International Journal of Evaluation and Research in Education (IJERE)

Vol.7, No.4, December 2018, pp. 259~263

ISSN: 2252-8822 DOI: 10.11591/ijere.v7.i4.14856  259

Dental and Oral Health Education for Elementary School Students

through Patient Hygiene Performance Index Indicator

Septian Emma Dwi Jatmika, Muchsin Maulana

Faculty of Public Health, Universitas Ahmad Dahlan, Indonesia

Article Info ABSTRACT

Article history: Caries is a problem that often occurs in school-age children. Special Region
of Yogyakarta is a province that has a high DMF-T index by 5.9 and exceeds
Received Aug 4, 2018 the national DMF-T index. One of the efforts to improve dental and oral
Revised Sep 8, 2018 health of school-age children is the health education method using
Accepted Sep 16, 2018 simulation methods, as well as simple techniques that may attract children's
attention and be understood. The aim of the current study is to knowing the
influence of oral and dental hygiene education intervention on dental and
Keyword: oral hygiene level at SD Negeri 3 Sleman students. This research used a kind
of quasi experimental research with one group pretest posttest design. The
Attitude research was done in SD Negeri 3 Sleman, the sample used was the 3rd
Pedagogical formation graders from 57 students in 2017. The intervention was done by dental and
Teaching profession oral hygiene education. Respondents were examined related to their dental
and oral hygiene levels. It was measured by the PHP Index (Patient Hygiene
Perfomance) before and after the intervention. According to results, The
average score of respondents’dental and oral hygine pre test was 0.082 and
the average post test score of respondents’dental and oral hygiene was 1.483.
There is the difference of 1.4007. This shows an increament in oral hygiene
of the respondent before and after the education. The results of statistical
analysis show that there is an influence of oral and dental hygiene which
pvalue 0.000. Thus, there is a need for dental and mouth hygiene education
to be conducted regularly and delivered with an interesting method.
Copyright © 2018 Institute of Advanced Engineering and Science.
All rights reserved.

Corresponding Author:
Septian Emma Dwi Jatmika,
Faculty of Public Health,
Universitas Ahmad Dahlan,
Jl. Prof. Dr. Soepomo S.H, Warungboto, Umbulharjo, Yogyakarta, Indonesia 55164.
Email: [email protected]

1. INTRODUCTION
Dental caries is a major dental and oral problem in developing countries. Caries is one of the most
common problems in school-aged children. Indonesia Ministry of Health reported the national prevalence of
dental and oral health problems was around 25.9% [1]. The percentage of dental and oral problem among
children of 5-9 years old group is around 28.9% and children of 10-14 years old group has a percentage of
25.2%, while in 12 years old group the percentage of children with oral and dental health problems is
24.8%. Based on World Health Organization (WHO) survey in 2007, 77% of children in Indonesia suffer
from dental caries. Yogyakarta Special Region is a province that has a high DMF-T index of 5.9 and
exceeds the national DMF-T index.
The most effective preventive action taken to maintain oral health is to brush teeth regularly and
correctly [2]. Results show that 93.8% of Indonesians have brushed their teeth every day, but only 2.3% brush
their teeth properly. Survey of Habit and Attitude in 2012 in Indonesia showed that the behavior of toothbrushing
at night before bed was recorded low. In the 5-10 years old group, only 13% of children have a

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 260  ISSN: 2252-8822

habit of brushing their teeth at night before bed [1]. In the age of 11-15 years old group only 22% who have a
habit of brushing teeth at night before bed, but while sleeping bacteria in the mouth develops twice stronger.
Children around 6 to 12 years old or school-aged children are still less aware of how to maintain
oral hygiene [1]. Therefore, efforts to maintain oral health should be done from an early age. Primary school
age is an ideal time to train a child's motor skills, including brushing teeth [3]. One of the efforts in
improving oral health is health education method. According to Angela tooth brushing skills should be taught
and emphasized in children in all ages, especially school children because at that age is easy to accept and
instill basic values [4]. School children need to learn how to improve their brushing skills, especially in
children with low oral hygiene levels and inadequate brushing skills, are expected to change behaviors that
adversely affect health and related to health norms.
Good models and simple techniques need to be given as examples of educational ways of brushing
teeth for children. The way to present oral and dental health education in children should be made as
attractive as possible through attractive counseling without reducing educational content, simulations or live
demonstrations, audio visual programs or controlled toothbrushing [3].
In Yogyakarta Special Region (DIY) recorded 93.6% of people who behave to brush their teeth
every day, but only 3.4% who brush their teeth properly. Tooth brushing behavior is most commonly done
after a morning shower with 88.6% percentage, whereas time after eating the society often do not brush the
teeth, it is around 5.2% [1]. Health Profile of Sleman District in 2013, there are ten major outpatient diseases
in various society health center for all age groups including dental caries disease. Patients with dental caries
in Sleman District in 2012 was ranked to be the eightth with the number of patients as many as 14.841
inhabitants.

2. RESEARCH METHOD
The research method was quasi experimental with one group pretest posttest design. Research
conducted in 2017 at SD Negeri 3 Sleman, 3rd graders. There were 49 students participated in this research.
The interventions conducted are oral and dental hygiene education. Respondents are examined related to
their dental and oral hygiene levels. One of the factors that influence dental and oral hygiene is the use of
brackets. This can be a confounding in research. Therefore, to overcome this, the research sample taken
were respondents who met the inclusion criteria, that is students who did not use the bracket. Dental and oral
hygiene levels were measured by the PHP Index (Patient Hygiene Perfomance) before and after the
intervention. The required instruments are liquids of disclosing solution, toothbrush and toothpaste, and
diagnostic set (glass mouth, sonde, tweezers, and excavator) . Analysis of the results of the study was
conducted using paired t test with 95% confidence level and α = 0.05. Ethical clearance for this research was
obtained from the research ethics committee of Universitas Ahmad Dahlan, Indonesia (Letter of Ethical
Approval, Number 011705054). Appropriate ethical conduct was maintained throughout the study.

3. RESULTS AND DISCUSSION

The number of respondents studied was 49 students. All of respondents are around age 9 years
(100%). The majority of respondents are male (59.2%). Percentage of good PHP index is greater than
moderate PHP index.
The statistical test is used to analyze the average difference of the independent variable with the
dependent variable. The bivariate analysis in this study was Paired Sample Test. Paired Sample Test was
done by looking at value of Pvalue <0.05 aimed to know whether there is difference of mean between before
and after giving of education. Then continued to count magnitude difference between before education and
after education. Paired Sample Test Results of Effect of Dental and Moral Hygiene Education on Dental and
Oral Hygiene Students at SD Negeri 3 Sleman was presented on Table 1.
Table 1 shows that the average value of pre test of dental and mouth hygiene respondents is 0.082
and the average post test of dental and mouth hygiene respondents is 1.4830. There is a difference which is
around 1.4007. This shows an increase in dental hygiene of the respondent before and after being educated.
The results of statistical analysis showed that there is influence of oral and dental hygiene education to
dental hygiene where pvalue 0.000.

Table 1. Paired Sample Test Results

Group Frequency Average SD pV
Pre Test 49 0.0823 0.62846
Post Test 49 1.4830 0.19744

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IJERE ISSN: 2252-8822  261

Based on the results of research conducted at SD Negeri 3 Sleman, obtained respondents are at the
age of 9. It is 100%. Most of respondents gender are male which is 29 respondents (59.2%) and 20
respondents (40.8%) are female. All respondents are in the age of 9 due to class levels suggested by the
school ,as well as considering the existence of inclusion criteria and exclusion from the researcher, they are
3rd grader elementary school who does not use braces.
The result of bivariate analysis about the influence of oral and dental hygiene education on dental
and oral hygiene shows that there is difference of mean value before and after education. When pre-test the
average value is 0.0823 but after doing the post test the average value becomes 1.4830. This shows that
there is a difference in mean score between before and after education of 1.4007 and indicates an increase in
oral hygiene before and after education. Improvement of dental hygiene and mouth of respondents caused
by the researcher who gave intervention in the form of giving about tooth and mouth hygiene on respondent
using simulation method with jaw model media. The results of counseling is students' knowledge increases
so it is expected to fix well the maintainance of dental and oral hygine which can be applied everyday. The
value of paired sample test analysis is 0.000; it can be concluded as the influence of oral and dental hygiene
education on oral and dental hygiene level among elementary school students of SD Negeri 3 Sleman. Thus,
students can understand the material presented by the researcher related to oral hygiene, rsuted in to the
increased levels of oral and dental hygiene. Characterized by a decrease in the score of PHP students.
Knowledge or cognitive is a very important domain for the formation of one's actions [5]. Behavior based on
knowledge will be more lasting than behavior that is not based on knowledge. If the recipient of the new
behavior is based on knowledge, awareness and a positive attitude then the behavior of the recipients will be
long lasting. In the other hand without the knowledge, it won’t be long lasting. This is in line with previous
research which stated that students who have good knowledge have a chance 2.2 times to have good dental
and oral hygiene status [6].
Materials given by researchers to improve students' knowledge about oral hygiene during
counseling include good and correct tooth brushing techniques, brushing time, toothbrush form and diseases
that is caused by not doing brusing teeth properly. The material is given because the students need to
understand well so that the maintenance of good dental and oral health of the childern is good along with
their dental and oral hygine level. Several research results stated that there is correlation between tooth
brushing frequency and dental hygiene level, there is correlation between oral hygiene with brushing skill in
blind children (p value = 0.002), there is difference of meaningful index debris between soft and medium
soft brush (p value = 0.077), there is correlation between bristle damage to the level of dental hygiene in
children (p value = 0.002) and there is correlation of dental maintenance behavior with caries experience
score (p value = 0.03) and oral hygiene score (p value = 0.00) [7-11].
Dental and oral health education is an educational process that aims to improve oral health. One of
the theoretical foundations of the use of methods and media in the educational process, the Dale's Cone
Experience Theory. According to the theory, there are several methods that can be used in the educational
process. Basically the educational process involving more senses will be easier to be accepted and
remembered by individuals [5] [12-14]. In this study, researchers conducted counseling with educational
methods using lectures and simulations of brushing teeth. The method of simulating the practice of brushing
the teeth can make the passive learning atmosphere become more active, the children move to be carefree,
so that the child is able to capture more messages or information delivered [15].
Similar research reported there was a higher knowledge increase by a score difference of 30 in the
simulated game group given about dental health education with snake ladder games compared to lecture
groups [16]. Dental health education using a simulated snake game ladder resulted to the child can see more
than one of the five senses. The more the five senses used the better. Even more messages or information
will be obtained easily [17]. In essence, humans learn through six levels, and from what people see and hear,
it is said they will learn as much as 50% [18].
Provision of oral and dental education will be more effective and optimal if it uses the right
methods and media. Provision of dental education requires aids or props to facilitate the educational goals to
receive what is delivered. In this process one can obtain knowledge in the form of information through the
existing educational media. Education media is a tool in an educational process. Media has an important role
in maximizing the delivery of the message so that it can be well received by the target of education. In this
study, researchers used the jaw model as a visual aid in the extension process. The jaw model is used as a
visual aid tool to assist the researcher when describing good and correct tooth brushing techniques. Dental
brushing technique is taught as vertical, horizontal, rotating, vibration (vibrate), circular and physiological
for every part of mouth [19].
When dental and oral health education interventions were conducted using a simulation method using
the jaw model, students were shown various forms of teeth and how to brush teeth properly and correctly. The
students are directed to feel the jaw model so that it can recognize the various forms of human

Dental and Oral Health Education for Elemetary School Students through … (Septian Emma Dwi Jatmika)
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teeth, namely the incisors, canine teeth, small molars and large molars. Students can also distinguish teeth in
the maxilla and teeth in the lower jaw. By groping the grooves of the teeth on the model, the students were
able to know the gums on the jaw model. Students also recognize the various surfaces of the tooth, the
surface of the tooth facing the lips or cheeks (the outer surface of the tooth), the surface of the tooth facing
the tongue or the ceiling (the inner surface of the tooth) and the chewing area of the tooth. Then the students
are guided to perform motor movement brushing teeth by using a toothbrush without paste on the jaw
model. After that the students are simultaneously guided to do toothbrush simulation using good and correct
technique. When getting a dental health education using a simulated method by the media of the jaw model,
then the students will use their four senses, namely the sense of touch, the listener, the vision and the sense.
Similar research reported there was a significant difference in the sample groups which got education about
oral hygiene using jaw models before and after intervention [20]. The results showed that there was a
decrease of PHP index score in the sample group after intervention.
Some principles in the selection of educational media should also be considered. Since the selected
media must be tailored to the material that is goig to be delivered; educators must understand the
characteristics of the media so that between the media and the methods used are appropriate; the suitability
of the media used by the target group; as well as the completeness of the media shoould be considered as
well. In order to provide better perception to the target of education [21]. In this study, researchers used the
method of simulation with media jaw jaw model as a visual aid in the extension process in elementary
school students. Methods and media are tailored to several things, the first material to be delivered is about
good brushing techniques and correct time of brushing teeth, toothbrush form and diseases due to not
brushing teeth properly and correctly. Therefore the need for props to help visualization of the child.
Second, the simulation method is chosen because when delivering the material there is a need to practice
good and correct way of brushing teeth. Therefore it is necessary to do the simulation of good and correct
way. Third, the provision of dental and oral hygiene education using the simulation method with the jaw
model media is suitable for elementary students, because the simulation method stimulates the child to be
active. Thus it can be concluded that the provision of oral and dental hygiene education in elementary school
children using simulation methods with media jaw model can be used as a medium of learning while playing
for children, so it can motivate children to learn.
This is in line with several studies. On the provision of dental health education in children using several
methods and media which states that dental health education using video media (p value = 0.000) and media flip
chart (p value = 0.000) can improve the knowledge of dental and child health significantly, dental health
education using booklet media (p value = 0.025) and media flip chart (p value = 0.008) can increase knowledge of
tooth and child meaningfully, cartoon animation media effectively change dental and oral health care behavior to
be better p = 0.000), health education using audio visual media (p value = 0.000) can improve dental and oral
health maintenance, dental and mouth health counseling with power point media (p value = 0.001) and flipchart (p
value = 0.001) increase the level of knowledge of children [22-26].
One of the way that can be done is to focus the reach of school-based dental services such as
School Dental Health Efforts (UKGS) by instilling the importance of healthy behavior since the child who is
in elementary school until he completes his education at high school level. The most effective preventive
measures are those undertaken by students in the school because healthy lifestyles should be emphasized
early and carried out continuously to become habits [27] [28]. In addition, this group is also more easily
formed considering students are always in guidance and supervised by the teachers so it is very potential to
implant habit of healthy living behavior. In Act No. 23 of 1992 on Health mentioned that the
implementation of school health is aimed to improve the ability of healthy life for learners so that they can
learn, grow and develop harmoniously and optimally become more qualified human resources. One of the
advantages of school-based health programs is that it provides an opportunity to reach more children during
the early development period when the health patterns can still be changed or modified. The state of the
school also provides a supportive atmosphere for learning and the reinforcement of children so that teachers
can use new strategies or methods to encourage children to participate in dental and oral disease prevention
measures [27]. Therefore, it needs to be a positive support, especially from the school to continue providing
oral hygiene education for students using methods and media whch are interesting periodically, in order to
improve the level of children health, especially students’dental and oral health to get better

4. CONCLUSION
There is difference of mean value of dental and oral hygiene level of respondent. This shows the
improvement of dental and oral hygiene of respondents before and after getting the education. The result of
statistical analysis shows that there is influence of oral and dental hygiene education to dental hygiene where

IJERE Vol. 7, No. 4, December 2018 : 259 – 263

 IJERE ISSN: 2252-8822  263

pvalue 0.000. Thus, there is a need for dental and mouth hygiene education to be conducted regularly and
delivered with an interesting method.

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Dental and Oral Health Education for Elemetary School Students through … (Septian Emma Dwi Jatmika)