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Indian Journal of Community Medicine

Oral Health Status and Risk Factors for Dental and Periodental Diseases Among Rural Women in Pondicherry

Author(s): M. Jagadeesan*, S.B. Rotti**, M. Danabalan**

Vol. 25, No. 1 (2000-01 - 2000-03)

*Department of Community Medicine Sri Ramachandra Medical College & Research Institute, Porur, Chennai 600 116 **Department of Preventive and Social Medicine Jawaharlal Institute of Post Graduate Medical Education & Research, Pondicherry - 605 006


Research questions: 1. What is the status of oral health among rural women? 2. What are the risk factors for unfavourable oral health?

Objectives: 1. To find out the dental and periodontal status of rural women. 2. To identify the risk factors for the unfavourable dental and periodontal status.

Study design: Cross-sectional study.

Setting: Jawaharlal Institute's Rural Health Centre.

Participants: Females aged 15 yrs. and above.

Study variables: Age, educational status, marital status, occupation, per capita income, chewing habits.

Outcome variables: Dental diseases, periodontal pockets.

Statistical analysis: Chi-square test, analysis of variance, Odd's ratio and logistic regression.

Methods: A house to house survey was done among 912 women aged 15 years and above using a pretested proforma and oral examination in a rural area of Pondicherry, India. The prevalence of dental and periodontal diseases were studied and the association of these diseases with age, educational status, marital status, occupational status, per capita income, chewing habits were analyzed.

Results: A total of 912 women were studied. The prevalence of dental caries was 40.5%, missing teeth due to caries was 27.3%, missing teeth due to causes other than caries were 13.2%. The average DMFT (Decayed, Missing, Filled Teeth) was 3. The logistic regression analysis showed that marital status (married), house-wives, use of ash and other things for brushing the teeth and use of hands and sticks for cleaning teeth were the risk factors for dental carries and age (≥30 yrs), educational status (illiterate), agricultural labourers, joint families, chewers and type of the brush (hands and sticks) were significantly associated with missing teeth due to non caries causes. The prevalence of periodontal diseases was 0.8%, 20.1%, 20.6% and 25.6% for bleeding, calculus, shallow pockets and deep pockets respectively. The logistic regression analysis showed that the age (≥30 yrs.) educational status (illiteracy), marital status (married), agricultural labourers, chewers and type of brush (hand and sticks)were significantly associated with severe form of periodontal disease. It was observed that 6 women were having leucoplaklia and all of them were using tobacco.

Conclusion: The cross sectional study showed that some socio-demographic factors and chewing habits had influenced the level of dental and periodontal diseases.

Keywords: Dental and periodontal diseases, Risk factors, Rural women


The oral health is an important aspect of community health. The International Dental Association has set a goal of Oral health for all by 2000 A.D. 1. Globally two distinct trends can be identified based on the information available from global data bank on oral health. One is improvement of oral health in most of the developed countries and another is deterioration for most developing countries. In India, various surveys conducted have revealed an increasing trend of dental caries in the past four decades2. The DMFT (Decayed, Missing and Filled Teeth) scores in India fall in the moderate category (DMFT=2-4)3. The prevalence of periodontal diseases also has been reported to be high in India. It is said that every second person above the age of 35 years has gum pockets. In India 85% of total teeth extracted after 30 years are due to periodontal diseases4. To plan proper intervention methods it is necessary to find out the prevalence and factors associated with them. No such study has been conducted in this part of our country. Hence, this study was conducted to assess the oral health status of adult rural women for identifying the risk factors and to measure the level of the risk associated with leading risk factors.

Material and Methods:

Study place and period:

The union territory of Pondicherry consists of four regions in South India, namely - Pondicherry, Karaikkal, Mahe and Yanam. Its total population was 789,416. The union territory of Pondicherry has good health infrastructure. The Mahatma Gandhi Dental College, Pondicherry provides the dental care to the UT of Pondicherry. It has well equipped mobile dental service units.

This study was conducted in the service area of Jawaharlal Institute's Rural Health Centre (JIRHC), Ramanathapuram in the UT of Pondicherry. This centre provides services to four villages namely - Ramanathapuram, Thondamanatham, Pillaiyarkuppam and Thuthipet. It was decided to study the women aged 15 years and above because the periodonatal status can be assessed only after the age of 15 years. The total number of women in that age group was 2370. Out of these 1100 women were selected for the study by using systematic random sampling method taking alternate house in that area (The required sample size was only 720). The study period was from 1st October 1994 to 31st March 96.

Interview and examination:

All the eligible women were contacted at their houses by a house to house survey. Each one was explained about the investigator's visit. After getting consent, each women was interviewed using a pretested proforma. After the interview she was examined by using mouth mirror, periodontal probe and torch light. For each woman the scores were given for each tooth, extent of periodontal tissue and mucosal status as prescribed by WHO5 The codes used for recording mucosal status were "O" for normal, "1" for inflamed and "2" for neoplastic changes.

For each woman separate mouth mirror and periodontal probe were used. After the day's interview the Instruments were collected separately and sterilized in a steam sterilizer.

The data was analyzed using foxbase and SPSS softwares. There were eight variables finally included for logistic regression as they were found significant by univariate analysis. They included age, educational status, marital status, occupation, type of family, chewing habits, substance used for brushing and type of brush. Income was not found significant at the univariate analysis level, hence it was not included in the logistic regression. Age, educational status, marital status, type of family, chewing habits and type of brush were converted into dichotomous variables. The occupation and substance used for brushing were converted into polychotomous variables.


A total of 912 women were studied out of the selected sample of 1,100 (82.9%). Others were not studied because either they could not be contacted in additional two visits made by the investigator in a month's time or they refused for the oral examination.

Table I: Age-wise dental status of rural women:

Age group
(in yrs)
Caries (%) Missing
(caries) (%)
(non-caries) (%)
DMFT (%) Normal
teeth* (%)
15-19 31.1 9.3 0.7 33.8 72.8
20-24 43.9 27.3 2.3 54.5 45.5
25-29 55.0 33.6 2.9 63.6 36.4
30-34 62.5 36.4 0.0 71.6 28.4
35-44 44.0 36.3 9.3 60.9 39.0
45 and above 23.3 26.7 43.4 72.1 27.8
Total 40.5 27.3 13.2 60.2 39.8

*Full teeth according to the age.

As age advanced the proportion of women with dental caries increased upto the age of 30-34 years but the level was low among women of 45 years and above.

A similar trend was found for missing teeth due to caries. The proportion of women with missing teeth due to causes other than caries was quite high in the age group of 45 years and above (43.4%). The proportion of women with DMFT >0 was about 34% in the study population.

Table II: Logistic regression for factors associated with dental caries (n=912)

Variable Classification No. studied Dental
caries (%)
Odds ratio
(95% CI)
Marital status Unmarried 154 27.9
Married 758 43.0 1.9** (1.4-2.1)
Occupation Other & semiskilled 182 36.8
House-wives 384 34.4 1.6* (1.1-1.7)
Agricultural labourers 346 49.1 0.6* (0.5-0.8)
Type of family Nuclear 537 46.0
Joint 375 32.5 0.8* (0.7-0.9)
Chewing habits Non chewers 687 46.4
Chewers 225 22.2 0.5* ?(0.3-0.7)
Substance used for brushing Tooth paste 291 35.4
Tooth powder 333 49.5 0.7*** ?(0.5-1.0)
Ash & others 288 35.1 1.3* ?(1.1-1.6)
Type of brush Tooth brush 459 37.9
Others 453 43.0 1.3* ?(1.0-1.6)

*P<0.01, **p<0.05, ***p<0.05

Table II shows the logistic regression analysis of factors associated with dental caries. It shows that marital status (married OR - 1.9), House-wives (OR - 1.6), use of ash and other things for cleaning the teeth (OR - 1.3) and use of sticks and other things for brushing the teeth (OR - 1.3) were positively correlated with caries. Factors such as type of family (Joint family), occupation (agricultural labourers) and chewing habit (chewers) were negatively correlated with the prevalence of caries.

Table III: Logistic regression for factors associated with missing teeth due to causes other than caries (n=912)

Variable Classification No. Studied Missing teeth
non-caries (%)
Odds ratio
(95% CI)
Age <30 years 423 1.9
≥30 years 489 22.9 2.0* (1.4-3.1)
Educational status Literate 382 3.4
Illiterate 530 20.3 1.4** (1.0-2.0)
Occupation Others and semiskilled 182 2.7
House-wives 384 20.3 0.7** (0.5-1.1)
Agricultural labourers 346 10.7 2.3* (1.5-3.4)
Type of family Nuclear 537 7.3
Joint 375 21.6 1.6* (1.3-2.0)
Chewing habits Non chewers 687 50.8
Chewers 225 35.6 1.7* (1.3-2.2)
Type of brush Tooth brush 459 3.9
Others 453 22.5 1.6* (1.2-2.3)

*p<0.01, **p>0.05

Table III shows the risk factors associated with the missing teeth due to causes other than caries. It reveals that age ≥30 years (OR=2.0), illiteracy (OR=1.4), agricultural labourers (OR=2.3), Joint family (OR = 1.6), chewing (OR = 1.7) and sticks and other things used for brushing the teeth were the positive risk factors for the missing teeth due to causes other than caries. House-wives had negative association with the missing teeth due to causes other than caries. Marital status and substances used for cleaning were not associated with this condition.

In the present study, there were 18(2%) totally edentulous women. All of them were above the age of 45 years.

Table IV: Periodontal status of rural women (n=887)

Age group (in yrs) Normal
pockets (%)
pockets (%)
15-19 71.5 2.0 21.8 4.0 0.7 151
20-24 57.5 2.3 20.5 15.2 4.5 132
25-29 40.3 0.7 34.3 22.1 2.6 140
30-34 27.3 0.0 26.1 31.8 14.8 88
35-44 14.3 0.0 21.4 33.0 31.3 182
45 and above 0.5 0.0 4.1 18.6 76.8 194
Total 292 7 178 183 227 887

X2=581.47, d.f.=28, p<0.01

Table IV shows the periodontal status according to age. As age advanced, the proportion of normal periodontium was coming down and minor periodontal diseases were also coming down. At the same time the severe forms (shallow and deep pockets) of periodontal diseases were higher. This finding was statistically significant (p<0.01).

Table V: Logistic regression for factors associated with Periodontal Disease (deep & shallow pockets) (n=887)

Variable Classification No. studied Periodontal disease(%) Odds ratio (95% CI)
Age <30 years 423 15.8
≥30 years 464 73.9 2.3* (1.9-2.8)
Educational status Literate 381 21.5
Illiterate 506 64.8 1.2** (1.0-1.6)
Marital status Unmarried 154 6.5
Married 733 54.6 1.7** (1.1-2.6)
Occupation Others & semiskilled 180 21.1
House-wives 362 52.8 0.6* (0.4-0.8)
Agricultural labourers 345 52.5 1.5** (1.1-2.0)
Chewing habits Non chewers 682 32.8
Chewers 205 70.7 2.4* (1.8-3.2)
Type of brush Tooth brush 458 67.5
Others 429 70.2 2.4* (1.9-2.9)

*p<0.01, **p<0.05

Table V shows the risk factors associated with periodontal diseases i.e. shallow pockets and deep pockets. Age more than or equal to 30 years (OR 2.3), illiteracy (OR 1.2), marital status (married, OR 1.7), occupation (agricultural labourers, OR 1.5), chewing habits (OR 2.4) and type of brushing (sticks and others, OR 2.4) were the significant risk factors.


The present study was a cross-sectional study in which information on the possible risk factors was collected on all the women included in the study. This enabled the logistic regression analysis of the risk factors apart from determination of prevalence of the conditions reflecting the oral health status. The overall coverage of the survey was 82%. The women who refused for oral examination and those who were not available at the time of investigator's visit and two subsequent visits in the same month, were excluded from the study.

Dental status:

The present study showed an overall prevalence of 40.5% for dental caries. This is lesser than that of 53.2% found out by Goyal et al in 19956. The ICMR surveys have shown an increasing trend; in forties, 55.5%, in fifties, 65% and in eighties 80%2. The lower prevalence in this study might be due to selection of women above 15 years. In a study conducted by Norheim in Northern Norway the prevalence as 27% which was lesser than that found in the present study7. Widstrom et al have reported 90% in Finnish immigrants in Sweden8.

Missing teeth due to caries followed a pattern similar to that of dental caries which might be due to similar factors influencing both conditions. The overall prevalence of teeth missing due to caries was 27.3%.

The proportion of women with one or more of missing teeth due to causes other than caries was 13.2%. Slade et al from Australia have reported that all the people had at least one missing tooth8.

In the present study, there were 2% of totally edentulous women. All of them were above the age of 45 years. In 35 to 44 years age group none of them were edentulous. The present study had lesser prevalence of edentulous women when compared to all South East Asian countries3.

The average DMFT in the present study was 3. ICMR has shown the average DMFT as 0.06 in the forties, 2 in the fifties and 4 in the eighties. In younger ages DMFT was mainly constituted by caries and missing teeth due to caries whereas in older ages the DMFT was mainly constituted by missing teeth due to causes other than caries2.

Risk factors for dental caries:

Among study population chewers had very low prevalence of caries. Chewers included those who were chewing betel quid and betel quid with tobacco. The lesser prevalence among chewers might be due to the fact that chewing increases salivary secretion which contains high levels of antibodies which is protective against pathogenic bacteria and tabacco itself has some antibacterial effect10

This study showed that there was no relationship between economic standing and dental status as there was not of much gradient in the income levels in the study population, but, a study done by Norheim showed an inverse relationship between the economic and dental status7. It was found that the number of remaining teeth decreased with increasing age and decreasing income and/or social class. In general, women, young people and people with a a high socio-economic status had less caries, better oral hygiene and periodontal condition and received more restorative dental care than the remaining population. In the present study, married women, house-wives, women using tooth paste and brush for cleaning the teeth had lesser caries. The missing teeth due to caries was influenced by similar factors as those for caries.

Risk factors for missing teeth due to causes other than caries:

Missing teeth due to causes other than caries were higher among those aged 30 years and above. This could be due to bad periodontal status in the higher age groups. It is well known fact that as the age advances the periodontium becomes lax and the attachments get loose. Apart from age, the other significant risk factors such as illiteracy, agricultural labourers, joint family, chewers and women using fingers and sticks for cleaning the teeth might have exercised their influence.

Periodontal status:

In the assessment of periodontal status only 887 women were included, because 18 women were totally edentulous and 7 women were not having minimum of two teeth in any one of the sextant. They were excluded from the analysis. The prevalence of periodontal diseases in the present study was 0.8%for bleeding only, 20.1% for calculus, 20.6% for shallow pockets and 25.6% for deep pockets. The prevalence of gingival bleeding and calculus were low in the present study compared to that observed by Goyal et al6. A study conducted in northern Norway showed that the prevalence of periodontal pockets were almost equal to that observed in the present study7. Other studies, Slade et al in Australia and Kawamura et al in Japan have found similar results8,11 .

Risk factors for periodontal diseases:

In the present study, women with deep and shallow periodontal pockets were included for the logistic regression analysis. It showed that the age was one of the factors determining the presence of pockets. The women aged thirty years and above had 2.3 times higher risk compared to those less than 30 years. Expert group of WHO has observed that the destruction of periodontium followed a linear progression from adolescence to old age12.

This study showed that the women with higher educational status had less severe periodontal diseases. This is comparable with the results of a survey done by Mukerjee et al in 199513. It has been found that people who were more prosperous had better oral hygiene and were more aware of oral health values12.

The other significant risk factors found out in this study for periodontal diseases were married women, agricultural labourers, chewing habits and those using sticks and hand for cleaning the teeth14. However, lesser number of house-wives had periodontal pockets compared to women with other occupations.

Mucosal status:

In the present study, 6(0.7%) women had leucoplakia. This is lower than the results of a study conducted by Mehta et al among villages in Maharashtra (2.9%)15.


Higher age was a significant non-modifiable risk factor for dental and periodontal diseases. Some other factors like marital status, occupation and type of the family were significant risk factors for some conditions. These are difficult to be modified. But, the educational status, chewing habits and cleaning practices were other significant modifiable risk factors.


We wish to acknowledge our thanks to Dr. (Mrs.) S. Chitra, former dental surgeon cum tutor for providing initial training to the first author and for giving suggestions for conducting the study, the staff of JIRHC, Ramanathapuram for their help while conducting the study and the women who participated in the study for their co-operation.


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