A preliminary comparative study on dental health between convict and non-convict people within Erbil, Kurdistan of Iraq

Aza Bahram Khdir[1]                                  Yasin Kreem Amin[2]

ABSTRACT

This investigation involved determination of prevalence range of dental caries and hygiene study among convicts and general population within Erbil, Kurdistan of Iraq. Ages, gender, education level and smoking habit have been taken in consideration for both group of samples (convict and non-convict). The study dealed with a total of 153 person from both group and they were sampled from Erbil Central Prison and Erbil Juvenile Prison, as well as from various location within Erbil district as control group. The results indicated that prisoners have more dental problem than others and it was found that number of smokers are much more within jails and generally they have lower standard of education. However a qualified dental team should be prepared to provide an optimum dental treatment to prisoners. More detail investigation in this respect is needed for dental aspects of the country.

Keywords: Dental health, Caries, Smokers, Convict people, Erbil Prison.

 Introduction

According to World Health Organization (WHO), the oral health regarded as a key indicator of general health, comfort and quality of life. It comprises a range of diseases and conditions that include dental caries, Periodontal disease, Tooth loss, Oral cancer, Oral manifestations of HIV infection, Oro-dental trauma, Noma and birth defects such as cleft lip and palate. However, the Global Burden of Disease Study in 2017 had expected that oral diseases may affect 3.5 billion people world-wide, in fact, the untreated dental caries were among the most prevalent non-communicable diseases (WHO, 2018).

Almost all oral health services in Iraq provided either by the Dental Schools or National Health Service (NHS), and private sectors. In fact, such services were developed significantly in Iraq mainly after 2003. During 2010, it was found that there were more than 5,900,000 dental visits in the primary dental care of the NHS. However all treatment were for securing the oral health which include, prevention, restoration, prosthodontics, orthodontic & surgical treatments (ALBUJEER & TAHER, 2017).

Oral health of people in general regardless being convict or not, nowadays are concerned with dental caries or cavities, also known as tooth decay which is a breakdown of teeth due to acids that result from bacterial activity (Silk, 2014). The cavities may possess a range of different colors from yellow to black (Laudenbach & Simon, 2014). Symptoms may include pain and difficulty with eating (WHO | Oral Health, 2012; Laudenbach & Simon, 2014). Complications may include inflammation of the tissue around the tooth, tooth loss, and infection or abscess formation (Venes, 2013). The present study were performed in order to find out the variation of different dental hygiene between convict and other people, taking in consideration the age as well as the gender, and the level of education of two groups of samples from prisoner and outside prisoner.

In general, prisoners everywhere have high rates of chronic and blood-borne diseases, mental and psychological illnesses and dental diseases (Reddy et al., 2012). They usually come from disadvantaged groups with less education, higher unemployment rates and lower chances of adopting healthy practices, finally they are among people who have no or a very little access to health care. Furthermore, their disease risk increases because of health damaging practices such as the use of tobacco, alcohol and substance abuse (Heidari et al., 2007). Therefore it is logic to find out that the time of their admission to prison, convicts usually are already present with a considerable amount of unmet dental treatment needs (Heidari et al., 2007; Walsh et al., 2008) which are unlike to receive the required attention. This latter situation could be attributed to many factors such as a lack of resources for dental treatment in the prison health care system and legality, or perhaps to the difficulties that face dentists to deal with the high security constraints in the prison environment. In addition, doctors in general are usually attracted to the more financially rewarding through private practice environment (Nobile et al., 2007; Walsh et al., 2008).

In fact the aim of the study mainly was, to determine the extent of distribution and prevalence of dental caries as well as oral hygiene status among convicts and general population in Erbil, Kurdistan region, Iraq. For the best of our knowledge, this study is the first attempt to fill up the existing gap of dental information in this respect within Kurdistan that will be definitely follow by more details investigation in coming years.

Methods

The present investigation was carried out for a period of fourteen month (November 2018 – January 2020). Samples were taken randomly from two groups of people (convict and non-convict people) each with not less than 75 people making up the total investigated people to 153 person. Samples of convict group were taken from Erbil main two prisons where as members of the second group involved random samples from different location within Erbil district.

The procedure used for present study was involved clinical examination for caries assessment for every person using WHO criteria 15 and the Decayed, Missing, and Filled Permanent Teeth parameter (DMFT) was recorded.  A disposable probe was used for this test. The second procedure was questionnaire as it shown down below through a direct interview with all members involved in the present study. It includes information about age, gender, education level, smoking, accessibility to case, and oral health problem in general and dental primary bleeding.  

Data Analysis

Using Chi square, the two groups were compared regarding background variables (age and education), cigarette smoking, using chewing tobacco, caries experience, dental pain, problems affecting daily activities, perceived need for treatment, bleeding on brushing, having decayed, and missing, filled teeth. Significance level was set at 5% (P ≤ 0.05). Statistical analysis was done using SPSS version 22

Results

Questionnaire and clinical examination data were prepared for 153 people i.e. 75 prisoners and 78 non-convict people in the comparison group (control group). However, some prisoners refused to complete some items in the questionnaire. These unanswered items were dropped during data analysis. The results indicated that the groups were nearly similar and clear to each other in respect to age, gender (P= 0.236 and P= 0.234 respectively). In fact, the total male people were only 103 within both groups whereas female represent 50 people only (Figure 1). However, in respect to the age it was found that more than 65% of the samples were between 29-59 years old and their total number was 102 out of the total 153 person enrolled during the present project.

 Figure 1: Comparison between the two study groups in gender.

Regarding educational level of both groups it was found that there was a significant difference (P< 0.0001) in case of group one (convict sample) half of them were either illiterate or only preliminary certificate holders whereas the number decline significantly within samples in group two ( non-convict people). The trend of the result change when considering higher level of education, the number decreased in case of convict group when contrasted with non-convict group, the comparison between the two study groups in education level is summarized in Figure 2

Figure 2: Comparison between the two study groups in respect to education level.

. Oral hygiene

In respect to oral hygiene investigation results indicate that daily smoking of cigarettes was higher within members of prisoners’ group than the control group (P< 0.00001). In which most of the convicts group were smoker (74.7%) 56 out of 75 samples examined whenever considering the absolute number, it seems that total number of smoker are quite close to non-smoker people (Table 1) while in comparison with control group only (29.5%) were found to be smoker (Table 1).

Table 1: Comparison between the two study groups as with regards regard to smoking.

Caries experience

Table 2 shows the comparison between the two study groups in caries experience. The percentage of comparison group (within non-convict) with carries was higher than the convicts group, but these differences were not statistically significant (P= 0.542). Regarding the missing teeth, the results was contrary to the caries experience, in which the missing tooth was higher in convicts group than the comparison group but these differences was not statistically significant (P= 0.089).

Table 2: Comparison between two study groups regarding dental problems.

Although there are noticeable differences among smokers and non-smokers regarding dental carries, the results showed no significant differences among the two groups (P= 0.374) (Table 3).

 Table 3: comparison among smokers and non-smokers regarding dental carries.