|Year : 2019 | Volume
| Issue : 1 | Page : 36-39
Correlation of stress and periodontal disease severity among coal mine workers in Tamil Nadu: A clinicobiochemical study
B Na Vinoth Kumar, Pratebha Balu, Jananni Muthu, R Saravana Kumar, I Karthikeyan, S Sakthi Devi
Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry, India
|Date of Web Publication||11-Oct-2019|
Dr. B Na Vinoth Kumar
PG student, Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Puducherry
Source of Support: None, Conflict of Interest: None
Background: Working environment has a huge impact on both general and oral health. Coal mining is one of the age-old industries throughout the world and in India. Occupational stress is high among coal mine workers. Stress contributes to periodontal disease severity and progression. In literature, there is hardly any information available regarding the estimation of stress among coal mine workers. Thus, the purpose of the study was to estimate stress in terms of salivary cortisol levels and to correlate the same with periodontal disease severity among coal mine workers in Tamil Nadu.
Methods: Forty systemically healthy coal mine workers above 18 years of age were enrolled in the study. Information regarding socioeconomic status and habits, followed by clinical examination including periodontal parameters such as probing pocket depth (PPD), clinical attachment level (CAL), number of missing teeth, and Periodontal Screening and Recording (PSR) Index were recorded using a standard pro forma. Unstimulated saliva was collected, and cortisol levels were measured using enzyme-linked immunosorbent assay. Pearson's correlation was done to correlate the salivary cortisol level and periodontal parameters.
Results: The salivary cortisol level was assessed for 40 participants. Out of 40 participants, 80% of them were either user of smoking or smokeless forms or both. Only 20% were nonusers. The mean salivary cortisol levels were found to be higher among the past smokers and current users of smokeless tobacco (9.31 ± 0). There was a positive correlation between CAL, PPD, PSR, and missing teeth and salivary cortisol levels ( r = 0.801, 0.800, 0.581, and 0.473, respectively) and were statistically significant.
Conclusion: Our results suggest that there was a high correlation between salivary cortisol and periodontal disease severity among coal mine workers and the results were statistically significant.
Keywords: Clinical attachment level; coal mining; cortisol level; periodontal disease; probing pocket depth
|How to cite this article:|
Kumar BV, Balu P, Muthu J, Kumar R S, Karthikeyan I, Devi S S. Correlation of stress and periodontal disease severity among coal mine workers in Tamil Nadu: A clinicobiochemical study. Indian J Multidiscip Dent 2019;9:36-9
|How to cite this URL:|
Kumar BV, Balu P, Muthu J, Kumar R S, Karthikeyan I, Devi S S. Correlation of stress and periodontal disease severity among coal mine workers in Tamil Nadu: A clinicobiochemical study. Indian J Multidiscip Dent [serial online] 2019 [cited 2020 Jan 18];9:36-9. Available from: http://www.ijmdent.com/text.asp?2019/9/1/36/268988
| Introduction|| |
Periodontitis is a multifactorial disease affecting the supporting structures of teeth which includes the gingiva, periodontal ligament, and alveolar bone. The pathogenesis of periodontitis is greatly influenced by the presence of risk factors. Occupation, an environmental factor, plays an important role in determining oral and periodontal health. The nature and duration of work have an impact on both systemic and oral health., Coal mining is one of the age-old industries throughout the world and in India. Coal mining production occurs throughout the week. The workers are engaged in tedious work around the clock and work in rotating shifts in deep, open pits leading to stressful working environments. Hence, occupational stress is expected to be high among coal mine workers.
Stress has a direct effect on the hypothalamus–pituitary–adrenal axis., Stress induces the release of glucocorticosteroids like cortisol which in turn depresses the immune system by diminishing the IgA and IgG secretions, thereby enhancing the periodontal disease progression., There are several studies that have reported psychosocial stress, physiological stress, anxiety, and depression to be associated with significant amount of periodontal disease progression and wound healing.,,, Furthermore, stress influences the consequences of behavioral patterns, extending from negligence of oral hygiene, to dietary inadequacies, and use of tobacco and alcohol leading to severe forms of advanced periodontal inflammation and disease.,,, To the best of our knowledge, there are no studies available in literature correlating salivary cortisol levels and periodontal disease severity among coal mine workers in Tamil Nadu.
| Methods|| |
The study and the protocol were reviewed and approved by the Institutional Ethical Committee (IGIDSIRB2016 NDP30PGVBPAI). The present study was carried out at Neyveli Lignite Corporation India Limited, Tamil Nadu. Considering the data from the previous study by Refulio et al., using the formula n ≥ (Z1−α/2+ Z1−β)2 (σ12+ σ22/ r) ÷ (μ1−μ2)2, sample size was calculated as 40 subjects.
A total of forty coal mine workers were enrolled based on inclusion and exclusion criteria. The inclusion criteria were as follows: (1) participants with age >18 years and (2) participants should have at least ten natural teeth excluding third molars. Due to the exhausting physical nature of the coal mining process, females were not employed in mining pits. The exclusion criteria were as follows: (1) participants with systemic diseases and (2) participants who underwent periodontal therapy in the past 6 months. Each participant signed a consent form acknowledging their voluntary and nonprejudicial participation in the study.
From all the study participants, information regarding socioeconomic status and habits were recorded using a standard pro forma. Periodontal examination comprised probing pocket depth (PPD) at six sites (mesiofacial, midfacial, distofacial, and the corresponding lingual/palatal surfaces) around the teeth, clinical attachment level (CAL), number of missing teeth, and Periodontal Screening and Recording (PSR) Index. All the parameters were recorded by a single examiner using mouth mirror and Community Periodontal Index (CPI) probe, as recommended by the World Health Organization.
Salivary cortisol estimation
Unstimulated salivary samples were collected. Saliva was allowed to accumulate in the floor of the mouth and the participant was asked to spit out into the Eppendorf tubes and stored at −20°C until analysis. The samples were then centrifuged at 3000 rpm for 15 min, and the clear supernatant was used for analysis. Cortisol levels were estimated using Salivary Cortisol ELISA Assay Kit (DiaMetra) in accordance with the manufacturer's instructions.
| Results|| |
The collected data were analyzed using statistical software SPSS (17.0 version).
The participants were stratified based on the form of tobacco usage. Out of the 40 participants, 20% were nonusers, 37.5% were users of both tobacco and smokeless tobacco, 2.5% were past smokers and current users of smokeless tobacco, 7.5% were current users of smokeless tobacco, 32.5% were current smokers without smokeless tobacco usage, and none of the workers were past smokers [Table 1].
|Table 1: Distribution of the study participants based on tobacco form usage pattern|
Click here to view
The salivary cortisol level was assessed using salivary cortisol ELISA assay kit and calibration curve was obtained [Figure 1].
The mean salivary cortisol levels were found to be highest among the past smokers and current users of smokeless tobacco (9.31 ± 0) followed by the current users of both forms of tobacco (6.19 ± 3.02), current smokers without smokeless tobacco (5.84 ± 3.27), nonusers (3.45 ± 2.24) and current users of smokeless form alone (3.38 ± 2.14), respectively. This difference in salivary cortisol levels with regard to tobacco form usage patterns of the study participants was not statistically significant ( P = 0.110) [Table 2].
|Table 2: Influence of tobacco form usage pattern on salivary cortisol levels of the participants|
Click here to view
Pearson's correlation coefficient test was used to correlate the salivary cortisol level with the periodontal parameters. There was a positive correlation between CAL and salivary cortisol levels (0.801), followed by PPD and salivary cortisol levels (0.800), PSR and salivary cortisol levels (0.581), and number of missing teeth and salivary cortisol levels (0.473). The correlation among various parameters was found to be statistically significant ( P < 0.05) [Table 3].
|Table 3: Correlation between salivary cortisol level and periodontal parameters|
Click here to view
| Discussion|| |
The present study was done to estimate the stress among coal mine workers in Tamil Nadu and correlate the salivary cortisol levels with periodontal disease severity among coal mine workers in Tamil Nadu. A high prevalence of usage of smoking and smokeless forms of tobacco was observed in the present study. Coal mine workers develop high occupational stress. They work in deep pits where the concentration of oxygen is reduced and also the tiresome physical work drives the workers toward deleterious habits. In our study, 80% of the coal mine workers were either users of smoking or smokeless forms or both. Only 20% were nonusers. This finding was in accordance with the previous studies done among coal mine workers of Telangana, India, where 87.6% were tobacco users and only 36 participants (10%) were free from tobacco. Another study done among coal mine workers of Kozlu district, Turkey, 58.5% were tobacco users, 41.5% did not use tobacco in any form, and none of the workers used chewing tobacco.
Stress among coal mine workers was assessed in terms of salivary cortisol levels and periodontal parameters were recorded in terms of PPD, CAL, number of missing teeth, and PSR Index. To the best of our knowledge, this is the first study to correlate the salivary cortisol level with periodontal status among coal mine workers. Salivary cortisol level was assessed using ELISA kit which allows the determination of cortisol from 0.5 ng/ml to 100 ng/ml.
The salivary cortisol levels were found to be higher among the past smokers and current using smokeless forms of tobacco (9.31 ± 0) followed by current users of both tobacco and smokeless tobacco (6.19 ± 3.02). Similar result was obtained in the previous study, in which the salivary cortisol was increased in the current smokers when compared with nonsmokers.
In our study, on analyzing the correlation between salivary cortisol and periodontal parameters, a positive correlation between CAL, PPD, PSR, and missing teeth and salivary cortisol levels ( r = 0.801, 0.800, 0.581, and 0.473 respectively) was observed and were statistically significant. This observation was in agreement with the previous study among inmates of central prison which showed a positive correlation between salivary cortisol levels, PPD, and CAL. Similarly, another study reported that patients with moderate chronic periodontitis had statistically significantly higher levels of salivary cortisol level than patients with a diagnosis of slight chronic periodontitis.
Based on the observations, stress reduction therapies such as yoga, meditation, and music therapy to be introduced to the workers in coal mines or in other industries with stressful working environment. This might help them combat with the stress in working environment and reduce their stress level, and also routine oral health checkups and oral health awareness programs should be conducted among the coal mining population.
| Conclusion|| |
There was a high level of stress among coal mine workers as estimated in terms of salivary cortisol in our study, and there was a positive correlation between salivary cortisol level and clinical periodontal parameters.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Clarke NG, Hirsch RS. Personal risk factors for generalized periodontitis. J Clin Periodontol 1995;22:136-45.
Siegrist J, Rödel A. Work stress and health risk behavior. Scand J Work Environ Health 2006;32:473-81.
Petersen PE, Henmar P. Oral conditions among workers in the Danish granite industry. Scand J Work Environ Health 1988;14:328-31.
Genco RJ, Ho AW, Grossi SG, Dunford RG, Tedesco LA. Relationship of stress, distress and inadequate coping behaviors to periodontal disease. J Periodontol 1999;70:711-23.
Breivik T, Opstad PK, Gjermo P, Thrane PS. Effects of hypothalamic-pituitary-adrenal axis reactivity on periodontal tissue destruction in rats. Eur J Oral Sci 2000;108:115-22.
Miller DB, O'Callaghan JP. Neuroendocrine aspects of the response to stress. Metabolism 2002;51:5-10.
Yang EV, Glaser R. Stress-induced immunomodulation and the implications for health. Int Immunopharmacol 2002;2:315-24.
Takada T, Yoshinari N, Sugiishi S, Kawase H, Yamane T, Noguchi T. Effect of restraint stress on the progression of experimental periodontitis in rats. J Periodontol 2004;75:306-15.
Deinzer R, Rüttermann S, Möbes O, Herforth A. Increase in gingival inflammation under academic stress. J Clin Periodontol 1998;25:431-3.
Deinzer R, Kottmann W, Förster P, Herforth A, Stiller-Winkler R, Idel H. After-effects of stress on crevicular interleukin-1beta. J Clin Periodontol 2000;27:74-7.
Cole-King A, Harding KG. Psychological factors and delayed healing in chronic wounds. Psychosom Med 2001;63:216-20.
Croucher R, Marcenes WS, Torres MC, Hughes F, Sheiham A. The relationship between life-events and periodontitis. A case-control study. J Clin Periodontol 1997;24:39-43.
Deinzer R, Hilpert D, Bach K, Schawacht M, Herforth A. Effects of academic stress on oral hygiene – A potential link between stress and plaque-associated disease? J Clin Periodontol 2001;28:459-64.
Deinzer R, Granrath N, Spahl M, Linz S, Waschul B, Herforth A. Stress, oral health behaviour and clinical outcome. Br J Health Psychol 2005;10:269-83.
Suchday S, Kapur S, Ewart CK, Friedberg JP. Urban stress and health in developing countries: Development and validation of a neighborhood stress index for India. Behav Med 2006;32:77-86.
Haber J. Smoking is a major risk factor for periodontitis. Curr Opin Periodontol 1994; p. 12-8.
Refulio Z, Rocafuerte M, de la Rosa M, Mendoza G, Chambrone L. Association among stress, salivary cortisol levels, and chronic periodontitis. J Periodontal Implant Sci 2013;43:96-100.
Abbas I, Mohammad SA, Peddireddy PR, Mocherla M, Koppula YR, Avidapu R. Oral health status of underground coal mine workers of Ramakrishnapur, Adilabad district, Telangana, India – A cross-sectional study. J Clin Diagn Res 2016;10:ZC28-31.
Cengiz Mİ, Zengin B, İçen M, Köktürk F. Prevalence of periodontal disease among mine workers of Zonguldak, Kozlu district, Turkey: A cross-sectional study. BMC Public Health 2018;18:361.
Badrick E, Kirschbaum C, Kumari M. The relationship between smoking status and cortisol secretion. J Clin Endocrinol Metab 2007;92:819-24.
Fenol A, Jebi S, Krishnan S, Perayil J, Vyloppillil R, Bhaskar A, et al.
Association of stress, salivary cortisol level, and periodontitis among the inmates of a central prison in Kerala. Dent Res J (Isfahan) 2017;14:288-92.
Shripad RN, Girish B, Nikesh M. Association of stress and chronic periodontitis by estimation of serum cortisol level. Int J Curr Res 2016;8:42418-22.
[Table 1], [Table 2], [Table 3]