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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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ORIGINAL ARTICLE
Year : 2014  |  Volume : 32  |  Issue : 2  |  Page : 125-129
 

Oral health status of Tibetan and local school children of Kushalnagar, Mysore district, India: A comparative study


1 Department of Pedodontics and Preventive Dentistry, Kurunji Venkataramana Gowda Dental College and Hospital, Sullia, Dakshina Kannada, India
2 Department of Pedodontics and Preventive Dentistry, Yenepoya Dental College and Hospital, Deralakatte, Mangalore, Karnataka, India

Date of Web Publication17-Apr-2014

Correspondence Address:
K S Havaldar
No. 106,Vishwas Jupiter Apartment, Opp. Srinivasa Physiotherapy College, Behind G.S.I qtrs, Shivanagar, Pandeshwara, Mangalore-1, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.130959

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   Abstract 

The presence of migrants culturally different from inhabitants of the host country is now a widespread phenomenon. It is known that dietary habits and oral hygiene practices vary from country to country, which in turn has a profound effect on oral health. Objectives: To assess and compare the oral health status of Tibetan school children and local school children of Kushalnagar (Bylakuppe). Study design: A survey was conducted at Kushalnagar (Bylakuppe), in Mysore district, India to assess the oral health status of Tibetan school children (n = 300) and local school children (n = 300) and compared using World Health Organization oral health proforma (1997). Results: The proportional values are compared using chi-square test and the mean values are compared using Student's t-test. Statistically significant results were obtained for soft tissue lesions, dental caries, malocclusion, and treatment needs. However, results were not significant when gingivitis was compared in the two populations. Conclusions: Tibetan school children showed higher prevalence of Angular cheilitis, gingival bleeding, dental caries experience, malocclusion, and treatment needs in comparison with non-Tibetans. Among the Tibetan school children, the requirement for two or more surface filling was more.


Keywords: Migrants, oral health status, tibetans


How to cite this article:
Havaldar K S, Bhat S S, Hegde S K. Oral health status of Tibetan and local school children of Kushalnagar, Mysore district, India: A comparative study. J Indian Soc Pedod Prev Dent 2014;32:125-9

How to cite this URL:
Havaldar K S, Bhat S S, Hegde S K. Oral health status of Tibetan and local school children of Kushalnagar, Mysore district, India: A comparative study. J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2019 Nov 21];32:125-9. Available from: http://www.jisppd.com/text.asp?2014/32/2/125/130959



   Introduction Top


The presence of migrants culturally different from inhabitants of the host country is now a widespread phenomenon. [1] The desire to escape poverty, religious, or political oppression and attraction for greater opportunities have uprooted millions of people. [1] The uprooting and the resettlement of the migrants will have lasting effects on people's lives. [1] Ever since their exodus from Tibet, about 100,000 Tibetans have settled in small disparate communities in India and Nepal. [2] The phenomenon of acculturation, the gradual influence on tradition, the cultural beliefs, and values by those of the host communities will also be of consequence to the health situation. [1] Tibetans are staying in India as refugees in various settlements throughout the country for the past 40-50 years after China occupied Tibet in 1949. There have been slight changes in Tibetan culture, lifestyle, habits, and health due to changes in the habitat and adaptation to a new environment. Kushalnagar (Bylakuppe) in Mysore district, India is one of the settlements where Tibetans got rehabilitated in 1960. [2]

It is known that dietary habits and oral hygiene practices vary from country to country, which in turn has a profound effect on oral health. [3] The present study was undertaken to know the dietary habits, oral hygiene practices, oral health status, and treatment needs of Tibetan refugees and compare with local school children.


   Materials and Methods Top


Study design and subjects

In Kushalnagar (Bylakuppe), Mysore, India there exist two Tibetan settlements. One settlement is called "Lugsom Samdupling Tibetan Settlement" (L.S.T) which was established in 1960 and other "Tibetan Dickey Larsoe Settlement" (T.D.L) in 1969. L.S.T has a total population of 10,496 and T.D.L has a total of 4,056 according to the 2001 census. Each settlement has various camps. L.S.T settlement contains 6 camps and T.D.L settlement contains 14 camps. All the camps in both the settlements were taken into consideration. By simple random sampling procedures, 6 schools from L.S.T-1, L.S.T-2, T.D.L-6, and T.D.L-9 were selected. The study population consisted of 300 subjects in which 160 were males and 140 were females. Non-Tibetans reside in a village which is located 2 km away from Tibetan settlements. It was selected for comparison with the Tibetans. By simple random sampling, four schools were selected. The total population of non-Tibetans consisted of 300 out of which 173 were males and 127 were females.

Clinical examination

Subjects were examined seated on a chair with examiner standing in front of the chair and the data was recorded by a separate recorder. Natural light was used at all locations. The subjects were positioned so as to receive maximum illumination, avoiding discomfort from direct sunlight to either the subject or the examiner.

The survey consisted of two parts. First part comprised of a questionnaire on oral hygiene practices, dietary habits and demographic details. The second part consisted of World Health Organization oral health assessment form (1997) [4] used to record the oral health status and treatment needs. Examiners were trained in a pilot study which was conducted among 20 individuals. Each examiner was thoroughly calibrated and interexaminer variability was found to be good (crohnback's alpha = 0.72).

Questionnaire was pretested in a pilot study which was conducted among 20 individuals. Split half method was use and kappa value was found to be acceptable (0.72).

Statistical analysis

The data obtained were analyzed using statistical package for social sciences (SPSS, version 11.5). The proportional values are compared using chi-square test and the mean values are compared using Student's t-test.


   Results Top


The total study subjects of Tibetan and non-Tibetan school children were 300 and 300, respectively. Among the Tibetans, 96.3% used toothbrush and tooth paste as compared with 89.3% of non-tibetans.10.6% of non-Tibetans used tooth brush and powder as compared to 3.3% of Tibetans. Only 0.33%of Tibetan used fingers and tooth powder for cleaning their teeth. Among Tibetan school children 99.67% were nonvegetarians compared with 84% non-Tibetans school children. Among the Tibetans, 1.3% did not consume any sweets, 42.6% of them consumed once daily, 44.3% consumed twice daily, 10% consumed thrice daily, 0.6% consumed sweets more than thrice daily. Among the non-Tibetans, 10.3% did not have any sweet intake. 1% of them consumed once daily, 50% twice daily, 32.6% thrice daily, 6% of them consumed sweet more than thrice daily.

Among Tibetan school children, 81.6% did not show any extraoral lesions compared with 97.3% of the non-Tibetan school children. 0.67% of Tibetan school children showed ulcerations of the head, neck and limbs. 1.6% showed ulcerations of nose, cheeks, and chin. A total of 15.3% of them showed ulceration of commissures. 0.3% presented with other type of lesions like abscess. About 2.7% of non-Tibetan school children have showed the presence of extraoral lesion among which 1% of them have showed ulceration of head, neck, and limb. A total of 1.3% of them have showed ulceration of nose, cheek, and chin and only 0.3% of them have showed lesions like abscess, which is statistically significant (P < 0.05). Abscess was noted among 0.6% Tibetans and only 0.3% among non-Tibetan child.

Only 0.3% of non-Tibetan school children showed presence of mild dental fluorosis and was statistically insignificant (P > 0.05). The percentage of non-Tibetan school children with enamel hypoplasia was 8.6% when compared with the Tibetan school children which were only 4.3% and was statistically insignificant (P > 0.05). About 0.3% of the Tibetan school children had clicking and slight tenderness of the TMJ.

About 60.3% of the Tibetans have healthy gingiva compared with 63.2% of the non-Tibetans. The prevalence of gingival bleeding was 32% among the Tibetans compared with 26.3% among the non-Tibetans. 7.6% of the Tibetan school children had calculus compared with 10.3% of the non-Tibetan school children. This difference is statistically not significant (P > 0.05). Among the Tibetan school children, 47.4% of the 13 year olds showed more calculus deposition and 51.4% and 40% of the 12- and 14-year-old school children showed more bleeding compared to calculus. The difference is statistically significant. Among the non-Tibetan school children 48.6% of the 13-year-old showed more gingival bleeding compared with calculus deposition. A total of 35.2% of the 12-year-old had more calculus deposition compared with gingival bleeding. The difference is statistically significant (P < 0.05).

The caries experience among the Tibetan school children was 69% compared with 62.7% among the non-Tibetans. This difference is not statistically significant (P > 0.05). The mean dynamical mean field theory (dmft) for the Tibetan subjects was 1.67 (dt-1.67, mt-0, ft-0) when compared with non-Tibetans who had a dmft of 2.08 (dt-2.08, mt-0, ft-0). The difference is not statically significant (P > 0.05). The mean DMFT for the Tibetans was 0.83 (DT-0.81, MT-0.01, FT-0.01) when compared with 0.38 (DT-0.38, MT-0.003, FT-0.004) of non-Tibetans [Figure 1]. The difference is not statistically significant (P > 0.05).
Figure 1: Graph comparing mean dynamical mean fi eld theory /DMFT between Tibetan and non-Tibetan school children

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The mean decayed missing filled surfaces of tooth (dmfs) for the Tibetan subjects was 2.6 (ds-2.59, ms-0, fs-0) as compared with non-Tibetans who had the dmfs of 2.83 (ds-2.83, ms-0, fs-0). The difference is not statistically significant (P > 0.05). The mean DMFS for the Tibetans was 1.44 (DS-1.38, MS-0, FS-0.22) when compared with 0.98 (DS-0.96, MS-0, FS-0.19.) of non-Tibetans. The difference is not statistically significant (P > 0.05).

According to dental aesthetic index, 93.6% of the Tibetan school children had minor malocclusion, 6% of them had definite malocclusion, and only 0.3% of them had severe malocclusion. When compared with non-Tibetan school children, 89.3% of them had minor malocclusion, 10.3% of them had definite malocclusion, and 0.3% had severe malocclusion. This difference is not statistically significant. According to dental aesthetic index-treatment need, 93.6% of the Tibetan school children required slight need, 6% of them required elective need, and 0.3% of them required high treatment need. When compared with non-Tibetan school children, 89.3% of them had slight need of treatment, 10.3% required elective treatment, and 0.3% had high need of treatment.

The treatment requirement of Tibetan school children was higher when compared with non-Tibetans school children. About 20.7% of Tibetan school children required fissure sealant. A total of 14.4%of children required one surface filling, 24.6% children required two or more surface filling, 6.4% of children required crowns for their teeth for different reasons. A total of 1.5% of them required veneer or laminates for their teeth, and 16.4% of them required pulp care 15.6% of them required extraction of the decayed teeth. Among the non-Tibetans, 26.1% of school children required fissure sealant, 29.3% of them required one surface filling, 17.6%of them required two surface fillings, 0.5% of them require crowns for their teeth for different reasons. A total of 0.5% of them required veneers or laminates for their teeth,20.2% of them required pulp care and restoration, 5.6% of children required extraction. About 0.32%of the Tibetans and 26.3%of non-Tibetans required oral hygiene instructions. A total of 7.6% of the Tibetan school children required scaling, polishing and root planning compared with 10.3% of the non-Tibetan school children [Table 1], [Table 2], [Table 3].
Table 1: Oral health-related behaviour variables of study population

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Table 2: Oral health-related variables of study population

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Table 3: Number and percentage of subjects requiring various treatments among the two groups

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   Discussion Top


Tibetans are staying as refugees in India for the past 40-50 years after China has occupied Tibet in 1950. [2] Little is known regarding oral health status and treatment needs of Tibetan refugees who are a minority ethnic community in the country. The main aim of the study was to assess and compare the oral health status of Tibetan school children and local school children in Kushalnagar (Bylakuppe), Mysore district.

Tibetans still follow their own culture and traditions despite staying away from their motherland; however, changes have been noticed in their lifestyle and diet, which might have influence on dental diseases. In the present study, Tibetans are staying in Kushalnagar (Bylakuppe) for the last 50 years. Despite having a dental clinic in the settlement, the treatment requirement is still high which shows lack of awareness and motivation toward oral health among Tibetans. Among non-Tibetans the high-unmet dental treatment needs may be ascribed to their lower economic condition, lack of awareness and limited accessibility to oral health care services.

Dental caries

The present study revealed that there is no much difference in prevalence of dental caries between Tibetan and non-Tibetan school children. The caries experience was less among the Tibetan school children (31%) when compared with non-Tibetan school children (37.3%). It is statistically not significant. The mean dmft for the Tibetan subjects was 1.67 (dt-1.67, mt-0, ft-0) when compared with non-Tibetans who had a dmft of 2.08 (dt-2.08, mt-0, ft-0). The difference is statistically significant. The decreased caries experience (dmft) among Tibetan school children than non-Tibetan school children may be attributed to better oral hygiene with the higher utilisation of tooth brush and tooth paste.

Soft tissue lesions

The prevalence of ulcerations of the commissures was 15.3% among Tibetans. The ulcerations of commissures was nil among the non-Tibetans. It is statistically significant.

Abscess was noted among 0.6% Tibetans and only 0.3% among non-Tibetan children. The present study is not in accordance with the study conducted by Ikeda et al., [3] on Cambodian population where the prevalence of Angular cheilitis was 0.5% and with the study of Nair et al., [5] who reported a prevalence of 4% in Vietnamese population.

Gingival disease

The prevalence of gingival bleeding among Tibetan school children was 32% when compared with non-Tibetan school children, which was 26.3%. It is not statistically significant. This study is in accordance with the study conducted by Robertson et al., [6] and Mac Allan, [7] Aurelius and Lindstrom. [8] In our study, calculus was found to be more among non-Tibetan school children (10.3%) when compared with Tibetan school children (7.6%). This could be due to poor oral hygiene practices which does not remove plaque effectively leading to its accumulation. This study is not in accordance with the study conducted by Edward et al., [9] among the Tibetan children in Tibet. The reason may be attributed to better oral hygiene practices, among the Tibetan children in the present study.

In this study, among the Tibetan school children 47.4% of the 13-year-old showed more calculus deposition and 51.4% and 40% of the 12- and 14-year-old school children showed more bleeding. Similar results were obtained in a study conducted by Alexander et al. [10]

Malocclusion

The present study revealed that the prevalence of malocclusion was high among the Tibetans, when compared with non-Tibetans. According to dental aesthetic index, 93.6% had minor malocclusion, 6% of them had definite, and 0.3% of them had severe malocclusion among Tibetan school children. This study is in accordance with the study conducted by Elham et al., [11] in north Jordanian school children.

Treatment needs

The present study revealed that treatment need is high among Tibetan school children than non-Tibetan school children.


   Conclusion Top


  • A total of 300 Tibetan school children-160 males and 140 females were examined and 300 non-Tibetans-173 males and 127 females were examined.
  • Prevalence of angular cheilitis was significantly higher among Tibetan school children than non-Tibetan school children.
  • Presence of gingival bleeding was more in Tibetan school children than the non-Tibetan school children.
  • The treatment requirement was higher among Tibetan school children when compared with non-Tibetan school children. Among the Tibetan school children, the requirement for two or more surface filling was more.


 
   References Top

1.Selikowitz HS. Acknowledging cultural differences in the care of refugees and immigrants. Int Dent J 1994;44:59-61.  Back to cited text no. 1
    
2.Life in Exile. Department of Home, Dharamsala (H.P); 1992.  Back to cited text no. 2
    
3.Ikeda N, Handa Y, Khim SP, Durward C, Axéll T, Mizuno T, et al. Prevalence of oral mucosal lesions in a selected Cambodian population. Community Dent Oral Epidemiol 1995;23:49-54.  Back to cited text no. 3
    
4.World Health Organization. Oral Health Surveys - Basic Methods. Geneva: WHO; 1997.  Back to cited text no. 4
    
5.Nair RG, Samaranayake LP, Philipsen HP, Graham RG, Itthagarun A. Prevalence of oral diseases in a selected Vietnamese population. Int Dent J 1996;46:48-51.  Back to cited text no. 5
    
6.Robertson JA, Reade PC, Steidler NE, Spencer AJ. A dental survey of Tibetan children in Dharamsala. Community Dent Oral Epidemiol 1989;17:44-6.  Back to cited text no. 6
    
7.McAllan LH. A survey of the gingival health of Indo-Chinese child refugees Part II. Aust Dent J 1988;33:91-5.  Back to cited text no. 7
    
8.Aurelius G, Lindstrom B. Longitudinal study of oral hygiene and dietary habit among immigrant children in Sweden. Community Dent Oral Epidemiol 1980;8:165-70.  Back to cited text no. 8
    
9.Lo EC, Jin LJ, Zee KY, Leung WK, Corbet EF. Oral health status and treatment need of 11-13 year old urban children in Tibet, China. Community Dent Health 2000;17:161-4.  Back to cited text no. 9
    
10.Alexander S, Hegde S, Sudha P. Prevalence of malocclusion and periodontal status in Tibetan schoolchildren of Kushalnagar, Mysore district. J Indian Soc Pedod Prev Dent 1997;15:114-7.  Back to cited text no. 10
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11.Abu Alhaija ES, Al-Khateeb SN, Al-Nimri KS. Prevalence of malocclusion in 13-15 year-old North Jordanian school children. Community Dent Health 2005;22:266-71.  Back to cited text no. 11
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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