Assessment of oral health belief and oral hygiene practices among the Toda tribe in Nilgiris district of Tamil Nadu

ABSTRACT

Background:

Oral diseases make significant contributions to the global burden of disease, which is particularly high in the underprivileged groups of both developed and developing countries. The underlying cultural beliefs and practices influence the conditions of the teeth and mouth, through diet, care-seeking behaviors, or use of home remedies. The aim of the study was to assess the oral hygiene practices and beliefs of the tribal gypsies among the Chennai population.

Methods:

The cross-sectional study consisted of questionnaire with 10 closed ended questions. The first part of the questionnaire included information on age, sex, education, and occupation. Second part the questionnaire included information on oral hygiene practices, attitudes toward oral health and oral health beliefs. The collected data was tabulated in Microsoft Office excel. Statistical analysis was conducted by using SPSS version 23.0.

Results:

From the above results, it can be concluded that the people had enough knowledge about the oral hygiene practices. About 82% believed that if dental problems were neglected there would be serious implications for their oral health.

Conclusion:

Based on the findings, it can be concluded that the gypsies might have favorable compliance for oral health promotional programs.

Introduction

A vital part of overall health and wellness, oral health affects both physical and psychological elements. A person’s quality of life, sense of self-worth, and social confidence all improve with optimal and acceptable dental health, which in turn enables people to interact and communicate with confidence.[1]

Dental caries and periodontal disease are the two main dental issues that show up in young children. Maintaining good dental hygiene can be difficult when permanent teeth are erupting (7–13 years).[2] This will raise the likelihood of periodontal disease manifestations such as gingivitis and cavities. Simple corrective actions, such as routine dental checkups, behavior modifications, and chemical and mechanical plaque control techniques, could prevent such early onset risk factors.[2,3]

The practices surrounding oral health among the Toda tribe, a vulnerable indigenous group, can be challenging to maintain. The Toda community, native to the Nilgiris Hills of Tamil Nadu, India, is renowned for its distinct culture.[4] As pastoralists, they primarily engage in buffalo herding and live in small, close-knit villages. The tribe’s traditional practices and beliefs are deeply connected to the natural surroundings and spiritual customs.[5,6]

The oral health practices of the Toda people are largely shaped by their cultural values and the use of local remedies. Like many other indigenous groups, the Todas rely on natural, locally-sourced materials for maintaining oral hygiene, instead of modern dental products.[7,8] For instance, they chew on twigs from specific plants, which are believed to have antimicrobial properties that help in cleaning teeth and preventing dental issues like cavities and gum disease.[9]

Additionally, the Toda community values a diet of natural foods, which they believe contributes to overall well-being, including the health of their teeth. In recent years, however, the influence of modern healthcare systems and increased access to dental care have started to affect their traditional oral health practices.[10,11] Despite this, the Toda tribe continues to maintain a strong connection to its heritage and cultural ways, holding onto their traditional methods while adapting to modern influences.[12]

The two main obstacles to receiving dental care in these tribes are structural issues and access. Particularly in isolated areas of Gudalur in the Nilgiris district of Tamil Nadu, there are a lot of unmet oral health needs.[13] These include a shortage of dental specialists, a dearth of transportation options, and a limited number of dental care facilities.[14] These cultures frequently have poor oral health results and suffer in silence. Furthermore, most therapy expenditures are paid for out of pocket when accessible. Because of this, people from lower socioeconomic classes frequently choose to either not address their tooth problems or, if they do, have it extracted to ease their suffering.[15] One of the most common illnesses among people is dental caries.[16]

Dentoalveolar infection and the pain it causes are the main side effects linked to tooth caries. These issues may have a negative impact on people’s quality of life and place an excessive financial strain on their families.[17] Numerous investigations have conclusively shown that dental caries is a dynamic process in which the tooth’s demineralization and remineralization occur simultaneously.[18]

Several researchers have documented the oral health status of the Indian population. In 2003, national oral health survey reported that there’s a prevalence of 53.8% caries experience in 12-year-old, Significant Caries (SiC) and mean of Decayed, missing, and filled teeth (DMFT) of 3 and 1.8 respectively. Most of the 12 years aged population had experienced caries in one or more of their total number of teeth.[19] In India, fluorosis is one among the severe public health problems, as almost two-third states are fluoride endemic.[20] Approximately 25 million people in India are currently affected by fluorosis, and 66 million are at risk of developing fluorosis, including the population aged 14 years.[21]

It is of immense importance to associate the fact that the population can significantly contribute in the health promotion, as well as in spreading the preventive information among their family members and the society.[22] Therefore, the change to a positive healthy routine and positive attitude can be brought about by giving adequate information, education and motivation as well as healthy practices to the population.[23] Therefore the aim of the present study was to assess the oral health belief and oral hygiene practices among the Toda tribe in Nilgiris district of Tamil Nadu

Materials and Methods

The cross-sectional study was carried out among the tribal Toda people in the Gudauri area of the Nilgiris district. In April 2024, the study was carried out. The study’s goal was explained to the tribes, and their informed consent was acquired. The participants’ anonymity was preserved. The Institutional Ethical Board granted ethical clearance prior to the study. The sample size was estimated to be 230 based on the study by Chellappa et al., 2021,[24] with a power of 95 and it was calculated by G power software.

Dental screening examinations (ADA Type III) was conducted by primary investigators who were given prior training with a inter reliability 0.82. The oral health beliefs and practices was assessed through a questionnaire consisted of 13 closed ended questions and was given to the tribes. The questionnaire was pre validated by two studies.[25,26]

The questionnaire consisted of three parts. The first part of the questionnaire included information on age, sex, education and occupation and the necessary demographic details. Second part the questionnaire included on their perceived seriousness, importance, barriers and benefits of oral health beliefs and attitude. Third part consisted of six questions relating to their oral hygiene practices. This included on questions about different kinds of cleaning aids, techniques for brushing the teeth, frequency of the brushing routine, whether the participant was willing to take efforts for sustaining good oral hygiene etc.

After the assessment, the tribes were referred for basic oral prophylaxis and free basic dental treatment to the nearby primary health center through blanket referral method. The camp was conducted in association a local NGO which helped in accessing the tribes.

The collected data was tabulated in Microsoft Office excel. Statistical analysis was conducted by using SPSS version 25.0. Frequency and percentages were used to express the beliefs and practices. Graphs and tables were used to represent the data.

Results

The study population consisted 230 Toads, who were dwelling in Nilgiris district. It consisted of 46.5% males and 53.5% females. In the age category, there were 32.6% people in 18-35 years, 55.7% in 31–45 years and 11.7% in 46–60 years [Table 1].

Table 1.

Demographic details of the study population

Demographic variables	Frequency	Percentage
Age groups
18–30	75	32.6
31–45	128	55.7
46–60	27	11.7
Total	230	100
Gender
Males	107	46.5
Females	123	53.5
Total	230	100

There were 60.8% people were using toothpaste, 24.8% using no materials to clean their teeth, 12.5% using charcoal and 1.9% using tooth powder to clean the teeth [Figure 1]. As cleaning aid, 49.9% used tooth brush, 27.8% used combination of finger and tooth brush, 20.3% used finger and 2% tribes used twigs as a cleaning aid [Figure 2].

Figure 1.

Materials used to clean the teeth

Figure 2.

Type of cleaning aid

Results revealed that 80.1% people brushed once a day, 17.2% do not brush at all and 2.7% brushed twice a day [Figure 3]. When asked about the frequency of changing tooth brush, 64.8% change when the bristles got frayed, 23.4% changed every 6 months, 7.2% changed every 3 months, 3.8% changed every 2 months and 0.8% changed every month [Figure 4].

Figure 3.

Frequency of brushing

Figure 4.

Frequency of changing toothbrush

Results also revealed that 82.17% believed that dental problems can get serious if neglected, 30.43% people believed that it is important to retain natural teeth throughout life, 66.52% were afraid of dentists, 39.56% believed that visiting dentist can reduce dental problems [Table 2].

Table 2.

Oral health beliefs of the Toda tribes

Beliefs and attitudes of oral hygiene practices and oral health among tribals of South India
Variables n (%)	Belief about dental problems can get serious if neglected	Is it important to retain natural teeth throughout life	Afraid of visiting dentist	Visiting dentist can reduce dental problems
Yes	189 (82.17)	70 (30.43)	153 (66.52)	91 (39.56)
No	41 (17.83)	160 (69.57)	77 (33.48)	139 (60.44)

Discussion

Distinct rural communities follow separate dental hygiene methods. Consequently, this is expected to have a significant effect on India’s rural population’s oral health. Even in the twenty-first century, a large portion of the rural population still maintains their dental hygiene by using traditional or indigenous remedies.[27] It has been noted in most studies and literature that there is a correlation between an individual’s oral hygiene practices and status. Numerous surveys and research have demonstrated a positive link between these two, in line with these investigations.

A total of thirteen numerous researches have yielded comparable findings and demonstrated a relationship between dental hygiene level and oral hygiene practice. In many underdeveloped nations, such as India, oral health is given far less importance, particularly in rural areas.[28] Because the health sector has few resources, poverty, and the few assignments it receives are primarily focused on serious illnesses like HIV/AIDS, TB, and malaria rather than only oral problems.

The dental health status of adults in industrialized countries has improved due to various factors such as adopting a healthy lifestyle, improving self-care practices, changing living conditions, establishing preventative oral care programs, and effectively using fluorides.[29] These elements, however, are largely lacking in underdeveloped nations, with significantly worse conditions in rural areas. Many people still maintain their dental hygiene by using traditional methods like finger, datum, and dantmajan, which are found in rural areas. Therefore, it is crucial to implement effective oral hygiene practices to achieve the population’s goal of having good oral hygiene.[30]

In the present study, 80.1% preferred brushing once when compared to the other 17.1% subjects, who brushed twice a day. In a study by Vikram Simha Bommireddy, only 7.3% brushed twice a day. Also in the present study, 23.4% changed toothbrush once every 6 months. In the comparative study, 7.3% only changed toothbrush in 6 months.[31]

In the present study, 20.3% used finger and 49.9% used toothbrush to clean their teeth. In a study done by Devi et al.,[32] 56% Narikuravars of Tamil Nadu used their fingers and only 13% used toothbrush. Also in the present study, 60.8% used toothpaste. This is very contrast to the comparative study in which only 20% used tooth paste. But this is in accordance with a study by Sindhu et al.[33] in which 64.3% Narikuravars used toothpaste to clean their teeth.

The present study showed that about 66.52% out of the total subjects are afraid of meeting the dentists for any form of dental treatment whereas 60% of the people believe that their dental problems will not be treated on visiting the dentist. Despite various health consequences, the study shows that the gypsies’ tribes are careless when it comes to seeking medical attention. It is obvious that obstacles to healthcare, including financial, administrative, geographical, physical, and cultural ones, must be removed, as must the divide between the native population and medical personnel. For all healthcare services, primary care is the initial point of contact between patients and medical professionals. For the public to receive coordinated primary care in an efficient manner, a full range of health services must be quickly accessible. By facilitating access to higher levels of treatment and services through referrals from primary care, such successful primary care can be strengthened.[34]

The limitations of the study include: various other myths and beliefs related to oral-health are left out in the current research; hence, scrutinizing the research to know more about the prevailing myths among the tribal population is required. Further research on a large tribal population is necessary to overcome the limitations of the current research.

Conclusion

Based on the findings, it can be concluded that gypsies might have favorable compliance for oral health promotional programs. Misbeliefs associated with oral-health is commonly prevalent among tribal population, which acts as a barrier in seeking oral healthcare. It is recommended to create awareness about oral health and its reality among the gypsies, improve access to oral healthcare, and repeat advice to break misbeliefs.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.