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Table of Contents
ORIGINAL ARTICLES
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 1-4

Association between occupational exposure to acidic chemicals and occupational dental erosion in the workers of a battery company in Bengaluru city: A case–control study


1 Department of Public Health Dentistry, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India
2 Department of Pedodontics and Preventive Dentistry, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India
3 Department of Prosthodontics and Crown and Bridge, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India

Date of Submission04-Dec-2019
Date of Acceptance13-Dec-2019
Date of Web Publication20-Mar-2020

Correspondence Address:
Silpi Chatterjee
Department of Public Health Dentistry, Hazaribag College of Dental Sciences and Hospital, Demotand, Hazaribag 825301, Jharkhand.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_41_19

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  Abstract 

Introduction: Occupational exposure to acids has been described in association with oral health, which is explained by the high irritant and corrosive acid effects that damage the enamel structure, cause inflammatory and immune reactions, and reduce the salivary pH, which can also compromise resistance to infections in oral cavity. So, this study was conducted to access the dental erosion and afford them the necessary treatment. Aim: The aim of this study was to evaluate the association between occupational health behaviors and occupational dental erosion in the employees of battery company, Bengaluru, Karnataka, India. Materials and Methods: A case–control study was planned among the workers of battery company in Bengaluru City. Total 362 subjects were selected for the study, among which 181 were cases and 181 were controls. The data were collected by administering a questionnaire, which included demographic data, years of experience, and oral hygiene practices. The dental erosion was assessed according to recommended diagnostic criteria of Smith and Knight Tooth Wear Index. Results: A total of 35.2% of the subjects had dental erosion in the age of 50–59 years. Comparison of dental erosion among the age-group revealed a statistically significant difference (P < 0.00). Approximately 14.5% cases and 1.75% of the controls had at least one tooth surface with dentine, which was statistically significant (P < 0.00). Conclusion: This study documents the association between deterioration of the oral health status and a hazardous workplace environment. Findings pointed to the need of establishing appropriate educational, preventive, and treatment measures coupled with efficient surveillance and environment monitoring for the detection of acid fumes in the workplace environment.

Keywords: Battery workers, dental erosion, oral health status


How to cite this article:
Chatterjee S, Tiwari S, Saxena S, Kumari A, Singh R. Association between occupational exposure to acidic chemicals and occupational dental erosion in the workers of a battery company in Bengaluru city: A case–control study. Int J Oral Care Res 2020;8:1-4

How to cite this URL:
Chatterjee S, Tiwari S, Saxena S, Kumari A, Singh R. Association between occupational exposure to acidic chemicals and occupational dental erosion in the workers of a battery company in Bengaluru city: A case–control study. Int J Oral Care Res [serial online] 2020 [cited 2020 Apr 9];8:1-4. Available from: http://www.ijocr.org/text.asp?2020/8/1/1/281142




  Introduction Top


The tooth wear or tooth surface loss is a common term that is used to describe the surface loss of dental hard tissues from causes other than developmental ones, dental caries, and trauma. The wear of teeth is irreversible and increases with age. With multifactorial etiology, tooth wear varies in severity, location, and clinical representation. Tooth wear has conventionally been subdivided into three categories: attrition, abrasion, and erosion, usually based on etiologic factors and clinical features. Among these, dental erosion is the most common, and it causes great damage to dental hard tissues.[1]

Majority of people employed in various industries are exposed to perilous environment. Every occupation is associated with one or the other ill effects on health.[2] Industrial environmental factors may be considered responsible for dental erosion among battery workers as they were exposed to sulfuric acid fumes created by the harmful processes known as forming and charging.[3] This study was conducted in Bengaluru (Karnataka, India) to obtain data on the prevalence and severity of dental erosion among battery manufacturing industry workers. These data can be useful in future for planning preventive, curative, and promotive oral health program for battery factory workers.


  Materials and Methods Top


A case–control study was conducted to evaluate the association between occupational health behaviors and occupational dental erosion among the employees of Exide Battery Company, Bengaluru, Karnataka, India. Data were collected for 2 months from the workers of lead battery manufacturing units in Bengaluru City. The study proposal was submitted for approval, and the clearance was obtained from the ethics review board of Oxford Dental College, Bengaluru, Karnataka, India. Permission to conduct the study was obtained from higher authority of the company where the study was conducted. On a fixed day and time, investigator visited the factories, appraised the manager about the study, thereby obtaining permission to conduct study on the workers in their factories. Employees who agreed to participate in the study provided informed consent for conducting the oral examination.

The study population comprised employees of Exide Battery Company, Bengaluru, Karnataka, India. Participants were screened for suspected lead exposure. The study sample comprised 181 cases and 181 controls. The employees who were having dental erosion were included in the study. Those who were not having dental erosion were not included in the study. The data were collected for 2 months, by allowing flexibility for the study participants. The data were collected during the office hours, giving preference to their availability. A pretested pro forma, completed by interview, was used to collect information on demographic details, dietary habits, oral hygiene practices, and gastric complaints. Details on acidic food and beverage consumption and tooth sensitivity were also recorded. Each clinical examination was carried out under good artificial light and community periodontal Index probe. All workers who consented to participate were examined for dental erosion. Dental erosion was assessed according to recommended diagnostic criteria (Smith and Knight Tooth Wear Index). A self-administered questionnaire was used in the study. The questionnaire consisted of seven closed-ended questions. The questions were based on the demographic details, dietary habits, oral hygiene practices, gastric complaints, details on acidic food and beverage consumption, and tooth sensitivity. Care was taken to make the questions as simple as possible for the participants to comprehend. Pilot study was carried out on 10% of the sample in the Exide Battery Company. The data were collected by using a questionnaire. The pilot study was performed to check the feasibility and relevance of pro forma.


  Results Top


Results were analyzed in accordance to the objectives of the study and aim of the trial. Also, the descriptive data and characteristics of the study participants were analyzed and explained using the tabular and graphical representations of the same.

In this study, there were 362 participants. In the age-group 20–29 years, cases were 39% (n = 71) and controls were 42% (n = 42); in the age-group 30–39 years, cases were 38.8% (n = 70) and controls were 66% (n = 36.6); in the age-group 40–49 years, cases were 17% (n = 31) and controls were 16.5% (n = 30); and in the age-group 50–59 years, cases were 5.2% (n = 9) and controls were 5% (n = 9). In the study population, 154 (85.5%) of the cases and 44 (24.4%) of the controls had at least one tooth surface with exposed dentine [Figure 1]. Comparison of the dental erosion among the cases and controls revealed a statistically significant difference (P < 0.001) [Figure 2]. When the comparison of responses to various questions by cases and controls was carried out, it revealed a statistically significant difference (P < 0.001).
Figure 1: Prevalence of dental erosion

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Figure 2: Distribution of study population based on tooth surfaces with individual teeth along with surface

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  Discussion Top


Oral cavity injuries, which occur as a direct result of an occupation, are rather common. The injurious effects of occupational hazards may manifest themselves in the teeth, jaw bones, periodontal tissues, tongue, lips, and oral mucosa. The effects of the various etiology agents depend on their specific chemical, physical, and bacterial nature, their physical state, and their mode of entry.[4] Prevalence varies across different age-groups, occupational groups, geographic areas, and cultures. It changes over time as well. For example, in Korea, the prevalence of occupational dental erosion was reported as 8% in 1993 and 11.3% in 2003.[5] Unfortunately, many individuals do not recognize the condition and do not seek help until after their aesthetics are affected or they have hypersensitive teeth.[6] The prevalence of dental erosion is higher in the workers in battery and galvanizing occupations. Battery workers, exposed to sulfuric acid, have the highest prevalence (60%) of erosion, with 20% being severe cases.[2] There is very less information on the effect of occupational hazards on oral health status in the workers of lead battery manufacturing units in Bengaluru City. In this study, the investigator did not know the departments the workers belonged to. This blind arrangement prevented the investigator’s subjective expectations from affecting the results. Unfortunately, there is no standard method to measure dental erosion. Different definitions, parameters, and terminology used by various researchers across the world confound the interpretation of studies. To date, there is not one ideal index that can be used for epidemiological prevalence studies, clinical staging, and monitoring.

In this study, dental erosion was assessed using Tooth Wear Index by Smith and Knight.[7] Evidence from calibration exercises revealed lack of uniformity when assessing enamel surface wear only, but dentinal exposure was considered a more reliable measure.[8] This index was used as dental erosion, due to industrial airborne acids, has a common clinical presentation, that is, erosive lesions are located at the incisal portions of the upper and lower anterior teeth, particularly the centrals. In a study from Finland, battery workers were exposed to 0.06–2.0mg/m3.[9] In a more recent study from Japan, the work environmental sulfuric acid density was above the tolerable range, 1.0mg/m3. Comparison of the findings of these studies may suggest that the higher concentrations of acid fumes in the working environment are related to the higher proportions of loss of tooth substance. Unfortunately, data on acid fume levels in the lead battery manufacturing unit visited were not available, and access to the information regarding acid fumes was forbidden. However, the investigator’s observation of unprotected acid handling and reduced safety measures mad workers were exposed to excessive acid fumes.


  Conclusion Top


Oral health is as important as general health, but it is receiving less attention than it actually deserves in the present scenario, especially in the developing countries.[10] The data presented in the study emphasized on the association between dental erosion and occupational health. High prevalence of dental erosion was observed among cases (acid-exposed workers) than that among control group workers. This study revealed that long-term exposure of sulfuric acid mists in the working environment significantly increased the chances of having dental erosion among exposed workers. The markedly better general and oral health conditions in the control groups compared to their acid-exposed counterparts confirmed the association between deterioration of the oral health status and the hazardous workplace environment. Exposure to sulfuric acid fumes is significantly associated with deteriorated oral health status and dental erosion. Oral hygiene is an essential part of industrial hygiene.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agarwal R, Mishra G, Sexena V, Singh N, Sharva V, Yadav K. Assessment of dental erosion status among battery factory workers in Mandideep, India. IJOSH 2014;4:11-5.  Back to cited text no. 1
    
2.
Malcolm D, Paul E. Erosion of the teeth due to sulphuric acid in the battery industry. Br J Ind Med 1961;18:63-9.  Back to cited text no. 2
    
3.
Khurana S, Jyothi C, Dileep CL, Jayaprakash K. Oral health status of battery factory workers in Kanpur city: A cross sectional study. J Public Health Dent 2014;12:80-7.  Back to cited text no. 3
    
4.
Tuominen M, Tuominen R. Dental erosion and associated factors among factory workers exposed to inorganic acid fumes. Proc Finn Dent Soc 1991;87:359-64.  Back to cited text no. 4
    
5.
Kim HD, Hong YC, Koh DH, Paik DI. Occupational exposure to acidic chemicals and occupational dental erosion. J Public Health Dent 2006;66:205-8.  Back to cited text no. 5
    
6.
Lussi A, Hellwig E, Zero D, Jaeggi T. Erosive tooth wear: Diagnosis, risk factors and prevention. Am J Dent 2006;19:319-25.  Back to cited text no. 6
    
7.
Smith BG, Knight JK. An index of measuring the wear of teeth. Br Dent J 1984;156:435-8.  Back to cited text no. 7
    
8.
Giunta JL. Dental erosion resulting from chewable vitamin C tablets. JADA 1983;107:253-6.  Back to cited text no. 8
    
9.
Tredwin CJ, Scully C, Bagan-Sebastian JV. Drug-induced disorders of teeth. J Dent Res 2005;84:596-602.  Back to cited text no. 9
    
10.
Edeer D, Martin CW. Occupational Dental Erosion.Richmond, BC: WorksafeBC Evidence-based Practice Group; 2019.  Back to cited text no. 10
    


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