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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 162-165

A study to assess the periodontal status of eunuchs residing in Central Gujarat, India: A cross-sectional study


1 Department of Public Health Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
2 Department of Pediatric Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
3 Department of Periodontology, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India

Date of Submission02-Jun-2020
Date of Acceptance10-Aug-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Pulkit Kalyan
Department of Public Health Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_52_20

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  Abstract 


Introduction: The extent of periodontal tissue destruction can be assessed using pocket depth which also indicates the condition of the extent of the local inflammation. There are so many social stigmas associated with eunuchs community that these people do not come out in open and even if they come out in open, they often resort to various debilitating lifestyle habits that affect their general well-being and oral health in a negative sense. The objective of the present study is to assess the periodontal status among the eunuchs residing in Central Gujarat and to analyse the association between the periodontal status of eunuchs residing in Central Gujarat and various demographic variables. Methodology: The survey was conducted in Central Gujarat, and data were collected through primary source using the WHO Oral Health Assessment Form for Adults (2013) to assess the periodontal status and loss of attachment. Clinical examination was performed by using a plane mouth mirror and Community Periodontal Index Probe (WHO probe) (CPI) probe under adequate natural/artificial light. Results: Out of 384 eunuchs, the mean value of periodontal pocket depth among the eunuchs is 3.12 ± 0.89; clinical attachment loss is 2.88 ± 0.74. The difference in the periodontal pocket depth and clinical loss of attachment was statistically insignificant indicating that there is no difference in periodontal pocket depth and clinical loss of attachment across all the age groups and education status of eunuchs. Conclusion: The results of the current study showed poor periodontal status among eunuch population in Central Gujarat. The periodontal condition helps estimate the oral condition of this population. These estimates are important for the future planning of dental services among eunuch community.

Keywords: Eunuchs, Gujarat, oral health, periodontal


How to cite this article:
Kalyan P, Dave B, Deshpande N, Panchal D. A study to assess the periodontal status of eunuchs residing in Central Gujarat, India: A cross-sectional study. Adv Hum Biol 2020;10:162-5

How to cite this URL:
Kalyan P, Dave B, Deshpande N, Panchal D. A study to assess the periodontal status of eunuchs residing in Central Gujarat, India: A cross-sectional study. Adv Hum Biol [serial online] 2020 [cited 2021 Apr 17];10:162-5. Available from: https://www.aihbonline.com/text.asp?2020/10/3/162/295836




  Introduction Top


Specific microorganisms in the dental plaque may lead to inflammatory disease in oral cavity, periodontal disease. This leads to loss of attachment, destruction of periodontal ligament, and adjacent supporting bone. The extent of periodontal tissue destruction can be assessed using pocket depth which also indicates the condition of the extent of the local inflammation.[1] One of the most common dental diseases affecting the adult population is periodontal disease. The etiopathogenesis of the disease depends on a lot of factors.[2],[3],[4] Systemic diseases such as cardiovascular disease, stroke, and diabetes, as well as for pre-term, low-birth weight infants could be attributed to periodontal disease.[5],[6]

The word EUNUCH is derived from a Greek word meaning 'keeper of the bed'.[7] These transgender communities historically exist in many cultural contexts, known as Bakla in the Philippines, Xaniths in Oman, Serrers among the Pokot people of Kenya, and Kinnars, Jogappas, Jogtas, or Shiv-Shaktis in South Asia.[8]

One of the most vulnerable sections in the Indian Population are Hijras, meaning Eunuchs. There are so many social stigmas associated with this community that these people do not come out in open and even if they come out in open, they often resort to various debilitating lifestyle habits that affect their general well-being and oral health in a negative sense. It is because of the fear of how they may be treated and most probable chance of being looked down upon, they do not seek a health-care provider. In India, many hijras live in well-defined, organized, all-hijra communities, led by a guru. The lack of being in an advantaged and privileged position in the society, they are devoid of a respectable living and are seen doing prostitution or earning money from families on any festive occasion.[9] All the above factors make them a vulnerable population in our country.[10]

Periodontal disease is the most common disease in the oral cavity, and oral health is an integral part of healthy life.[11] The objective of the present study is to assess the periodontal status among the eunuchs residing in Central Gujarat and to analyse the association between the periodontal status of eunuchs residing in Central Gujarat and various demographic variables.


  Methodology Top


Type of study

Descriptive cross-sectional survey as the study aims to assess the periodontal status among Eunuchs residing in Central Gujarat.

Place of study

The present survey was conducted in Central Gujarat which includes Ahemdabad, Vadodara, Anand, Kheda, Panchmahal, Dahod and Chhota Udaipur.

Source of data

The data were collected through primary source using WHO Oral Health Assessment Form for Adults (2013) to assess the periodontal status and loss of attachment.

Sample description

As the study was a cross-sectional survey, the sample was selected using the following formula:



Where | Margin of error = e || z-score = z

Z2is the abscissa of the normal curve that cuts off an areaαat the tails(1 − α) equals the desired confidence level, e.g., 95%) 1, e is the desired level of precision, P is the estimated proportion of an attribute that is present in the population, and q is 1 − p.

Taking into consideration, that the prevalence of positive oral health impact on quality of life be 0.50, P = 0.50 and q = 0.50, the sample size is 384.

Inclusion criteria

  • Eunuchs: All the self-identified eunuchs willing to participate and gave informed consent during the study period were considered for the study.


Exclusion criteria

  • Participants with a history of medication for any systemic illness (medically compromised patients)
  • Participants who had mental disorders, etc.


Prior permission was obtained from the ethics committee before the commencement of the study viz., SVIEC/ON/Dent/PhD/19020 dated 19th March, 2019. Verbal and written consent from eunuchs fulfilling the inclusion criteria was taken prior to the examination. The informed consent form, assent form and participation information sheet were presented in Gujarati (local language) to the Gharana head or Guru of the transgenders of the respective regions. Non-probability snow ball sampling was used in the inclusion of self-identified Eunuchs. The data were recorded by one examiner (Primary Investigator) and one recorder (Calibrated dental hygienist) for the entire study. To ensure uniform interpretation, understanding and application by the examiner, of the codes and criteria for the periodontal diseases to be observed and recorded in the pro forma used, the examiner was priorly calibrated and trained in the Department of Public Health Dentistry, KM Shah Dental College and Hospital before the commencement of the study. The calibration procedure was performed on a group of 10 participants which were not included in the study. The intra examiner reliability was assessed by using the Weighted Kappa statistics, which was 0.85.

Clinical examination was performed by using a plane mouth mirror and CPI probe under adequate natural/artificial light. An examination of the oral cavity to record the periodontal status and loss of attachment was made on every subject.

The data collected were edited, coded in MS Excel and analysis will be done in the appropriate statistical software. Data collected through structured schedules (quantitative data) will be analysed using the following techniques: Descriptive Statistics and Chi-square Test of Association.


  Results Top


Out of 384 eunuchs, 19 were <18 years, 286 were between the age group 18–60 years and 79 above 60 years. Among the sample of 384 eunuchs 230 were illiterate, 90 were those who passed 10th standard, 62 had studied till 12th Standard, only 2 were graduates and none had done the post-graduation [Table 1].
Table 1: The sociodemographic characteristics of the sample

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The mean value of periodontal pocket depth among the eunuchs is 3.12 ± 0.89, clinical attachment loss is 2.88 ± 0.74 [Table 2].
Table 2: The descriptive statistics of parameters assessed for

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The eunuchs brushed their teeth with toothbrush and tooth paste. The eunuchs brushed their teeth once daily. Majority of them had tobacco hewing habit, and the habit was multiple times in a day [Table 3].
Table 3: The frequency distribution of participants according to the habits

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The difference in the periodontal pocket depth and clinical loss of attachment was statistically insignificant as the result of ANOVA P value was more than 0.05 indicating that there is no difference in periodontal pocket depth and clinical loss of attachment across all the age groups and education status of eunuchs [Table 4].
Table 4: The difference in periodontal status according to age group and education status

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  Discussion Top


The present study was conducted on 384 eunuchs residing in Central Gujarat through snowball sampling technique. Limited literature was available on this area; still sincere attempt has been made to compare our results with other studies.

The present study revealed that almost 98.9% of eunuchs suffered from poor oral hygiene and showed the prevalence of gingivitis and 94.27% of eunuchs suffered from periodontitis in various ways as assessed by CPI. The similar kind of result was seen in a study by Torwane et al.[12] who reported 86.5% of total population of eunuchs suffering from gingivitis and 92.8% of eunuchs suffering from periodontal disease. A similar high prevalence of periodontal disease was also reported in the study by Fareed[13] and Peterson[14] who conducted a similar study on vulnerable population. This indicates that the vulnerable section of the population such as eunuchs and tribals are more prone to poor oral health due to unhygienic oral cavity.

The current study assessed the CAL as 2.88 which is indicating of the prevalence of periodontal disease present. The mean pocket depth was seen to be 3.12 mm which represents the presence of poor oral condition of eunuchs. This is due to the accumulation of calculus, plaque and debris. This similar result was reported by Torwane et al.[12] who reported 21 (10.1%) eunuchs were having attachment loss of 4–5 mm and 6–8 mm respectively. However, 13 (6.3%) eunuchs were having attachment loss of 12 mm or more. Their result was statistically non-significant when associated with gender. The result reported by Peeran et al.[11] showed CAL of 2.39 and pocket depth of 2.41 mm which was comparatively lower that the present study. Similar results showed by Bhat and Sushi[15] in which no significant difference in loss of attachment was observed among gender.

The effect of deleterious habits such as tobacco chewing and smoking has an effect on the poor oral health status of the eunuchs in this study. A study by Torwane et al.[12] also revealed that males and eunuchs to engage in these deleterious habits which are the risk factors of periodontal disease as mentioned in Kundu et al.[16] The habit of chewing tobacco and smoking leads to increase in the colonisation of shallow periodontal pocket by various pathogens and leads to the formation of deep periodontal pocket. Smoking alters the neutrophil chemotaxis, phagocytosis and oxidative burst, leads to increased TNF alpha, prostaglandin E2, neutrophil collagenase and elastase in gingival crevicular fluid.[17]

Hongal et al.[18] showed in their study that the level of dental health knowledge, positive dental health attitude and dental health behaviours were interlinked and positively associated with the level of education as an educated individual gains the requisite knowledge from multiple sources.

The present study shows the poor periodontal status of eunuchs. This is an indicative of lack of accessibility to a dentist by eunuchs. Being from a stigmatised population, there may be a reason that they do not intend to come out in open and get the treatment done fearing people's perception about them The extreme level of stress and anxiety faced by the eunuchs lead to them resorting to deleterious habits which lead to poor oral hygiene status.

There is an immediate need to develop the preventive and promotive strategies which help in improving the oral health related quality of life of eunuchs. This in turn will motivate this socially stigmatised community to have a positive dental health attitude and behaviour. The health policies aimed to improve the accessibility of the dental services and providing dental health education will help the eunuchs to have good oral health status. The roleplayed by NGOs, private dental practitioners is pivotal in this regard. The government should also focus on dedicated health policy for these vulnerable weaker sections of the population.


  Conclusion Top


The results of the current study showed poor periodontal status among eunuch population in Central Gujarat. The awareness and screening camps of the eunuchs will help in this regard. The periodontal condition helps estimate the oral condition of this population. These estimates are important for the future planning of dental services among eunuch community. The study has attempted sincerely to provide a baseline data for future studies and highlights the unmet needs of the eunuchs in Central Gujarat.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Susin C, Valle P, Oppermann RV, Haugejorden O, Albandar JM. Occurrence and risk indicators of increased probing depth in an adult Brazilian population. J Clin Periodontol 2005;32:123-9.  Back to cited text no. 1
    
2.
Folmer T, van Den Heuvel JL, Jansen J, van Opijnen L, Wouters SL. An epidemiological survey of periodontal disease in Dutch adults. Community Dent Oral Epidemiol 1978;6:65-70. Hugoson A, Jordan T. Frequency distribution of individuals aged 20-70 years according to severity of periodontal disease. Community Dent Oral Epidemiol 1982;10:187-92.  Back to cited text no. 2
    
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Freitas E, Meyer K, Davis RK, Kristoffersen T. A baseline study of periodontal conditions among youths and adults in Portugal. Community Dent Oral Epidemiol 1983;11:250-4.  Back to cited text no. 3
    
4.
Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol 1996;1:821-78.  Back to cited text no. 4
    
5.
Rose LF, Genco RJ, Cohen DW, Mealey BL, editors. Periodontal Medicine. St. Louis: BC Decker; 2000.  Back to cited text no. 5
    
6.
Page RC. The pathology of periodontal diseases may affect systemic diseases: Inversion of a paradigm. Ann Periodontol 1998;3:108-20.  Back to cited text no. 6
    
7.
Rehan N, Chaudhary I, Shah SK. Socio-sexual behaviour of Hijras of Lahore. J Pak Med Assoc 2009;59:380-4.  Back to cited text no. 7
    
8.
Nanda S. Neither Man Nor Woman: The Hijra of India. 2nd ed. Belmont, CA: Wadsworth Publishing; 1999. p. 196.  Back to cited text no. 8
    
9.
Bhakti M, Hijrahs The Plight of Transvestites. Available from: http://gyaanyatra.affp.org.uk/news/story/hijrahsplighttransvestites. [Last accessed on 2012 Aug 20].  Back to cited text no. 9
    
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Eunuchs of India. Available from: http://www.menknowwomen.com/HIjras_pdf/I%20Eunuchs%20in%20India.pdf. [Last accessed on 2010 Sep 25].  Back to cited text no. 10
    
11.
Peeran SW, Thiruneervannan M, Kumar N, Almarshoudi S, Ahmed FMA. Oral hygiene and periodontal status among eunuchs in Chennai, India. EC Dent Sci 2017;15.4:123-6.  Back to cited text no. 11
    
12.
Torwane NA, Hongal S, Saxena E, Rana PT, Jain S, Gouraha A. Assessment of periodontal status among eunuchs residing in Bhopal city, Madhya Pradesh, India: A cross-sectional study. Oral Health Dent Manag 2014;13:628-33.  Back to cited text no. 12
    
13.
Bhat PK, Sushi K. Periodontal health status and oral hygiene practices of Iruliga tribal community residing at Ramanagar district, Karnataka, India. JIOH 2010;2(1):17-26.  Back to cited text no. 13
    
14.
Peterson PE. Oral health status of children and adults in Madagaskar. Indian Dent J 1996;46:41-7.  Back to cited text no. 14
    
15.
Bhat PK, Sushi K. Periodontal health status and oral hygiene practices of Iruliga tribal community residing at Ramanagar district, Karnataka, India. J Int Oral Health 2010;2:17-26.  Back to cited text no. 15
    
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Kundu D, Mehta R, Rozra S. Periodontal status of a given population of West Bengal: An epidemiological study. J Indian Soc Periodontol 2011;15:126-9.  Back to cited text no. 16
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17.
Newman MG, Takei H, Carranza FA, editors. Clinical Periodontology. 9th ed. Philadelphia: WB Saunders Company; 2002. p. 245-52.  Back to cited text no. 17
    
18.
Hongal S, Torwane NA, Goel P, Byarakele C, Mishra P, Jain S. Oral health related knowledge, attitude and practices among eunuchs (Hijras) residing in Bhopal City, Madhya Pradesh, India. A crosssectional questionnaire survey. J Indian Soc Periodontol 2014;6:23-7.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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