|Year : 2015 | Volume
| Issue : 3 | Page : 155-160
Assessment of periodontal status of Indian police personnel of Central India: A cross-sectional representative study
Aishwarya Singh1, Ajay Bhambal1, Sudhanshu Saxena2, Vidhatri Tiwari3, Utkarsh Tiwari4, Anupriya Singh5
1 Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Jabalpur, Madhya Pradesh, India
2 Department of Public Health Dentistry, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
3 Department of Public Health Dentistry, People's Dental Academy, Bhopal, Madhya Pradesh, India
4 Department of Pedodontics and Preventive Dentistry, People's Dental Academy, Bhopal, Madhya Pradesh, India
5 Department of Prosthodontics and Crown and Bridge, People's College of Dental Sciences and research Centre, Bhopal, Madhya Pradesh, India
|Date of Web Publication||4-Aug-2015|
64, Vaishali, Kotra, Bhopal, Madhaya Pradesh
Background: Periodontal health is an integral part of oral and in turn general health. Police personnel form the pillars for safety and security of a community hence their health is of utmost importance. The present study aimed to assess the periodontal health status of district police personnel employed in police stations of Bhopal District of Central India. Materials and Methods: A cross-sectional study was conducted on all the available police personnel at various police stations. Final sample size comprised of 781 subjects. The data were recorded on modified World Health Organization format (1997) comprising Community Periodontal Index (CPI) and loss of attachment. Results: The mean age of subjects was 40.5 years, 95.6% were males and 4.4% were females. Regarding highest CPI score, 23.4% subjects had a healthy periodontium whereas maximum subjects (31.3) had a CPI score 2. The CPI scores showed a significant relationship with post, age and education. Conclusion: Overall periodontal status was poor with a high number of subjects requiring oral health education.
Keywords: Oral health, periodontal status, police personnel
|How to cite this article:|
Singh A, Bhambal A, Saxena S, Tiwari V, Tiwari U, Singh A. Assessment of periodontal status of Indian police personnel of Central India: A cross-sectional representative study. SRM J Res Dent Sci 2015;6:155-60
|How to cite this URL:|
Singh A, Bhambal A, Saxena S, Tiwari V, Tiwari U, Singh A. Assessment of periodontal status of Indian police personnel of Central India: A cross-sectional representative study. SRM J Res Dent Sci [serial online] 2015 [cited 2020 Jul 3];6:155-60. Available from: http://www.srmjrds.in/text.asp?2015/6/3/155/162162
| Introduction|| |
Oral health and general health are governed by various factors such as lifestyle, dietary habits, socioeconomic conditions, occupational environment; etc.  Oral health means more than healthy teeth. Oral health enables an individual to speak, eat and socialize without active disease, discomfort or embarrassment. Oral health plays a critical role in the pursuit of health and health promotion of an individual, contributes to personal well-being and quality-of-life, and thus, for the whole community. Oral diseases afflict humans of all ages and in all regions of the world. Practically, no individual in the course of their lifetime escapes from dental diseases.  The work environment constitutes an important part of man's total environment, so health to a large extent is affected by work conditions. Occupational environment plays a major role on the health of the exposed. The health hazards get more severe with the difficulty of the job.  This fact is more important in situations as of the police personnel who provide continuous service to the civilians.
Policing is a complex occupation. Differences in job design and in the wider societal context within which police men work, adds to the intricacy of policing. Due to the complexity of policing, risks and exposures may vary within forces, between forces and internationally. Police officers play a pivotal role in the society. Officers' involvement ranges from general, daily, proactive patrol activities to specific criminal activities such as narcotic investigations. Because there is such a wide range of activities involved in police work, there are many health and safety issues surrounding policing as an occupation. 
It has been reported by different researchers that due to enormous stress, police officers suffer from different physiological disorders, such as gastrointestinal disorders, chronic insomnia, psychological disorders, and family dysfunction.  It has also been reported by few researchers that police officers suffer increased rates of cardiovascular and metabolic disorders, divorce rates, and suicides than the general population. ,
The place that is occupied by the police in a state is similar to the place occupied by the military in a nation. Data of US army  published between the years 2000 and 2003 give figures that 2.8-9.6% of medical emergencies were of oral origin. In a study conducted by Mombiedro Sandoval and Llena Puy,  only 7.2% of the Spanish military personnel had all the sextants healthy.
It is essential to prevent periodontal diseases and promote oral health for this special group of the population. Thus, is important that research be completed on the oral health issues of police officers in order to identify hazards and ways to reduce risk. The failure to identify and solve health concerns of officers has potentially serious consequences for the health and well-being of officers, their families and general public, as police officer's fatigue reduces contribution of policing the community.
No epidemiological data have been reported on periodontal health status of police personnel of Bhopal city. This information is important for establishing priorities and determining the type and quantity of prevention and treatment services required, as well as the type of personnel required to provide them.
Keeping this in mind, this study has been undertaken with an aim of assessing the periodontal health status and treatment needs among police personnel of Bhopal city, Central India. The objectives of the study are to suggest measures for improvement of their oral health and planning programs for improvement of their oral health.
| Materials and Methods|| |
A descriptive cross-sectional study was conducted among all the active police personnel posted at various police stations of Bhopal city, Madhya Pradesh, Central India. The list of all the police stations and sanctioned strength of the district executive force posted at various police stations of Bhopal city was obtained from police headquarters. The total sanctioned strength was found to be 2109 which included Inspectors, Sub Inspectors, Assistant Sub Inspectors, Head Constables and Constables, posted across 35 police stations. A pilot study was conducted to arrive at the sample size of 781.
On an average, 35-40 policemen are available at one time in a police station. The police stations were selected on a random basis through lottery method and were visited till the sample size was achieved. A total of 22 police stations were visited. The head of the selected police stations was contacted and informed about the schedule of survey, so as to ensure maximum participation. Selected police stations were visited, and each policeman present on the day of examination was included in the final sample of the present study. Subjects who were absent on the day of examination or were on external assignments were excluded from the study.
A predefined Performa  used in the national survey was used to record information about demographic data, oral hygiene practices, dietary habits, adverse habits, systemic information, knowledge and experience of dental problem, information about dental visit. The Performa was filled by interviewing policemen prior to the examination. The clinical examination was conducted using Community Periodontal Index (CPI), loss of attachment (LOA) index and World Health Organization (WHO) dentition status for dental caries from the WHO Oral Health Assessment Form (1997).
The permission to carry out this study was obtained from Institution's Ethical Committee. Furthermore, permission was taken from the Senior Superintendent of police before examination. A schedule was prepared for data collection. One police station was to be examined per day. The study was to be conducted for a period of 3 months, from January 2014 to March 2014 across the police stations in Bhopal city.
Before conducting the survey, the training and calibration of examiner were done. Intra-examiner reliability was assessed using the kappa statistic which was in the range of 0.80-0.85.
Examination was done in premises of the respective police stations. Subjects were examined seated in a chair, under natural daylight. The subjects were positioned so as to receive maximum illumination while avoiding discomfort from direct sunlight.
The data obtained were subjected to statistical analysis with the consult of a statistician. Chi-square test was used to analyze categorical variables. Mann-Whitney test was used to compare findings between two different groups and Kruskal-Wallis test was used to compare means between three or more groups. Statistical analysis was done using Statistical Package of Social Science (version 17; SPSS Inc., Chicago, IL, USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons. Significance level was fixed at P ≤ 0.05.
| Results|| |
A total of 781 police personnel were examined, out of which 747 (95.6%) were males and 34 (4.4%) were females. The study sample comprised of 448 (57.4%) Constables, 180 (23%) Head Constables and 153 (19.3%) officers. On further dividing, the population four age groups are observed. The age group 21-30 years comprised of 182 (23.3%) police personnel, 176 (22.5%) police personnel belong to 31-40 years of age, maximum that is 287 (36.7%) police personnel belong to the age group of 41-50 years, whereas minimum that is 136 (17.4%) subjects belong to the age group of 51-60 years. On the basis of educational level the subjects can be divided into below graduates (300 [38.4%]), graduates (349 [44.7%]) and postgraduates (132 [16.9%]) [Table 1].
Of 781 police personnel, 183 (23.43%) had healthy periodontium. bleeding was present in 119 (15.2%) subjects, calculus was present in 245 (31.3%) subjects, pocket of 4-5 mm was present in 220 (28.1%) subjects, pocket of 6 mm or more was recorded in 8 (1%) and in 4 (0.5%) subjects, it was excluded and not recorded in 2 (0.2%). There exists a significant association of CPI scores with post (P = 0.00), age (P = 0.00) and education (0.00) [Table 2].
Overall mean number of healthy sextant was 1.3 ± 2.31, bleeding 0.81 ± 1.78, calculus 2.21 ± 2.40, pocket of 4-5 mm 1.50 ± 2.24 and on an average 0.06 ± 0.52 sextant had pocket of 6 mm or more. A significant association existed between mean number of healthy sextant and post (P = 0.00), age (0.00) and education (P = 0.00), mean number of bleeding sextant and age (P = 0.00) and education (P = 0.00), mean number of sextant presenting calculus and age (P = 0.02), mean number of sextant having pocket of 4-5 mm and post, age and education (P = 0.00), and mean number of sextant having pocket of 6 mm or more and post (P = 0.02) and age group (P = 0.00) [Table 3].
|Table 3: Distribution of study subjects according to the mean number of sextant and highest CPI score|
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Of 781 police personnel, 418 (53.5%) had no LOA. An attachment loss of 4-5 mm was present in 192 (24.5%) subjects, 6-8 mm attachment loss was present in 150 (19.2%) subjects, 9-11 mm was present in 15 (1.9%) subjects, in 4 (0.5%) subjects it was excluded and not recorded in 2 (0.2%). There exists a significant association of LOA scores with post (P = 0.00), age (P = 0.00) and education (0.00) [Table 4].
Overall mean number of sextant with no attachment loss was 3.13 ± 2.85, 4-5 mm loss was recorded in 1.52 ± 2.39, 6-8 mm in 1.16 ± 2.24, and loss of 9-11 mm was recorded in 0.10 ± 0.62. A significant association existed between mean number of sextant no LOA and post (P = 0.00), age (0.00) and education (P = 0.00), mean number of sextant with 4-5 mm loss and age (P = 0.00) and education (P = 0.00), mean number of sextant presenting attachment loss of 6-8 mm and age (P = 0.02), and between mean number of sextant having 9-11 mm loss and post, age and education (P = 0.00) [Table 5].
|Table 5: Distribution of study subjects according to the mean number of sextant and highest LOA scores|
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| Discussion|| |
Police personnel of every Indian state provide security and create a peaceful community with their cooperation. Police personnel in India is state government employees, who have access for free and/or discounted medical care at government hospitals and government identified private hospitals. All these perks should warrant good general as well as oral health. But their tiresome and stressful working environment with 24 h duty often exposes them to highest physical strain and mental stress. Because of their odd working pattern, they often miss timely food, sleep, rest, and recreation and family contacts. This complicates their life and pulls down their level of living. 
A study reported that even low-grade dental pain could disrupt sleep, interfere with concentration, degrade individual performance and frequently risk medical evacuation. Thus, a good oral health among serving personnel is essential for their efficient performance.  Good oral health of the police personnel would reduce the number of urgent dental intervention and absence from duties and hence, would improve the security of the entire community.
The study area Bhopal city, being the capital of the state Madhya Pradesh, possesses all the major administrative offices, the legislative assemblies, and political offices, thereby present a challenge to maintain law and order in the city. Bhopal also has a history of communal disturbances (1959 and 1992) which makes maintaining peace on the more challenging job. These factors keep policemen under constant workload and stress, which makes it common for them to neglect their general health including oral health. Furthermore, stress acts as a potential factor for engaging in deleterious habits which then further deteriorates oral health.
A thorough literature search revealed very few studies related to oral health of police personnel. The present study to our knowledge is the first epidemiological study related to oral health among district police personnel of Bhopal city.
Periodontal diseases are multifactorial and can be crippling in nature and hence require special attention. An assessment of periodontal status revealed that 75.8% subjects suffered from periodontal disease which can be attributed to age. There existed a significant difference across posts (P = 0.00) and age groups (P = 0.00). The Constables (28.8%) showed healthy periodontal status as compared to officers (15.7%), which can be understood in light of their age. A total of 37.9% of Constables belonged to the age group 20-30 years and 47% of officers belonged to the age group of 51-60 years. These results are in contrast to study conducted among Indonesian soldiers where officers showed better CPITN scores, however, they also reported that the periodontal conditions deteriorated rapidly in the older groups.  The global trends of periodontal status of armed forces demonstrate considerable variation owing to age group. On one hand where the prevalence of health sextant did not exceed 9% in armed forces of Spain,  Israel,  and Finland;  on the other hand, prevalence of healthy individuals was above 53% among military personnel in Denmark  and Italy.  The high prevalence of periodontal disease can also be attributed to the irregular work shifts, high prevalence of adverse habits and lack of concentration on oral health in particular.
Calculus (31.3%) was found to be the most prevailing periodontal disease, being similar to study conducted on Spanish military (70%)  and Katz et al. (27%). Although presence of calculus was the most common finding in present study, National Oral Health Survey 2002 (Madhya Pradesh)  reported that bleeding was the most prevalent condition present, with or without calculus and pockets. Pockets (4-5 mm) were present in about 5.7% and 11.3% subjects in the age groups of 35-44 years and 65-74 years, which is comparable to those found in surveys of Spanish (10%)  and Danish military (8%). 
Education factor was found to be associated with periodontal health (P = 0.00). Postgraduates (28.8%) showed healthy periodontium as compared to undergraduates (13.4%). Katz et al. demonstrated similar results among Israeli permanent military personnel and advocated that higher education has a positive effect on adopting health preventive measures.
Demonstration of the progression of periodontitis requires documentation of additional attachment loss. In the present study, 53.5% subjects exhibited no attachment loss. A strong age impact on the periodontium is reflected by the present study. According to present study, officers had more pockets and LOA as compared to Constables (55% and 37.8%, respectively) which is in agreement to studies done by Basavraj et al. (80% and 52.4%, respectively) and Naveen and Reddy  (82.9% and 56.4%, respectively). Naveen and Reddy  suggested that the reason for high number of subjects (65%) exhibiting no LOA was because 70% of the population was below 45 years of age. This is further supported by our study where 64% of subjects were below 45 years of age. This may represent differences in health habits among younger subjects.
These findings present a challenge and an opportunity. The challenge is to find ways to promote oral health and adopt healthy oral habits among police personnel. The opportunity is to explore and understand what causes the neglect of health in general, and oral health in particular, so that effective oral health promotion and tobacco control strategies might be devised. Limitations of the present study included recall bias and conscious falsification by the subjects. Despite these shortcomings, this study found some important and often neglected correlates of dentition status and unmet treatment needs that need to be addressed. Though the study was conducted in one Central Indian garrison, but the sample size is fairly adequate and can reliably represent the overall pattern of periodontal status in Police personnel of India. Moreover, the study results have even wider demographic applications and can be applied to Indian population as a whole because this sample represents various ethnic groups from different parts of India. Maintaining good general health and oral health in particular among police personnel should be a high priority for societal, economic, and readiness reasons.
It is recommended that:
- The capability of the dental office in terms of manpower should be increased. A full-time dentist must be available for the personnel at the district police hospital. Systematic dental services may improve the oral health of the police personnel.
- Regular screening is mandatory for this group of the population.
- Execution of primary health care education programs employing proper oral hygiene care.
- Special oral health care programs focusing on improving access to and use of preventive dental services should also be conducted.
| Conclusion|| |
The key to an informed and motivated public lies in the hands of the dental profession, authorities, and individual. The findings of the present study reveal poor periodontal health status of Police personnel, with only 23.4% of individuals having healthy periodontium. Health education and promotion, with its key concepts of equity and equality, empowerment and advocacy offers an appropriate approach in improving both general and oral health of this particular group. It shifts the responsibility for health from the formal health care system to individuals, communities and decision-makers at all levels of society. The professional examination and diagnosis should involve the felt and expressed dental needs. In both aspects, a crucial need for public health action is clearly evident.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]