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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
NAME OF THE CANDIDATE
Dr. JASPREET SINGH TUTEJA
AND ADDRESS ( in block letters)
POST GRADUATE STUDENT
DEPARTMENT
OF
PUBLIC
HEALTH
DENTISTRY
THE OXFORD DENTAL COLLEGE HOSPITAL
AND RESEARCH CENTRE, BOMMANAHALLI,
HOSUR ROAD, BANGALORE.
2.
NAME OF THE INSTITUTION
THE
OXFORD
HOSPITAL
AND
DENTAL
COLLEGE
RESEARCH
CENTRE,
BANGALORE.
3.
4.
COURSE OF THE STUDY AND
MASTER OF DENTAL SURGERY
SUBJECT
PUBLIC HEALTH DENTISTRY.
DATE
OF
ADMISSION
TO
05 MAY 2010
COURSE
5.
TITLE OF THE TOPIC
ORAL HEALTH STATUS OF
WORKERS IN
LEAD BATTERY MANUFACTURING UNITS IN
BANGALORE CITY - A CROSS SECTIONAL,
COMPARATIVE STUDY.
1
BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
The oral cavity is vulnerable to external agents and some occupational exposures are
associated with oral changes in both hard and soft tissues. Occupational exposure to
acids has been described in association with oral health, explained by the high
irritant and corrosive acid effects that damage the enamel structure, cause
inflammatory and immune reactions and reduce the salivary pH that can also
compromise resistance to infections in oral cavity.1 The chronic
process
of
exposures to acid mists may also irritate soft tissues resulting in other oral healthrelated effects, such as periodontal changes or oral mucosal lesions. This further
increases the susceptibility to infection by promoting salivary changes and cause
protein coagulation which leads to certain destructive oral lesions.2
Occupational dental erosion is caused by exposure to various types of acidic
contaminants in the workplace such as chemicals, sulfuric acid, petrochemicals,
metals and semiconductors.3 The prevalence of dental erosions is higher in workers
in battery and galvanizing occupations. Battery workers, exposed to sulfuric acid,
have the highest prevalence 60% of erosion, with 20% being severe cases.4
Industrial hygiene is concerned with anticipating, recognizing, evaluating and
controlling workplace conditions that may cause workers’ injury or illness. This
requires environmental monitoring and analytical methods to detect the extent of
worker exposure and employ engineering, work practice controls and other methods
to control potential health hazards. Occupational environment lead to development
of lot of hazards on general health and oral health in day to day life.5
There is very little information on the effects of occupational hazards on oral health
status of individuals in developing countries .6 Therefore, the aim of the present
study is to assess the oral health status in workers’ of lead battery manufacturing
units in Bangalore city.
2
6.2 REVIEW OF LITERATURE
A study was conducted on the workers in the storage battery industry and found that
only men exposed to acid mist display erosion of the incisor teeth and that the
degree of erosion was classifiable into four groups. The factors influencing the
degree of erosion were investigated. These seemed to be: length of exposure, lip
level, and concentration of acid in the air. Statistical analysis was done and findings
in the group of workers exposed to acids and an unexposed group were compared.
The erosion process was painless. There was progressive destruction of the tooth
crown from direct impingement of acid droplets. Moreover, advanced cases showed
almost complete loss of crown. Erosion ceased when lip level was reached.7
A study was conducted to evaluate the oral health situation of workers in a modern
battery factory; in particular, to describe the prevalence and the severity of dental
erosion and attrition in relation to exposure of airborne acids in the work
environment. All workers at the factory were included in the survey and a total of 61
dentate individuals completed a questionnaire on their work environment, dental
health, and symptoms from the mouth, nose and throat. Information on oral health
status, erosion and attrition was collected by clinical examinations. Measurements of
the work environment at a factory showed that the workers were exposed to sulfuric
acids (0.4-4.1 mg/cm3). 56% of workers complained of sharp and thin teeth and
29% of short teeth. Poor dental health conditions were observed (e.g. mean D-T =
3.8); the mean number of teeth with crown restoration was 5.3. The prevalence of
erosion was 31% and 92% were affected by attrition. Erosion was found only in
front teeth while attrition also occurred in posterior teeth. In conclusion, severe
erosion and attrition due to sulfuric acid mists should be recognized as an
occupational disease.8
3
A study was conducted to evaluate the effect of occupational exposures to acid
mists and gases and ulcerative lesions of the oral mucosa. All 665 active male
workers of a metal processing factory were the study population. Semi-quantitative
measures of exposure were estimated from a job exposure matrix constructed with
industrial hygienist scoring and job titles. Ulcerative lesions of the oral mucosa were
identified with standardized clinical dental exams. Past exposure to acid mists were
positively associated with ulcerative lesions of the oral mucosa but only among
workers without lip sealing (age- and alcohol consumption-adjusted prevalence ratio
(PR), PR(adjusted) = 3.40; 90% CI: 1.48-7.85). Also in this worker group, the
mixture of acid mists and acid gases was associated with ulcerative lesions of the
oral mucosa limited to exposure in the past (PR(adjusted) = 2.83; 90% CI: 1.127.17) .2
A study was conducted to investigate that occupational exposure to acid mists is
positively associated with periodontal disease, assessed by periodontal attachment
loss. The study sample included 530 male workers at a metal processing factory.
Data were obtained from interviews and oral examinations. Periodontal attachment
loss was defined as > 4mm at probing, in at least one tooth. A job exposure matrix
was utilized for exposure evaluation. Exposure to acid mists was positively
associated with periodontal attachment loss > 4mm at any time (prevalence ratio, PR
adjusted = 2.17), past (PRadjusted = 2.11), and over 6 years of exposure(PR
adjusted = 1.77), independently of age, alcohol consumption, and smoking, and
these results were limited to workers who did not use dental floss. Exposure to acid
mists is a potential risk factor for periodontal attachment loss, and further studies are
needed, using longitudinal designs and more accurate exposure measures.1
A study was conducted at a lead storage battery factory in 1991, which found that
the work environmental sulfuric acid density was above the tolerable range
(1.0mg/m3) and that long-term workers had dental erosion. Therefore, workers
handling sulfuric acid were given an oral examination and rates of dental erosion by
tooth type, rates of erosion by number of working years and rates of erosion by
sulfuric acid density in the work environment investigated. Where dental erosion
4
was diagnosed, degree of erosion was identified according to a diagnostic criterion.
No development of dental erosion was detected in the maxillary teeth, and erosion
was concentrated in the anterior mandibular teeth. Its prevalence was as high as
20%. Rates of dental erosion rose precipitously after 10 working years. The
percentages of workers with dental erosion were 42.9% for 10–14 years, 57.1% for
15–19 years and 66.7% for over 20 years with 22.5% for total number of workers.
The percentages of workers with dental erosion rose in proportion to work
environmental sulfuric acid density: 17.9% at 0.5–1.0, 25.0% at 1.0–4.0 and 50.0%
at 4.0–8.0mg/m3. This suggests that it is necessary to evaluate not only years of
exposure to sulfuric acid but also sulfuric acid density in the air in factory workers.9
6.3 OBJECTIVES OF THE STUDY
1. To assess the soft tissue, periodontal tissue and hard tissue status of the
workers’ in lead acid battery unit.
2. To assess the pH and flow rate of saliva.
3. To determine whether the sulfuric acid fumes in working environment is
associated with dental erosion.
4. To educate the workers regarding work place safety measures & protect
their oral health.
5
MATERIALS AND METHODS:
7.1 SOURCE OF DATA
All the workers’ in lead battery manufacturing factories and small scale
manufacturing units of the Bangalore city.
7.2 METHOD OF COLLECTION OF DATA
Sample size
Sample = z2pq/Δ2
× design effect
Design effect = 2
Total sample = 384 × 2
= 768
z = 1.96(standard normal distribution)
p = 0.5 (prevalance)
q = 1- p
Δ= 0.05(margin of error = 5%, 95 % confidence interval)
The sample of 768 was derived which was rounded off to 800. Therefore, total
number of 800 subjects will be taken from the all the battery manufacturing factories
units of Bangalore city using the simple random sampling method.
Inclusion criteria

All the lead battery factories that give permission and the subjects who are
willing to participate and give the consent.
Exclusion criteria

Subjects who are on acidic medications, medication which lead to
hyposalivation and medications which has vomiting as a side effects.

Subjects suffering from specific medical disorders eating disorder, acidic
reflux conditions leading to vomiting .

Subjects with salivary hyofunction.
6
DATA COLLECTION AND ORAL EXAMINATION
In this cross sectional study oral examination of all the workers working in the lead
acid battery manufacturing unit will be carried out in a separate examination area
so that the examiner will be unaware of the exposure status of the workers. The
examination will be carried out during the normal working hours. After the
completion of examination , a special proforma will be filled giving the information
on health and dietary habits including acidic food and beverages, oral health care,
socio demographic background and length of service. Also information about their
working area will be ascertained.
The oral examination will be carried out using the WHO oral health assessment
form which will include soft tissue and hard tissue examination i.e, extra oral
changes, dental caries status, oral mucosal diseases, periodontal status and fluorosis
status.
During the oral examination of the workers the presence of dental erosion and
degree of dental erosion will also be examined using the Basic Erosive Wear
Examination (BEWE) scoring system and saliva samples will also be collected for
assessing the pH and flow rate of saliva.
STATISTICAL METHOD
The values obtained will be statistically analyzed with the t-test to identify
significant differences between workers with dental erosion and workers with no
dental erosion.The data analysis and graphic preparations will be performed using
the SPSS and Microsoft Excel 2007 software.
7.3 Does the study require any investigation or interventions to be conducted on
patients or other humans or animals?
Yes, this study requires investigation to be conducted on workers in lead battery
manufacturing units.
7.4 Has ethical clearance been obtained from your institution?
Yes, the ethical clearance has been obtained from the institution.
7
8. REFRENCES:
1.Almedia TF, Vianna MI, Santana VS, Filho ISG. Occupational exposure to acid
mists and periodontal attachment loss. Cad. Saúde Pública, Rio de Janeiro,
2008,Mar;24(3):495-502.
2. Vianna MI, Santana VS, Loomis D. Occupational exposures to acid mists and
gases and ulcerative lesions of the oral mucosa Am J Ind Med. 2004 Mar;45(3):23845.
3. Kim HD, Douglass CW. Association between occuational health behaviors and
occupational dental erosion. J Public Health 2003 Fall ; 63(4):244-9
4. Edeer D, Martin CW.Occupational Dental Erosion. Richmond, BC: WorksafeBC
Evidence Based Practice Group; February 2010.
5. U.S. Department of Labour Occupational Safety and Health Administration.
Informational Booklet on Industrial Hygiene.OSHA 3143;revised 1998.
6.Amin WM ,Al-Omoush SA,Hattab FN.Oral health status of workers exposed to
acid fumes in phosphate and battery industries in Jordan.Int Dent J.2001 Jun;51(3) :
169-74.
7. Malcolm.D and Paul .E.Erosion of the teeth due to sulphuric acid in the battery
industry. Brit. J. industr. Med., 1961; 18 : 63-6.
8. Petersen PE, Gormsen C. Oral conditions among German battery factory workers.
Community Dent Oral Epidemiol. 1991 Apr;19(2):104-6.
9. Suyama Y, Takaku S, Okawa Y and Matsukubo T. Dental Erosion in Workers
Exposed to Sulphuric Acid in Lead Storage Battery Manufacturing Facility. Bull
Tokyo Dent Coll 2010;51(2):77-83
8
9.
Signature
Candidate
of
the
10.
Remarks of the Guide
11.
Name & Designation of
DR.NAGANANDINI
11.1 Guide
PROFESSOR AND HEAD OF THE DEPARTMENT
DEPARTMENT OF PUBLIC HEALTH DENTISTRY
11.2 Signature
DR NAGANANDINI
113 Head of Department
PROFESSOR AND HEAD OF THE DEPARTMENT
DEPARTMENT OF PUBLIC HEALTH DENTISTRY
11.4 Signature
12.
12.1
Remarks
of
Chairman & Principal
the
DR.K.S GANAPATHY (PRINCIPAL)
THE
OXFORD
DENTAL
COLLEGE
RESEARCH CENTRE. BOMMANAHALLI,
BANGALORE.
12.2 Signature
9
HOSPITAL
AND
10