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Dental Health Handbook as Parents Monitoring in the Formation of

Independence for Brushing Teeth in Early Childhood

Article  in  Indian Journal of Public Health Research and Development · January 2020

DOI: 10.37506/v11/i1/2020/ijphrd/193920

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 DOI
766  Indian Journal of Public Health Research & Development, January 2020, Vol. 11, Number:
No. 01 10.37506/v11/i1/2020/ijphrd/193920

Dental Health Handbook as Parents Monitoring in the

Formation of Independence for Brushing Teeth in
Early Childhood

Ngatemi1, Tedi Purnama1

1
Lecturer Departement of Dental Health, Ministry of Health Polytechnic Jakarta I, South Jakarta, Indonesia

Abstract
Oral health problems that many have encountered are dental caries and periodontal disease where the
prevalence of dental caries of children aged 5-6 years by 93% with def-t index of 8.43. Such conditions
do not meet the WHO target and FDI is 50% of children aged 5-6 years free of dental caries, it is because
children are not capable of independent activity in brushing teeth. Proper behavior change strategies can be
done by providing dental health education by parents. Dental health handbook could be a learning brushing
teeth in efforts to establish the independence of brushing their teeth in early childhood. This study aims
to effectiveness of dental health handbook as monitoring the parents in the formation of independence of
brushing teeth in early childhood. Method: This study uses quasy experiment with pretest and posttest design
with one group, by providing dental health guide books and training to parents. This research was conducted
in PAUD Fatahillah Pangkalan Jati Depok. The independent variables: dental health guide books, variable
between: knowledge and attitudes of parents and the dependent variable: the skills brushing teeth free of
plaque and score early childhood. Data were tested using a paired sample test and wilcoxon. Result: the
provision of dental health handbook effectively improve the knowledge and attitudes of parents (p <0.001)
and effectively to the improvement of skills brushing teeth and a decrease in plaque score (p <0.001).
Conclusion: effective dental health handbook as monitoring the parents in the formation of independence of
brushing teeth in early childhood.

Keywords: dental health handbook, independence brushing teeth, early childhood

Introduction left untreated will cause periodontal infection. Bacteria

Oral health is for general health, meaning that if
someone toothache then general health will be disturbed.
Oral health problems that many have encountered are
dental caries and periodontal disease.1-3
Dental caries is a disease in hard tissue of teeth
that is characterized by the breakdown of enamel and
dentin caused by the metabolic activity of bacteria in
plaque that causes demineralization. Dental caries if
periodontal pathogens are inflammatory mediators
which then enter the bloodstream, causing systemic
disease, such as: increasing the risk of heart attack,
stroke risk, increase the severity of diabetes, respiratory
diseases, preterm labor, rheumatoid arthritis, osteoporosis,
pancreatic cancer, kidney disease and interfere with the
system digestion, especially in children. Dental caries
in preschool children is commonly known as early
childhood caries, because the enamel of primary teeth is
thinner than permanent teeth, so it is more susceptible to
dental caries.4-7

Dental caries in Western Australian Aboriginal

Corresponding Author:
children aged 1-4 years especially preschool disease is
Tedi Purnama
number 5 of the disease to be treated from the hospital.
Department of Dental Health, Poltekkes Kemenkes
According to Kwan in Santoso (2017), more than 50
Jakarta I, Jl. Wijayakusuma No. 47-48 South Jakarta
million hours of school per year is lost as a result caused
e-mail: tedipurnama@poltekkesjakrta1.ac.id
 Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01  767
by toothache in children who have an impact until the
life of an adult, meaning that dental caries in preschool
years greatly affect the quality of life of children and
growth.8, 9
Riskesdas in 2018 proved that the prevalence of
dental health of children aged 5-6 years by 93% with
def-t index of 8.43. Such conditions do not meet the
WHO target and FDI is 50% of children aged 5-6 years
free of dental caries.9, 10
One cause of the high prevalence of dental caries
for dental health maintenance behaviors are less than the
maximum, this is evidenced Indonesia’s population had
brushed his teeth with the categories of behavior really
only reached 2.8% and by 2.8 West Java Province.10,
11Efforts to prevent the occurrence of dental caries can
be done through the behavior of most major dental
maintenance and recommended by way of brushing your
teeth. That is the simple act of brushing teeth to remove
plaque and food debris with a toothbrush and toothpaste,
because plaque and leftover food is a major cause of
dental caries, therefore it is necessary to build a habit of
brushing their teeth at an early age.12,13
Early childhood is a “golden age period”, meaning
the golden period for all aspects of human development,
whether physical, emotional and social cognition, where
the development of intelligence in this period increased
by 50%. Early childhood is the ideal time for a child’s
motor skills, including brushing teeth, so that will cause
a sense of responsibility for the cleanliness of himself.14
Changes in a child’s behavior depends on the
ability of adaptation to the stimulus response beyond
himself. It fits in the Roy adaptation theory (Sari et
al, 2012) suggests that changes in a person’s behavior
depends on the incoming stimulus and adaptability of
the person, that is to say through the right stimulus and
the appropriate development of children, will help in
entering the next phase of development is well. It is also
affecting the child’s behavior change is a stimulus from
the environment, namely the involvement of family
members. Through the active participation of parents it
will be better the child’s behavior in brushing teeth and
guidance of parents in brushing teeth to prevent dental
caries.13, 15, 16
Dental health guide books selected as the media for
dental health education because it can accommodate
writing and drawing in large numbers so as to help
parents who have young children in maintaining their
oral health. The use of guide books can also be motivated
to instill a sense of responsibility for the maintenance of
oral health of their children. This is evidenced research
Darwis et al (2011) that the use of guide books can
improve the status of early childhood dental hygiene.17,18
Based on this background, researchers interested
in proving that the administration of dental health
handbook as monitoring the parents in the formation of
independence of brushing teeth in early childhood.
Method
The method used in this study is quasy experiment
with the design of pre- and post-test with one group
design. The experiment was conducted in PAUD
Fatahillah Pangkalan Jati Depok during September and
October 2019. Samples were taken with total sampling,
as many as 46 students and 46 parents. The independent
variable in this study are dental health handbook, the
between variable is parents’ dental health behavior
(knowledge and attitude) and the dependent variable
is the independence of brushing and plaque score early
childhood.
Data collection knowledge and attitudes of parents
measured the questionnaire with the following activities:
pre-test, training and provision of health handbooks in
the elderly and post-test. In early childhood intervention
for 10 days with details of activities as follows: pre-
test, intervention by parents and post-test measurement
tool is a checklist sheet brushing and plaque index
measurement sheets. The research data using a ratio
scale statistical test, if normal data using a paired sample
test, while not normal using wilcoxon test.
Results
Research result shows that the respondents to the
age of 4 years as many as 4 children (8.7%), aged 5 years
as many as 18 children (39.1%) and the age of 6 years
sebnyak 24 children (52.2%). While respondents male
sex as many as 18 children (39.1%) and female gender
of respondents were 28 people (60.9%), he explained in
the following table 1.
768  Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01
Table 1. Characteristics of respondents

No Variables Total Percentage

1 Age

4 years 4 8.7

5 years 18 39.1

6 years 24 52.2

2 Gender

Male 18 39.1

Femele 28 60.9

Table 2. The mean value of plaque index of children, knowledge and attitudes of parents

No Variables Mean SD Min-Max

1 Tooth brushing skills

Pre-test 4.37 1.142 3-7

Post-test 8.48 1.110 6-10

2 Children’s plaque index

Pre-test 36.22 10:50 12-60

Post-test 26.83 9291 10-48

3 Knowledge parents

Pre-test 7:28 1.760 5-11

Post-test 10:07 1.806 7-13

4 Attitude parents

Pre-test 36.41 8.798 25-35

Post-test 50.33 9.031 55-65

Table 2 shows the average value of the value of the skills children brushing their teeth increased from 4.37
became 8.48. The value of the index on the child plaque scores decreased from 36.22 into 26.83. The average value
of the knowledge of parents has increased from 7.28 into 10.07, and the average value of parents’ attitudes also
increased from 36.41 into 50.33.

Table 3. Test of normality

No Variables Pre-test Post-test

1 Tooth brushing skills of child 0.000 0.001

2 Plaque index of child 0.184 0.067

3 Knowledge of parents 0.001 0.008

4 Attitude of parents 0.001 0.008

* Shapiro-Wilk
 Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01  769
Table 3 shows the results of the normality test Discussions
for the plaque index score of children with normal
Provision of dental health guide books and training
distribution because the p-value >0.05 then proceed
to parents do to improve the knowledge and attitudes of
parametric test, while for the results of the child’s teeth
parents in the maintenance of oral hygiene. According to
rub skills, knowledge and attitudes of parents are not
Santoso (2017), is a dental health maintenance training
normal distribution because the p-value of <0.05 so non-
activities planned through the learning process that aims
parametric test.
to provide knowledge, inculcate and practice the skills
Table 4. Test the effectiveness of the knowledge until someone can independently perform maintenance
and attitudes of parents and after intervention actions oral hygiene.9

The result of the effectiveness of variable data and

Variables Mean ± SD P-value
knowledge of dental health maintenance attitude of
Pre-test 7.28 + 1.760 parents shows that the p-value 0.001 (P <0.05) means
Knowledge 0.001 that dental health guide books effectively improve
Post-test 10.07 + 1.806 the knowledge and attitudes of parents in raising their
children’s oral health. Improved knowledge and attitudes
Pre-test 36.41 + 8.798 caused by the guidebooks can be learned in time at any
Attitude 0.001 time, parents can actively learn independently so that
Post-test 50.33 + 9.031 the retention of material oral hygiene maintenance can
* Wilcoxon easily catch. Health education is essentially a business
activity or health messages to the community, group
The results of the effectiveness test given knowledge or individual. With the training given, respondents get
before and after treatment showed that the p-value was the learning that results in a change from the previously
0.001 (p <0.05) means that the provision of dental health unknown becomes known, the former did not understand
handbook effectively improve the knowledge of parents being understood. This study is also consistent with the
and the p-value the attitude of parents is 0.001 (p <0, results of research Amin (2014) found a positive effect
05) means that the provision of dental health handbook of dental health education to changes in values, attitudes
effectively improve the attitudes of parents. and actions of parents to maintain their children’s oral
health.19, 20
Table 5. Test effectiveness skills brushing teeth
plaque index scores before and after intervention Besides given a guide book, parents who have given
their dental health maintenance training because then
Variables Mean ± SD P-value parents will be monitoring the activities of brushing
Pre-test 4.37 + 1142 teeth as efforts to establish the independence of children
Tooth brushing brushing their teeth. According Subekti (2017) assisting
0001
skills *
Post-test 8.48 + 1.110 parents in toothbrushing influence behavioral change
brushing and dental hygiene level of the child.21
Pre-test 36.22 + 10.50
Plaque index ** 0001
Post-test 26.83 + 9.291 The results of the effectiveness test the skills of data
brushing teeth showed p-value was 0.001 (p <0.05),
* Wilcoxon ** Paired Sample Test
meaning that the provision of dental health guide books
The results of the effectiveness test of skills brushing in older people brushing their teeth effectively improve
teeth before and after treatment showed that given the the skills of early childhood. Intervention during 10 days
p-value was 0.001 (p <0.05) means that the provision of brushing teeth effectively improve the skills of young
of dental health handbook in older people effectively children because parents provide mentoring children in
improve the skills of early childhood brushing teeth and the learning process of brushing his teeth, parents and
plaque index score of p- value is 0.001 (p <0.05) means children directly involved in how to brush their teeth
that the provision of dental health handbook in older properly. This is in line with research Purnama (2019)
people effectively lower the score the plaque index in mentoring brushing teeth for 10 days by a parent can
early childhood. shape the behavior of preschool children brushing their
teeth. This success has also seen an increase in plaque
770  Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01
free scores of children. The results of the effectiveness
test data indicate that the p-value was 0.001 (p <0.05),
meaning that the provision of dental health guide books
to parents free of plaque effectively improve the scores
of children. Score plaque free early childhood has
increased since the sample has been taught to understand
the practice to brush their teeth. Practice brush their
teeth will be able to remove plaque. Research Raj
(2013), proving that brushing your teeth with the correct
technique will improve oral hygiene preschoolers.22, 23
Conclusions
Based on the results research, it can be concluded
that:
1. Dental health handbook is effective in increasing
knowledge of parents’ oral health maintenance. This
was proven significantly
2. Dental health handbook is effective in increasing
the attitude of maintaining oral health of parents. This
was proven significantly
3. Dental health handbook is effective as a
monitoring for parents in the formation of independence
in brushing teeth at early childhood. This was proven
significantly
4. Dental health handbook is effective as
monitoring of parents in reducing index plaque scores in
early childhood. This was proven significantly
Acknowledgement: This study was funded by
Ministry of Health Polytechnic Jakarta I. The authors
thank to all partisipants and research assistans.
Conflict of Interest: The authors reported no
conflict of interest.
Ethical Clearance: All participants were signed the
informed consent prior to the data collection.
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