Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Model of Dental and Oral Health Care Services on

Decreasing Debris Index Scores in the
Implementation of Oral Hygiene
in Elderly with Dementia
Nuraisya, Rasipin, Endaharyati Eko ningtyas, Diyah Fatmasari, Bedjo Santoso
Poltekkes Kemenkes Semarang,Dental Therapist and Hygienist
Tirto Agung Rd, Semarang Central Java, 50628, Indonesia

Abstract:-Background: Oral hygiene is still a major Nations Fund for Population Activities (UNFPA), there are
problem for the elderly. Riskesdas in 2018 stated that currently around 737 million elderly people in the word. [3]
dental problems in the 55-64 age group increased by 48.5%
and those aged 65 and over by 38.6%. The government's Dementia (senile) is a cognitive decline that is so severe
efforts to realize dental and oral health services are that it interferes with activities of daily living and social
regulated in Kepmenkes No. 58 of 2012 and its activities experienced by a person. [4] Dementia in the elderly
implementation is regulated in Kepmenkes No. 284 of 2006 is a condition of general and progressive cognitive impairment
but the implementation of dental and oral health care for related to the physical health of the elderly. Elderly people
the elderly with dementia has not yet been specifically aged over 60 years are often found with dementia problems
implemented, so an innovative model of developing oral which until now it is estimated that more than 30 million
health care is needed that is designed according to the people worldwide suffer from dementia with various causes.
needs of the elderly with dementia in performing oral [5]
hygiene. independently. Research Objectives: a model of
dental and oral health care for the elderly with dementia With age, aging is unavoidable and every individual will
that is feasible and effective in reducing the debris index experience changes both physically and mentally. In addition,
score in the implementation of oral hygiene for the elderly the elderly experience natural processes and changes in the
function of body tissues, including changes in oral tissues,
with dementia. Methods: Research and development
such as dry mouth, pale mucosa, thinning of the mucosa,
(R&D) with a quasi-experimental method of pre-test and
post-test with control group design. The research subjects attrition and tooth loss. [6],[7]
were divided into 2 groups, namely 16 intervention groups Oral hygiene is still the main problem for the elderly.
and 16 control groups. The research instrument used a Poor oral hygiene in the elderly will affect the masticatory
questionnaire and an observation sheet, with DI as the function, because the chewing function will decrease, which
variable. The statistical test used the Intraclass correlation will affect overall health and nutritional status, which will
coefficient for expert validation, and the dependent cause the elderly to avoid certain foods, especially foods that
variable used the Man Whitney, Wilcosxon, Paired and are difficult to chew and cause changes in eating patterns. [8]
Independent sample test. Result : Dental and oral health Dental and oral hygiene is one of the main factors that trigger
care for elderly with dementia is relevant in lowering the various oral diseases, especially dental caries, periodontal
Debris Index score (p=<0.001) compared to the control disease and various infectious diseases and even tooth loss.
group. Conclusion: The development of a model of dental dental disease is the elderly.[11] This situation shows that
and oral health care for the elderly with dementia is Indonesia's dental and oral diseases are still high, and the needs
feasible and its application is effective for the of the Indonesian people for dental treatment (dental treatment
implementation of oral hygiene in the elderly compared to needs) are still high.[12]
the control group.
Minister of Health Regulation No. 58 of 2012 concerning
Keywords:- Dental and oral health care, Elderly dementia. the implementation of dental nurses, the main task of dental
I. INTRODUCTION nurses in carrying out dental and oral health care services for
individuals, groups, and communities in health care
Elderly is an age group in humans who have entered the facilities.Permenkes No. 58 of 2012, dental and oral health
final stages of the phase of life. In this group categorized as care is a systematic approach process in the fields of
elderly, an aging process will occur which is characterized by promotive, preventive, and simple curative.[13] Dental and
changes in the physical and mental health of the elderly.[1] In oral health care services are planned dental and oral health
line with the increasing age of a person and the process of services, which can be carried out for certain community
decline followed by the emergence of physiological disorders, groups within a certain period of time, and are carried out
decreased function, cognitive disorders, affective and continuously in the simple promotive, preventive, and curative
psychosocial disorders. [2] Based on data from the United fields provided to individuals, groups, and communities. [14].

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Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
II. METHODOLOGY Score Mean p-Value*

The design of this study was a quasi-experimental Pretest

and Post-test Design (Non Equvalent Control Group). Expert
Respondents consisted of 32 elderly people with dementia. behavior 92
The minimum sample size required is 32 people. The sample dental and oral health care 98 96 0.003
was divided into two, namely 16 people for the intervention gariatrics 98
and control groups. The elderly with dementia who became the Table 1. Expert Validation
object of the study were the elderly in the working area of the Interclass correlation coefficient
Padang Sari Public Health Center and the Pudak Payung
Public Health Center, Semarang City. Based on the results of the assessment of 3 expert
validators, it is known that the distribution of frequency data
The instrument for implementing the Askepgilut model for behavioral experts is 92%, dental and oral health care
in the elderly with dementia uses an assessment sheet using a professionals are 98%, and gariatry experts are 98%. The
questionnaire and an observation sheet, with the variable average value of eligibility is 96 with a very decent category.
Debris Index. while the feasibility of the model was measured The results of expert validation show that the p-value = 0.003
using the askepgilut instrument which was designed based on means that the dental and oral health care model for the elderly
the characteristics of the elderly. is relevant as a method of dental and oral health education for
the elderly with dementia.
The research data uses an interval scale, statistical tests
use the intraclass correlation coefficient to determine the D. Model Test
feasibility of the module. Meanwhile, the normality test used Variabel P-volue
the Shapiro Wilk test because the number of respondents was Intervensi Kontrol
less than 50. The effectiveness test on normal data for the (n=16) (n=16)
paired group used the dependent sample test and for the DI Pre-Test 0,628 0,201
unpaired group, the independent sample test was used. DI Pos-Test 0,277 0,100
III. RESULTSAND DISCUSSION Table 2. Normality Test Data Debris Index Elderly
*Shapiro-Wilk
A. Data Collection
The results of information collection were carried out The results of the normality test showed that the Debris
through interviews and systematic reviews which concluded Index intervention group had a P-Value value > 0.05 so it
that oral hygiene is still the most important problem for the could be concluded that the data were normally distributed, so
elderly. awareness of the elderly regarding oral hygiene is still the parametric test was continued.
low. This is because the elderly are indifferent to taking care
of themselves related to dental and oral health, so the elderly Paired t-test*
need assistance with the participation of the family to maintain
dental and oral health in the elderly. There is no dental health kelompok mean±SD mean±SD P-value
maintenance program for the elderly, specifically for teeth. pre-test pos-test
intervensi 2,56±0,512 1,63±0,500 0,000
B. Design and Build
The collection of information produces data that is used to kontrol 2,94±0,250 2,50±0,516 0,004
design a model of dental and oral health care for the elderly
with dementia that is tailored to the needs of the elderly with Table 3. I Paired t-Test Results
dementia. The results of collecting information revealed that *Wilcoxon
there was no dental and oral health care for the elderly with
dementia so that oral hygiene in the elderly was still poor. So The results of the paired data effectiveness test for
the researchers made dental and oral health care for the elderly elderly with dementia showed that the P-value of the
that were adapted to methods that were suitable for the elderly. intervention group was 0.000 (p<0.05), meaning that the
development of a dental andoral health care model was
C. Expert Validation effective in reducing DI in the implementation of oral hygiene
There are 3 validarors, namely behavioral experts, dental in the elderly. The p-value of the DI in the control group was
andoral health care experts, gariatricexperts. Validation was 0.004 (p<0.05), meaning that the oral health care model used
carriedout to obtain data that was used as a basis for testing the in the control group was effective in reducing DI in the elderly
feasibility of the model of dental and oral health care for the with dementia in the implementation of oral hygiene.
elderly with dementia

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Volume 6, Issue 11, November – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Independent t-Test** journal on dental care and characteristics of the elderly
[6],[13],[16].
kelompok mean±SD mean±SD
pre-test pos-test F. Discussion
For the implementation of oral hygiene in the elderly in an
intervensi 2,56±0,512 1,63±0,500 effort to reduce the debris index score in the elderly with
dementia, special efforts are needed through the
kontrol 2,69±0,479 2,38±0,619
implementation of dental and oral health care for the elderly in
P-value 0,481 0,001 its implementation and assistance by the family, based on the
opinion of Desi (2015). receive special attention because it
Table 4. Independent t-Test Results affects general health. Good knowledge of oral hygiene is very
**Independent Sample Test important to prevent dental and oral diseases. Maintaining oral
hygiene is one way to maintain the condition of the elderly
The results of the test of the effectiveness of the unpaired body.[17]
data DI the pre-test data between the intervention group and The increasing number of the elderly population will
the control group were not significantly different, it could be cause problems, one of which is self-care for the elderly who
seen that the p-value was 0.481 (p>0.05) while the post-test are reduced about dental and oral hygiene. Poor oral hygiene
data for the intervention and control groups were significantly can cause health services to increase, besides that there is a
different, it was seen that the p-values were significantly physical decline such as difficulties in communication and
different. -value is 0.001 (p<0.05) meaning that the socializing experienced by the elderly.[18],[19].
development of a model of oral health care for the elderly with
dementia is more effective in improving attitudes in the Any type of serious dental health problems in the mouth
implementation of oral hygiene compared to the care used in will cause oral infections that cause respiratory problems in
the control group. This is evidenced by the decrease in the the elderly. The elderly are at risk for oral health problems due
average value after being treated in the intervention group to lack of knowledge about oral hygiene, inability to perform
better than the control group, namely the intervention group to oral care, or changes in the integrity of the teeth and mucosa
1.63 while the control group to 2.38. due to disease.[20]

Unpaired Data Test Value Change (∆)** IV. CONCLUSION AND RECOMMENDATIONS

Mean±SD P-value Based on the results of the study, it can be concluded that
Pre-Post Tes the dental and oral health care model is feasible and its
application is effective in the implementation of oral hygiene
intervensi 2,25±1,732 0,000 in reducing the scoe debris index in the elderly with dementia.
kontrol 0,31±0,479
The suggestion from the author is for further researchers,
Table 5. Unpaired Data Test Value Change (∆)** it is hoped that further research can be carried out by
categorizing the age of the elderly towards this model of dental
The results of the unpaired data test, the pre-post delta
and oral health care, as well as being able to conduct research
(∆) values were significantly different, it was seen that the p-
with different methods and develop research variables.
value was 0.000 (p<0.05), meaning that the development of a
model of oral health care for the elderly with dementia was
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