Assessment of Oral Health-Related Quality of Life among Kutia Kandha Tribes of Odisha.

Aim and
Objectives: Among the 75 listed particularly vulnerable tribal groups (PVTG), the highest number is found in Odisha. They do not have proper access to oral health-care services and at-risk to various oral conditions and lesions. Hence, the purpose of the study was to assess the oral health quality of life and its association with different factors of the Kutia Kandha tribal population. Materials and Methodology: A cross-sectional study was channeled among 600 Kutia Kandha tribe of Odisha. The oral health impact profile (OHIP-14) questionnaire was used to check the oral health-related quality of life. Number and percentages were derived using Microsoft Excel and for inferential statistics, a model was developed using multivariable logistic regression using STATA software. P was set at 0.05, which was considered to be statistically significant.
Results: Total sample composed of 330 men and 270 women with a mean age of 40.62 ± 16.29 years. Smoking was seen among 19.8% of tribal people had smoking habit and 72.33% (n = 434) of the study group consumed smokeless tobacco. Only a few used fluoridated (3.8%) dentifrice. The mean OHIP score of the tribe was 30.67 ± 4.514 and about 65% of participants reported poor oral health quality of life scores.
Conclusion: The oral health quality of life of the tribe is poor and the prevalence of tobacco among the target population because of the unavailability of dental services. Proper health education and motivation can be acknowledged to this group are required to improve their oral health. Copyright:

INTRODUCTION

India, with an estimated population of about 1.4 billion, stands the second-most populous country in the world.[1] It is divided into various social groups based on their locality and their livelihood. According to article 366 (25) of our Indian constitution, the scheduled tribes have been referred to as those indigenous communities, who are scheduled in accordance with the article 342. Their population is scattered in 30 states and union territories and the total number of individual ethnic groups notified under scheduled tribe is 705. As per the 2011 census, the total tribal population of the nation is 10.43 crores. This constitutes 8.6% of the total population and majority (89.97%) of them reside in rural areas and only 10.03% dwell in urban areas.[2] The decadal population growth from census 2001 to 2011 of the tribals has been nearly 23.66% against the 17.69% of the total population.

One integral part of scheduled tribe is PVTGs known as particularly vulnerable tribal groups (PVTG) who are 75 in number. They are characterized by preagriculture level of technology application, moribund or declining population, exceedingly low-level literacy, and endurance level of economy. One such tribe is Kutia Kandha who mostly inhabit in Kandhamal district, Odisha.[23]

Oral health quality of life is defined as an inherent part of general health and well-being. It is acknowledged by the World Health Organization as an essential and significant segment of the Global Oral Health Program. The theoretical model that has been altered from Wilson and Cleary in 1995, incorporates biological, social, psychological, and cultural factors, is built on psychological and social science theories and epidemiological findings.[4] Oral health conditions and oral hygiene practices are also a major cause of morbidity which deteriorates the quality of life. Conversely, the tribal people do not have proper access to oral health-care services and as a result are susceptible to various oral conditions and lesions.[56] Hence, improvising oral health will significantly intensify the different attributes of tribal individuals.

In 1983, a study was conducted on the oral health of Kandhas of Phulbani district[5] but since then, there has been no single study on the oral health status of the Kutia Kandha tribe who actually require special care and attention. Another study was also conducted on the oral health status of the tribals residing in Northern Odisha.[6] Therefore, the current survey was undertaken with the objective to assess the impact of oral hygiene practices on the oral health quality of life of Kutia Kandha.

MATERIALS AND METHODOLOGY

A cross-sectional study was conducted from January 2021 to March 2021 residing in Kandhamal district, Odisha. Participants who were present at the time of the study, permanent residents of Kandhamal district and individuals who gave informed consent were enclosed in the study. Uncooperative subjects, people troubled with chronic systemic conditions or medically compromised and participants below 18 years of age were eliminated from the study.

The sample size was found to be 582 and to cover for the nonrespondents, a total of 600 participants were screened during the study. Ethical clearance was obtained from the institutional ethical committee review board. Informed consent for participation was obtained and the aim of the study was explained. The questionnaire consisted of sociodemographic, personal habits – smoking, smokeless tobacco, paan, and alcohol, and oral hygiene practices such as types and method of cleaning, materials used, and frequency of brushing.

The oral health-related quality of life (OHRQOL) was assessed by the oral health impact profile-14 (OHIP-14) which is a self-filled questionnaire. The pretested OHIP-14 questionnaire consists of 14 items. It focuses on seven various dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) which were translated into the local language (Odia) later back-translated into English to adapt culturally and linguistically to local settings. The questionnaire was self-filled by a few literate tribals. The rest responses were filled by the author after the questions were translated to them by the local translator. The COVID-19 protocols and guidelines were followed during data collection with the help of N-95 masks, face shields, and social distancing.[7] Internal consistency was evaluated with Cronbach's alpha coefficient (α =0.8). The questionnaire was designed on a 5-point Likert scale (never-0, seldom-1, sometime-2, often-3, and very often-4). The final score for each participant ranged from 0 to 56. The greater the score, the poorer was the OHRQOL and vice versa. The scores were categorized as good (score 0–14), fair (score 15–28), poor (score 29–42), and very poor (43–56).

Statistical analysis

Number and percentages were derived using Microsoft Excel. A model was formulated using multivariable linear regression to predict total OHIP-14 scores and examine the relation between independent and outcome variables using STATA software (version14.1; Stata, College Station, TX). The model was totally adjusted for age, gender, personal habits, and oral hygiene practices. P ≤ 0.05 was set to be statistically significant.

RESULTS

From the sociodemographic point of view, the sample composed of 330 men and 270 women with a mean age of 40.62 ± 16.29 years. Bulk of the sample was 18–34 years old (32%, n = 192). Smoking was reported in 19.8% of tribal people had a smoking habit and 72.33% (n = 434) of the study group consumed smokeless tobacco readily available in the market. Alcohol was consumed by 81% of the population and 84% of the target population did not consume paan. Only a few used fluoridated (n = 24, 3.8%) and herbal toothpaste (n = 28, 4.4%) and majority of the tribal population (n = 548, 91.3%) did not use any materials for cleaning as they used various types of twigs (Sal-50%, Khajuri-22.6%, and Neem-21.16%). About 48% followed horizontal method of cleaning and 96.16% of the population brushed only once in a day [Table 1].

Table 1

Sociodemographic details of the study population (n=600)

Variables	Frequency (%)
Age
18-34	192 (32.0)
35-44	176 (29.3)
45-64	160 (26.0)
65 maximum	72 (12.0)
Gender
Male	330 (55)
Female	270 (45)
Smoking
Yes	119 (19.8)
No	481 (80.1)
Smokeless tobacco
No	166 (27.67)
Yes	434 (72.33)
Paan
No	506 (84.3)
Yes	94 (15.6)
Alcohol
No	112 (18.67)
Yes	488 (81.34)
Dentifrices
Fluoridated	24 (3.8)
Herbal	28 (4.4)
No material	548 (91.3)
Materials used
Sal twig	300 (50)
Khajuri twig	136 (22.6)
Neem twig	127 (21.16)
Toothbrush	37 (6.1)
Type of cleaning
Horizontal	309 (48.3)
Vertical	233 (36.4)
Circular	58 (9.67)
Frequency of brushing
Once	577 (96.16)
Twice	23 (3.6)

Table 2 represents the oral health quality of life assessed by OHIP-14 responses. The mean OHIP score of the tribe was 30.67 ± 4.514. The mean and standard deviation of the seven components of OHIP-14 scores were also determined. It was higher in physical pain category (6.00 ± 1.59). Approximately, 65% of the total population (n = 393) had poor oral health quality of life scores and none of them reported good oral health quality of life.

Table 2

Oral health impact profile items and responses

Quality of life	Never (0)	Seldom (1)	Sometime (2)	Often (3)	Very often (4)	Mean±SD
Functional limitation
Trouble pronouncing any words	153 (25.5)	5 (0.83)	141 (23.5)	220 (36.67)	81 (13.5)	4.12±1.90
Sense of taste worsened	196 (32.67)	6 (1)	50 (8.34)	308 (51.34)	40 (6.67)
Physical pain
Painful aching in your mouth	36 (6)	24 (4)	6 (1)	250 (41.67)	284 (47.34)	6.00±1.59
Uncomfortable to eat any foods	48 (8)	128 (21.34)	10 (1.67)	140 (23.34)	274 (45.67)
Psychological discomfort
Self-conscious	74 (12.34)	9 (1.5)	130 (21.67)	291 (48.5)	96 (16)	5.06±1.51
Feel tense	54 (9)	5 (0.83)	146 (24.34)	365 (60.84)	30 (5)
Physical disability
Diet been unsatisfactory	83 (13.83)	129 (21.5)	138 (23)	170 (28.34)	80 (13.34)	3.07±1.59
Interrupt meals	204 (34)	233 (38.84)	129 (21.5)	22 (3.67)	12 (2)
Psychological disability
Difficult to relax	75 (12.5)	160 (26.67)	214 (35.67)	133 (22.17)	18 (3)	3.30±1.69
Been a bit embarrassed	144 (24)	150 (25)	199 (33.17)	56 (9.33)	51 (8.5)
Social disability
Irritable with other people	27 (4.5)	116 (19.34)	25 (4.17)	293 (48.84)	139 (23.17)	3.78±1.60
Had difficulty doing your usual jobs	244 (40.67)	105 (17.5)	192 (32)	53 (8.83)	6 (1)
Handicap
Life in general was less satisfying	40 (6.67)	46 (7.67)	33 (5.5)	312 (52)	169 (28.17)	5.33±1.73
Been totally unable to function	55 (9.17)	118 (19.67)	36 (6)	278 (46.34)	113 (18.83)

SD: Standard deviation

Table 3 depicts the adjusted odds ratio of personal habits and oral hygiene practices with OHRQOL. When the age and gender were adjusted with the oral health quality of life along with oral hygiene practices and personal habits, none were statistically significant.

Table 3

Multivariate logistic regression with OHIP as dependent variable, divided by various demographic, personal habits and oral hygiene practices of the tribe (n = 600)

Variables	OR	95% CI	P	Variables	OR	95% CI	P
Age				Age
18-34	0.95	0.40-2.27	0.92	18-34	0.98	0.41-2.36	0.977
35-44	1.01	0.41-2.44	0.97	35-44	1.07	0.44-2.63	0.86
45-64	1.06	0.43-2.60	0.88	45-64	1.13	0.46-2.80	0.77
65 maximum	1			65 maximum	1
Gender				Gender
Male	1			Male	1
Female	1.21	0.72-2.04	0.46	Female	1.22	0.72-2.07	0.44
Smokers				Cleaning type
Present	1			Sal	1
Absent	0.86	0.47-1.55	0.62	Khajuri	1.97	0.94-4.11	0.07
Smokeless tobacco				Neem	0.87	0.47-1.60	0.67
Present	1.11	0.60-2.05	0.72	Toothbrush	1.53	0.34-6.93	0.5
Absent	1			Dentifrices
Paan				Fluoridated toothpaste	1
Present	1.80	0.83-3.90	0.13	Herbal toothpaste	0.89		0.7
Absent	1			Cleaning method
Alcohol				Horizontal	1
Present	1.03	0.47-2.22	0.94	Vertical	0.89	0.51-1.56	0.7
Absent	1 (reference)			Circular	0.94	0.43-2.01	0.87
				Frequency of brushing
				Once	1
				Twice	1.12	0.25-5.06	0.88

1 - Reference. OR: Odds ratio, CI: Confidence interval

DISCUSSION

The mean age among the Temuan tribe of Malaysia was 39.94 (±13.196) years which ranged from 18 to 83 years old. Most of the participants (22.2%) belonged to the age group of 35–44 years old. The geriatric population considered those 60 years old or older, formed about 7.7% of the participants.[8] This was almost similar to the present study, in which 29.3 were from the age group of 35– 44 years and 12% of the tribal people who were aged 65 years and more.

The data regarding the usage of oral hygiene aids showed that they used different types of twigs such as Sal twig (50%), Khajuri twig (22.6%), and Neem twig (21.16%). Only 9.67% used toothbrush with either herbal toothpaste (4.4%) or fluoridated toothpaste (3.8%), whereas 91.3% of tribal people did not use any materials for brushing. These findings are analogous to the survey done by Bhat and Kundankuppe,[9] in which the majority (79.8%) of them used chew sticks. An absolute majority of Birhor (84.25%) and Santhal tribals (74.3%) also used Sakhua twigs to clean their teeth.[1011] Similar findings were noticed by Jordan RA[12] in the rural population of the Gambia in West Africa, where the majority of the population used chew sticks (50.6%) followed by toothbrushes (34.6%). Padma BK et al.[13] also stated that chew sticks were commonly used than toothbrushes as an oral hygiene aid among the Iruliga tribes in Karnataka, India. Furthermore, most of the Koyas tribe followed the cleaning method with twig as their regular oral hygiene method, but Lambadas used toothbrushes as their cleansing aid.[14] Mohanty et al. also reported that 66.1% of children aged between 8 and 13 years used toothpaste and toothbrush.[15]

In a contrasting study done by Sirisha et al.[16] it showed that 40.4% of Yenadis used chewsticks, whereas 51 (32.6%) of them utilized finger with either salt or charcoal. Only 42 (26.9%) of them used toothbrushes with either toothpaste or toothpowder. The Bhils tribal population of Rajasthan cleaned their teeth only with water.[17] In another contrasting survey conducted on the elderly tribes of Kalpetta, it revealed that a greater percentage of the study population were using only finger for teeth cleansing which was a major reason for poor oral hygiene.[18] Khadir et al.[19] and Valsan et al.[20] who conducted a study in aborigines of Selangor, West Malaysia, and Paniya tribals of Kerala, respectively reported that bulk of the population used toothbrush with toothpaste and they brushed their teeth once routinely. This was in accordance with our present study in which the majority of the tribals (96.4%) brushed their teeth only once every day.

When the percentage distribution of the tribal population was analyzed according to their responses in OHIP-14, it was found that the participants in the present study reported more problems in physical functioning and fewer problems in physical disability. Similar findings were found in a study done on elderly tribals where more problems were associated with physical functioning.[18] This deviation may be because of a high number of oral health problems which remains untreated among tribal patients as a result of which maximum problems were reported in physical functioning.

This study also has some limitations. The primary limitation of this study is that it is a cross-sectional, and thus it is not possible to make causal inference from the association found. Second, the participants did not know their exact ages. They provided their assumed ages for the study. Third, the participants were not keen to only do an oral health checkup for which many participants did not turn up. Their expectation was to receive free medicines from the data collection team. Despite such barriers, the strength of this study is that this is the first study known to the best of our knowledge conducted on the oral health quality of life among the Kutia Kandha tribe with regard to proper social distancing and by following the COVID-19 protocols and guidelines.[21]

CONCLUSION

The oral health quality of life of the Kutia Kandha tribe is poor. The prevalence of both smoke and smokeless form of tobacco habits is high and is of great concern. There is unavailability of dental surgeon in the primary health-care center. Therefore, proper health education and motivation can be imparted on this group to alter their oral health in a better way. The results from this study form a baseline data for the health officials for the provision of suitable program for the improvement of oral health among the vulnerable tribals of Kutia Kandha as well as across the Odisha state.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.