JICDRO is a UGC approved journal (Journal no. 63927)

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Year : 2009  |  Volume : 1  |  Issue : 3  |  Page : 6-11

Effect of duration of mishri application on periodontitis

Department of Periodontics & Oral Implantology, Pravara Institute of Medical Sciences, Rural Dental College, Loni, India

Date of Web Publication23-Feb-2011

Correspondence Address:
Ameet Mani
Department of Periodontics & Oral Implantology, Pravara Institute of Medical Sciences, Rural Dental College, Loni
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Source of Support: None, Conflict of Interest: None

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Aim: Adverse effects of varieties of culturally integrated form of tobacco on periodontium have been studied in recent era. The purpose of the present study was to evaluate the effect of duration of mishri on clinical attachment loss in people using mishri as dentifrice.
Materials and Method: A total number 60 patients were divided into those using mishri for less than 5 years (Group 1), between 5-10 years (Group 2), more than 10 years (Group 3). Clinical parameters like Probing depth, Recession, Clinical attachment level were measured using Florida probe. It was observed that Group 1 patients had less attachment loss in comparison to Group 3. Whereas Group 3 patients had more clinical attachment loss than Group2 and Group 1.
Conclusion: Thus it was noticed that the effect of duration of using Mishri was directly proportional to clinical attachment loss of periodontium.

How to cite this article:
Mani A, Marawar P P, Shah S, Thorat V. Effect of duration of mishri application on periodontitis. J Int Clin Dent Res Organ 2009;1:6-11

How to cite this URL:
Mani A, Marawar P P, Shah S, Thorat V. Effect of duration of mishri application on periodontitis. J Int Clin Dent Res Organ [serial online] 2009 [cited 2022 Jan 28];1:6-11. Available from: https://www.jicdro.org/text.asp?2009/1/3/6/77006

   Introduction Top

Periodontitis is one the most common type of periodontal disease. Various etiological factors have been proposed that are responsible for periodontitis including plaque, calculus, systemic diseases and habits like smoking, betel nut and tobacco chewing.

The use of tobacco is widespread. Varieties of culturally integrated forms of tobacco are available [1] . Tobacco products are divided into two broad categories:

  1. smoking tobacco like cigarettes, bidi, cigar.
  2. smokeless tobacco like tobacco plug, snuff, dentifrices etc.

In 1986, the Surgeon General concluded that smokeless tobacco is an addictive drug sharing many qualities with other drugs of abuse such as morphine and cocaine. Smokeless tobacco can be used to deliver psycho-active and dependence-producing levels of nicotine [2] . Tolerance develops with repeated use, causing the user to increase nicotine dosing through increased use and/or switching to products with higher nicotine yields [2]

There have been lot of research regarding effect of smoking on periodontium. But very few studies had been done to evaluate the effect of smokeless tobacco on periodontium. Mishri is a form of smokeless tobacco which contains burnt tobacco [1] . It is a black powder obtained by roasting and grinding tobacco on a hot metal plate until it is uniformly black & is most commonly used as a method of oral hygiene maintenance in rural Maharashtra especially by women [1] . Women, who use it to clean their teeth initially, soon apply mishri several times a day. In a survey of 100,000 individuals in a rural area, 22% were mishri users; the prevalence was 39% among women and 0.8% among men [3] .

The aim of this study is to evaluate the effect of duration of mishri used as dentifrice on clinical attachment loss in people using mishri.

   Materials & Method Top

All the patients selected in the study were taken from the OPD, Dept. of Periodontics, Rural Dental College, Loni. The study procedure was explained to each patient & informed consent taken from them.

Inclusion criteria

  1. Patients using mishri for less than 5 years
  2. Patients using mishri from 5 years to 10 years
  3. Patients using mishri for more than 10 years
Exclusion criteria

  1. Subjects using other forms of tobacco

   Study Design Top

A total of 60 subjects were included in the study, those who used mishri for less than 5 years (n=27), from 5-10 years (n=19) and for more than 10 years (n=14), out of which 28 were males & 32 were females. The subjects were divided into three groups according to the duration of mishri application [Table 1] and Loss of clinical attachment level [Table 2].
Table 1: Study Group According To Duration Of Use Of Mishri

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Table 2: Study group distributed according to the loss of clinical attachment level

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   Clinical Parameters Top

For each patient clinical periodontal parameters like

  1. Probing Pocket depth (PD),
  2. Recession
  3. Clinical attachment level (CAL) was measured using Florida probe.
Data was sent for statistical analysis

   Statistical Analysis Top

The association between the duration of use of mishri and clinical attachment level of the three groups was determined by Pearson's chi-square analysis. P value of

   Result Top

[Table 1]shows distribution of three groups according to the duration for which mishri was used and [Table 2] shows clinical attachment loss.

[Table 3] summarizes the association between duration of mishri and clinical attachment loss. There were 20 subjects of group I who had a clinical attachment loss of 1-2mm, whilst only 2 subjects showed a clinical attachment loss of more than 3mm of the same group. i.e. around 74.07% from group I have CAL of 1-2mm.
Table 3: Association between Duration of use of Mishri and CAL

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There were 10 subjects of group III who had a clinical attachment loss of more than 3mm, whilst only 2 subjects showed a clinical attachment loss of less than 1-2mm of the same group. i.e. around 71.42% had CAL of more than 3mm.

Clinical attachment loss was also on the greater side in group II. Around 8 subjects had CAL of 2-3mm and 7 subjects had CAL of more than 3mm.

Further statistical analysis involved a chi-square analysis of [Table 3] which showed highly significant association between duration of use of mishri and CAL.

From [Table 4], it is seen that there is positive correlation between duration of use of Mishri (in years) and CAL values (in mm). It means if duration of use of Mishri increases, values of CAL also increase. By applying Student's `t` test this correlation is highly significant. (P<0.01).
Table 4: Correlation between loss of clinical attachment level and no. of subjects

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   Discussion Top

In this study we have analyzed that the duration of mishri used directly correlates with clinical attachment loss seen in subjects using mishri as a dentifrice. Subjects using mishri for less than 5 years showed less clinical attachment loss as compared to that seen with subjects using mishri for more than 10 years. In India the misconception is widespread that tobacco is good for teeth. Prevalence varies in different parts but minimum seems to be 15% and goes up to as high as 84% in rural areas [4] . Prevalence is more in socially and economically disadvantaged group [4] .

Gingival recession and loss of attachment are the most common sequel of smokeless tobacco users. The risk is up to nine times higher in smokeless tobacco users than in non users [4] . Recession occurs even with adequate plaque control and the gingiva may not regenerate even after cessation of habit [4] .

In vitro studies have demonstrated that tobacco extracts affect monocytes, oral keratinocytes and production of inflammatory mediators, which may play a role in the development of these localized tissue alteration. The use of smokeless tobacco has been reported to cause tooth decay [7] and discolouration of dental restorations [8] . Chewing tobacco, in particular, is associated with an increased risk for dental caries because of higher sugar content, increased gingival recession, and enhanced collagenase activity. Abrasive particles in chewing tobacco may contribute to significant dental attrition, which may require dental restoration in advanced cases [9],[10] . Cross-sectional studies have suggested that smokeless tobacco users with co-existing gingivitis have high rates of gingival recession, mucosal pathology, and dental caries [11] .Smokeless tobacco has also been associated with irreversible gingival attachment loss resulting in root exposure [12] .

Furthermore there is a vicious triad of improper cleansing of teeth & initiation & progression of periodontal disease due to use of mishri.

   Tobacco Litigation Top

Dealing with tobacco-caused diseases requires an understanding of the companies that manufacture and market tobacco products, and an examination of how to shape the behavior of these companies [5] . Since these corporations are created by law, and seek to maximize value for their owners within the constraints that laws place on the marketplace, it is only natural that a very significant part of tobacco control activities will consist of legal strategies [5] .The 1992 amendment to India's Drugs and Cosmetics Act 1940 barred the use of tobacco as an ingredient in any toothpaste or toothpowder [6] . We carried out our study 16 years after the law had been amended and found that regulations have not been implemented adequately.

   Conclusion Top

Our study suggests definite correlation between use of mishri and health of gingiva and periodontium. Gingival recession, loss of attachment, discoloration of teeth, halitosis, tooth abrasion and habituation are most commonly associated with long term use of mishri. However further research work is required in this field. Proper implementation of law and patient's education regarding ill effects of mishri and proper brushing technique are required.

   References Top

1.Prakash C. Gupta, Ray Cecilys. Smokeless tobacco and health in India and South Asia. Respirology.8 (4):419-31. December 2003   Back to cited text no. 1
2.Henningfield JE, Fant RV, Tomar SL. Smokeless tobacco: an addicting drug. Adv Dent Res. 11(3):330-5. September 1997   Back to cited text no. 2
3.Prakash C. Gupta. Health consequences of tobacco use in India. World Smoking Health 1988; 13:5-10.   Back to cited text no. 3
4.John G.Spangler, Paul Lee Salisbury, III. Smokeless tobacco: epidemiology, health effects and cessation strategies. American Family Physician, October 1995   Back to cited text no. 4
5.Sweanor, David. Legal strategies to reduce tobacco-caused disease. Respirology.8 (4):413-418, December2003.   Back to cited text no. 5
6.D N Sinha, P C Gupta, MSP. Use of tobacco products as dentifrices among adolescents in questionnaire study. British Medical Journal.vol 3282(7435); 323-24.February2004   Back to cited text no. 6
7.Tomar SL, Winn DM.Chewing tobacco use and dental caries among US men. J Am Dent Assoc 1999; 130:1601-10.   Back to cited text no. 7
8.Walsh PM, Epstein JB. The oral effects of smokeless tobacco. J Can Dent Assoc 2000; 66:22-5   Back to cited text no. 8
9.Bowles WH, Wilkinson MR, Wagner MJ, Woody RD. Abrasive particles in tobacco products: a possible factor in dental attrition. J Am Dent Assoc 1995; 126:327-31; quiz 138.   Back to cited text no. 9
10.Milosevic A, Lo MS. Tooth wear in three ethnic groups in Sabah. Int Dent J 1996; 46:572-8   Back to cited text no. 10
11.Offenbacher S, Weathers DR. Effects of smokeless tobacco on the Periodontal, mucosal and caries status of adolescent males. J Oral Pathol 1985; 14:169-81   Back to cited text no. 11
12.Ernster VL, Grady DG, Greene JC, Walsh M, Robertson P, Daniels TE, et al. Smokeless tobacco use and health effects among base ball Players. JAMA 1990; 264:218-224  Back to cited text no. 12


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


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    Materials & Method
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