Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : ZC01 - ZC07 Full Version

Comparison of Stress and Periodontal Health Status among Individuals Practicing Yoga with Age and Gender Matched Controls in Hyderabad City


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/50803.15826
Siva Kumar Patanapu, Nagarani Veeraboina, Swetha Meruva, Syeda Farha Fatima, Sunkari Nikhitha, Kandadi Vasavi Reddy, Sreenivas Voruganti, Vangala Veda Naga Priya

1. Assistant Professor, Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketpally Nalgonda, Hyderabad, Telangana, India. 2. Senior Resident, Department of Public Health Dentistry, Positive Dental Pvt. Ltd., Dilsukhnagar, Hyderabad, Telangana, India. 3. Junior Resident, Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketpally Nalgonda, Hyderabad, Telangana, India. 4. Junior Resident, Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketpally Nalgonda, Hyderabad, Telangana, India. 5. Junior Resident, Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketpally Nalgonda, Hyderabad, Telangana, India. 6. Senior Resident, Department of Public Health Dentistry, Clove Dental, Secunderabad, Hyderabad, Telangana, India. 7. Senior Resident Doctor, Department of Public Health Dentistry, SVR Dental Hospital, Nalgonda, Telangana, India. 8. Junior Resident, Department of

Correspondence Address :
Nagarani Veeraboina,
Mansoorabad, LB Nagar, Hyderabad, Telangana, India.
E-mail: shivakumarkittu@gmail.com

Abstract

Introduction: Stress, the most basic psycho-social factor causes disruption of a person’s physiological as well as psychological well-being. Yoga originated in India thousands of years ago, is a primordial philosophical system aimed at bringing harmony to the individual’s physical, mental, and emotional aspects.

Aim: To examine and compare the stress and periodontal health status of yoga practitioners in Hyderabad city with age and gender matched controls.

Materials and Methods: This case-control study was conducted on 278 subjects by the Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketpally Nalgonda, Hyderabad, Telangana, India from August 2019 to January 2020. Out of the selected subjects, 139 were the cases, aged between 25-40 years, who were practicing yoga in hyderabad city regularly while 139 were age and gender matched controls, selected from general population, not practicing yoga. The survey tool comprised of the Perceived Stress Scale (PSS developed by Cohen S et al.,). Oral health status was recorded using the World Health Organisation (WHO) Basic Oral Health Survey Assessment Form of 2013. The data was analysed using version 21.0 of the Statistical Package for Social Sciences (SPSS). Statistical significance was set at p≤0.05.

Results: The total of 278 subjects (139 cases; mean age 28.30±7.73 years and 139 controls; mean age 29.25±7.73 years) were included. Both the genders in the control group had noticeably elevated mean scores for caries status (1.50±0.59), periodontal status (3.69±0.57) and Loss of Attachment (LOA) (code 1: 1.63±1.33) and overall PSS score (1.81±0.60) compared to cases. The difference in periodontitis (p-value=0.05), OHI-S (Simplified Oral Hygiene Index) scores (p-value <0.001), PSS scores (p-value <0.001) and gingival scores (p-value <0.001) was found significant. A similar trend was noted when compared with both males and female regarding OHI-S and gingival scores but the difference was statistically non significant. The PSS score difference was found significant with age (p-value=0.02), gender (p-value=0.02) and subjects who were practicing yoga regularly (1.67±0.69) (p<0.001) as compared to controls. However, all age groups who were not practicing yoga reported with poor periodontal health with high LOA scores compared to practitioners and no significant association was found between perceived stress and method (p-value=0.22) or frequency (p-value=0.17) of cleaning their teeth.

Conclusion: This study finding is extremely important for Indian population, where more than 50% of the population is suffering with gum diseases due to stress. Hence, suitable preventive and treatment approaches are endorsing to combat from the stress and periodontal disease. Therefore, yoga is effective in prevention of oral diseases and maintenance of personal as well as oral hygiene and healthy gingiva by improving the lifestyle, reducing the tension and periodontal inflammation.

Keywords

Oral Hygiene, Perceived stress, Periodontal disease, Quality of life

Oral health is a key indicator of overall health, well-being, and quality of life (1). Besides general health conditions, dental diseases continue to be a significant public health problem across the globe (2). Dental caries and periodontal diseases are among the most common oral health problems that affect the human population at high prevalence rates (3). In addition to various pathological factors, diet, lifestyles, psycho-social factors like anxiety, stress, and depression can also cause oral diseases.

Stress, the most basic psycho-social factor causes disruption of a person’s physiological as well as psychological well-being (4),(5). According to Lewith GT et al., stress is “the disruption of a person’s biological, psychological and social dimensions as a result of environmental challenges or perceived threat” (6). An individual experiences stress in response to changes in the ecological factors and arrange to achieve healthy living. Meanwhile, one’s sense of well-being is maintained within acceptable limitations, but if these stimuli exceed typical limits, they become stresses (5).

However, individuals who experience long-term stress can cause elevated amounts of cortisol, a stress hormone that can weaken the immune system. Therefore, this weak defense system favors the microorganisms to colonise in the oral cavity causing various diseases (7). Oral symptoms of stress include canker sores, dehydration, burning mouth syndrome, bruxism, halitosis, etc.,(8). Many researchers found that stress is a potential risk factor for periodontal disease and it modulates host response to bacteria as well as influences the progression of disease (8),(9),(10),(11),(12).

Yoga originated in India thousands of years ago, is a primordial philosophical system aimed at bringing harmony to the individual’s physical, mental, and emotional aspects (13),14]. Because of its greater effectiveness and lack of associated side effects, it is considered a popular stress-relieving therapy (15). Numerous yoga studies have demonstrated that, it can be beneficial for a broad spectrum of health conditions, including psychological well-being (anxiety, depression, stress response) (16),(17),(18),(19),(20).

However, yoga does not treat a specific disease or a specific symptom but it treats the individual’s entire system (physical body, breathing, mind and emotions) (15). By practicing Asanas (exercise postures), pranayama (breathing techniques), and meditation, one can achieve this. In recent years, data from randomised controlled trials suggested that yoga reduces symptoms of anxiety and depression and also has a significant effect on oral environment (5),(16). Research has shown that people who are stressed are more likely to neglect their dental care (3),(13),(14). Stress on the jaw muscle can lead to jaw clenching and teeth grinding. It can also shift the jaw, which can affect the alignment of the teeth and cause decay and periodontal disease. Therefore, the holistic application of yoga to clinical practice can provide health benefits that go beyond traditional treatment.

A previous study observed the effectiveness of yoga in maintaining oral hygiene and preventing dental problems, but found no strong evidence of a link between periodontal disease and yoga (3). Different types of studies have looked into the link between yoga and dental health, but the results have been ambiguous (3),(13),(14),(15),(16). Only a few studies have explored the impact of yoga on stress management (13),(14),(15),(16), but there is no study that evaluates and compares stress and oral health between yoga and non yoga practitioners. As a result, the current study was planned to compare the stress and periodontal health status of yoga practitioners to age and gender matched controls.

Material and Methods

The present case-control study was conducted in the Department of Public Health Dentistry, Kamineni Institute of Dental Sciences (KIDS), Narketpally Nalgonda, Hyderabad, Telangana, India, for a period of six months from August 2019 to January 2020. The survey was conducted within the working hours of the yoga centers (generally in morning hours). Approval for the study was obtained from the Institutional Review Board (KIDS/IEC/PHD/2019/02). Subjects interested to participate completed the consent form after being informed about the study protocols and agreed to participate.

Inclusion criteria

Cases: Those subjects aged 25-40 years (divided into three age groups as 25-30, 31-35, and 36-40 years) and individuals who practice Yoga regularly in Hyderabad city were included as cases in the study.

Controls: The age and gender matched subjects selected from the general population who were not practicing Yoga were included as controls.

Exclusion criteria: Subjects with any systemic conditions affecting periodontal status that required antimicrobial prophylaxis before clinical examination (herpes simplex infection, rheumatic fever, infective endocarditis, or prosthetic joint infection), patients on recent medication (antibiotics and immunosuppressant), and subjects who had received oral prophylaxis in the previous three months were excluded from the study.

Sample size calculation: The sample size was calculated using periodontal health status in both groups, with a 95 percent confidence interval and 90 percent power, and a 10% dropout rate. Based on previously published preclinical investigations, it was determined that a minimum of 123 participants were required (3),(5),(11),(12),(13),(14). Alpha error=5%, Beta error=90%, Standard Deviation=9, Precision=2, sample size obtained was minimum of 123 subjects in each group. Hence, 278 subjects were included in present study (139 subjects in each group) by employing stratified random sampling method.

The Greater Hyderabad Municipal Corporation (GHMC) provided a list of zones in Hyderabad (south, north, east, west and central zone). To ensure that each zone received an equal amount of samples, the final sample was divided into five zones (278/5=55.6), resulting in about 55 individuals. Because there are five zones, the study required a total of ten yoga centres (2×5 zones) be included in the study.

Procedure

The survey tool comprised of the Perceived Stress Scale (PSS) developed by Cohen S et al., and demographic details like age, gender, history of yoga practice was obtained (21). A higher PSS score reflects a larger degree of felt stress by an individual. The overall PSS score was calculated as the sum of ten elements, ranging from 0 to 40. Moreover, it has an excellent internal consistency and test retest reliability (α=0.78). In addition, Cronbach’s alpha ranged from 0.64 0.86 as validated through various studies (10),(11),(12),(21).

In clinical oral examination, oral hygiene status was assessed using Simplified-Oral Hygiene Index (OHI-S) by Greene JC and Vermillion JR (1964) (22). Dentition status was recorded based on the codes and criteria according to World Health Organisation (WHO) Basic Oral Health Survey Assessment Form, 2013 (23). While periodontal condition (gingival bleeding and pocket) was assessed using Community Periodontal Index (CPI) modified and Loss of Attachment (LOA) according to WHO criteria 2013 (23).

Loss of Attachment (LOA)- codes (23)

0=0-3 mm
1=4-5 mm Cemento-Enamel Junction (CEJ) within black band
2=6-8 mm CEJ between upper limit of black band and 8.5 mm ring
3=9-11 mm CEJ between 8.5 mm and 11.5 mm ring
4=12 mm or more CEJ beyond 11.5 mm ring
X=Excluded sextant
9=Not recorded

Statistical Analysis

Statistical analyses were done using Statistical Package for Social Sciences Software (SPSS version 21.0). Chi-square test was used to find the significant difference between two or more variables. Mann-Whitney U test, Analysis of Variance (ANOVA) was used for comparison of mean scores of all variables based on age and gender. The Crude Odds ratio and adjusted odds ratio were calculated for cases and controls. The variables adjusted were age, gender, dental visit, history of yoga practice and oral hygiene practices. Logistic regression was also applied to see association between cases and controls for the oral parameters (OHI-S, Caries Status, Gingivitis, Periodontitis and LOA). Statistical significance was set at p≤0.05.

Results

In the present study, the mean age of the cases was 28.30±7.73 years and for controls was 29.25±7.73 years. The controls were pair-matched for age and gender and an equal number of controls were taken in each age group similar to that of cases. The bulk of the study participants (124; 44.60 percent) were in the age group of 31-35 years, with 84 (30.22 percent) in the age group of 36-40 years and 70 (25.18 percent) in the age group of 25-30 years.

Among total population, females were 142 (51.08%) and males were 136 (48.92%). In both case and control groups, the majority had never visited the dentist in past six months (cases-83; 59.21% and controls- 97; 69.78%). Regarding the history of yoga practice among cases, around 41% of subjects practicing yoga since three years and only a small percentage of subjects (17.27%) practicing yoga regularly for more than three years (Table/Fig 1). With regard to oral hygiene practices, almost the entire population cleaned their teeth once (cases- 135; 97.12% and controls- 133; 95.68%) with majority using toothbrush and toothpaste (cases-127; 91.37% and controls- 119; 85.61%).

On the subject of the perceived stress scale, subjects who were not practicing yoga had a significantly higher mean score (1.81±0.60) compared to subjects who were practicing yoga regularly (1.67±0.69) (p<0.001).

When mean PSS scores were examined by age group, the 25-30 years old group showed a substantially higher mean score (1.91±0.66) than the 31-35 year (1.73±0.64) and 36-40 year (1.62±0.64) with p-value=0.02. Likewise, significant gender difference (p-value=0.02) was also observed, with females (1.83±0.60) having a higher mean PSS score than males (1.60±0.69). (Table/Fig 2).

The majority of the study population had (48.5%) poor oral hygiene. However, more number of the study population had fair Debris Index-Simplified (DI-S) (123; 44.2%) and Calculus Index-Simplified (CI-S) (115; 41.3%) scores. When cases and controls were compared, it was noted that a higher proportion of cases (76; 27.3%) had fair DI-S and OHI-S (96; 69%) scores whereas more number of controls had poor scores for the same (DI-S=59; 42.4% and (OHI-S=105; 74.1%). These differences were statistically significant (p<0.001 and p<0.001, respectively). However, comparable mean Calculus Index- Simplified scores were noted among the subject who were practicing yoga and those who do not (Table/Fig 3).

On the whole, controls ensured higher mean score for all oral parameters than cases and the difference was significant except for gingival (p=0.22) and Caries status (p=0.67). Regarding LOA score, subjects who do not practice Yoga had significant higher mean score for code 1 (1.63±1.33; p<0.001) and code 2 (1.18±1.25; p=0.004) than who do yoga (Table/Fig 4).

All control age groups (25-30 years=1.94±0.64, 31-35 years=1.80±0.57, and 36-40 years=1.74±0.60) showed substantially higher mean PSS scores than cases (p<0.001) in the same age group. No significant group difference was found for OHI-S scores among all ages (p>0.05). Regarding caries status, all age groups in controls showed higher mean score than cases but the difference was insignificant. A similar trend was observed for gingival status but the significant difference was noted with age group 36-40 years only (p=0.05). As it came to periodontal health, controls of all ages reported poor periodontal health with high LOA scores when compared to cases, however only the age groups 31-35 (p=0.02) and 36-40 (p<0.001) showed a significant difference.

The mean scores of all oral measures increased significantly (p<0.05) with increasing age, according to intragroup comparisons within patients and controls. As a result, in both the case and control groups, patients aged 36-40 years reported significantly higher mean scores for all oral indicators, indicating poor oral health. In contrast, mean perceived stress scores were significantly reduced as age of the subjects increased in both case (p=0.003) and control group (p=0.04) (Table/Fig 5).

When compared to patients, both males and females in the control group had significantly higher mean scores for oral parameters (caries status, periodontal state, LOA) and overall PSS score compared to cases (p≤0.05). A similar trend was noted regarding OHI-S and gingival scores but the difference was not statistically significant.

Among cases, males had significantly higher mean scores for all the parameters but the difference was statistically significant for OHI-S (p<0.001), periodontal disease (p=0.006) and LOA scores (p=0.003) compared to females. In contrast, females (1.73±0.67) perceived significantly more stress than males (1.51±0.70) among cases (p=0.03).
Within controls, however, there was a significant gender difference, with males having a higher mean score (3.73±0.53, p<0.001) for periodontal disease and LOA score (1.95±1.17, p<0.001) than females. In contrast, females (1.33±0.53) showed a significantly higher mean OHI-S score than males (1.09±0.53) (p<0.001). Furthermore, overall mean PSS, caries and gingival scores were comparable among males and females in control group (Table/Fig 6).

Risk factors, age (p=0.004), gender (p<0.001) and years of practicing yoga (p<0.001) showed a significant effect on individual’s oral health. In the present study, subjects aged 25-30 years in the control group were at 1.01 times higher odds for developing dental diseases compared to other age groups. However, after adjusting for other variables, the age group 25-30 years reported to have lower and significant association {Odds Ratio (OR)=0.28; p=0.004}.

Cleaning teeth using alternative hygiene aids (such as neem sticks, miswak, and so on) was associated with a decreased risk of acquiring oral disorders (OR=0.71), but when adjusted, it was associated with a 1.15 times higher risk of developing dental problems. Subjects who cleaned their teeth less frequently had a 3.13 times higher risk of poor oral health (OR=3.38; adjusted OR=2.54), but there was no significant difference between cases and controls in terms of the manner or frequency with which they cleaned their teeth (p>0.05).

A similar situation was observed when association between gender and stress was evaluated, wherein females were at higher odds (OR=1.02) of developing the stress compared to males, but after adjusting, a lower significant association was noted (OR=0.82; p<0.001). When it came to dental visits, controls without a history of dental visits had a 1.63 times higher risk of acquiring stress than those who had a history of dental visits. Even after controlling for other variables, this result remained.

Subjects who did not practise yoga had a 3.38 times higher odds of developing stress than those who did. Conversely, after adjusting for other variables, controls showed significantly lower association (adjusted OR=2.54) compared to subjects who practicing Yoga regularly (p<0.001) (Table/Fig 7).

When oral hygiene was taken into account, controls had a higher likelihood of having poor oral hygiene than cases who had good and fair oral hygiene (OR=5.23).Even after adjusting for other variables, subjects who are not practicing yoga were more likely to have poor oral hygiene (adjusted OR=2.30) (p<0.001).

Taking periodontal status into account, controls showed significantly (p<0.001) higher risk of developing periodontal diseases compared to cases (OR=3.38) but after adjusting the risk of association reduced (adjusted OR=2.54). Likewise, subjects who were no practicing yoga were at higher odds of developing LOA ≥9mm (code 3, 4) (OR=11.31). However, the risk of association was lowered after adjustment (adjusted OR=6.46) (p<0.001) (Table/Fig 8).

Discussion

One of the major causes of dental diseases is mere ignorance towards oral hygiene practices and lack of knowledge for the proper maintenance of the oral cavity. In addition to these, poor lifestyle habits play a major role in substandard oral hygiene (3). Modern industrious and civilised lifestyles result in increased levels of stress leading to various health problems including dental. Chronic elevations of stress hormone may lead to the immune system becoming resistant leading to poor defence mechanisms, thereby increasing oral infections (7),(24). Investigations have also shown that stressed people are also more likely to neglect their oral hygiene, which can lead to caries and periodontal disease (7),(8),(9),(10).

Yoga, originated in India, helps in relieving both mental and physical infirmities. Despite the fact that it was performed in ancient India 5000 years ago, it has only recently gained widespread popularity (3). It is thought to help with a variety of mental and physical ailments, including schizophrenia, depression, anxiety, and post-traumatic stress disorder (PTSD) (25),(26). Yoga has been shown to reduce stress and anxiety while also improving a person’s quality of life (24),(27), Hence, these beneficial effects of yoga were helpful in preventing oral diseases associated with stress.

The psychological determinant of health has always been underplayed, yet emerges as a significant factor in various diseases (26). Physical exercise, on the other hand, is a key component in reducing inflammation, and those who are physically active have lower inflammatory markers than those who live a sedentary lifestyle (24). Yoga incorporates mind-body relaxation techniques and helps to control stress-related alterations (3). As a result, the primary goal of this research was to see how effective yoga is at maintaining oral hygiene, preventing dental disorders, and reducing stress.This is the first case-control study that considers independent oral health benefits related with yoga practice and samples drawn from the general population. Earlier research (3),(24),(25),(26),(27) focused on the influence of yoga on chronically ill persons and the usefulness of yoga in a variety of systemic illnesses.

Among the total study population, females were 51.08% (n=142) and males were 48.92% (n=68) in each case and control group. However, almost equal number of male and females were included in case, which indicates that the interest of practicing yoga were parallel in both males and females. Most of our lives today are so busy because of workload, scheduled plans, lifestyle choices, and priorities that it gives minimum time for healthy practices (28). It has been noted in this study that around 41% of subjects have been practicing yoga for three years and only a small percentage of subjects (17.27%) have been practicing yoga regularly for more than three years.

Subjects who practised yoga on a regular basis had lower stress levels than those who did not. Similarly, Malathi A and Damodaran A assigned 50 stressed Indian medical students to yoga or a non intervention control group, finding showed that yoga group’s sense of well being improved as a result of the reduced stress (20). Moreover, subjects aged 25-30 years perceived higher stress compared to other age groups. It may be fact that the, younger people have academic or personal competition in career and education (29). A study conducted by Singh K et al., among young individuals in Uttarakhand found similar results (3). Furthermore, significant gender difference (p=0.02) was noted with high levels of stress among females. This suggests that women take on more responsibilities at work while retaining their responsibilities at home. Similar findings were noted with a study done by Kiecolt-Glaser JK et al., among 30-45-year-old women of USA and Al-Sowygh ZH among Saudi female students of King Saud University (27),(30).

Taking oral hygiene into account, subjects who practice yoga had fair oral hygiene status and those who did not practice had poor oral cleanness in current study. Mechanical plaque control, on the other hand, is dependent on the individual’s lifestyle, such as sleeping in late, not having enough time to clean one’s teeth, delay wake up in the morning, and so on. However, individuals who follow a yogic lifestyle get up early in the morning for yoga in order to clean their teeth (31). However, more number of controls was at high risk of developing caries, periodontitis and LOA ≤9 mm (code 1, 2) than cases. Similarly, a study conducted by Kiecolt-Glaser JK et al., among 50 healthy women in Ohio and Sudhanshu A et al., on 80 women in New Delhi, concluded that yoga can help you improve your lifestyle, relieve stress and reduce gingival inflammation (27),(32). Psychological stress and yoga are supposed to be reciprocally related. Yoga provides a variety of options for managing one’s overall health, including stress reduction and the prevention of autonomic deregulation. Reduced perceived stress levels lead to fewer negative anxiety and depression feelings, a higher sense of well-being, and increased sensory-motor function (28).

In the current study, stress among study population declines as age increases in both yoga as well as non yoga group but mean PSS score were higher among controls than cases for all ages. Similar findings were noted by Streeter CC et al., among 34 subjects in Boston, USA and Shohani M et al., among 52 women living in Ilam, Iran (31),(33). They discovered that practicing yoga poses is linked to higher levels of G-Aminobutyric Acid (GABA) in the brain, which leads to better mood and less stress.

When the complete study sample was considered as a whole, independent of the cases and controls, it was discovered that oral health and periodontal status deteriorated with age (p<0.001). This could be due to the fact that younger people are more concerned about their appearance in both a personal and social setting, and hence are more likely to practice good dental hygiene. In contrast, mean perceived stress scores were significantly reduced as age of the subjects increased in both groups (p<0.001). Significant data suggests that older people have fewer life experiences and rate them as less stressful than younger people (30).

A remarkable observation of the present study was that, all age groups who were not practicing yoga reported with poor periodontal health with high LOA scores (p<0.001) compared to practitioners. This was in accordance with the systematic review by Woodyard C; and stated that yoga is a more natural way of life that aids in the prevention of dental and soft tissue disorders of the oral cavity that are caused by life’s pressures (34). In this study, it was observed that both males and females in the control group had high stress levels and poor periodontal health compared to cases because stress decreases the blood supply to the teeth and gums as a result of which teeth become unhealthy and weak (35). These findings were in accordance with the case control design by Seltmann CL et al., in USA and a systematic review by Jayawardena R et al., (36),(37).

In the current research, female yoga practitioners perceived more stress than male practitioners. It may be due to a completely different women hormonal system, female sex hormones decrease the sympathoadrenal and Hypothalamic-Pituitary-Adrenal (HPA) axis (e.g., cortisol) responsiveness. This causes sluggish cortisol feedback in the brain, as well as reduced or delayed control of the stress response, causing them to react more emotionally and become emotionally weary (35). In contrast, Bhattacharya S et al., found low stress reduces inflammation and improve oxidative status and immunity of the body among male yoga experts (38). In the present study, subjects without practicing yoga and no history of dental visit were higher risk for developing stress and were more prone for oral diseases. However, Bussing A et al., revealed a linear relationship between yoga practice frequency and subjective health parameters in a cross-sectional investigation (39).

In the present study, when compared to other age groups, participants aged 25-30 years in the control group had a 1.01 times higher odds of experiencing stress. In contrast, data from 200 undergraduates and 84 mature adults was evaluated by Archer JA et al., observed that the link between stress and well-being and stress and health was significantly modulated by groups, however the association (OR=0.51) was weaker in older persons in both situations (40). However, health-related factors such as cognitive impairment, the coexistence of two or more chronic illnesses in the same person, and depressive symptoms may explain the rise in perceived stress levels as people get older. These findings are logical, as perceived stress has been linked to depressive symptoms, which have been shown to worsen with age (41).

In terms of gender, men controls had a higher risk of developing stress (OR=1.02) than female non yoga practitioners. The findings are unlike with the study by Sudhanshu A et al., among 15 to 45-year-old periodontal patients in New Delhi and stated that both females and males had comparable stress levels (32). It could be that females are more likely to show outward signs or to express that they are stressed. However, males may also be more likely to internalise their stress and not express it (42).

Plaque build-up, tooth decay, and gum disease are all caused by a dry mouth, which provides an environment where bacteria can thrive. Practicing yoga can stimulate the salivary glands and help to prevent your mouth and throat from drying out. Yoga positions like forward bends, twists, and inverted poses are believed to increase saliva production (3),(28). In current study, non yoga practitioners were significantly higher risk of developing dental diseases compared to cases. These findings were in line with the study by Singh K et al., among young adults in Uttarakhand (28).

Therefore, the present study highlights the effect of yoga on oral health through stress reduction. The study’s merits are its well-defined and pair-matched case and control groups. Other advantages include the exclusion of participants with systemic diseases, a major confounding factor for periodontal disease, and the allocation of regular yoga practitioners. However, several studies (29),(37),(38),(39),(40) have been done in the past to know the effect of yoga on stress and oral diseases but those entire samples were drawn from the individuals with systemic conditions (mental disorders, musculoskeletal disorder and cancer patients). Moreover, there is a need for more studies with larger number of people and other factors affecting oral health should be considered because they act as confounders.

Limitation(s)

The study reported here has several limitations like small sample size; most relevant socio-demographic and clinical factors were not matched between cases and controls and not consider the frequency, length and type of yoga practice. The survey used to assess the study participant’s oral hygiene but did not discuss periodontal probing radiographic screening to assess bone loss etc.

Conclusion

According to the findings of this study, stress and poor dental health play a significant impact in the occurrence of periodontal diseases. However, this study stated that there should be a direct or indirect effect of yoga on oral disease and it may be due to decrease stress levels and change in lifestyle patterns. This study’s findings are particularly significant for the Indian population; as more than half of the population suffers from periodontitis as a result of stress. As a result, to combat stress and periodontal disease, appropriate preventative and treatment techniques are recommended. Therefore, yoga is useful in the prevention of dental disorders as well as the maintenance of oral hygiene and healthy gingiva by enhancing one’s lifestyle, lowering stress, and reducing periodontal inflammation.

The future studies are recommended on a larger sample size, more planned case-control study with comparable socio-demographic and clinical characters along with explicitly different yoga techniques, may be exasperated in different cultures for the self-management of excessive stress, for better generalisability of the results. Such researches would throw more light on the generalisability of yoga practice and the reproducibility of the effect of yoga worldwide.

Acknowledgement

We would like to thank all of Hyderabad’s yoga studios, as well as the Kamineni Institute of Dental Sciences and Hospital’s Public Relations Officers for their participation in these activities and for conducting the screening throughout the public campaign. We would like to express our gratitude to the Yoga practitioners in particular for their passionate support.

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DOI and Others

DOI: 10.7860/JCDR/2022/50803.15826

Date of Submission: Jun 11, 2021
Date of Peer Review: Aug 11, 2021
Date of Acceptance: Oct 25, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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