Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

3D Braille as Media in Improving

Tooth Brushing Skill for Blind Children
Fastabiqul Hanif1*, Lanny Sunarjo2, Bedjo Santoso3, Masrifan Djamil4, Ari Suwondo5 Dyah Fatmasari6
1, 2, 3,4, 5, 6
Poltekkes Kemenkes Semarang, Dental Therapist and Hygienist,
Tirto Agung Rd., Semarang Jawa Tengah 50268, Indonesia

Abstract:- The problem experienced by blind children is status, growth and weight of children[6]. More than 50
that difficult to do self-activity especially in behavioral million hours per year are lost due to children are often
dental and oral health care. One of the behavioral absent for school because of dental and oral health
change strategies for blind children is through dental problems. This makes the intellectual level of the child
and oral health education with counseling activities decreases if it continues lead for a long time[7].
which should put attention to the characteristics of the
blind child as well as utilize the hearing and touch Daily tooth brushing behavior in normal children in
senses by implementing 3D Braille Media. It is a Indonesia is 94.7% yet the proper toothbrushing percentage
development of 3D printing media comprising is only 2.8%. Meanwhile the daily tooth brushing behavior
procedure of proper tooth brushing. The aim of this in Central Java, Indonesia is 94.6%, but in contrast, the
research is to create 3D Braille as a media of learning to proper brushing teeth behavior is just 1.7 %.[8].
improve tooth brushing skills for blind children. We
implemented Research and Development (R & D) Based on the results of a preliminary study in one of
method which has five stages of research: data SLB (Special Education School) in Indonesia precisely in
collection, design and build, expert validation, model Jepara regency, Central Java, as much as 40% of tooth
test and model result. It’s performed in the Quasy brushing activities are carried out by blind children in the
experiment pre-test and post-test with control group morning or in the afternoon bathing. The blind children who
design sample divided into 2 groups, of which 15 blind like cariogenic food is 73% and proper tooth brushing
children were in intervention group using 3D Braille technique percentage is only 7%.
media and 15 blind children were in control group using
Braille flipcharts. The data used intraclass corellation Either clinical or non-clinical factors can influence the
coeffiecient test, paired and independent sample caries of permanent tooth. One of the most dominant
test. The results show that 3D Braille is worthy of a contributing factors is behavior and OHI-S (Oral Hygiene
learning media about tooth brushing with p-value of Index Simplified). Therefore, a plan for overcoming the
0.000. Besides, it is more effective in improving tooth problem is by promotive and preventive activities[9]. Efforts
brushing skills with p-value of 0.002, as well as lowering to improve the degree of dental and oral hygiene of blind
the index debris with p-value of 0.020. According to the children is on behavioral change, because behavior is a
results of the research, it can be inferred that the factor that affects awareness in taking care of dental and oral
impementation of 3D Braille Media model is more hygiene. Knowledge influences dental and oral hygiene,
effective in improving the tooth brushing skills and attitude as well as skills. In addition, it also affect the status
lowering the index debris compared to Braille of dental and oral hygiene. Behavior change strategies is in
flipcharts. form of strength, law, and education[10][11].

Keywords:- 3d Braille, Blind Children, Tooth Brushing One of the behavioral change strategies for blind
Skills. children through dental and oral health education is with
counseling activities. However, the method has to be
I. INTRODUCTION adjusted with respect to the condition of blind children.
Children with blindness have limited sense of sight so it is
Children with blindless have a high level of caries and difficult to recognize an object visually in the learning
poor oral and dental hygiene compared to normal children process. Blind children rely on the sensitivity of the sense of
[1][2]. The prevalence of caries in blind children in the touch. The way to utilize their sense of touch is by using
world, one which stands high is in India with 60% braille letters. Braille is a tactile writing system used for
percentage. Nevertheless, in Indonesia, the caries prevalence blind children. Traditionally, these letters have been
reach more up to 80.6%[3][4]. Not to mention, the embossed on paper. The blind know and easily understand
prevalence of dental and oral hygiene in blind children in braille writing because they are accustomed of reading
India is 40%, while Indonesia strikes to 50%[5]. Globally, braille writing. This makes dental and oral health education
dental caries has a higher impact on quality of life due to more easily accepted[12][13].
pain in the oral cavity and reduction of oral cavity function
for communication and as a tool for digestion. The more the Braille media has been applied in Indonesia to improve
number of teeth lost, the lesser the cognitive and memory the dental and oral hygiene. Nevertheless, the media only
function. Chronic caries is known to affect the nutritional introduces letters to blind children so that they are less able

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Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
to recognize the whole object of picture. The recognition of media for blind children as replication based on
braille arising picture, allows blind children to feel the shape Notoadmojo, Maher and Roger's theories.
of objects and recognize visual picture quickly so that it
helps the development of tactile sharpness and mobility of C. Expert Validation
children as well as their feeling to sense and feel the
ambience[14][15]. Expert Validation
n f(%) p-value
According to the background and problem, a 3D Relevant 10 100
braille becomes an urge to be created in order to improve 0,000
Irrelevant 0 0
the skill of toothbrushing in blind children. It is a * Intraclass correlation coefficient
development of 3D Printing media where procedures of Table 1:- 3d braille Statistical test validation from the
proper brushing are provided to stimulate the attention, expert
interests, thoughts and feelings of blind children to begin
improving their tooth brushing skills. 3D braille media Table 1 show the 3D braille statistical test validation
model trains the hands and mind coordination of blind from the expert which indicates the p-value score is in
children besides reading dental and oral hygiene messages 0.000, which means that the 3D Braille model is relevant
on it. Also, there are 3D printed-object so that what they and suitable as a media to improve the skill of tootbrushing
read is conveyed through these picture-object. in blind children.

II. METHODOLOGY D. Model Test

The research methodology is Research and No Variable p-value*

Development (R&D), which is used to produce a product Intervention Control
and test the effectiveness of it. The Research and Blind children (n=15)
Development (R&D) procedure consists of 5 main steps, Pre-test skill 0,960 0,331
namely data collection, design and build, expert validation
Post-test skill 0,930 0,363
and revision, model test, and model results[17].
Pre-test debri index 0,150 0,880
Post-test debri index 0,140 0,721
The research design was quasy experiment (pre and
*Shapiro-wilk
post-test with control group design). This research was
Table 2:- Data Normality Test For Blind Children
carried out in SLBN (State Special Education School)
Semarang, Indonesia as an intervention group and SLBN
Table 2 shows the data normality test for blind children
(State Special Education School) Jepara, Indonesia as a
control group. The sampling technique was purposive as the respondents. Normality test results show that the p-
value is more than 0.05, so it wrapped that the data are
sampling with 30 children divided into two groups, 15
normally distributed so it can be continued using the
children in each intervention group and the control group.
Research data using ratio scale. Intraclass correlation parametric test.
statistical test was implemented to determine the feasibility
of the model, while the normality test used the Shapiro
Wilk test regarding the number of respondents is less than
50. The effectivity test on the paired group normal data
used dependent sample test and for the unpaired group, it
used the independent sample test.

III. RESULTS AND DISCUSSION

A. Data Collection
The results of data collection conducted through
interview method and Systematica Literature Review
concluded that to improve the skill of tooth brushing in *paired sample test
blind children, it needs learning method and media adapted Table 3:- Paired-Data Effectivity Test
to the characteristics of blind children by utilizing the senses
of hearing and touch. Table 3 shows theh paired-data effectivity test. The
effectivity of the data test on the skill of tooth bruhsing in
B. Design and Build blind children show that the p-value of the intervention
The result from data collection is used to produce the group is 0.000 which is less than 0.05, meaning that the 3D
model design. The results of information revealed that blind braille media model is effective in increasing the skill of
children cannot independently take care of their dental and tooth brushing. The p-value of the control group is 0.000 (p
oral hygiene. So the researchers made a 3D Braille media <0.05), meaning that the braille flipchart media and tooth
model with respect to the needs of method and learning brushing demonstration are effective in improving the
brushing skills of blind children.

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Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Same results also occur on the effectivity test of debris IV. DISCUSSION
index, which show that the p-value of the intervention group
is 0.000, in which p-value is less than 0.05, meaning that the 3D braille media model was performed to blind
3D braille media model effectively reduces the debri index. children in addition to learning media as well as to improve
The p-value of the control group is 0.000 (p <0.05), the skill of toothbrushing and reduce the debris index. The
representing that the flipchart braille media and tooth skill of tooth brushing has increased because 3D braille
brushing demonstration are effective in reducing the debris media have many advantages. There are stimuli, triggering
index of blind children. thoughts, attractiveness, creativity that makes them
understand their brushing skill because the media take the
Variabel Unpaired-data test * role of blind children in terms of hearing and touching
n Mean±SD Delta P-Value senses. In the learning process, the education was carried
out 10 minutes before the learning hours in small groups
Skill
according to their respective classes. The children are
Intervention 15 17,47± 2,200 directly involved demonstrating on how to brush their teeth
3,20 0,002
Control 15 14,27±2,815 properly. This is consistent with the theory of Stimulus-
Debris Index Organism-Response (SOR) behavior change which states
that behavior change depends on the stimulus or stimulus
Intervention 15 0,840±0,462
0,52 0,020 provided.
Control 15 1,360±,0,674
*Independent sampel test Blind children could express their motivation in this
Table 4:- non-paired data effectivity test learning method, besides, small group discussion was more
effective in improving dental and oral hygiene compared to
Table 4 shows the non-paired data effectivity test. The large group[18], as well as the implementation of
effectivity test on the skill of toothbrushing of blind toothbrushing was also implemented on day 1 to 10 (2
children show that the p-value is 0.002 (p <0.05), meaning weeks). The practice of brushing was done in the school
that the 3D braille media model is more effective in yard according to the group. Each group was accompanied
increasing brushing skill compared to flipchart braille by their class teacher. In the second week, the children
media and tooth brushing demonstration. began to show changes on their way to brush their teeth. A
child's direct involvement, in fact, can improve tooth
The effectivity test on debris index for blind children brushing skill[19]. Stage by stage has made a significant
shows that the p-value is 0.020 (p <0.05), meaning that the change in the intervention group because to change a
3D braille media model is more effective in reducing debris person's habit, it requires a constant period. Steady learning
index for blind children compared to flipchart braille media on toothbrushing will change someone's behavior
and tooth brushing demonstration. better[20].

E. Model Result The debris index of blind children has decreased

The result of the model is 3D braille media which is because the sample has been taught to understand the
the outcome from the development of counseling method practice of brushing the teeth properly. Correct and proper
and innovative media for tooth brushing by exploiting the tooth brushing practices can get rid of plaque and
senses of hearing and touch and in accordance with the debris[21]. The practice of proper tooth brushing will
characteristics of blind children regarding the improve the dental and oral hygiene of blind children[22].
implementation of 3D braille media model guided by the Basically, the intelligence ability of a blind child is the
school teachers. same as a normal child. Yet, if the skill of tooth brushing in
blind child is lacking, it will affect their own dental and
oral hygiene.

The 3D braille model is stated to have succeeded in

changing the habit of toothbrushing in blind children. It can
be seen because 10 days afterwards, the blind child
continued to brush their teeth after school break and the
blind children are able to do it properly. Consequently, the
debri index is decreased. The success of 3D braille is due to
the fact that the implementation has been carried out for 10
days to provide more stimulus in the learning process by
involving the teacher in guiding and assisting children in
brushing their teeth.
Fig 1:- 3D Braille Media

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Volume 5, Issue 6, June – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
V. CONCLUSION [12]. E. Mardiati, Salikun, and K. Aprianti, “the
Effectiveness of Audio Media and Braille Leaflet
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and touching, 3D Braille model successfully proven that it Halemani, V. Buddiga, and S. Mythri, “A comparative
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Dent., 2015, vol. 5, no. Suppl 2, pp. S129-32.
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