Assessment of oral health status among endosulfan victims in endosulfan relief and remediation cell - A cross-sectional survey

Abstract

Background:

Endosulfan is a highly toxic agrichemical used in the cashew plantations. The Stockholm Convention held in April 2011 recommended a global ban on the manufacture and use of endosulfan because of its adverse effects on human health and the environment. Its impact on the quality of food, water, and beverages; and its ability to cause neurobehavioral disorders, congenital malformations in female subjects, and abnormalities related to the male reproductive system are studied, but however information regarding the oral health of endosulfan victims is scant.

Objectives:

To assess the oral health status of the endosulfan victim in rehabilitation center.

Method and Methodology:

A cross sectional study on 18 subjects of 4-50 years of age were interviewed and examined using modified WHO oral health assessment proforma (1997) in Endosulfan Relief and Remediation Cell in Kokkada, Belthangady Taluk, Dakshina Kannada district, Karnataka, India.

Results:

Among the subjects, 10 (>50%) were found to be in age group <20 years. The overall oral health status of the endosulfan victim's in rehabilitation center considered to be poor, as many of the subjects suffered from major medical problems like mental retardation, physical disabilities etc.

Conclusion:

This study emphasizes the need for special attention from government and voluntary organization to improve overall health status of the victims.

INTRODUCTION

Endosulfan is considered as a highly controversial chemical substance because of its toxicity. According to the guidelines of the International Union of Pure and Applied Chemistry, the chemical name of endosulfan is 6, 7, 8, 9, 10, 10-hexachloro-1, 5, 5a, 6, 9, 9a-hexahydro-6, 9-methano-2, 4, 3-benzodioxathiopin-3-oxide. This toxic chemical is produced by the Diels-Alder reaction of hexachlorocyclopentadiene with cis-butane-1, 4-diol, and the product is then reacted with thionyl chloride, liberating hydrogen chloride.[1]

Various reports have been published from various countries on the serious adverse effects of endosulfan on human health, and the use of this chemical has been reported to be associated with a high incidence of central nervous system disorders, cancer, and reproductive disorders. After studying various etiological factors, the National Institute of Occupational Health (Indian Council of Medical Research) reported that the aerial spraying of endosulfan was responsible for unusual illnesses in certain regions.[2]

Several studies have revealed the hazards of endosulfan use; its impact on the quality of food, water, and beverages; and its ability to cause neurobehavioral disorders, congenital malformations in female subjects, and abnormalities related to the male reproductive system. Taking into account the health disorders caused by this chemical in the human population, the Stockholm Convention in April 2011 recommended a global ban on the manufacture and use of endosulfan. However, its use is still rampant in India.[3]

Endosulfan has also shown to have a genotoxic effect on human liver carcinoma cells,[4] hepatocyte derived transformants,[5] and abnormalities in germ cells.[6]

Aerial spray of endosulfan in Karnataka began in 1980 as a measure to control the tea-mosquito bug in cashew plantations of the Karnataka Cashew Development Corporation. Thousands of hectares of cashew gardens in over 90 villages of the four Taluks namely Puttur, Belthangady, Sullia, and Bantwal in Dakshina Kannada District were sprayed with endosulfan for almost two decades before it was stopped in the year 2000. The pesticide was also sprayed in cashew plantations in the other divisions of Karnataka Cashew Development Corporation namely Moodabidri, Kumta, and Kundapur.

After endosulfan spraying started in Kokkada, the village in Belthangady saw a sharp increase in the number of health complications, but the villagers could not ascertain the reason behind it. In the following years, instances of cancer, skin problems, infertility, etc., increased and hundreds of mentally and physically deformed children were born. The magnitude of the tragedy in Kokkada, along with the neighboring Nidle and Patrame Villages, has reported the maximum number cases of endosulfan poisoning in Dakshina Kannada District.[7]

As there is no information regarding the oral health status of endosulfan affected victims, the objective of the present study, the first of its kind, is to assess the oral health status of victims. In this article, we aim to report the oral health status of endosulfan-affected individual in Endosulfan Relief and Remediation Cell, Kokkada, Belthangady Taluk, Dakshina Kannada District, Karnataka, India.

METHODOLOGY

A cross-sectional study was conducted on 18 subjects of 4–50 years of age in Endosulfan Relief and Remediation Cell in Kokkada, Belthangady Taluk, Dakshina Kannada District, Karnataka, India. The subjects were asked to sit comfortably on a chair in a well-ventilated room, and clinical examination was carried out under natural light with a mouth mirror, explorer, and community periodontal index probe. The data were recorded by the investigator on a printed Modified World Health Organization (WHO) Oral Health Assessment Form (1997).

RESULTS

Age distribution

The age of the subjects was found to be from mere 4 years to 50 years. Among the subjects, 10 (>50%) were found to be in age group <20 years and rest of subjects above 20 years [Table 1].

Table 1.

Age distribution among study subjects

Gender distribution

Among the subjects, 10 were female, and 8 were male [Table 2]. Five out of the 10 females and 3 out of 8 males were found to be mentally retarded, who were taken care by the caretaker of the cell.

Table 2.

Gender distribution among study subjects

Oral health characteristics

There was no abnormality in terms of extraoral appearance and oral mucosal characteristics. None of the study subjects had either enamel hypoplasia or dental fluorosis. One subject reported the problem of temporomandibular joint (tenderness on palpation as well as reduced jaw mobility) and 11 subjects were in need of the prosthesis as none of them had any prosthesis for the missing teeth.

Periodontal status

The overall periodontal status among the study subjects was considerably poor. Five subjects were not recorded because of <15 years of age. Five subjects had a score of one which implies bleeding on probing, two subjects each had a score of three and four stating pocket depth 4–5 mm and more than 6 mm, respectively. Seven subjects had a score one of loss of attachment which implies 0–3 mm attachment loss and six subjects with score two which implies attachment loss of 4–5 mm [Table 3].

Table 3.

Distribution of oral health characteristics

DISCUSSION

The results of this cross-sectional study conducted among victims of endosulfan exposure in Endosulfan Relief and Remediation Cell in Kokkada, Belthangady Taluk, Dakshina Kannada District, Karnataka, India, provide a unique opportunity to analyze the oral health status of victims affected by endosulfan exposure. To assess the oral health status of the study group, Modified WHO Oral Health Assessment Form (1997) was used.

The present study is first of its kind, carried out on oral health status of endosulfan victims along with related data from the records of the cell.

The Karnataka State government has, for the first time, acknowledged that endosulfan, the now-banned pesticide, has caused deaths and other disabilities in Puttur, Beltangady, Sullia, and Bantwal taluks of Dakshina Kannada. According to figures put out by the District Health and Family Welfare Department, there have been as many as 15 deaths because of the pesticide in the 4 Taluks.[8]

The Endosulfan Relief and Remediation cell in Kokkada addresses the needs of endosulfan victims in and around the villages of Dakshina Kannada district. Majority of the subjects enrolled in the relief center were among villagers from Kokkada, along with the neighboring Nidle and Patrame villages of Belthangdy Taluk in Dakshina Kannada District. Although most of them pursued minimum basic level of education, the socioeconomic status of the subjects appeared to be low, considering the occupational details provided in the records.

The study size was arrived by examining all the subjects present in the relief cell which was found to be 18 on the day of examination, as the study design was descriptive cross-sectional survey and thus avoiding the selection bias.[9]

A study was conducted to report the characteristics of cancer patients from the endosulfan-affected areas of Kasaragod District. Of the reported 20 cases in the study, seven had head and neck cancer, with the specific cancer sites being buccal mucosa in two cases, hypopharynx, nasopharynx, oropharynx, eye–conjunctiva, and lip in one case each.[10] Present study noted that among the studied subjects, the history of cancer was not reported in any subjects in endosulfan relief and remediation cell as recorded from records of the cell.

A study was conducted to evaluate the association between maternal residence near agricultural pesticide application during the key periods of gestation and development of autism spectrum disorders (ASD) in children reported that children of mothers living within 500 m of field sites had increased risk for ASD (odds ratio: 6.1) compared to those with mothers not living near pesticide applied field sites thus maternal residence near agricultural pesticide applications in California's Central Valley during defined time periods of gestation could be associated with ASD among children.[11]

CONCLUSION

On the basis of these findings, it is very difficult to arrive at a conclusion on the role of endosulfan exposure on oral health condition as the subjects were less in the present study. However, to establish an etiological relationship between endosulfan affecting oral health disorders, more epidemiological research studies have to be initiated. Ideally, a population-based approach should be adopted to determine the oral health disorders incidence in population of endosulfan victims. Since the Government has banned the use of endosulfan, a combined retrospective and prospective study may be useful in arriving at the oral ill effects due to endosulfan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.