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Abstract:

Background: According to data from the Badan Pusat Statistik (BPS) in 2019 there were
9.6% of elderly people in Indonesia. Biologically, the elderly will experience an aging
process characterized by decreased bodily functions, including the function of the salivary
glands. One of the disease that is often found in the elderly is xerostomia. Xerostomia is a dry
mouth caused by a lack of saliva production. Complaints of this disease are often found in the
elderly due to decreased organ function (organ degeneration). Chemical prevention is carried
out by rinsing with a rinse of siwak (Salvadora persica) extract because it is suspected that
there are natural chemicals that can stimulate the salivary glands. Purpose: This study aims
to determine the effect of the miswak extract mouth rinse on the saliva flow rate of
xerostomia sufferers in the elderly. Method: The method used is to collect data and
information through e-books, journals, scientific papers relevant to this writing. Conclusion:
The conclusion is that giving 50% siwak extract mouth rinse to the elderly has a significant
effect on the salivary flow rate of xerostomia sufferers.

Key words: Salvadora persica, saliva, xerostomia.

Introduction

Health which includes physical and spiritual health is the most important thing that
every human being wants. To realize human health, especially for the elderly, you must also
pay attention to oral health, because oral health is the gateway to getting the general health
desired by the community. The good oral health is a picture of a good general health
condition. On the contrary, bad oral health describes a bad health condition.

According to data from the Badan Pusat Statistik (BPS) in 2019 there were 9.6% of
elderly people in Indonesia. It shows that Indonesia will get into an aging population, because
the number of people aged 60 years and over has exceeded 7.0% (Lilis heri, 2019).

Increasing age in humans is accompanied by decreasing an organ function (organ

degeneration) due to natural factors or disease. One of the disease that is often found in the
elderly is dry mouth (xerostomia). Xerostomia commonly founds in the elderly, where the
frequency ranges from 13-39%, and increases to 60% in those who undergo medication or
hospitalization. According to the International Dental Federation (IDF), 50% of the
population aged 40-50 years or older experience a decreasing in objective salivary flow, and
an increasing of 70% in a population aged 70 years or older.

Prevention of the condition of xerostomia in the elderly can be done mechanically and
chemically. One example is the use of a mouth rinse. The use of mouth rinse continuously
can have negative effects such as dehydration of the mucosal tissue (Bahar. A, 2011). An
alternative mouth rinse is made from natural ingredients that are considered more efficient,
cheap, and environmentally friendly, namely the siwak (Salvadora persica) extract mouth
rinse. World Health Organization (WHO) has recommended the use of siwak stalks as a tool
for oral health, by means of the mechanics of softwood fibers and the therapeutic action of
their chemical constituents. Siwak extract has many benefits, such as used for an
antibacterial, effective in reducing plaque bacteria, and can stimulate the salivary glands. The
essential oil in siwak’s stalks, like benzyl isothiocyante, can increase a secretion of saliva in
the oral cavity.

Purposes

This paper aims to determine the effect of the siwak extract mouth rinse on the saliva
flow rate of xerostomia sufferers in the elderly.

Methodology

This research is a type of library research which related to the method of collecting
library data, or research where the object of research is explored through a variety of library
information (books, encyclopedias, scientific journals, newspapers, magazines, and
documents) (Syaodih, 2009). ). The data used in this research is secondary data. The data
source in question is in the form of primary or original scientific journals of less than ten
years on the website (non-print).

Literature review

1. Siwak (Salvadora persica)

Salvadora persica, or what is known as arak tree, is an evergreen tree that grows into a
small tree or shrub with a bent trunk, this plant is able to stand in extreme conditions
such as very dry soil or soil that contains a lot of salt. Siwak is more than just an
ordinary toothbrush. Besides having an elastic stem fibers and does not damage teeth,
Siwak also has many natural antimicrobial properties, and can also function to erode
 dental plaque. Siwak has many functions in maintaining the health of the oral cavity,
both mechanically and chemically. Its chemical content includes using Siwak in
extract form, among others. Research conducted by Syamsiah Syam, et al. In 2018
showed that the 25% solution of Siwak extract used for gargling showed increased
salivary secretion results because Siwak contains essential oils that function to
increase salivary flow. Increasing the flow of saliva will later increase the buffer
activity contained in saliva so that the pH of the saliva will also increase.
2. Saliva
Saliva is one of the fluids in the oral cavity besides the gingival crevicular fluid and
secretions from the oral epithelium. The saliva of the common people is often referred
to as saliva. Saliva has a function to lubricate the tissues in the oral cavity, protect the
tissues in the oral cavity so that it does not occur abrasion during chewing, clean the
debris leftover in the oral cavity. Saliva also plays a role in the formation of acquiring
pellicles on the tooth surface that triggers plaque formation (Tibor et al, 2007; Greabu
et al, 2009).
Saliva consists of 99% water and the rest is a component of organic molecules and
inorganic molecules secreted by the major salivary glands and minor salivary glands.
The secretion of saliva is mainly produced during taste and chewing. In healthy
conditions, 0.5 ml of saliva remains in the oral cavity. Factors that can cause reduced
salivary secretion is hormonal changes that occur in the elderly and disease factors in
the salivary glands (xerostomia, parotitis, etc.). The salivary glands can be stimulated
using mechanical, chemical, neural, psychological, and pain stimuli.
3. Xerostomia
Xerostomia is a dry mouth condition. This condition can be caused by many factors,
both physiological and pathological. For instance, exercise, talking too long, and age
factors, are physiological factor. Reduced saliva can cause drying of the mucous
membranes and oral mucosa to become dry and sticky, which can lead to irritation
and infection, and a burning feeling.

Discussion

1. Mechanism of salivary secretion

The salivary glands consist of components that can secrete saliva into the oral
cavity through ducts called salivons. Salivon consists of acinus, intercalated duct, and
striated duct (Holsinger and Bul, 2007). The secretion of the salivary glands is largely
 controlled by the autonomic nerves, namely sympathetic and parasympathetic. The
process of salivary secretion is preceded by a stimulus that activates the stimulation
reflex. The sour and salty taste is a strong stimulus so that it can trigger the secretion
of the salivary glands (Ekstrom et al, 2012).
The parasympathetic nervous system delivers nerve impulses to the nucleus of
salivarius, which will pass nerve stimulation to the sublingual and submandibular
glands. The secretion of saliva stimulated by the parasympathetic nerves is watery
(serous). Meanwhile, the salivary secretions stimulated by sympathetic nerves are
thick (mucous). Changes in salivary secretion are influenced by various factors,
including xerostomia.
2. Preparation of 50% miswak extract solution
The siwak stalks are washed in the beginning until they are clean then cut into
smaller pieces and then dried for 2 days. After that, it is finely ground through the
maceration process. The siwak powder was extracted with 96% ethanol solvent
added. Then, the mixture is filtered and obtained residue and filtrate. The filtrate is
concentrated and infused with a water bath so that a 100% concentration of siwak
extract is obtained. After that, dilution was carried out with aquadest and obtained
50% concentration of siwak extract. (Adzakiyah et al, 2015).
3. Effect of gargling with siwak extract solution
Siwak has a function in maintaining the health of the oral cavity, for example
by making it into a siwak extract mouth rinse. The content of chloride ions contained
in the siswak can help remove the pellicle which is the base surface for bacterial
colonization. The content of essential oils can increase salivary secretion, stimulate
salivary flow, and increase the amount of saliva production.
Saliva production varies from person to person. But in the elderly, the risk of
developing xerostomia is very high due to the influence of age and the presence of
atrophy in the salivary glands with age. In the elderly, the parenchyma glands are lost
which will be replaced by fatty and connective tissue, the intermediate ductal cell
lining experiences atrophy. This causes a decrease in the amount of salivary flow in
the elderly.
Research conducted by Kasuma et al in 2015 obtained an average Ph of saliva
before rinsing with a 50% siwak extract solution of 6.56. Meanwhile, the average pH
of saliva after rinsing with a 50% siwak extract solution was 7.4. According to
research also conducted by Syam et al, 2018 in the elderly who do not have systemic
 disease the result is 3.321 ml / 5 minutes before rinsing using a 25% siwak extract
solution. Meanwhile, those who had rinsed with a 25% siwak extract solution
significantly increased to 4.379 ml / 5 minutes.

Conclusion

Giving siwak extract mouth rinse to the elderly has a significant effect on salivary
flow rate, salivary pH, and salivary viscosity because there are essential oils that can
stimulate the secretion of the salivary glands.