CHENNAI: Behind the manicured green of the Nilgiris tea estates lies a stark oral health divide. Nearly two-thirds of plantation workers examined had advanced periodontal disease, while only 11.3 per cent reported using a toothbrush with toothpaste — a sharp contrast to the 74-98 per cent reported for toothbrush-and-toothpaste use across Tamil Nadu.
The findings from a study published in BMC Oral Health point to a combination of poor oral hygiene, limited access to dental care, and socioeconomic disadvantage among tea plantation workers in the Kothagiri Hills.
The cross-sectional study covered 540 workers who attended community dental screening camps across four tea estates between August and November 2023. It found that 62.6 per cent, or 338 workers, had periodontal destruction clinically consistent with advanced stage III/IV disease, with a 95 per cent confidence interval of 58.4 to 66.6 per cent.
The estates covered were the Rookery and Aganad divisions of Kilkothagiri Tea Estate, Tantea Estate and Thutta Palam Tea Estate. The findings also offer a glimpse into the socioeconomic circumstances of the plantation community.
Of the 540 participants, 389 (72 per cent) were women and 151 (28 per cent) men. As many as 387 workers (71.7 per cent) had no formal education, while only four (0.7 per cent) had graduate-level education or higher.
The economic profile was equally stark, with 510 participants (94.4 per cent) reporting a monthly income below Rs 10,000.
Access to dental care was limited. Although 303 workers (56.1 per cent) had visited a dentist, 237 (43.9 per cent) had never done so.
Even basic oral-hygiene practices reflected the disparity. Charcoal was used by 384 workers (71.1 per cent) to clean their teeth, while only 61 (11.3 per cent) reported using a toothbrush with toothpaste — a sharp contrast to the 74-98 per cent reported for toothbrush-and-toothpaste use across Tamil Nadu.
Another 45 workers used a toothbrush with tooth powder, while 50 used toothpaste or tooth powder with their fingers.
The clinical examination revealed notable differences between men and women. Severe clinical attachment loss of 6-8 mm was recorded in 31.1 per cent of men, compared with 19.3 per cent of women. Calculus was also more common among men (33 per cent) than among women (21 per cent).
Bleeding on probing, however, was more frequent among women, at 35 per cent compared with 22 per cent among men. Tooth loss attributed to periodontal disease was recorded in 19 per cent of participants.
The adjusted analysis found that men had 1.9 times the odds of severe periodontitis compared with women. Workers with low educational attainment had 2.3 times the odds, while irregular dental attendance was associated with 1.7 times the odds. Age was not statistically significant in the adjusted model.
Tobacco use was another concern. About 41 per cent of male participants reported tobacco use, particularly smoked forms such as beedi. Although tobacco variables were not retained in the final regression model because of multicollinearity, the researchers said tobacco exposure likely contributed substantially to disease severity.
The researchers called for regular periodontal screening, oral health education, tobacco cessation support, and referral services within plantation communities.
The study, however, has important limitations. It relied on voluntary, non-probability sampling from four estates, while periodontal staging was based on field clinical assessment without radiographic evaluation or a complete assessment of the 2017 classification. The cross-sectional design also rules out conclusions about cause and effect.
The authors stressed that the findings should not be generalised to all tea plantation workers in Tamil Nadu. They called for representative longitudinal studies using probability-based sampling, standardised periodontal assessment and appropriate multilevel analysis to validate the findings.
62.6%: 338 of 540 workers had advanced periodontal destruction
71.7%: Had no formal education
94.4%: Earned below Rs 10,000 a month
43.9%: Had never visited a dentist
71.1%: Used charcoal to clean their teeth
11.3%: Used a toothbrush with toothpaste
31.1%: Men with severe clinical attachment loss, compared with 19.3% of women
41%: Male participants who reported tobacco use
*Findings from four estates cannot be generalised to all tea plantation workers