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Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 384-388

Oral health status of cracker workers in Sivakasi, Tamil Nadu, India - A cross-sectional study

Department of Public Health Dentistry, Priyadarshini Dental College and Hospital, Thiruvallur, Tamil Nadu, India

Date of Web Publication7-Dec-2015

Correspondence Address:
M Mary Sherley
No: 9/1, Guruvappan Street, Pudupalayam, Cuddalore -607 001, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-5932.171204

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Introduction: Poor oral health and untreated oral diseases have a significant impact on quality of life. Oral and general health of cracker workers is in association with their working environment. Aim: To assess the oral health status of cracker workers in Sivakasi. Materials and Methods: A total of 350 subjects were included in this study. The subjects were randomly selected from 10 companies in Sivakasi. Data were collected by using WHO Oral Health Assessment Form for Adults (2013). The proforma included questions on knowledge, attitude, and practices of oral hygiene. Statistical analysis was performed using statistical package for social sciences version 16.0. Results: Among 350 subjects, 34.9% were males and 65.1% were females. The mean number of decayed, missing, and filled teeth was 2.52, 4.17, and 1.32, respectively. The mean of sextants with shallow pockets is 5.9 and its percentage is 54. The mean of sextants with deep pockets is 1.5 and its percentage is 14.6. Oral lesions were found to be present among 4.3% of study subjects.
Conclusion: Workers of fireworks industries those with dental caries, periodontal problems, and other dental complaints should be examined repeatedly for their oral health status.

Keywords: Awareness, cracker workers, oral health status, treatment needs

How to cite this article:
Sherley M M, Nivetha A, Ganesh R. Oral health status of cracker workers in Sivakasi, Tamil Nadu, India - A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:384-8

How to cite this URL:
Sherley M M, Nivetha A, Ganesh R. Oral health status of cracker workers in Sivakasi, Tamil Nadu, India - A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2022 Aug 17];13:384-8. Available from: https://www.jiaphd.org/text.asp?2015/13/4/384/171204

  Introduction Top

Oral health is an integral part of one's general health. Good oral health helps people to communicate, enjoy food, improves one's dignity, and personality. Oral health is not only important to our appearance and sense of well-being, but also to our overall health.[1] Thus, poor oral health and untreated oral diseases decides a person's quality of life. There exists a relationship between oral health and several systemic diseases.[2] Most oral diseases and conditions require professional dental care, however, due to limited availability and inaccessibility, the use of health services is markedly low among people living in rural areas.[3]

Sivakasi - Mini Japan. It is in the town of Virudhunagar district of Tamil Nadu. It is the major center of firework industry in India. Almost 70% of India's fireworks are produced here.[4] Working environment plays a crucial role in the general and oral health of workers.[5] Work related general and skin diseases are significantly higher among cracker workers.[6] Therefore, it is of utmost importance to throw light on general and oral health of cracker workers.

Due to an unhealthy diet, tobacco use, inaccessibility to dental services, and lack of literature among cracker workers, this study was conducted to assess the oral health status of cracker workers in Sivakasi.[7]

  Materials and Methods Top

This cross-sectional study was conducted among the cracker workers working in fireworks companies of Sivakasi town. The study was approved by the Institutional Ethical Committee.

The list of cracker companies was obtained from the Sivakasi fireworks association. Using simple random sampling method 10 companies were chosen. G*power statistical software was used to estimate the sample size. The estimated sample size was 350 workers based on 80% power and 0.05 alpha errors which included workers from age 25 years to 86 years. Inclusion criteria were the workers from 25 years of age and those who were present in the company at the time of study.

Before the commencement of the study, both the examiners were standardized and calibrated in the Department of Public Health Dentistry, by the Head of the Department, to ensure uniform interpretation, understanding, and the application of codes and criteria for the diseases to be observed and recorded and to ensure a consistent examination.

Workers those who were dealt with fireworks production were examined the irrespective of their knowledge, attitude, and practices of oral hygiene. Type III examination was carried out using a plane mouth mirror and WHO probe. Oral health status was recorded using WHO Oral Health Assessment Form for Adults.[8] Dentition status, periodontal status, the loss of attachment, dental fluorosis, traumatic injuries, dental erosion, oral mucosal lesions, prosthetic status, and treatment needs. On an average 45 subjects were examined per day for a time period of 15–20 min. As per the diagnosis, patients were prescribed with medicines and referred for further treatment.

Statistical analysis was performed using SPSS version 16.0 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.,). Comparison of two independent groups were made using Mann–Whitney U-test.

  Results Top

A total of 350 were examined with a minimum age of 25 years and a maximum age of 86 years. The mean age of study population was 47.04 years. In that 122 (34.9%) were males and 228 (65.1%) were females.

Workers who brushed their teeth once a day was 92.3% (323), 6.3% (22) brushed their teeth twice a day, and 1.4% (5) brushed their teeth thrice daily. Workers who brushed their teeth for about <3 min was 56.3% (197). Tooth paste, tooth powder, finger, brick powder, charcoal powder, neem stick, and tooth brush, were the materials used for cleaning their teeth [Figure 1].
Figure 1: Tooth paste, tooth powder, finger, brick powder, charcoal powder, neem stick, and tooth brush, were the materials used for cleaning their teeth

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[Table 1] shows the study subjects' responses on oral health. Most of the workers responded that the cause of dental caries was due to bacteria. Tooth brushes with hard bristles were used by the most of the workers. Horizontal technique was followed by 77.1% of workers and only 13.7% of workers change their tooth brush once in 3 months.
Table 1: The study subjects knowledge, attitude and awareness of oral health

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The mean number of decayed, missing, and filled teeth were found to be 2.52, 4.17, and 1.32, respectively. Gingival bleeding was a common finding among these workers. [Figure 2] shows the prevalence of gingival bleeding among Sivakasi cracker workers. The mean of sextants with shallow pockets (4–5 mm) is 5.9 and its percentage is 54. The mean of sextants with deep pockets (>6 mm) is 1.5 and its percentage 14.6. Moderate fluorosis was found to be among 0.9% of workers. Dental erosion was seen in 24.9% of workers and only 10.9% of the subjects had dental trauma. Oral lesions were present in 4.3% of workers and only 0.9% workers were using complete denture among the entire population.
Figure 2: Prevalence of gingival bleeding among Sivakasi cracker workers

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It was estimated according to WHO guidelines.[8] Maximum number of workers 209 (59.7%) requires prompt treatment including scaling. A total of 87 (24.9%) require preventive treatment. Among the workers only 15 (4.3%) needs immediate treatment such as surgical extractions, incision and excision required for biopsy, and the complete removal of lesion and the remaining population 39 (11.1%) does not require any treatment.

  Discussion Top

The present study is the first cross-sectional survey done to provide systematic information on oral health status of cracker workers in Sivakasi.

Industrial workers constitute a high-risk population due to their poor life style and oral diseases are seen more commonly in them.[9] There is a strong corelation between socioeconomic status and health. Lower socioeconomic status was deserved to be an important factor in Japanese workers for the high prevalence of periodontal disease and poor oral hygiene practices.[5] Access to dental care is a problem, particularly due to low socioeconomic status.[10]

Communication difficulties, financial crisis, lack of insurance, employment in remote areas, and transportation difficulties were the obstacles to receive the dental services, which was reported by Casey et al. in his study among paper workers and these could be the reasons for the poor oral health of the most of the cracker workers.[10]

The decayed, missing, and filled surfaces/teeth (decay-missing-filled index) has in use for about 65 years, and is well-established as the leading measure of caries experience in the dental epidemiology.[11] The comparison of present study can be done with other workers and general adult population as no previous comparable data is available for this specific occupation group. Similar prevalence of dental caries was found in the present study and in some other study conducted on two industrial population groups.[12]

The mean index or decayed-missing-filled teeth index in our study was high when compared to the study conducted on some mill workers [13] and also coincides with the study reported by Duraiswamy et al.[14] The mean number of decayed teeth was high in our study as reported by Ahlberg et al.[15] The mean number of missing component was higher when compared to the study was done in green marble mine workers in Udaipur district [14] and Japanese workers.[16] Filled teeth were the lowest in all categories in the present study and are same as compared to the study conducted in sweet and cable industry workers.[17] The mean number of teeth lost per worker showed a significant increasing trend with age which was similar with a study conducted previously.[16]

Regarding the periodontal status of the subjects, higher percentage of subjects in our study had a signs of periodontal disease. The prevalence of periodontal pocket was high among the cracker workers when compared with the study conducted among industrial workers in Davangere city, Karnataka [18] and factory workers in Shanghai.[19] The reason for this could be the presence of metallic dust in plaque and calculus of industrial workers which act as an irritating factor causing periodontal disease.[20] The result of periodontal disease in our study is in accordance with the study done on factory workers in China [19] and in Brazil.[21]

Prevalence of oromucosal lesion was found to be 4.3% which is very less as reported by Malaovalla et al.[22] Furthermore, the most common oromucosal lesion in our study was tobacco pouch keratosis. The most common site affected by the lesion was buccal mucosa, which was same as reported by Ikeda et al.[23] and Garcia-Pola Vallejo et al.[24] The prevalence of tobacco chewing and smoking was very low but was more as reported by Saraswathi et al.[25] Moderate degree of dental fluorosis was found among 0.9% of workers. The most prevalent treatment needs with present study was oral prophylaxis as reported by Romano and Pop.[26]

Periodontal treatment needs increase with increasing age in the study is as similar to that reported by a study done in Finland.[5] Tooth brush was used among 61% of workers, 29% used fingers, 7% used neem stick to clean their teeth, and only 6.3% of workers brushed their teeth twice a day. This shows the lack of professional oral health education. Though greater number of workers reported using tooth brush to clean their teeth, however, this habit failed to show its effect on the periodontal status of cracker workers.

There are some limitations in this study. Not much importance was given to data on tobacco use and alcohol consumption. However, several such cross-sectional surveys on tobacco use by adults have shown such studies have relatively low rates of misreporting.[27] Duration of working in the firework industry was also not recorded, which plays an important role in assessing the occupational effects on oral health.

We provided oral health education to the workers which created awareness on oral health practices among the cracker workers. Comprehensive oral health education for all cracker workers was not expedient in the circumscribed time period. Our survey was an eye opener to the workers since they had a chance to get the rid of all their doubts regarding oral health. As it was a cross-sectional survey, review about the sequel of oral health education given, could not be assessed.

The data obtained from this study gives an idea about the oral health status of cracker workers in Sivakasi, which may be useful to explore the etiology of those oral diseases and to plan oral health promotion programs. The workers of firework industries should be examined repeatedly for their overall oral health status. After evaluation for treatment, the workers should be provided oral health education and motivation to maintain their oral hygiene for the betterment of their lives and health.

  Conclusion Top

Results of this study give a clear cut sketch of the oral hygiene of the cracker workers. The overall oral health status of the workers was poor and it should be examined repeatedly. Steps should be taken to promote the oral health status of those workers in order to motivate them to maintain their oral hygiene.


The authors thank Dr. Arunachalam, Dr. Vivek Narayanan for granting us the permission to conduct the study and we thank Dr. R. Ganesh for supporting and guiding us throughout this study. We also thank the President of the fireworks association and all the CEO of respective factories for giving the permission and all the workers who participated in this study for their cooperation.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1]

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