Philip et al

International Journal of Public Health Dentistry

RESEARCH ARTICLE
Prevalence of periodontal diseases among the adult tribal population in Nilgiris- an
epidemiological study
Biju Philip, Koshy Chithresan, Vijayalakshmi Subramanian Vijayaragavan, Arun Maradi.

Abstract
Background: India has one of the largest tribal concentrations in the world. Nilgiris is a unique
biosphere in the Western Ghats and part of Tamil Nadu, India, has number of tribal groups as its
inhabitants. These inhabitants of Nilgiris are segregated from modern civilization. The accessibility of
these tribes to medical and dental care is minimal. Aim: To determine the prevalence of periodontal
disease, and the relationship of periodontal disease with the oral hygiene, oral hygiene methods
practiced and habits. Methods: The study was conducted among the adult (35- 44 yrs) tribals of
Nilgiris. Information regarding the population was collected from Association for Health Welfare in the
Nilgiris (ASHWINI). Community Periodontal Index and loss of attachment were used to record the
periodontal status of 303 tribals. Plaque Index was used to record the oral hygiene status. Results: In
the age group of 35-44years, 73.6% of the total population had periodontal disease. 23.8% of the
population had loss of attachment of 9-11mm, which is considered as severe periodontal disease.
When the habits like smoking, paan chewing and alcohol were compared with the periodontal
disease, the people who have these habits showed greater Plaque Index score, higher Community
Periodontal Index score and severe loss of attachment. Male population suffered severe periodontitis
than females. Conclusions: Overall prevalence of periodontal disease in the tribal population of
Nilgiris was 73.6%. Majority of the male population was affected by periodontal disease. Education
and motivation of the population is required to improve the oral hygiene, oral hygiene measures and
to refrain from habits like smoking, paan chewing and smokeless tobacco use and alcohol abuse.
Keywords: Periodontal disease; Loss of attachment; Community Periodontal Index; Plaque index;
Prevalence; Tribals.
identification of high risk groups are of great

Introduction

importance (2).
Oral health is an important aspect of overall
health status of an individual. Teeth and their
supporting (periodontal) structures are of
critical importance to oral health. Periodontitis
is one of the most widespread diseases of
mankind (1). As periodontal disease is one of
the primary causes of tooth loss and is also
associated with health problems such as
cardiovascular

diseases,

cerebrovascular

accidents, diabetes mellitus and pregnancy

associated complications, the estimation of its
prevalence
8

in

the

population

and

A systematic review on the prevalence of

periodontal diseases in India concluded that
periodontal diseases are one of the more
prevalent oral diseases affecting more than
50% of Indian community. Untreated chronic
periodontitis is responsible for tooth loss in
majority of the cases (3).
India

has

one

of

the

largest

tribal

concentrations in the world. Nilgiris is a unique

biosphere in the Western Ghats and part of
Tamil Nadu, India, characterized at the higher

the

International Journal of Public Health Dentistry 2013:4(1):8-12. Publishing Division, Celesta software Private Limited

Philip et al

International Journal of Public Health Dentistry

altitudes by grass lands and evergreen forests,

Paniya tribe, 21 from the Mullakurumba tribe,

has number of tribal groups which includes

80 from the Bettakurumba tribe, 3 from the

Paniyans,

Mullakurumbas,

Irula tribe, and 65 from the Kattunayakan tribe

Bettakurumbas and Irulas as its inhabitants

were examined. Before starting the survey, a

These tribes of Nilgiris are segregated from

pilot study was conducted among 50 people

the modern civilization. Most of them are

(10 people each from 5 villages). During the

working in the tea estates for daily wages.

pilot study a single examiner was calibrated

There is a considerable gap in the literacy

according to the WHO guidelines (5). The

level and socio-economic status compared

diagnostic criteria such as pocket depth,

with the general population. The accessibility

attachment

of these tribes to medical and dental care is

presence

minimal. They practice their own traditional

recorded 2 times on the same person on

methods to treat diseases. Even though they

successive days. In order to assess the

form a very small percentage of the total

periodontal

population, it is essential to extend our

(17,16,11,26,27,37,36,31,46,47)

knowledge and facilities in order to improve

examined using sterilized CPI probe and

their oral health status (4).

mouth

Hence aim of the present study was to

determined pocket depth, attachment loss,

determine

calculus

Kattunayakans,

the

prevalence

of

periodontal

loss,
of

bleeding

calculus

status,

mirror

in

on

and

plaque

ten

natural

and bleeding

probing,

index

were

teeth
were

day

light

and

status. The sites

disease, and the relationship of periodontal

examined per tooth were mesio-buccal, mid-

disease with the oral hygiene, oral hygiene

buccal,

methods practiced and habits.

mid-lingual/palatal, disto-lingual/palatal (6).

Materials and Methods

The data was recorded using the WHO oral

The present study was conducted among the

health

adult (35-44 years of age) tribal population of

Periodontal

Nilgiris

Paniyas,

Attachment (LOA) were used to record the

Mullakurumbas, Bettakurumbas, Irulas and

periodontal status (6). Plaque Index (PlI) was

Kattunayakans. They are concentrated in 48

used to record the oral hygiene status (7).

villages of Gudalur and Padalur thaluks of

Personal interview was conducted to collect

Nilgiris district. The available population in this

data regarding the oral hygiene measures and

age group was 2503. According to the World

habits like smoking, paan chewing, smokeless

Health Organisation (WHO) guidelines, a

tobacco and alcohol.

cluster of 25 people each from 12 villages

Results

(One site in each of 4 villages) were selected

The total number of people examined was

and examined in their habitat. Information

303. Among this 126 were males and 177

regarding the population and other details of

were females (Table1). Periodontal diseases

the tribes were collected from Association for

based on CPI, 75.2% of the total population

Health Welfare in the Nilgiris (ASHWINI). A

had

total of 303 people i.e. 134 people from the

periodontal

which

comprises

of

disto-buccal,

mesio-lingual/palatal,

assessment
Index

presence

of

pocket

form.
(CPI)

and

calculus;
4-5

Community

mm;

Loss

of

15.8%

had

6.3%

had

International Journal of Public Health Dentistry 2013:4(1):8-12. Publishing Division, Celesta software Private Limited

Philip et al

International Journal of Public Health Dentistry

periodontal pocket 6; 2% of the population

26.4%

had healthy periodontium (Table 2).

periodontium (Table 3).

Table 1: Distribution of the study population

according to ethnicity and gender

When the CPI scores were compared with oral

Ethnic group

Male

Female

Total

Paniya

43 (32.1%)

91 (67.9%)

134 (100%)

Mullakurumba

11 (52.4%)

10 (47.6%)

21 (100%)

Bettakurunba

37 (46.3%)

43 (53.8%)

80 (100%)

Irula

01 (33.3%)

02 (66.7%)

03 (100%)

Kattunayakans

34 (52.3%)

31 (47.7%)

65 (100%)

Total

126 (41.6%)

177 (58.4%)

303 (100%)

of

hygiene

the

population

measures

had

statistically

healthy

significant

differences between those using brush and

finger. Abundant presence of calculus was
observed in 79.7% of the population who used
finger as their oral hygiene measure, whereas
only 67.6% had presence of calculus for those
who used brush as oral hygiene measure
(p=0.024). When oral hygiene measures were
compared with Loss of Attachment, 27.4% of

Table 2: Community periodontal index scores

of the study population

population who used finger had an attachment

loss of 9-11mm and 11.7% had an attachment

CPI scores

Male

Female

loss of 12 mm, which was highly significant

0- Healthy

01 (0.8%)

05 (2.8%)

(p=0.006). Maximum Loss of Attachment (12)

1- Bleeding on probing

00 (0.0%)

01 (0.6%)

2 -Calculus

87 (69%)

141 (79.7%)

3 - Periodontal pocket
4-5 mm
4- Periodontal pocket
6 mm
X-Excluded

28 (22.2%)

20 (11.3%)

10 (7.9%)

09 (5.1%)

and smokers had more Plaque Index score

00 (0 .0%)

01 (0.6%)

than non- smokers. Association between

Total

126 (100%)

176 (99.4 %)

smoking and CPI index was found to be highly

was found among the people who used

charcoal as their dentifrice (p=0.113).
Association

Male

Female

0-3 mm
4-5 mm
6-8 mm
9-11 mm
12 mm
Excluded
Total

12 (9.5%)
19 (15.1%)
36 (28.6%)
42 (33.3%)
17 (13.5%)
00 (0.0%)
126 (100%)

68 (38.4 %)
37 (20.9%)
31 (17.5%)
30 (16.9%)
10 (5.6%)
01 (0.6)
176 (99.4%)

Prevalence of periodontal diseases based on

Loss of Attachment, 18.5% of the total
population had Loss of Attachment of 4-5mm;
22.1% had Loss of Attachment of 6-8mm;
23.8% with Loss of Attachment of 9-11mm;
8.9% with the Loss of Attachment 12mm and

Index

and

(p

value=0.012)

with

smokers

having higher CPI score than the nonsmokers. Loss of Attachment in smokers was
more

LOA score

Plaque

smoking was highly significant (p value=0.017)

significant
Table 3: Loss of Attachment (LOA) scores of
the study population

between

than

that

in

non-

smokers

(p

value=0.000).
Paan chewers had more plaque index (p
value=0.000),

CPI

(p

value=0.647,

not

significant) and loss of attachment scores (p

value=0.115, not significant) than non- paan
chewers. Smokeless tobacco users had more
Plaque

Index

(p

value=0.057),

CPI

(p

value=0.898, not statistically significant) and

loss

of

attachment

(p

value=0.631.

not

statistically significant) score than non-users.

Alcohol users had more Plaque Index scores
(p value=0.000), CPI scores (p value=0.005)
and loss of attachment (p value=0.006) than

10

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Philip et al

International Journal of Public Health Dentistry

non- alcohol users.

attachment (p value =0.000). This means that

Discussion

severity of periodontal disease is associated

Male population (33.3%) had severe loss of

with poor oral hygiene. This is in accordance

attachment (9-11mm) than female population

with

(16.9%).Hence the male population suffered a

population (11,12).

significantly more severe form of periodontitis

Overall prevalence of periodontal disease in

than females (p value=0.000). These results

the tribal population of Nilgiris was 73.6%.

comparable with that observed in general

Majority of the male population was affected

population also (8).

by

In the age group of 35-44years, 73.6% of the

motivation of the population is required to

total population had periodontal disease.

improve

23.8%

measures and to refrain from habits like

of

the

population

had

Loss

of

the

previous

periodontal

the

disease.

oral

of

Education

hygiene,

oral

and

hygiene

severe periodontal disease. But in the other

tobacco use and alcohol abuse. The role of

study of Indian tribal population of 35-44

ASHWINI and Government of Tamil Nadu is

years,

crucial in achieving these goals.

prevalence

of

periodontal disease (10). In another study

conducted in tribal population, prevalence of
periodontal disease was 80.3% and 84.8% in
surveys of same age group of Rajasthan, India
(9, 10).
The present study demonstrated that 90% of

and

tribal

smoking,

100%

chewing,

the

Attachment of 9-11mm, which is considered as

reported

paan

studies

smokeless

Affiliations of the authors:

1. Dr. Biju
Philip, Senior Lecturer, Department of Periodontics,
Annoor
Dental
College,
Muvattupuzha,
Cochin,Kerala, India 2. Dr. Koshy Chithresan,
Head of the Department, 3. Dr. Vijayalakshmi
Subramanian Vijayaragavan, Reader, 4. Dr. Arun
Maradi, Senior
Lecturer, Department of
Periodontics, Sri Ramakrishna Dental College,
Coimbatore, Tamilnadu, India.

the male population and 61% of the female

Conflict of Interest:

population

The author(s) declared no conflict of interests.

had

one

or

other

form

of

periodontal disease. The reason for increased

Source of Funding: Nil.

prevalence of periodontal disease in males

may be due to habits like smoking, alcohol and

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Corresponding author

Odontol Scant 1964; 22:121-135.

Dr. Biju Philip,

Senior Lecturer,Department of Periodontics, Annoor
Dental College, Muvattupuzha,Cochin, Kerala,
India.
e-mail:sushabiju@yahoo.co.in

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