Assessment Of Oral Health Status Of Lead Acid Battery Workers In Dhaka City Of Bangladesh A Cross Sectional Study

Journal of Dentistry and Oral Research Assessment Of Oral Health Status Of Lead Acid Battery Workers In Dhaka City Of Bangladesh: A Cross-Sectional Study. *Corresponding Author: Dr. Pranab Karmaker. Bangladesh Reference Institute for Chemical Measurements (BRiCM), Dhaka. Email: [email protected]. Received: 29-Apr-2026, Manuscript No. JODOR -5684 ; Editor Assigned: 30-Apr-2026 ; Reviewed: 19-May-2026, QC No. JODOR -5684 ; Published: 22-May-2026. DOI: 10.52338/jodor.2026.5684. Citation: Dr. Pranab Karmaker. Assessment Of Oral Health Status Of Lead Acid Battery Workers In Dhaka City Of Bangladesh: A Cross-Sectional Study. Journal of Dentistry and Oral Research. 2026 May; 17(1). doi: 10.52338/jodor.2026.5684. Copyright © 2026 Dr. Pranab Karmaker. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ISSN 2767-4037 Research Article Md. Fazlay Rabby 1 , Md. Shihabul Islam 2 , Md. Ziaul Islam 3 , Baizid Khoorshid Riaz 4 , Md. Abdur Rouf 1 , Sharmi Saha 1 , Tajnuva Mridula 1 , Fatima Siam 1 , Md. Farib Hasan 1 , Arup Kumar Saha 1 , Sabiha Kamal 2 , Diti Rani Das 5 , Pranab Karmaker 2* 1 Department of Dental Public Health, City Dental College and Hospital, Dhaka, Bangladesh. 2 Bangladesh Reference Institute for Chemical Measurements (BRiCM), Dhaka, Bangladesh. 3 Department of Community Medicine, National Institute of Preventive & Social Medicine, Dhaka, Bangladesh. 4 Directorate General of Medical Education (DGME), Mohakhali, Dhaka, Bangladesh. 5 Department of Pathology and Microbiology, Dhaka Dental College, Dhaka, Bangladesh. www.directivepublications.org Abstract Background: Oral health issues pose a significant health challenge in many countries all over the world. Exposure to harmful substances such as acid mists found in lead-acid battery factories can adversely affect the tissues in the oral cavity. Objectives: This study aims to investigate various oral health problems among lead-acid battery workers in Dhaka city of Bangladesh by considering different vital factors. Materials and Methods: A total 370 lead-acid battery workers from four different battery factories of Dhaka city were included in our present study and divided into two groups (study group and control group) based on acid or acid fumes exposure. Results: The findings of the current study suggested that a significant number of study participants had been suffering from dental caries (P value: <0.001), dental erosion (P value: <0.001), Sensitive teeth (P value: <0.001), gingivitis (P value: <0.001), oral ulcer (P value: <0.001), stained teeth (P value: 0.022) and mouth odor (P value: 0.048), in relation to their respective controls. Besides, some socio-demographic status including higher weight, obesity, illiteracy, lower family income, working with oral pipe, working >5 years, working >8 hours daily, brushing frequency, using no toothpaste, and some eating or drinking habits including low drinking water, regular intake of fast foods and soft drinks, taking betel leaf and betel nut, Jorda, oral tobacco and smoking were significantly related with oral health problems. Conclusion: A significant proportion of study participants experienced with various Oro-dental problems due to exposure to lead battery acid fumes. Keywords: Oral health, Battery workers, Dental erosion, Sensitive teeth, Oral ulcer, Gingivitis. INTRODUCTION Optimal oral health is crucial for overall well-being and enhancing quality of life. It involves in free from chronic mouth and facial pain, oral ulcers, gingivitis, sensitive teeth, tooth erosion, oral and throat cancer, oral sores, congenital conditions like cleft lip and palate, periodontal (gum) disease, tooth decay, tooth loss, and other related diseases and disorders [1]. Inadequate oral health during the early stages of life is strongly correlated with adverse oral health conditions that persist from childhood to adulthood and due to this problem individuals are continually susceptible to dental caries throughout their lifetime [2]. Previous researches have demonstrated a connection between oral health and various medical issues like early childhood caries (ECC) can lead to associated health complications, including hypertension and cardiovascular diseases obesity, COVID-19, diabetes mellitus, cancers, [3-8]. Oral diseases remain a public health problem for developed as well as developing countries, especially among the rural population. The World Health Organization (WHO) acknowledges the significant influence that oral health has on an individual's overall well-being, as well as on the collective health of populations. Consequently, WHO has prioritized the enhancement of oral health across all communities [9-10]. Oral health is an essential aspect of overall health, and its

Directive Publications Dr. Pranab Karmaker Page - 2Open Access, Volume 17 , 2026 significance is universally acknowledged. Numerous studies have documented the relationship between oral health and various systemic conditions, as well as its impact on quality of life. As evident from previous literature, governments and organizations in many developing countries have placed considerable importance on oral health [11-12]. It is well known that continuous exposure to acidic substances in an industrial setting can significantly harmful for teeth and oral tissues. Inhaling acidic mist in such environments can irritate the nose, mouth, and throat. This exposure can lead to the breakdown of the protective enamel and dentin layers of the teeth, making them vulnerable to acidic decalcification [13]. Moreover, exposure to acid mists may be linked to periodontal disease due to changes in intracellular and extracellular pH, which regulate cell growth and differentiation. These pH alterations can indicate the genotoxic effects and potential carcinogenicity of inorganic acids. Chronic tissue irritation by in organic acids can lead to more frequent infections like exposure to sulfuric acid triggers the immune responses, reducing phagocytic capacity and cytotoxic activity thar increases the chromosomal abnormalities in human lymphocytes [14-16]. Significant results were found that linked between dental erosion and the duration of acid exposure. A survey on 350 male workers at a Norwegian zinc extraction facility and a Japanese copper mine showed different caries patterns among those with dental erosion [17]. Besides, another study was carried out on 223 chromium induced electroplaters in Sao Paulo, Brazil, and the results found that approximately 50% of workers experienced with dental erosion and yellowing within less than a year of exposure [18]. A similar result was found in a case report in Jordan that patient had 20 years of working period in the chromium exposed occupation and this duration is high enough to result dental erosion [19]. The battery factories are the largest consumers of lead that utilizing approximately 80% of the global lead production. Around half of this lead production is issued to manufacturing lead-acid batteries. Additionally, 20% of lead production is used in various metal applications, such as cable sheathing, solder, ammunition, alloys, weights, ballast, and low-melting alloys [20, 21]. Lead compounds are utilized in a variety of applications including painting, stabilizing in glassware, ceramics, and plastics, manufacturing television tubes, and as antiknock additives in gasoline [22-25]. The most common forms of lead compounds are lead oxide (PbO) and lead tetra oxide (Pb3O4), which are used in the production of electric battery plates. However, these compounds are significant environmental and occupational pollutants due to their acidic nature [26-27]. Adults are predominantly exposed to lead in occupational place by means of inhaling lead particles and consuming lead contaminated water and food. Exposure to environmental lead is clearly a major public health hazard of global dimensions. However, because of rapid industrialization and the persistence of lead in the environment, exposure is likely to remain a significant public health problem in most developing countries for many years [28-30]. A comparative study among battery workers revealed a significant association between exposure to acid fumes in battery factories and dental erosion, as well as deteriorated oral health. Many factory workers involved in lead-acid battery production face risks to their oral health. However, information on oral health issues among lead-acid battery workers in Bangladesh is scarce. This study aims to investigate oral health problems such as dentition status, dental erosion, dental caries, attachment loss, periodontitis, tooth sensitivity, oral ulcers, loss of sensation, and swelling among these workers by considering various factors, including dental status, job- related activities, personal habits, dietary habits, and socio- demographic characteristics. The findings will aid in developing targeted measures to prevent and manage major oral health problems among lead-acid battery workers in Bangladesh. MATERIALS AND METHODS Study design and study place This cross-sectional study was conducted to assess oral health status of lead acid battery workers. The study was conducted from January to December 2022. It started with protocol development and completed with final report submission. A work schedule was prepared including all the tasks in a sequence. The first four months were applied for literature review and strategy finalization. The subsequent months were passed for questionnaire development, pretesting, data collection, compilation and analysis. The study areas were selected purposively for availability of lead acid battery workers, easy communication and well cooperation from the workers. The study was conducted in four workshops of Dhaka city including Mohakhali, Saidabad, Gabtoli, Dholaikhal. The workers expressed their interest to participate voluntarily in this study. Selection of study participants There are about 5000 lead acid battery factory workers in Dhaka city. The sample size was calculated by using sample size calculator [31] with 95% confidence level and 5% confidence interval. The sample size for the current study was calculated as 357, though the sample size was calculated as 357, we enrolled total 370 workers randomly for our present study. There were two types of workers in lead acid battery factories: (i) the workers who exposed to lead acid fumes (working in forming and charging department), and (ii) the workers who are not exposed to lead acid fumes (working in pasting, grid casting and packaging department). The first study group comprising 185 workers was considered as

Dr. Pranab Karmaker Directive Publications Page - 3Open Access, Volume 17 , 2026 experimental group (cases) and the latter one consisting of 185 workers was regarded as control group (controls). Selection criteria The study groups were fully briefed on the purpose of our current study and their consent was obtained prior to their participation to avoid any inconvenience and ensure their complete cooperation. The lead acid battery factory workers of all age groups who were present at the time of the study and willing to participate were included in our current study. The workers who were not willing to participate were excluded from this study. The examiner was well trained and calibrated to ensure consistent diagnosis and preventing any variability among the study subjects. Data collection A detailed schedule was prepared well in advance for the survey study and the investigator visited the study area within the prescheduled timeframe during the study period until the required sample size was obtained. A sufficient number of sterile instruments were used for the examinations during the study including plain mouth mirrors, explorers, tweezers, kidney trays, containers, Betadine™, saline, gauze, cotton with a cotton holder, disposable gloves, mouth masks, and data recording proforma. Data were collected by face-to-face interview, clinical oral examination with oral health index. The interview was conducted privately as far as possible and before preceding the data collection, the detail of the study was explained to each eligible workers and informed written consents were obtained from the workers. Interview and oral checkup were taken in a quiet place; no other person was allowed to influence the replying of the workers. It took on average 30 minutes to complete the interview of a single worker. Data were collected from 10 am to 4 pm. On an average, 10 workers were interviewed daily. Information was recorded about the department within the battery factory, job duration, exposure to various working conditions, and oral symptoms. Additionally, details such as name, age, sex, location, dietary habits, deleterious habits, and oral hygiene practices were documented. All the data were recorded by maintaining the World Health Organization 2013 (WHO-2013) proforma with slight modification. Ethical consideration Initially ethical clearance was obtained from the Institutional Review Board (IRB) of NIPSOM. The participants were briefed properly and motivated to participate in the study. The study participants were informed about the objectives, purposes of the study and informed consent would be taken from each participant. No intervention or any invasive procedures were applied in this study. The participants were interviewed separately and confidentially would be maintained strictly. Statistical analysis The raw data was obtained in a tabulated form using Microsoft Excel spreadsheet software. Data analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.0. The Chi-square test was used to compare categorical variables for proportions, the Mann– Whitney U-test was employed to compare quantitative ordinal variables, and the independent samples t-test was utilized to compare quantitative continuous variables. Descriptive statistical analysis included mean, median, mode, SD. Inferential statistics included chi square test to find out any significant relationship between two qualitative variables. The P values less than 0.05 were considered statistically significant. RESULTS Socio-demographic status of study participants In our current study, a total 370 Bangladeshi individuals were participated, of which 185 (50%) individuals were as experimental group where 185 (50%) were considered as control. The major portion of the both experimental group (69.7%) and control group (67.6%) were less than 30 years old. The comparison data of case and control group suggested that the experimental participants with lower weight (P value: 0.028), higher BMI (P value: 0.006), no literacy (P value: 0.001), lower income (P value: 0.003) had been significantly more suffering from oral health problems in relation to their corresponding control. Moreover, the case individuals who work with oral pipe (P value: <0.001), work more than 5 years (P value: <0.001) and work more than 8 hours per day (P value: 0.001) were significantly more affected with oral problems in comparison to their respective control group. Furthermore, the participants who brush their teeth once per day (P value: 0.003) and without toothpaste (P value: <0.001) had been significantly more suffering from oral problem rather than their respective control. But there no significant difference was found between experimental group and control group in case of body height, family type, sound sleep, exercise and use tooth brush (Figure 1 and Table S1).

Dr. Pranab Karmaker Directive Publications Figure 1. The socio-demographic status of overall lead acid battery workers (Cases and Controls). Table 1. The subgroup analysis for experimental participants (only case group) based on different Oro-dental problems. Variables Types Dental caries, n (%) Dental erosion, n (%) Sensitive teeth, n (%) Gingivitis, n (%) Oral ulcer, n (%) Yes No P valueYes No P valueYes No P valueYes No P valueYes No P value Obesity Yes 31 (17)16 (08) 0.222 36 (19)11 (06) 0.003 35 (19)12 (06) 0.005 25 (14)22 (12) 0.691 27 (15)20 (11) 0.712 No 77 (42)61 (33) 71 (39)67 (36) 70 (38)68 (37) 78 (42)60 (32) 75 (40)63 (34) Educational status Yes 88 (48)66 (35) 0.447 84 (46)70 (38) 0.043 81 (44)73 (39) 0.011 91 (49)63 (35) 0.037 77 (42)77 (42) 0.002 No 20 (11)11 (06) 23 (12)08 (04) 24 (13)07 (04) 12 (06)19 (10) 25 (13)06 (03) High/ Medium income Yes 12 (06)41 (22) <0.001 24 (13)29 (16) 0.028 41 (22)12 (06) <0.001 31 (17)22 (12) 0.625 73 (39)59 (32) 0.942 No 96 (53)36 (19) 83 (45)49 (26) 64 (35)68 (37) 72 (39)60 (32) 29 (16)24 (13) Work with oral pipe Yes 76 (41)42 (23) 0.027 54 (29)64 (35) <0.001 76 (41)42 (23) 0.005 51 (28)67 (36) <0.001 77 (41)41 (22) <0.001 No 32 (17)35 (19) 53 (28)14 (08) 29 (16)38 (20) 52 (28)15 (08) 25 (14)42 (23) Working more than 5 years Yes 84 (45)23 (12) <0.001 72 (39)35 (19) 0.002 78 (41)29 (16) <0.001 67 (36)40 (22) 0.026 89 (48)18 (10) <0.001 No 24 (13)54 (30) 35 (19)43 (23) 27 (15)51 (28) 36 (19)42 (23) 13 (07)65 (35) Working more than 8 hours/ day Yes 95 (51)70 (38) 0.525 96 (52)69 (37) 0.786 99 (54)66 (36) 0.011 89 (48)76 (41) 0.172 94 (52)71 (38) 0.150 No 13 (07)07 (04) 11 (06)09 (05) 06 (03)14 (07) 14 (08)06 (03) 08 (04)12 (06) Brushing twice per day Yes 20 (11)36 (19) <0.001 15 (08)41 (22) <0.001 11 (06)45 (24) <0.001 50 (27)06 (03) <0.001 38 (21)18 (10) 0.022 No 88 (48)41 (22) 92 (50)37 (20) 94 (51)35 (19) 53 (29)76 (41) 64 (34)65 (35) Brushing with toothpaste Yes 02 (01)11 (06) 0.001 03 (02)10 (05) 0.008 02 (01)11 (06) 0.002 02 (01)11 (06) 0.002 03 (02)10 (05) 0.016 No 106 (57)66 (36) 104 (56)68 (37) 103 (56)69 (37) 101 (55)71 (38) 99 (54)73 (39) Intake sugar rich foods Yes 47 (25)23 (12) 0.059 56 (30)70 (38) <0.001 61 (33)65 (35) 0.001 68 (37)58 (31) 0.494 65 (35)61 (33) 0.156 No 61 (33)54 (30) 51 (28)08 (04) 44 (24)15 (08) 35 (19)24 (13) 37 (20)22 (12) Page - 4Open Access, Volume 17 , 2026

Dr. Pranab Karmaker Directive Publications Intake water 8 glass/day Yes 45 (24)16 (09) 0.003 36 (19)25 (14) 0.820 51 (28)10 (05) <0.001 14 (08)47 (25) <0.001 11 (06)50 (27) <0.001 No 63 (34)61 (33) 71 (38)53 (29) 54 (29)70 (38) 89 (48)35 (19) 91 (49)33 (18) Intake fast food/ soft drinks Yes 88 (48)60 (32) 0.551 96 (52)52 (28) <0.001 91 (49)57 (31) 0.009 79 (43)69 (37) 0.208 87 (47)61 (33) 0.046 No 20 (11)17 (09) 11 (06)26 (14) 14 (08)23 (12) 24 (13)13 (07) 15 (08)22 (12) Intake betel leaf/betel nut Yes 77 (42)22 (12) <0.001 82 (44)17 (09) <0.001 88 (48)11 (06) <0.001 91 (49)08 (04) <0.001 93 (50)06 (03) <0.001 No 31 (16) 55 (30) 25 (14)61 (33) 17 (09)69 (37) 12 (06)74 (41) 09 (05)77 (42) Intake jorda Yes 62 (34)16 (09) <0.001 30 (16)48 (26) <0.001 58 (31)20 (11) <0.001 65 (35)13 (07) <0.001 68 (38)10 (05) <0.001 No 46 (24)61 (33) 77 (42)30 (16) 47 (25)60 (33) 38 (21)69 (37) 34 (18)73 (39) Intake oral tobacco Yes 64 (35)43 (23) 0.042 74 (40)13 (07) <0.001 68 (37)19 (10) <0.001 68 (37)19 (10) <0.001 82 (44)05 (03) <0.001 No 44 (24)34 (18) 33 (18)65 (35) 37 (20)61 (33) 35 (19)63 (34) 20 (11)78 (42) Smoking Yes 99 (54)61 (33) 0.015 97 (53)63 (34) 0.052 98 (53)62 (34) 0.002 99 (54)61 (33) <0.001 99 (54)61 (32) <0.001 No 09 (05)16 (08) 10 (05)15 (08) 07 (04)18 (09) 04 (02)21 (11) 03 (02)22 (12) Food habits of study participants In our current investigation, the food habit of the study participants was analyzed and a significant proportion of experimental participants (who were suffering from oral health problem) were found to intake less than 8 glass of water per day (P value: 0.004), to eat fast food regularly (P value: 0.012), to take soft drinks in regular basis (P value: 0.017) rather than their respective controls. Moreover, a significant number experimental participants with oral health problem were detected to consume betel leaf (P value: 0.009) and betel nut (P value: 0.009), to take jorda (P value: 0.001), having smoking habit (P value: <0.001), and to take oral tobacco (P value: 0.002) in comparison to their corresponding controls. But no significant number of experimental participants with oral health problem were found in case of taking carbohydrate, protein, fat, vegetables, fruits, supplemental vitamins and minerals, and drinking tea or coffee in relation to their respective controls (Figure 2 and Table S2). Figure 2. The food and drinking habits of overall study participants (Cases and Controls). Page - 5Open Access, Volume 17 , 2026

Dr. Pranab Karmaker Directive Publications Table 2. Regression analysis of study participants (Case vs. Control) using several variables. Variables Categories Cases (%) Controls (%) Odds ratio (95% CI)P values Weight (Kg) < 50 035 (18.9) 020 (10.8) 1.93 (1.06 – 3.48)

0.030 ≥ 50 150 (81.1) 165 (89.2) BMI (Kg/m2) ≥ 30 047 (25.4) 026 (14.1) 2.08 (1.23 – 3.54)

0.007 < 30 138 (74.6) 159 (85.9) Literacy No 031 (16.8) 010 (05.4) 3.52 (1.67 – 7.42)

0.001 Yes 154 (83.2) 175 (94.6) Income Low 132 (71.4) 105 (56.8) 1.90 (1.23 – 2.92)

0.004 Middle 053 (28.6) 080 (43.2) Work with oral pipe Yes 118 (63.8) 058 (31.4) 3.86 (2.50 – 5.94)< 0.001 No 067 (36.2) 127 (68.6) Working time (Years) ≥ 5 107 (57.8) 073 (39.5) 2.10 (1.39 – 3.19)< 0.001 < 5 078 (42.2) 112 (60.5) Working duration (h) ≥ 8 165 (89.2) 140 (75.7) 2.65 (1.50 – 4.70)

0.001 < 8 020 (10.8) 045 (24.3) Brushing time Once/day 129 (69.7) 101 (54.6) 1.92 (1.25 – 2.94)

0.003 Twice/day 056 (30.3) 084 (45.4) Used toothpaste No 172 (93.0) 089 (48.1) 14.3 (7.58 – 26.9)< 0.001 Yes 013 (07.0) 096 (51.9) Water intake (Glaas/D) < 8 124 (67.0) 097 (52.4) 1.84 (1.21 – 2.81)

0.004 ≥ 8 061 (33.0) 088 (47.6) Fast food Regular 148 (80.0) 127 (68.6) 1.83 (1.14 – 2.94)

0.013 Sometimes 037 (20.0) 058 (31.4) Soft drinks Regular 141 (76.2) 120 (64.9) 1.74 (1.10 – 2.73)

0.017 Sometimes 044 (23.8) 065 (35.1) Betel leaf Yes 099 (53.5) 074 (40.0) 1.73 (1.14 – 2.61)

0.009 No 086 (46.5) 111 (60.0) Betel nut Yes 099 (53.5) 074 (40.0) 1.73 (1.14 – 2.61)

0.009 No 086 (46.5) 111 (60.0) Jorda Yes 078 (42.2) 049 (26.5) 2.02 (1.31 – 3.14)

0.002 No 107 (57.8) 136 (73.5) Smoking Yes 098 (53.0) 048 (25.9) 3.22 (2.08 – 4.98)< 0.001 No 087 (47.0) 137 (74.1) Oral tobacco Yes 087 (47.0) 058 (31.4) 1.94 (1.27 – 2.97)

0.002 No 098 (53.0) 127 (68.6) Dental caries Yes 108 (58.4) 025 (13.5) 8.98 (5.37 – 14.9)< 0.001 No 077 (41.6) 160 (86.5) Dental erosion Yes 107 (57.8) 030 (16.2) 7.09 (4.35 – 11.5)< 0.001 No 078 (42.2) 155 (83.8) Sensitive teeth Yes 105 (56.8) 058 (31.4) 2.87 (1.88 – 4.40)< 0.001 No 080 (43.2) 127 (68.6) Gingivitis Yes 103 (55.7) 032 (17.3) 6.01 (3.72 – 9.69)< 0.001 No 082 (44.3) 153 (82.7) Oral ulcer Yes 102 (55.1) 019 (10.3) 10.7 (6.16 – 18.7)< 0.001 No 083 (44.9) 166 (89.7) Stained teeth Yes 100 (54.1) 078 (42.2) 1.61 (1.07 – 2.43)

0.022 No 085 (45.9) 107 (57.8) Mouth odor Yes 095 (51.4) 076 (41.1) 1.51 (1.00 – 2.28)

0.048 No 090 (48.6) 109 (58.9) Page - 6Open Access, Volume 17 , 2026

Dr. Pranab Karmaker Directive Publications Oro-dental problems of study participants The analysis of overall distribution of study participants based on ore-dental problems revealed that a significant number cases were suffering from dental caries (P value: <0.001), dental erosion (P value: <0.001), sensitive teeth (P value: <0.001), gingivitis (P value: <0.001), oral ulcer (P value: <0.001), stained teeth (P value: 0.022), and mouth odor (P value: 0.048), compared to their corresponding controls. However, no significant differences were observed between experimental group and control group regarding of dry mouth, toothache, root infections, enamel erosion, periodontics, broken teeth, tooth cavity, Hyperdontia and cracked tooth when compared to their respective controls (Figure 3 and Table S3). Figure 3. The distribution of overall study participants (Cases and Controls) by Oro-dental problems. Page - 7Open Access, Volume 17 , 2026 Subgroup analysis of experimental participants by dental caries The subgroup analysis by dental caries suggested that a significant proportion of experimental participants experiencing with dental caries whose family income is comparatively lower (53%, P value: <0.001), working with oral pipe (41%, P value: 0.027), working in the workshop more than 5 years (45%, P value: <0.001), not brushing twice per day (48%, P value: <0.001), brushing without toothpaste (57%, P value: 0.001), drinking water less than 8 glass per day (34%, P value: 0.003), intaking betel leaf and betel nut (42%, P value: <0.001), taking Jorda (34%, P value: <0.001), taking tobacco orally (35%, P value: 0.042) and having smoking habit (54%, P value: 0.015). But no significant difference was found among experimental participants with or without dental caries in case of obesity, educational status, working hour, intake sugar rich food, and intake fast food or soft drinks Table 1. Subgroup analysis of experimental participants by dental erosion The results of subgroup analysis by dental erosion revealed that obesity (P value: 0.003) and educational status (P value: 0.043) is not significantly associated with dental erosion where low income (P value: 0.028), working with oral pipe (P value: <0.001), and working more than 5 years (P value: 0.002) were significantly related with dental erosion. Additionally, a significant number of experimental participants have been suffering from dental erosion who did not brushing twice daily (50%, P value: <0.001), brushing without toothpaste (56%, P value: 0.008), consuming sugar rich foods (30%, P value: <0.001), fast foods or soft drinks (52%, P value: <0.001), and having habit of chewing betel leaf or betel nut (44%, P value:<0.001), Jorda (42%, P value: <0.001), oral tobacco (40%, P value: <0.001). But no significant portion of the study participants were experiencing with dental erosion regarding by daily working time, intaking water glass per day and having habit of smoking (Table 1). Subgroup analysis of experimental participants by sensitive teeth The subgroup analysis by sensitive teeth demonstrated that a significant number of experimental participants have sensitive teeth who is not obese (P value: 0.005), having educational status (P value: 0.011), belonging to lower income family (P value: <0.001), working with oral pipe (P value: 0.005), working at factories in more than 5 years (P value: <0.001), working more than 8 hours daily (P value: 0.011), not brushing twice daily (P value: <0.001), brushing without toothpaste (P value: 0.002), consume sugar rich foods (P value: 0.001), drinking less than 8 glass of water daily (P value: <0.001), taking fast foods or soft drinks (P value: 0.009), having habit of using betel leaf or betel nut (P value: <0.001), taking Jorda (P value:

Dr. Pranab Karmaker Directive Publications <0.001) and oral tobacco (P value: <0.001) and smoking (P value: 0.002) (Table 1). Subgroup analysis of experimental participants by gingivitis The results of the subgroup analysis based on gingivitis indicated that participants with higher educational status were significantly more likely to experience gingivitis (49%, P value: 0.037). Furthermore, a significant proportion of experimental participants have been facing with gingivitis who are working from more than 5 years (36%, P value: 0.026), brushing without toothpaste (55%, P value: 0.002), not drinking more than 8 glass of water (48%, P value: <0.001), taking betel nut or betel leaf (49%, P value: <0.001), taking oral tobacco (37%, P value: <0.001), and having habit of smoking (54%, P value: <0.001). However, a significant number of participants have not suffered from gingivitis who are working with oral pipe (36%, P value: <0.001), not brushing twice per day (41%, P value: <0.001), not taking Jorda (37%, <0.001). But no significant number of participants were experiencing with gingivitis regarding of obesity, status of family income, daily working time, taking sugar rich foods and intaking fast foods or soft drinks (Table 1). Subgroup analysis of experimental participants by oral ulcer The subgroup analysis of oral ulcers showed that participants with higher educational status were significantly less likely to suffer from oral ulcers (77%, P value: 0.002). Besides, a significant percentage of experimental participants were experiencing with oral ulcer who are working with oral pipe (41%, P value: <0.001), working at workshop form more than 5 years (48%, P value: <0.001), brushing without toothpaste (54%, P value: 0.016), not drinking more than 8 glass of water (49%, P value: <0.001), taking fast foods and soft drinks (47%, P value: 0.046), taking betel leaf or betel nut (50%, P value: <0.001), having habit of using oral tobacco (44%, P value: <0.001) and smoking (54%, P value: <0.001). But participants who brushed twice per day have been not suffering from oral ulcer significantly (35%, P value: 0.022) where comparatively larger proportion of participants were facing with oral ulcer who did not take Jorda (39%, P value: <0.001). However, no significant number of participants were experiencing with oral ulcer in case of obesity, family income, working time per day, and intake sugar rich foods (Table 1). Regression analysis of the study variables The overall regression analysis of the study variables suggested that anthropometric characteristics including weight (< 50 Kg) [OR: 1.93, 95% CI (1.06-3.48), P value: 0.030]; Body mass index (≥ 30 Kg/m2) [OR: 2.08, 95% CI (1.23-3.54), P value: 0.007]; illiteracy [OR: 3.52, 95% CI (1.67-7.42), P value: 0.001] and low income [OR: 1.90, 95% CI (1.23-2.92), P value: 0.004] showed significant correlations with overall oral health problems (Table 2). Moreover, the results of this analysis revealed that the participants working with oral pipe [OR: 3.86, 95% CI (2.50-5.94), P value: <0.001]; working more than 5 years [OR: 2.10, 95% CI (1.39-3.19), P value: <0.001]; working more than 8 hours daily [OR: 2.65, 95% CI (1.50-4.70), P value: 0.001]; brushing once per day [OR: 1.92, 95% CI (1.25-2.94), P value: 0.003]; and brushing without toothpaste [OR: 14.3, 95% CI (7.58-26.9), P value: <0.001] have significant correlation with overall Oro-dental complications (Table 2). Furthermore, the analysis of eating habit demonstrated that the participants who are drinking 8 glass of water per day [OR: 1.84, 95% CI (1.21-2.81), P value: 0.004]; eating fast foods regularly [OR: 1.83, 95% CI (1.14-2.94), P value: 0.013]; and taking soft drinks [OR: 1.74, 95% CI (1.10-2.73), P value: 0.017]; were significantly more affected by oral health problems in comparison to their respective controls (Table 2). Additionally, the habit of taking betel leaf [OR: 1.73, 95% CI (1.14-2.61), P value: 0.009]; and betel nut [OR: 1.73, 95% CI (1.14-2.61), P value: 0.009]; using Jorda [OR: 2.02, 95% CI (1.31-3.14), P value: 0.002]; having oral tobacco [OR: 1.94, 95% CI (1.27-2.97), P value: 0.002]; and smoking [OR: 3.22, 95% CI (2.08-4.98), P value: <0.001]; have significant relationship with overall oral health problems (Table 2). Besides, the regression analysis on Oro-dental problems showed that a significant proportion of experimental participants were affected by dental caries [OR: 8.98, 95% CI (5.37-14.9), P value: <0.001]; dental erosion [OR: 7.09, 95% CI (4.35-11.5), P value: <0.001]; sensitive teeth [OR: 2.87, 95% CI (1.88-4.40), P value: <0.001]; gingivitis [OR: 6.01, 95% CI (3.72- 9.69), P value: <0.001]; oral ulcer [OR: 10.7, 95% CI (6.16-18.7), P value: <0.001]; stained teeth [OR: 1.61, 95% CI (1.07-2.43), P value: 0.022]; and mouth odor [OR: 1.51, 95% CI (1.00-2.88), P value: 0.048] in relation to their corresponding control (Table 2). DISCUSSION Generally, a large proportion of acid mists are produced from dilute sulfuric acid and open container of lead acid battery factories that are significantly corelated with human health issue especially oral health [32]. This acid mists may affect the oral health either by direct exposure or by systematic exposure and these processes of exposure for long time can cause irritation to soft oral tissues, which can lead to alterations in the oral health including lesions on the oral mucosa, periodontal issues, gingivitis oral bleeding and so on [33-35]. The current study was carried out to evaluate the oral health status in led battery factory workers and investigated the prevalence and types of oral health problems among workers who exposed to acid mists in Dhaka city, Bangladesh. In our present study, 185 battery workers were participated Page - 8Open Access, Volume 17 , 2026

Dr. Pranab Karmaker Directive Publications as study group (case group) who exposed to lead acid mists where age matched 185 workers were participated as control group who did not expose to acid fumes. The study group had the highest percentage of participants in the cases of those who were under 30 years old (69.7%), below 1.5 meters tall (53.0%), living in nuclear families (90.8%), living with low family incomes (71.4%), living in semi-built homes (73.5%), working over 8 hours (89.2%), doing no exercise (80.5%), not getting enough sleep (76.8%), brushing once a day (69.7%) and using no toothpaste (93.0%) (Table S1). Conversely, the majority of participants in the control group were those who weighed over 50 kg (89.2%), had a BMI of less than 30 kg/m2 (85.9%), were the most literate (94.6%), did not use an oral pipe (68.6%), had been employed for less than five years (60.5%), and used a toothbrush (96.2%) (Table S1). But a previous study carried out by Khurana et al. showed about 90.0% of study participants had experiences with more than 5 years which is completely opposite to our present study [13, 36]. Additionally, the experimental group included the greatest percentage of participants when it came to those who consumed fat (75.1%) and carbohydrates (72.4%) more frequently than twice a day, fruits irregularly (83.2%), less than eight glasses of water daily, fast food (80.0%), and soft drinks (76.2%) on a regular basis (Table S2). However, the control group had the highest proportion of participants who took protein less than twice a day (64.9%), ate vegetables on a regular basis (70.3%), did not consume minerals (90.3%) or vitamins (88.1%), drank tea or coffee on a regular basis (78.9%), did not consume betel leaf (60.0%), betel nut (60.0%), Jorda (73.5%), oral tobacco (68.6%), or smoked (74.1%) (Table S2). Dental erosion is the oral health issue that is characterized by a loss of dental hard tissue by different chemicals including acid mists [37]. A number of earlier studies conducted by Khurana et al. (2014) [13], Raj et al. (2016) [36], Kundu et al. (2017) [38], and others found that the persons who exposed to acid mists in battery factories experienced with considerable dental erosion. A similar finding was assessed in our current study, which revealed that the dental erosion of study group was significantly higher in comparison to their corresponding control group (P value: <0.001) (Figure 3 and Table S3). In our present investigation, as seen by Figure 3 and Table S3, a higher prevalence of gingivitis among experimental participants was found in comparison to their corresponding controls (P value: <0.001). This finding was consistent with research conducted by Khurana et al. (2014) [13], Amin et al. (2001) [19], and Kundu et al. (2017) [38]. Besides, the comparison of mouth odor in both the groups revealed a statistically significant difference (P value: 0.048) which was similar to the results from the studies conducted by Khurana et al. (2014) [13], and Raj et al. (2016) [36]. Moreover, oral ulcer is one of the most prevalence oral health problems among battery factory workers. Several scientists studied the oral health of workers in battery factories and Raj et al. (2016) [36] showed a significant number of study participants were suffering from oral ulcer and this result was consistent to our current findings (P value: <0.001). Additionally, the comparison of sensitive teeth in both study and control groups demonstrated that the study participants had comparatively more sensitive teeth (P value: <0.001) in relation to their respective controls which was similar with the findings of Khurana et al. (2014) [13]. On the other hand, a different number of studies was conducted previously on oral health issues by Khurana et al. (2014) [13], and Raj et al. (2016) [36] and reported that a significant number of study participants were observed to have dry mouth but no significant (P value: 0.600) difference was detected between the experimental group and control group in our present study (Table S3). Moreover, an earlier study carried out by Kundu et al. (2017) [38] revealed that a considerable proportion of study participants had enamel erosion and periodontics when compared to their respective controls. These results conflicted with the findings of our present investigation as no significant number of study participants was evaluated who had enamel erosion (P value: 0.122) and periodontics (P value: 0.234) (Table S3). Furthermore, no significant number of participants with toothache (P value: 0.521) was observed among study groups in comparison to their matching controls and our results were supported by the previous researches conducted by Khurana et al. (2014) [13], and Raj et al. (2016) [36]. Obesity is one of the most important risk factors for the development of many human diseases, including oral and dental disorders. Previous researches conducted by Suvan et al. (2013) [39] and Keller et al. (2015) [40] demonstrated a substantial correlation between obesity and a number of oral health conditions, like dental caries, periodontal disease, xerostomia, dental erosion, and dentinal hypersensitivity. In the present study, we found a significant relationship between obesity and sensitive teeth (P value: 0.005) as well as dental erosion (P value: 0.003) (Table 2). Moreover, in our current study, low educational status was significantly associated with dental erosion (P value: 0.043), sensitive teeth (P value: 0.011), gingivitis (P value: 0.037), and oral ulcer (P value: 0.002); low family income was considerably related with dental caries (P value: <0.001), dental erosion (P value: 0.028), and sensitive teeth (P value: <0.001), and smoking habit had a significant association with dental caries (P value: 0.015), sensitive teeth (P value: 0.002), gingivitis (P value: <0.001), and oral ulcer (P value: <0.001) (Table 2) and these findings are agreed by Moghaddam et al. (2020) [41], and Baniasadi et al. (2021) [42]. Additionally, the present experiment showed that the participants who had been working for more than 5 years, worked over 8 hours per day, did not brush twice per day, did not use toothpaste, took betel nut or betel leaf, Jorda and oral tobacco were significantly suffering from dental Page - 9Open Access, Volume 17 , 2026

Dr. Pranab Karmaker Directive Publications caries, dental erosion, sensitive teeth, gingivitis and oral ulcer (Table 2). These results were supported by different previous researches including Khurana et al. (2014) [13], Raj et al. (2016) [36], Yang et al. (2024) [43], Gunjal et al. [44], Gajendra et al. [45], Calzada et al. [46], and so on. Besides, food and drinking habit are very much crucial for the development of different oral health problems. A several studies carried out by Tenelanda et al. (2020) [47], Butera et al. (2022) [48], Elamin et al. (2018) [49], and Paszynska et al. (2022) [50] revealed that eating habit and drinking habit had significant relationship with increased risk of developing different oral health issues including dental caries, dental erosion, periodontics, dry mouth, toothache, sensitive teeth, oral cancer etc. These similar results were found in our present investigation as intake sugar rich food was significantly related with dental erosion, and sensitive teeth; drinking less than 8 glass of water daily was significantly associated with dental caries, sensitive teeth, gingivitis and oral ulcer; and intake fast food or soft drinks was significantly correlated with dental erosion, sensitive teeth, and oral ulcer. CONCLUSION In summary, the results of this study suggested that the study participants who exposed to acid fumes in battery factories were significantly more affected by oral health problems including dental caries, dental erosion, sensitive teeth, gingivitis, oral ulcer, stained teeth and mouth odor compared to the participants who did not expose to acid fumes. Moreover, some anthropometrics characteristics like weight (<50Kg), BMI (≥30 Kg/m2), illiteracy, and low family income; some working habits such as using oral pipe, working more than 5 years, working more than 8 hours daily, brushing frequency, using toothpaste during bruising; some eating or drinking habit including low drinking water, regular intake of fast foods and soft drinks, taking betel leaf and betel nut, jorda, oral tobacco and smoking were significantly related with Oro-dental problem of experimental groups. But some limitations were arisen during conducting our present study including small sample size. So, large scale should be conducted to find out real picture of the oral health status of the lead acid battery workers in Dhaka city of Bangladesh. Recommendation The main objective of this study was to assess oral health status of lead acid battery workers. This study revealed that lead acid battery workers do have some sort of Oro-dental health problems such as dental caries, dental erosion, oral ulcer, sensitive teeth, stained teeth, gingivitis, periodontitis and so on. On the basis of this study findings, to recommend following measures for the lead acid battery workers: firstly, to improve oral health status of the workers, special attention should be given by adopting effective measures like health education, awareness program, work health facility. Secondly, to prevent dental caries comprehensive measures including fluoride containing tooth paste, mouth wash and brushing of teeth twice daily and need proper treatment and dental flossing. Thirdly, to control Oro-dental health problems of the workers, special preventive measure like regular mouth gargling, scaling, filling etc. should be given. Fourthly, to prevent dental erosion of the workers, regular oral checkup should be arranged and according measures should be taken. Fifthly, to prevent oral ulcer specific initiation like consumption of oral tobacco, hard food like betel nut should be reduced. Sixthly, to improve Oro-dental health of the workers, usage of oral pipe should be reduced in their working place. These will help the workers to reduce exposure to lead. Finally, to combat the existing Oro-dental problems of the workers by regular and periodic dental checkup and giving necessary treatment, proper health education regarding dental hygiene. Acknowledgement The authors would like to thank to the owners of the battery factories from where we were able to collect valuable data for their precious insights and assistance in the conducting this study. We also appreciate the support and encouragement from our colleagues and institutions. Funding This research received no external funding. The authors have not received any financial support for the research, authorship or publication of this article. Conflicts of interest All the authors declared no conflicts of interest regarding the publication of this paper. All research and findings presented are free from any commercial or financial relationships that could be construed as a potential conflict of interest. REFERENCES 1. Van de Rijt LJM, Stoop CC, Weijenberg RAF, de Vries R, Feast AR, et al. The Influence of Oral Health Factors on the Quality of Life in Older People: A Systematic Review. Gerontologist. 2020 Jul; 60 (5): 378-394. 2. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, et al. Oral diseases: a global public health challenge. Lancet. 2019 Jul; 394 (10194): 249-260. 3. Kapila YL. 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