Abstract
Background
Kanikkaran are semi-nomadic tribes inhabiting Mundandhurai hills in Tamil Nadu. Their traditional method of maintaining oral health, seclusion, ignorance, and limited access to dental resources has led to their poor oral health situation. Thus, the present study is designed to assess the oral health status of the Kanikkaran tribals residing in Mundandhurai Hill of Tirunelveli district.
Methods
A cross-sectional epidemiological study was conducted among 907 Kanikkaran tribes in Mundandhurai hills. Mundandhurai Hills in Ambasamudram taluk of Tirunelveli district was selected by convenience method. World Health Organization (WHO) oral health assessment form and its self–oral health assessment form (2013) were used. Descriptive and inferential statistics were performed using SPSS version 23.0.
Result
There is a significant negative moderate correlation between age and dental caries (r = −0.752). There is a significantly high risk among tribes with the primary school of education and agriculture as an occupation for periodontal disease (OR = 3.48), premalignant lesion (OR = 2.52), and non-carious dental lesions (OR = 3.14). Males with primary school education and agriculture as occupation had a significantly higher consumption of sugar and use of tobacco (p < 0.05).
Conclusion
Primary school of education with agriculture/labor as occupation had a high prevalence of DMFT, periodontitis, premalignant, and non-carious dental lesions. The results of the present study punctuate the necessity of raising awareness of the significance of good oral health through education and implementation of necessary dental services in Kanikkaran tribes.
Keywords: Oral health status, Treatment needs. Tribal people, Kanikkaran tribes
Graphical abstract
1. Introduction
Oral health forms an important component of general health which makes a significant contribution to the global burden of the disease. Also, it has an impact on an individual's ability to perform socially. There exist different concepts of health, sickness, beliefs, knowledge, and practice in health promotion, depicting the values and morals among different groups of people.1 "Tribals" are isolated and live with their traditional values, customs, beliefs, and myths2 and remain isolated until developmental in tribal areas force interactions between them. The challenges in accessibility to health services and healthcare-seeking behavior seem to dominate the discourse in tribal health.3 Research has shown that low socio-economic and ethnic minority groups are less likely to utilize health care services.4 Also, the underlying cultural beliefs and practices influence oral health conditions through their kind of diet and oral care-seeking behaviors which mostly involve the use of home remedies.5
About half of the world's autochthonous people comprising, 635 tribal communities reside in India.2 Kanikkaran is one of the tribal communities found dwelling in forests or near forests in Kerala and Tamil Nadu with an estimated count of 24,000 living according to the 2011 census.6 They are socioeconomically backward and engaged in various kinds of forest agricultural activities for income.7
Determination of their health care needs using an appropriate approach with concerns about respecting their culture becomes a key challenge in public health. Information on socioeconomic status, regional oral health-related behaviors, and health statistics on trends across time serves as a valuable tool in oral health program planning and implementation. Oral health research of different tribals such as Paniyas of Wayanad,8 Kalpettas of Kerala,9 Santals of West,10 tribals of the Eastern Ghats,11 and Oraos in Bangladesh12 has been documented. However, the oral health status of Kanikkarans of Mundanthurai Hills has not been documented. Although the cultural beliefs and oral hygiene practices of Kanikkaran tribes are similar to other tribal communities, documentation of the oral health needs of Kanikkaran tribes can aid in planning and implementing health programs shortly. Thus, the present study aims to assess the oral health status, and behavior among Kanikkaran tribals of Ambasamudram Taluk, Tirunelveli district, Tamil Nadu, India. The objective is to assess the prevalence of dental caries, periodontal disease, non-carious lesions, oral mucosal lesions, sugary diet, and adverse tobacco habits among them.
2. Materials and methods
A cross-sectional epidemiological study following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines13 was carried out to assess the oral health status and oral health behavior of Kanikkaran tribals dwelling in Mundandhurai reserve forest of Papanasam, Ambasamudram taluk of Tirunelveli district. They are traditionally a nomadic community who carry a self-sustaining existence based on farming. The ethical clearance to conduct the study was obtained from the author's Institutional Review Board with Scientific Review Board Number SRB/SDC/PHD-2102/22/032.
A convenience sampling technique by lottery method was employed to select the taluks in Tirunelveli district and villages of the respective taluks. With 38 districts in Tamil Nadu, Tirunelveli district was selected using a lottery method. Of 11 taluks in Tirunelveli district, Ambasamudram taluk was picked up using the lottery method again. Out of 66 villages in Ambasamudram taluk, Papanasam village was also selected by lottery method. The Kanikkaran tribals dwelling in the Papanasam were recruited for the present study.
All inhabitants of the village were recruited for the study and the principal investigator (PI) stayed near the village for a month and collected the data. A total of 907 individuals including children and adults participated in the study. Participants were clustered as 0–6 years, 7–12 years, 13–18 years, 19–30 years, 31–40 years, 41–50 years, and 51–60 years; irrespective of gender; people inhabiting the village for more than a year, willing to participate were included. Inhabitants who were critically ill and did not consent to participate were excluded. A written consent was obtained from the participants after explaining the purpose of the study orally. Written consent in the vernacular language (Tamil) was signed by participants who can sign and a fingerprint was obtained for others. Similarly, for the children, written consent was signed by their parents/guardians. Confidentiality of the participants was maintained throughout the study process. The study was carried out in September and October 2022. Permission to conduct the study was obtained from the concerned authorities of the village. An officer of the village helped us in communication and to conduct the oral examination without any difficulty.
The collection of data was carried out in two parts. The first part had demographic details and the second part consisted of WHO oral health assessment proforma, self-assessment form 2013 for children and adults.14 A translated and back-translated self-assessment questionnaire was administered in the vernacular language (Tamil) to the study participants. The oral health status and self-perception of the participants were assessed by a single trained and calibrated PI. The PI received a series of clinical training at the Department of Public Health Dentistry of the author's hospital, which was then calibrated by the Head of the Department. Intra-examiner reliability was assessed by examining a group of 50 individuals per day and re-examined after 30 min. The kappa value for intra-examiner reliability obtained was 0.82. A door-to-door clinical oral examination was carried out by ADA-specified type IV oral examination with the help of a record assistant.14 Oral examination was conducted in a supine position under natural light with the help of a tongue depressor and explorer. The recorded scores of dentition status were considered as decay, missing, and filled teeth scores for statistical purposes. Similarly, gingivitis and periodontitis assessment were dichotomized as present and absent for statistical purposes.
The compiled recorded data were entered into a spreadsheet (Microsoft Excel 2017) and analyzed using the Statistical Package for Social Sciences version (SPSS) version 23.0 15 The descriptive statistics included computation of percentage, mean and standard deviation was implemented for demographic and clinical data. Statistical comparison was carried out using One-Way ANOVA followed by a post-hoc test for pair-wise comparison. Association and correlation between demographic variables and oral hygiene measures were evaluated using the Chi-square test and Pearson's correlation test respectively. Bivariate regression analysis was carried out to predict the risk of demographic variables with oral health status. For all the statistical tests, p-value <0.05 was considered significant.
3. Results
A total of 907 participants were examined in the study. Among them, 47.63% were males and 57.37% were females with mean age of 48.67 ± 2.548 ranging from 2 to 79 years. Most of the study participants completed primary school education, were involved in agriculture (60%), and used toothbrushes and toothpaste as oral hygiene aids [Table 1].
Table 1.
Demographic details of study participants.
| Characteristics | n (%) |
|---|---|
| Age | |
| 0–6 | 48 (5.2) |
| 7–12 | 99 (10.9) |
| 13–18 | 91 (10) |
| 19–30 | 191(21) |
| 31–40 | 150 (16.5) |
| 41–50 | 114 (12.5) |
| 51–60 | 120 (13.2) |
| >60 | 94 (10.3) |
| Gender | |
| Male | 432 (47.6) |
| Female | 475 (52.3) |
| Occupation | |
| Agriculture | 545 (60) |
| Labourer | 117 (12.8) |
| Students | 245 (27) |
| Oral Hygiene Aids | |
| Toothbrush/Toothpaste | 487 (53.6) |
| Finger | 205 (22.6) |
| Charcoal/Brick Powder | 119 (13) |
| Wooden stick | 181 (19.9) |
| Education | |
| No schooling | 106 (11.6) |
| < primary school | 198 (21.8) |
| Primary school | 321 (35.3) |
| Secondary school | 197 (21.7) |
| Higher secondary | 85 (9.3) |
Comparison of mean decayed, missing, filled teeth (dmft) of primary dentition showed a significantly high score of decayed teeth (dt), filled teeth (ft), and dmft among 0–6 years (p < 0.05) shown in Table 2. Similarly, a comparison of mean decayed, missing, filled teeth (DMFT) for permanent dentition showed a significantly high mean score of decayed teeth (DT) in 19–30 years and a significantly high mean DMFT in 51–60 years (p < 0.05) shown in Table 3. Also, a comparison of mean DMFT among other demographic variables showed a significantly high score with less than a primary school of education (p = 0.029) (Table 4).
Table 2.
Comparison of mean dmft score among age groups using One-Way ANOVA.
| Dentition status | Age groups; Mean ± SD |
p-value | ||
|---|---|---|---|---|
| 0–6 years | 7–12 years | 13–18 years | ||
| dt | 1.37 ± 1.42 | 0.91 ± 1.1 | 0.10 ± 0.50 | 0.003a |
| mt | 0.0 ± 0.0 | 0.10 ± 0.33 | 0.0 | 0.347 |
| ft | 0.20 ± 0.14 | 0.09 ± 0.38 | 0.0 | 0.042a |
| dmft | 1.40 ± 1.41 | 1.10 ± 1.24 | 0.10 ± 0.50 | 0.010a |
Statistically significant.
Table 3.
Comparison of DMFT scores among the age groups by One-Way ANOVA.
| Dentition status | Age groups; Mean ± SD |
p-value | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 0–6 years | 7–12 years | 13–18 years | 19–30 years | 31–40 years | 41–50 years | 51–60 years | >60 years | ||
| DT | 0.02 ± 0.10 | 0.36 ± 0.48 | 1.71 ± 1.58 | 4.70 ± 2.60 | 4.60 ± 3.05 | 4.48 ± 2.7 | 4.52 ± 3.15 | 3.97 ± 2.96 | 0.001a |
| MT | 0.0 | 0.07 ± 0.25 | 0.15 ± 0.42 | 0.02 ± 0.12 | 0.03 ± 0.21 | 0.10 ± 0.39 | 0.27 ± 0.85 | 0.75 ± 1.50 | 0.245 |
| FT | 0.0 | 0.08 ± 0.274 | 0.24 ± 0.58 | 0.10 ± 0.39 | 0.13 ± 0.50 | 0.05 ± 0.30 | 0.05 ± 0.28 | 0.03 ± 0.26 | 0.178 |
| DMFT | 0.02 ± 0.10 | 1.52 ± 0.57 | 2.11 ± 1.70 | 4.80 ± 2.70 | 4.81 ± 3.15 | 4.63 ± 2.80 | 4.83 ± 3.16 | 4.75 ± 2.90 | 0.018a |
Statistically significant.
Table 4.
Comparison of mean DMFT values among the study participants based on sex, education and occcupation using One-Way ANOVA.
| Demographics | Sub-variables | Mean ± SD | p-value |
|---|---|---|---|
| Sex | Male | 5.58 ± 2.96 | 0.120 |
| Female | 4.30 ± 1.23 | ||
| Education | No formal schooling | 5.01 ± 2.15 | 0.029a |
| Less than primary school | 5.40 ± 2.21 | ||
| Primary school | 4.82 ± 1.93 | ||
| Secondary school | 3.45 ± 1.08 | ||
| Higher secondary school | 3.12 ± 1.19 | ||
| Occupation | Agriculture | 5.41 ± 2.49 | 0.591 |
| Labourer | 4.79 ± 1.93 | ||
| Student | 4.47 ± 1.27 |
Statistically significant.
Pair-wise comparison of mean dmft and DMFT among the age groups using Tuskey's HSD post-hoc test showed a significant mean difference between 13 and 18 years and other age groups (p < 0.05). At the same time, other age group pairs showed no significance. Also, study participants with no formal and less than primary school education showed significant mean differences with secondary and higher secondary grades of education (p < 0.05). Similarly, post-hoc test of dmft showed a significant mean difference between all pairs of 0–6 years, 7–12 years, and 13–18 years (p < 0.05) shown in Table 5.
Table 5.
Scheffe's post-hoc pair-wise comparison test for mean DMFT and dmft scores among the age groups and education (Done for significant variables).
| Dentition status | Age groups | Mean Difference | p-value | 95% CI |
|---|---|---|---|---|
| DMFT | 13–18 years vs | −2.69 | 0.040a | −4.21 to −1.49 |
| 19–30 years | ||||
| 13–18 years vs | −2.70 | 0.043a | −4.53 to −1.54 | |
| 31–40 years | ||||
| 13–18 years vs | −2.52 | 0.031a | −3.79 to −0.09 | |
| 41–50 years | ||||
| 13–18 years vs | −2.72 | 0.028a | −4.62 to −1.26 | |
| 51–60 years | ||||
| 13–18 years vs | −2.64 | 0.033a | −4.91 to −1.68 | |
| >60 years | ||||
| Education | Mean Difference | p value | 95% CI | |
| No formal schooling vs | 1.56 | 0.021a | 0.84 to 1.79 | |
| Secondary school | ||||
| No formal schooling vs | 1.89 | 0.014a | 0.91 to 2.01 | |
| Higher secondary school | ||||
| < Primary school vs | 1.95 | 0.033a | 0.92 to 2.23 | |
| Secondary school | ||||
| < Primary school vs | 2.28 | 0.019a | 1.28 to 2.89 | |
| Higher secondary school | ||||
| Primary school vs | 1.37 | 0.027a | 1.15 to 2.09 | |
| Secondary school | ||||
| Primary school vs | 1.70 | 0.041a | 1.24 to 2.45 | |
| Higher secondary school | ||||
| dmft | Age groups | Mean Difference | p value | 95% CI |
| 0–6 years vs | 0.30 | 0.045a | 0.02 to 0.71 | |
| 7–12 years | ||||
| 7–12 years vs | 1.00 | 0.025a | 0.83 to 1.93 | |
| 13–18 years | ||||
| 0–6 years vs | 1.30 | 0.001a | 0.99 to 2.20 | |
| 13–18 years |
Statistically significant.
Fig. 1 shows the overall distribution of gingival diseases among the study participants. About 50% and 25% of the study participants had gingivitis and periodontitis respectively with significant differences based on age groups and education (p < 0.05). The distribution of gingivitis was high among participants in the age group 41–50 years (78.1%) while that of periodontitis in 31–40 years (76.6%). Similarly, the prevalence of gingival disease was high among participants with no formal education (gingivitis = 92.5% and periodontitis = 73.6%) given in Supplementary Table 1.
Fig. 1.
Comparison of the frequency distribution of gingivitis and periodontitis among the study population using the Chi-Square test.
The prevalence of premalignant, aphthous ulcer, and the abscess was 12.3%, 10%, and 7.7% respectively. There is a significant difference in the distribution of oral mucosal lesions among the age groups, education, and occupation (p < 0.05) shown in Fig. 2A. Prevalence of premalignant lesions was high among 51–60 years with no formal education; whereas abscess and aphthous ulcer is more prevalent among 31–40 years and 41–50 years with primary school of education and agriculture as occupation (Supplementary Table 2). Similarly, there is a significantly high prevalence of attrition and abrasion among participants with no formal education and agriculture (p < 0.05) given in Supplementary Table 3. The overall prevalence of attrition, abrasion, and abfraction was 21.9%, 17.4%, and 10.1% respectively (Fig. 2B).
Fig. 2A.
Comparison of the distribution of oral mucosal lesions and 2B: Comparison of the distribution of non-caries lesions among the study population using Chi-Square test.
Distribution of dietary and adverse habits shows a significant difference among age groups, sex, education, and occupation (p < 0.05). Male participants with no formal education and agriculture as occupation of age group 19–30 years had significantly high solid and liquid sugar consumption. Similarly, males with primary school education and agriculture as an occupation had a significant habit of smoking daily (p < 0.05). Females in primary school and agriculture had a significant habit of chewing tobacco daily (p < 0.05) (Table 6).
Table 6.
Distribution of dietary habit and adverse habit practices among study population using Chi-Square test.
| Variable | Sub variable | Sugar |
Tobacco |
||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Solid |
Liquid |
Smoking |
Chewing |
||||||||||||||||
|
Every day |
Several times a week |
Once a week |
p |
Every day |
Several times a week |
Once a week |
p |
No habit |
Every day |
Several times a week n (%) |
Once a week |
p |
No habit |
Every day |
Several times a week n (%) |
Once a week |
P | ||
| n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||||||||
| Age | 0–6 | 17 (1.8) | 31 (3.4) | 0 | 0.005a | 39 (4.2) | 9 (0.9) | 0 | 0.005a | – | |||||||||
| 7–12 | 76 (8.3) | 23 (2.5) | 0 | 89 (9.8) | 10 (1.1) | 0 | |||||||||||||
| 13–18 | 59 (6.5) | 29 (3.1) | 3 (0.3) | 68 (7.4) | 17 (1.8) | 6 (0.6) | |||||||||||||
| 19–30 | 151 (16.6) | 23 (2.5) | 17 (1.8) | 171(18.8) | 16 (1.7) | 4 (0.4) | 35 (3.8) | 41 (0.04) | 102(11.2) | 13 (1.4) | 0.005a | 101(11) | 34 (3.7) | 15 (1.6) | 11 (1.2) | 0.005a | |||
| 31–40 | 97 (10.6) | 14 (1.5) | 39 (4.2) | 109 (12) | 32 (3.5) | 9 (0.9) | 29 (3.1) | 29 (3.1) | 72 (7.9) | 20 (2.2) | 59 (6.5) | 53(5.8) | 31 (3.4) | 7 (0.7) | |||||
| 41–50 | 67 (7.3) | 10 (1.1) | 37 (4) | 71 (7.8) | 37 (4) | 67 (7.3) | 34 (3.7) | 17 (1.8) | 36 (3.9) | 7 (0.7) | 31 (3.4) | 39 (4.2) | 32 (3.5) | 12 (1.3) | |||||
| 51–60 | 59 (6.5) | 47 (5.1) | 14 (1.5) | 45 (4.9) | 11 (1.2) | 19 (2) | 24 (2.6) | 31 (3.4) | 39 (4.2) | 26 (2.8) | 45 (4.9) | 29 (3.1) | 25 (2.7) | 21 (2.3) | |||||
| >60 | 71 (7.8) | 21 (2.3) | 2 (0.2) | 31 (3.4) | 42 (4.6) | 21 (2.3) | 19 (2) | 19 (2) | 45 (4.9) | 11 (1.2) | 29 (3) | 31 (3.4) | 17 (1.8) | 17 (1.8) | |||||
| Sex | Male | 304(33.5) | 105(11.5) | 60 (6.6) | 0.006a | 290(31.9) | 101(11) | 56 (6.1) | 0.006a | 141(35.6) | 129(29.8) | 154 (35.6) | 8(1.8) | 0.003a | 259 (60) | 77 (17.8) | 44 (10.2) | 52 (12.03) | 0.004a |
| Female | 293(32.3) | 93 (10.2) | 52 (5.7) | 333(36.7) | 73 (8) | 70 (7.7) | 92(19.3) | 42(8.8) | 258(54.3) | 83(17.4) | 218 (45.9) | 49 (10.3) | 65 (13.7) | 143 (30.1) | |||||
| Education | No formal schooling | 14 (13.2) | 68 (64.2) | 24 (22.6) | 0.015a | 27 (25.5) | 51 (48.1) | 28 (26.4) | 0.024a | 49 (46.2) | 21 (19.8) | 24 (22.6) | 12 (11.3) | 0.031a | 39 (36.8) | 40 (37.7) | 13 (12.3) | 14 (13.2) | 0.029a |
| < primary school (198) | 116 (58.6) | 51 (25.7) | 31 (15.6) | 127 (64.2) | 37 (18.7) | 34 (17.2) | 64 (32.3) | 37 (18.7) | 70 (35.4) | 27 (13.6) | 106 (53.5) | 31 (15.6) | 15 (7.6) | 46 (23.2) | |||||
| Primary school (321) | 242 (75.4) | 47 (14.6) | 32 (9.96) | 219 (68.2) | 53 (16.5) | 49 (15.2) | 9 (2.80) | 84 (26.2) | 222 (69.2) | 6 (1.86) | 147 (45.8) | 37 (11.5) | 53 (16.5) | 84 (26.2) | |||||
| Secondary school (197) | 168 (85.3) | 18 (9.14) | 11 (5.6) | 167 (84.7) | 19 (9.64) | 11 (5.58) | 94 (47.7) | 11 (5.6) | 62 (31.5) | 30 (5.07) | 141 (71.6) | 11 (5.6) | 19 (9.64) | 26 (13.2) | |||||
| Higher secondary (85) | 57 (67.05) | 14 (16.5) | 14 (16.5) | 68 (80) | 14 (16.5) | 3 (3.53) | 17 (20) | 18 (21.2) | 34 (40) | 16 (18.8) | 44 (51.7) | 7 (8.23) | 9 (10.6) | 25 (29.4) | |||||
| Occupation | Agriculture (545) | 345 (63.3) | 132 (24.2) | 68 (12.5) | 0.037a | 383 (70.3) | 109 (20) | 53 (9.72) | 0.050a | 361 (66.3) | 95 (17.4) | 41 (7.52) | 48 (8.81) | 0.027a | 291 (53.4) | 72 (13.2) | 89 (16.3) | 93 (17.1) | 0.013a |
| Labourer (117) | 60 (51.3) | 38 (32.5) | 19 (16.2) | 87 (74.4) | 14 (12) | 16 (13.6) | 42 (35.9) | 30 (25.6) | 20 (17.1) | 25 (21.4) | 73 (62.4) | 24 (20.6) | 10 (8.55) | 10 (8.55) | |||||
| Student (245) | 192 (78.4) | 28 (11.4) | 25 (10.2) | 153 (62.4) | 51 (20.8) | 41 (16.7) | 101 (41.2) | 57 (23.3) | 25 (10.2) | 62 (25.3) | 193 (78.7) | 30 (12.3) | 10 (4.1) | 12 (4.9) | |||||
Statistically significant.
The correlation of age and dental caries experience showed a significant negative moderate correlation (r = −0.752). The linear regression equation is DMFT = 1.691–0.947 * (age in years) with a good model fitness of 0.429 as R2 value (Table 7) (done only for significant correlation). Binary logistic regression analysis showed that primary school education had a significant 2 to 3 times of risk for gingivitis and periodontitis compared to secondary school. Similarly, primary schools of education and agriculture/laboring had 2 to 3 odds of risk for oral mucosal lesions and non-caries lesions (Table 8). Age had no significant association with gingivitis, periodontitis, non-caries lesions, and oral mucosal lesions.
Table 7.
Pearson correlation and linear regression of age and DMFT scores.
| Variables | Correlation co-efficient (r) | R2 Value | Constant | β - coefficient | p-value |
|---|---|---|---|---|---|
| Agea DMFT | −0.752 | 0.429 | 1.691 | −0.947 | 0.034a |
Statistically significant.
Table 8.
Binary logistic regression analysis of demographic variables and oral health measures.
| Oral health measure | Demographics | Odd's ratio | p-value |
|---|---|---|---|
| Gingivitis | Sex | ||
| Male | Ref | 0.248 | |
| Female | 1.07 | ||
| Education | |||
| Secondary school | Ref | 0.015a | |
| Primary school | 2.31 | ||
| Occupation | |||
| Student | Ref | 0.147 | |
| Agriculture/Labour | 1.12 | ||
| Periodontitis | Sex | ||
| Male | Ref | 0.315 | |
| Female | 1.46 | ||
| Education | |||
| Secondary school | Ref | 0.007a | |
| Primary school | 3.48 | ||
| Occupation | |||
| Student | Ref | 0.596 | |
| Agriculture/Labour | 1.01 | ||
| Non-caries lesions | Sex | ||
| Male | Ref | 0.889 | |
| Female | 0.98 | ||
| Education | |||
| Secondary school | Ref | 0.025a | |
| Primary school | 3.14 | ||
| Occupation | |||
| Student | Ref | 0.039a | |
| Agriculture/Labour | 2.59 | ||
| Oral mucosal lesions | Sex | ||
| Male | Ref | 0.745 | |
| Female | 0.85 | ||
| Education | |||
| Secondary school | Ref | 0.013a | |
| Primary school | 2.52 | ||
| Occupation | |||
| Student | Ref | 0.027a | |
| Agriculture/Labour | 1.35 | ||
Statistically significant.
* Statistically significant * Statistically significant.
4. Discussion
Despite various government allowances, hilly tribes are not accessible to dental care. Considering the non-availability of any previous study conducted on the evaluation of the oral health assessment of the Kanikkarans, who still retain their most primitive forms of customs and beliefs on disease, the present study provides the baseline information on the oral health status, their self-assessment on the oral health issues.
The oral health status was evaluated according to the age groups, sex, education, and occupation. The present study highlights the use of improper oral hygiene aids by nearly one-third of the tribal population. This agreed with the results of previous studies conducted by Mandal et al.10 Bhowate et al.16 and Vaish et al.,17 where the Kandha tribes used datum twigs to clean their teeth due to the lack of awareness of proper dental care.
The prevalence of periodontal disease was high among females of the age group 30–60 years. This might be attributed to inappropriate use of oral hygiene aids following their primitive cultural beliefs, inaccessible dental care, smoking cheroot, chewing tobacco (which helps in passing stools – their cultural belief), and aging in periodontal tissues. These results are consistent with the findings by Kumar et al.18 and Singh et al.19
The prevalence of dental caries was high in 2–12 years and the mean DMFT score was high among males in 51–60 years of age group (Mean = 4.83 ± 3.16). This finding follows the findings of a study conducted by Lang et al.20 (mean DMFT = 4.20). Also, Schamschula et al.21 in their study among Australian aborigines showed that mean DMFT per person increased from the value of 17.1 teeth at 20 years to 20.7 teeth at 35 years. This high prevalence of dental caries can be attributed to the fact of improper oral hygiene, dietary factors (high consumption of solid and liquid sugars) among participants involved in agriculture and labor, and unaffordability towards dental care.
In the current study, nearly half of the population 47% of subjects reported using only indigenous tooth cleaning methods, mostly by charcoal and wooden sticks which are coarse and can abrade the enamel leading to the high prevalence of non-carious lesions (attrition, abrasion) among the study population. This was following the previous study by Valsan et al.8 and Vivek et al. among Paniyan tribes in Kerala.22 Nearly 12% of the population had premalignant lesions (leukoplakia, smokers palate/pouch keratosis), which is consistent with the study conducted by Shanavas et al.23 among Paniya and Kurichya group of tribal in Wayanad. The results of the present study reported no significant association between sex and premalignant lesions. This finding contradicted the study conducted among the Irular and Narikuravar tribes of the Vellore district.24 A significant association between gender and tobacco habits was found in tribal gypsies of Thoothukudi district of Tamil Nadu.25 Such a significant association was not elucidated in the present study.
The results of Kanikaran tribes showed that 35.6% of males and 19.3% of females had no smoking habits; while 25.2% of males and 9.2% of females had no tobacco chewing habits. These findings were not consistent with those of the Paliyan and Pulayan tribes of Tirunelveli and Dindigul district of Tamil Nadu.26 A significant association between sugar consumption (solid and liquid forms) and age, sex, and education was exhibited in the present study. This dietary association is consistent with the study conducted among Irular and Narikuravar tribes in the Vellore district of Tamil Nadu24 and the Dravidian population of South India and Malaysia.27
5. Strengths and limitations
To the knowledge of the authors, this is the first study to report the oral health status and behavior of Kanikkaran tribes. All inhabitants of the village (n = 907) have been included in the study. This study exhibits the oral health burden among the Kanikkaran tribes in Tirunelveli district of Tamil Nadu. The data has highlighted the implementation of a basic oral health program for the population targeting the high prevalence of periodontal disease, premalignant disease, and non-caries lesions. The program should be free of cost delivering emergency oral care and preventive care, and oral health education by tribal primary oral health care personnel. This will aid in connecting tribal people and the general population and motivate them to seek dental services. A well-designed program should focus on the transformation of unhealthy customs into healthy ones.
The main limitation of this study is its cross-sectional study design owing to reporting bias. Covariates such as the availability and accessibility of oral health care services in the village which could have a significant link with the high prevalence of oral diseases were not explored. Further, longitudinal studies evaluating long-term trends are needed to extrapolate the results to Kanikkaran tribes in other states and districts.
6. Conclusion
Kanikkaran tribes with the primary school of education and agriculture as the occupation had a high prevalence of DMFT, periodontitis, oral mucosal, and non-carious lesions. Most of them consumed more sugars in the form of solids and liquids and used tobacco daily showing their lack of awareness of oral health and general health. This study elucidated the valuable results that can serve as a base upon which health authorities and dental professionals could plan strategies for oral health promotion, treatment, and prevention of oral disease among the Kanikkaran tribes at affordable cost. Health education on dietary practice and adverse habits should be focussed. Also, there is a need for the development of newer oral health development policies that must be taken seriously to bring a healthy society.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.jobcr.2024.03.006.
Contributor Information
Rahmath Meeral P, Email: prahmath31@gmail.com.
Arthi Balasubramaniam, Email: arthi.bds@gmail.com.
Meignana Arumugham Indiran, Email: drmei.sdc@saveetha.com.
Karthik M, Email: mkarthikmurthy@gmail.com.
Appendix A. Supplementary data
The following is the supplementary data to this article:
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