically pleasing faces” Journal of Oral
Health and Research, September 2010; vol 1: issue 3, Page No. 100-
105.

11. Deepak Bhayya, Tarulatha R Shyagali.“Gender influence of occlusal

characteristics of primary dentition in 4-6 years old children of Bagalkot
city, India” Oral Health and Preventive Dentistry, vol 9: No 1. Page
No: 17-27.

212
12. Kalyani Trivedi, Tarulatha R Shayagali, JigarDoshi,
MadhuPandey.”Comparison of Arch width of Indian Population with
southern Chinese and Caucasians– A cross sectional study.” Journal Of
Indian Dental Association

13. Kalyani Trivedi, Tarulatha R Shyagali,JigarDoshi, YagneshRajpara.

“The reliability of esthetic component of IOTN in the assessment of
subjective orthodontic treatment need.”J. Adv Dental Research,
January2011; II (I): October: 59-65.

14. Deepak P. Bhayya, Tarulatha R. Shyagali.“Parental Attitude and

Knowledge towards the Usage of Barrier Techniques by Pediatric
Dentist” People’s Journal of dental research,Vol. 4(2), July 2011.

15. Shyagali TR,Bhayya DP “Study of Oral Hygiene Status and Prevalence

of Gingival Diseases in 10-12-year-old School Children in Sholapur City,
India.”- Nig Dent J Vol 18 No. 1 Jan - June 2010.

16. Mallikarjun K, Kohli Anil, K Arvind, Vatsala V, DeepakBhayya,

Tarulatha R Shyagali.“Chronic Suppurative Osteomyelitis of the
mandible- A Case Report”-J.Int Oral Health, Volume 3; Issue 2: April
2011.

17. Kalyani Trivedi, Sourav Singh, Shivamurthy DM, Jigar

Doshi,TarulathaShyagali, Bhavik Patel“Analysis of cephalometricsfor
orthognathic surgery: Determination of norm applicable to Rajasthanip
opulation”- National Journal of Maxillofacial Surgery | Vol 1 | Issue 2
| Jul-Dec 2010 | 103-107.

18. Tarulatha R Shyagali,KalyaniTrevedi, YagneshRajpara. “Simple “TRS”

Auxiliary Tube for Segmental T Loop”- The Orthodontic CYBER
JournalMarch, 2011.

19. Amit Prakash, Arundhati P. Tandur, TarulathaShyagali,Rahul

Bhargava. “Deep Bite Correction with Cetlin’s Intrusion Arch”- The
Orthodontic CYBER JournalAugust, 2011.

213
20. Deepak P Bhayya, Tarulatha R Shyagali, Uma B Dixit, Shivaprakash.
“Tooth Fragment Reattachment: An Esthetic Alternative and Report of
Two Cases” -Dental Follicle - The Monthly E- Journal Of Dentistry,
Vol - VI Number- I May 2011.

21. Jigar R Doshi, Kalyani Trivedi, TarulathaShyagali. “Assessment of

Anteroposterior apical jaw base relationship using Mount Vernon Index
(MVI)” -Journal of Oral Health Research, Volume 2, Issue 1, January
2011.

22. Mallikarjun K, Deepak P Bhayya, Deepesh Singh, Tarulatha R

Shyagali.“Metachromatic Leukodystrophy: A Rare Case Report”-
Journal Of Academy Of Advanced Dental Research, Vol 2; Issue 3:
September 2011

23. Tarulatha R Shyagali,VarthikaTripati, JigarDosh ,Amith Prakash.

Evaluation of Condylar Growth in Mandibular Repositioning Cases
Using Fixed and Removable Functional Appliances. International
Journal Of Advanced Research On Oral Sciences 1:1 (2011).

24. Jigar R. Doshi, Kalyani Trivedi, TarulathaShyagali. “Predictability of

Yen Angle & Appraisal of Various Cephalometric Parameters in the
Assessment of Sagittal Relationship Between Maxilla and Mandible in
Angle’s Class II Malocclusion”- People’s Journal of Scientific
Research, Vol. 5(1), Jan. 2012
25. Amit Prakash, Arundhati P. Tandur, TarulathaShyagali, Rahul Bhargava
“Post distalization methods of stabilization of molar”- The Orthodontic
CYBER Journal, December, 2011.
26. Jigar R. Doshi, Kalyani Trivedi, TarulathaShyagali“Asymmetric “T”
Loop archwire for Deep Bite correction – A Case Report.”-The
Orthodontic CYBER Journal, February, 2012.

27. Tarulatha R. Shyagali, ChandralekhaBasavaraj Urs, Shashikala

Subramai, Deepak P. Bhayya. “Evaluation of stresses generated by
altering bracket mesh base design in bracket-cement-tooth continuum
using finite element method of stress analysis”. The Art and Practice of
DetofacialEnchancement (WJO), volume 13, 2012, e66-e74.

214
28. Tarulatha R Shyagali, Deepak P Bhayya“Patient’s attitude and
knowledge towards the usage of barrier technique by orthodontists.”Int J
Infect Control 2012, v8:i2 d

29. Tarulatha R Shyagali, Amit Prakash, Nitin Dungarwal. “A new stent for
implant placement”. Orthodontic WavesVolume 71, Issue 4, December
2012, Pages 134–137.

30. Tarulatha R Shyagali, Deepak P Bhayya, Amit Prakash, Nitin

Dungarwal, Adit Arora. “Comparison of stresses generated by different
bracket debonding forces using finite element analysis”. Journal of
Indian Orthodontic Society, 2012; 43(3): 137-140.

31. Deepak P Bhayya, Tarulatha R Shyagali, Uma B Dixit, Shivaprakash.

Study of occlusal characteristics of primary dentition and the prevalence
of malocclusion in 4 to 6 years old children in India.Dental Research
Journal September 2012; 9(5):619-623.

32. KalyaniTrevedi, Tarulatha R Shyagali, Varun Jain. “Reliability of

investigating Vertical skeletal growth pattern using OPG and Lateral
Cephalogram – A comparative Study.” JPAHER 2009, Vol I (I).

33. “Determination of Cephalometric Norms of Dentofacial patterns for

Indian adults of Rajasthani origin.” JPAHER, 2009, Vol. 1: Issue 1, Page
No. 30-33.

34. “Predictability of beta angle and appraisal of various cephalometric

parameters in the assessment of sagittal relationship between maxilla and
mandible in Angle’s Class I malocclusion.”JPAHER, 2009, Vol. 1: Issue
2, Page No. 18-21.

35. “Study of change in depth on the antegonial notch in horizontally and

vertically growing patients.” JPAHER, 2009, Vol. 1: Issue 1, Page No.
27-29.

36. “Molar Distalization – A review.”JPAHER, 2009, Vol. 1: Issue 2, Page

No. 2-4.

215
37. “Comparison of twin block & functional appliance: A systematic review
&Meta analysis.”JPAHER, 2009, Vol. 1: Issue 2, Page No. 14-17.

38. “Estimation of oral salivary fluoride retention in children following

fluoride dentifrices and fluoride mouth rinses.” JPAHER, 2010, Vol. 1:
Issue 4, Page No. 9-13.

39. Comparative evaluation of anchorage loss between self-ligating appliance

and conventional pre-adjusted edgewise appliance using sliding
mechanics. JPAHER 2010: vol II (II).

40. Deepak P Bhayya1, Tarulatha R Shyagali. Traumatic Injuries in the

Primary Teeth of 4-6 Year-Old School Children in Gulbarga City, India-
A Prevalence Study. Journal of Oral Health and Management.

41. Tarulatha R Shyagali, Deepak Bhayya. Smile esthetics. Dental Poster

Journal 2013.

42. Nitin Dungarwal, JayeshRahalkar, SonaliDeshmukh, Amit Prakash,

NiketanDhoka, Tarulatha R Shyagali.Evaluation of Maxillary
Interpremolar, Molar Width by DRNA Indices and Arch Dimension,
Arch Form in Maratha Population. Journal of Indian Orthodontic
Society Volume 47, Issue 4, October-December(Supplement-IV) 2013
Pages No: 461-467.

43. YagneshRajpara, Tarulatha R. Shyagali,Kalyani Trivedi,

PrabhurajKambalyal, TapanSha,Varun Jain. Evaluation of facial
asymmetry in esthetically pleasing faces. Journal of Orthodontic
Research | May-August 2014 | Vol 2 | Issue 2, 1-6.

44. Tarulatha R Shyagali, YagneshRajpara, Kalyani Trivedi. Simple “TRS”

Auxiliary Tube for retraction of anterior segment using Segmental T
Loop mechanics.International Journal of Orthodontics, VOL. 25
NO. 1 SPRING 2014.

45. Tapan Shah, TarulathaShyagali, Kalyani Trivedi. “The correction of

crowding using the conservative treatment approach”. Nepal
Orthodontic society Journal, Vol. 4, No. 1, June 2014.

216
46. Tarulatha R Shyagalia, Deepak P Bhayya. "Evaluation of orthodontic
treatment expectations of Indian parents and their children". Pakistan
Orthodontic Journal 2014:6(1) 19-26.

47. JigarDoshi,TarulathaRevanappaShyagali, Kalyani M. Trivedi “Skeletal

Class II Malocclusion correction using the Bass appliance - A Case
Report”. APOS Orthodontic Trends| January 2015 | Vol 5 | Issue 1:
44-48

48. JigarDoshi, Kalyani Trivedi, Tarulatha R Shyagali.“Clinical efficacy of

Damon System in borderline cases.”Orthodontic Update 2015; 8:28-32.

49. Tarulatha R. Shyagali, Deepak P. Bhayya, Chandralekha B. Urs,

Shashikala Subramaniam. “Finite element study on modification of
bracket base and its effects on bond strength”. Dental Press J Orthod.
2015 Mar-Apr;20(2):76-82

50. YagneshRajpara, Tarulatha R. Shyagali“An Assessment of Sexual

Dimorphism in Relation to Facial Asymmetry in Esthetically Pleasing
Faces.” ACTA INFORM MED. 2015 FEB 23(1): 44-48

51. Jay Soni, TarulathaR.Shyagali, Deepak P. Bhayya,Romil Shah.

“Evaluation of Pharyngeal Space in Different Combinations of Class II
Skeletal Malocclusion”.ACTA INFORM MED. 2015 OCT 23(5): 196-
201.

52. Rana Tiwari, TarulathaR Shyagali, Abhishek Gupta, Rishi Joshi, Anil
Tiwari, Priyank Sen.“Predictability and Reliability Of reproduction of
different Anterio-Posterior Skeletal Discrepancy Indicators in different
age groups - A Cephalometric Study”-Journal Of Clinical And
Diagnostic Research.

217
“Evaluation of oral health status and treatment need among Mining
Labourers, in Udaipur city, India”

Date: Serial No. :

(All the answers given by you will be strictly confidential. It is used only for scientific
purpose and your personal information will not be revealed to anybody).

Consent:

This study and procedure involved in it have been explained to me and I agree with it
and ready to co-operate with my free will and wish.

Signature / Thumb impression

1. Name: …………………………………………………………

2. Age: …….yrs. 3. Gender: ……….

4. Address……………………………………………………………………………….

5. Literacy Status: A. Illiterate B. Primary school C.High school D. PUC E. Diploma F.

Graduate G.PG.

6. Factory unit: A. Administrative staff B. Maintenance staff C. Transportation unit

D. Cutting unit E. Polishing unit F. Others

7. Monthly income:

218
9. Diet. : A) Vegetarian B) Mixed

10. Do you eat sweets Yes/ No

b) Frequency: i. Daily / weekly/ occasionally

ii. Once/ twice/ more than twice

11. Do you have any following personal habits?

Duration Frequency
a) Smoking User/Ex-user/No

Duration Frequency
b) Tobacco chewing User/Ex-user/No

Duration Frequency
c) Pan/Gutkha chewing User/Ex-user/No

Duration Frequency
d) Alcohol User/Ex-user/No

12. How many times do you clean your teeth in a Day?

a) Once b) Twice c) After every meal

13. How do you clean your teeth?

a) Tooth brush b) Finger c) Others (Neem Stick / Mango stick, etc.)

14. What material you use to clean the teeth

a) Tooth paste b) tooth powder c) Others (Brick powder/Mud/Charcoal)

15. Do you have the habit of teeth grinding at the work place? Yes/No

219
16. Do you take any protective measures in face while working? Yes/No

If yes, please specify ……………………………………………………………

17. Duration of employment at the factory: …………………………..

18. A) a) Do you have any Medical check up in your organization? Yes/no

b) Do you have any Dental check up in your organization? Yes/no

B) If yes, a) once in a month b) twice in a month c) once in a year d) others

19. a) Do you have medical insurance/allowances/schemes: Yes/No

b) Do you have dental insurance/allowances/schemes: Yes/No

20. A) Have you visited the dentist before? Yes/No

B) If yes, what was the reason?

a) Removal of teeth b) Replacement of teeth c) Filling

d) Cleaning e) Root canal treatment

f) Others …………….

C) If No, what was the reason?

a) No Problem in the teeth b) Not interested

c) Lack of permission in the factory/ Lack of time

d) Lack of dentist nearby e) High cost of treatment e) Fear

f) Others ………………………………………

220
22. Did you had work loss in the last one year because dental care visits Yes/No

23. Do you suffer by any systemic (General) disease?

a) Diabetes b) Hypertension

c) Eye diseases d) Respiratory diseases

e) Skin diseases f) Heart diseases

g) Hearing disorders

h) Others ………………………..

24. Are you suffering from teeth sensitivity? Y/N

Abrasion Y/N…………………………………..

Attrition criteria …………………………………………

Grade 1 : Loss of surface features, the dentin is not involved

Grade 2 : Involvement of the dentin for less than one third of the area of the
tooth surface.

Grade 3 : Involvement of the dentin for more than one third of the area of the
tooth surface.

221
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