Association Between Socioeconomic Status And Oral Health Among Selected South Indian Population
Tahreem Fathima1, Arvina Rajasekar2*
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai- 77, India.
2 Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai- 77, India.
*Corresponding Author
Dr. Arvina Rajasekar,
Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai-
77, India.
Tel: +91 9486442309
E-mail: arvinar.sdc@saveetha.com
Received: September 13, 2021; Accepted: September 22, 2021; Published: September 23, 2021
Citation:Tahreem Fathima, Arvina Rajasekar. Association Between Socioeconomic Status And Oral Health Among Selected South Indian Population. Int J Dentistry Oral Sci. 2021;8(9):4602-4605. doi: dx.doi.org/10.19070/2377-8075-21000937
Copyright: Dr. Arvina Rajasekar©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Socioeconomic factor is one of the major predisposing factors in the development of periodontal disease.
People from low economic status less frequently visit the dentists for preventive care compared to those of higher status.
Aim: The aim of the study was to assess the association between socioeconomic status and periodontal status among a selected
South Indian population.
Materials and Methods: The present cross-sectional study was carried out among 150 out patients who reported to the
Department of Periodontics, Saveetha Dental College and Hospitals, Chennai between December 2020 - February 2021.
The patients were categorised based on their socioeconomic status and periodontal status. Based on the periodontal status,
patients were categorized into clinically healthy gingiva (50 patients), gingivitis (50 patients), periodontitis (50 patients).Based
on Prasad’s scale of socioeconomic status, patients were categorized as: upper class, upper middle class, middle class, lower
middle class, lower class. The association between socioeconomic status and periodontal status was then assessed. The data
was analyzed using Statistical Package for Social Sciences (SPSS Software, Version 23.0). Chi-square test was done for data
summarization and presentation.
Results: Majority of the patients who belonged to the upper class had clinically healthy gingiva (15.33%) and the patients who
belonged to the lower class had periodontitis (16.67%). The association between socioeconomic status and oral health status
was done using chi square test and it was found to be statistically significant p=0.03 (p<0.05).
Conclusion: The present study reveals that periodontitis was more commonly seen in people who belong to lower socioeconomic
status and people who belonged to higher socioeconomic had clinically gingiva. Therefore, there is a positive association
between socioeconomic status and oral health status.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
Oral Health; Socioeconomic Status; Periodontitis; Innovative; Gingivitis.
Introduction
Gingivitis is a site-specific inflammatory condition initiated by
dental biofilm accumulation [1]. The accumulation of dental
plaque on the gingival margin triggers inflammatory effects that
can become chronic [2] Gingivitis with dental plaque affects the
protective tissues of the teeth and may lead to the development
of a wide range of clinical signs and symptoms, such as bleeding,
bad breath edema, redness, and gingival enlargement [3]. This
inflammatory condition called gingivitis is characterized by gingival
redness, edema, and bleeding on probing without detectable
alveolar bone loss or tooth-supporting structures [4]. Gingivitis is
reversible without permanent damage if properly treated. However,
if left untreated, it can progress to periodontitis leading to
the destruction of alveolar bone and subsequently may lead to
tooth loss. Gingivitis management is a crucial strategy to prevent
the development of advanced periodontal disease [5]. Furthermore,
gingival inflammation leads to the release of inflammatory
mediators into the circulatory system, which may have a negative
impact on overall health [6].
Periodontitis is defined as an inflammatory disease of supporting tissues of teeth caused by specific microorganisms or groups
of specific microorganisms, resulting in progressive destruction
of the periodontal ligament and alveolar bone with periodontal
pocket formation, gingival recession or both [7]. Periodontal disease
includes a group of inflammatory conditions, typically initiated
by oral bacteria, progressing from reversible accumulation of
plaque and inflammation of gingival tissue (gingivitis) to irreversible
breakdown of the supportive tissues of the teeth and eventually
tooth loss (periodontitis) [8-12]. High prevalence of periodontal
disease in adolescents, adults, and older individuals makes
it a public health concern. Several risk factors such as smoking,
poor oral hygiene, diabetes, medication, age, hereditary, and stress
are related to periodontal diseases [13-21]. Smoking is one of the
most important risk factors for periodontitis, and the reduction in
periodontal disease prevalence is related to the drop in smoking
rates [22]. Bacteria are the primary etiological agent in periodontal
disease, and it is estimated that more than 500 different bacterial
species are capable of colonizing the adult mouth [23]. Periodontal
infection may significantly enhance the risk for certain systemic
diseases or alter the natural course of systemic conditions; and
conditions in which influences of periodontal infection are documented
include coronary heart diseases (CHD) and CHD-related
events such as angina and infarction, atherosclerosis, stroke,
diabetes mellitus; preterm labor, low-birth-weight delivery; and
respiratory conditions such as chronic obstructive pulmonary diseases
[24]. Periodontitis initiates systemic inflammation and can
be monitored by inflammatory markers like C-reactive protein or
fibrinogen levels. Pathogens of the subgingival microbiota can interact
with host tissues even without direct tissue penetration, and
the subgingival microbiota accumulate on the oral cavity to form
an adherent layer of plaque with the characteristics of a biofilm.
Periodontal diseases are more frequent and more severe among
individuals of low socioeconomic status (SES) than among their
peers of higher socioeconomic status [25]. In cases of periodontal
diseases, higher neighborhood socioeconomic status will be associated
with healthy behaviors among community members like
reductions in smoking prevalence and dissemination of healthrelated
information to these individuals, which in turn could prevent
periodontal diseases independent of individual socioeconomic
status. The socioeconomic status of a geographic area can
influence the available supply of health professionals [26]. Our
team has extensive knowledge and research experience that has
translate into high quality publications [27-46]. The current study
was done to assess the association between socioeconomic status
and periodontal status among a selected South Indian population.
Materials and Methods
The present cross-sectional study was carried out among the
out patients who reported to the Department of Periodontics,
Saveetha Dental College and Hospitals, Chennai. This study was
Conducted between December 2020 - February 2021. The ethical
approval of the current study was obtained from the Institutional
ethical board and a written consent was obtained from all the
study participants.
A total of 150 patients were enrolled. The demographic details of
the patients were collected. The patients were categorised based
on their socioeconomic status and periodontal status. Based on
the periodontal status, patients were categorized into clinically
healthy gingiva (50 patients), gingivitis (50 patients), periodontitis
(50 patients). The patients were diagnosed based on the clinical
parameters including bleeding on probing, clinical attachment
loss and probing depth. Patient who presented with no bleeding
on probing, 1-3 mm pocket depth and no clinical attachment loss
were categorized under clinically healthy gingiva, patients who
presented with bleeding on probing, 1-3mm of pocket depth
with no attachment loss were categorized under gingivitis and patients
with bleeding on probing, pocket depth of more than 3 mm
with attachment loss were classified under periodontitis. Based
on Prasad’s scale [47] of socioeconomic status, patients were categorized
as: upper class, upper middle class, middle class, lower
middle class, lower class. The association between socioeconomic
status and periodontal status was then assessed.
The data was analyzed using Statistical Package for Social Sciences
(SPSS Software, Version 23.0). Chi-square test was done for data
summarization and presentation. The Chi-square test was employed
with a level of significance set at p<0.05.
Results
In the current study, 150 patients were enrolled. The patients were
categorised under gingivitis, periodontitis and clinically healthy
gingiva based on their periodontal status. Out of 150 patients, 50
patients were found to have clinically healthy gingiva, 50 patients
had gingivitis and 50 patients had periodontitis. The association
between socioeconomic status of patients and periodontal status
was assessed.
Among patients who belonged to the upper class, 15.33% of
them had clinically healthy gingiva, 8.67% of them were found to
have gingivitis and 2% of them were found to have periodontitis. Among upper middle class, 9.33% had clinically healthy gingiva,
7.33% were found to have gingivitis and 1.33% were found to
have periodontitis. Among the middle class, 5.33% had clinically
healthy gingiva, 7.33% were found to have gingivitis and 2% were
found to have periodontitis. Among the lower middle class, 1.33%
were found to have clinically healthy gingiva, 3.33% were found
to have gingivitis and 11.33% were found to have periodontitis.
Among the lower class, 2% were found to have clinically healthy
gingiva, 6.67% were found to have gingivitis and 16.67% were
found to have periodontitis. It was evident that the majority of
the patients who belonged to the upper class had clinically healthy
gingiva (15.33%) and the patients who belonged to the lower class
had periodontitis (16.67%). The association between socioeconomic
status and oral health status was done using chi square test
and it was found to be statistically significant p=0.03 (p<0.05).
Figure 1. Barchart shows the association between socioeconomic status and periodontal status. The X-axis represents socioeconomic status and Y-axis represents the percentage of patients with clinically healthy gingiva (blue), gingivitis (green) and periodontitis (brown). Majority of the patients who belonged to the upper class had clinically healthy gingiva (15.33%) and the patients who belonged to the lower class had periodontitis (16.67%). The association between socioeconomic status and oral health status was done using chi square test and it was found to be statistically significant p=0.03 (p<0.05).
Discussion
The present study was done to assess the association between socioeconomic
status and oral health status among a selected South
Indian population.
Socioeconomic status is one of the risk determinants which influence
the occurrence of periodontal disease. The current study
shows that patients who belonged to higher socioeconomic status
had clinically healthy gingiva. Borrell et al., conducted a study on
the association of periodontitis among blacks and whites in the
US. It has been reported that periodontal diseases are more frequent
and more severe among individuals who belonged to low
socioeconomic status (SES) than among their peers of higher
SES [48]. Another study conducted by Luisa et al., revealed that
people who belonged to higher socioeconomic status had clinically
healthy gingiva and it also indicates that individuals' income
level was associated with severe periodontitis [49].
In a similar study by Beck et al., it was found that there was more
pocket depth in blacks when compared to whites. In Beck's study
blacks were considered belonging to lower socioeconomic status
and whites were considered belonging to higher socioeconomic
status [50]. Our results are in agreement with the above studies.
Also, the current study indicates that the majority of the patients
who belonged to lower socioeconomic status presented with periodontitis.
A previous study conducted by Locker et al., documented
differences in periodontal health according to socioeconomic
status indicated that people who belonged to lower socioeconomic
status are more prone to periodontitis[51]. In a similar study
carried out by Rupasree et al., it was documented that there is a
strong association of lifestyle, education level, and socioeconomic
status with periodontal health [52].
In a similar study conducted by Jose et al., concluded that socioeconomic
factors such as primary education and low social class,
as well as gender, age and smoking, were associated to a significant
degree with greater prevalence of periodontal disease [53].
In a study conducted by Ahmed et al., it was observed that people
belonging to the lower class are more prone to periodontitis [54].
Our results are in agreement with the above studies. This might be
because of the variation in the oral hygiene practices and access to
dental services between upper and lower socioeconomic groups
may result in poor oral hygiene leading to periodontitis. Therefore
the present study emphasizes the need to create awareness among
people belonging to low socioeconomic status about the importance
of oral health.
Conclusion
The present study reveals that periodontitis was more commonly
seen in people who belong to lower socioeconomic status and
people who belonged to higher socioeconomic had clinically gingiva.
Therefore, there is a positive association between socioeconomic
status and oral health status.
Acknowledgement
The authors would like to acknowledge the help and support rendered
by the Department of Periodontics, Saveetha Dental College
and Hospitals, Saveetha Institute of Medical and Technical
Sciences, Saveetha University for the constant assistance with the
research.
Source of Funding
The present project was sponsored by
• Saveetha Institute of Medical and Technical Sciences,
• Saveetha Dental College and Hospitals,
• Saveetha University,
• Globe Trade, Doha.
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