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 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 109-113

Effect of drinking water habits and oral hygiene status in elementary school children: A Quasi experimental study


Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Date of Submission22-Jul-2019
Date of Acceptance09-Oct-2019
Date of Web Publication28-Mar-2020

Correspondence Address:
Dr. Dini Setyowati
Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Jl. Prof. Dr. Moestopo No. 47, Surabaya.
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_190_19

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  Abstract 

Aim: To describe the effectiveness of drinking mineral water after consuming snacks in improving dental and oral hygiene of elementary school students. Materials and Methods: This was a quasi-experimental study with pretest–posttest control group design. The population of this study was 105 students selected from an elementary school in Surabaya, Indonesia. The sample size used in this research was 36 students aged 12 years old and have their first lower molars fully erupted. The sampling technique used was random sampling technique. The respondents were divided into three groups: Group 1 (eating only), Group 2 (eating and drinking), and Group 3 (eating, drinking, and gargling). Primary data were obtained from intraoral examination carried out by Debris Index (DI) with three-score category. The examination was only conducted in several tooth: posterior tooth (fully erupted tooth) and anterior tooth (upper and lower central incisors). Independent variable in this research was drinking 250 mL of mineral water, meanwhile the dependent variable was student’s DI. Statistical analysis was carried out using analysis of variance correlation test and using the Statistical Package for the Social Sciences (SPSS) software, version17. Results: Dental and oral hygiene status group is homogeneous (P = 0.484). A significant difference was observed between variables, such as eating and drinking with gargling group (P = 0.4250), the eating and drinking group (P = 0.2250), and the control group (P = 1.4833). Conclusion: Students who regularly drink water, especially with gargling habit, have a better oral hygiene than those who do not drink regularly.

Keywords: Children Oral Hygiene, Debris Index, Drinking Behavior, Mineral Water, Oral Hygiene


How to cite this article:
Setyowati D, Cahyani DR, Heroesoebekti R, Ramadhani A. Effect of drinking water habits and oral hygiene status in elementary school children: A Quasi experimental study. J Int Oral Health 2020;12:109-13

How to cite this URL:
Setyowati D, Cahyani DR, Heroesoebekti R, Ramadhani A. Effect of drinking water habits and oral hygiene status in elementary school children: A Quasi experimental study. J Int Oral Health [serial online] 2020 [cited 2020 Jul 11];12:109-13. Available from: http://www.jioh.org/text.asp?2020/12/2/109/281484


  Introduction Top


Dental health is a part of children’s health, which has to be taken care of.[1] It is because the pain caused by dental health problems can affect the quality of life of children, as it can interfere with their ability to learn, play, eat, and sleep.[2] One of the most common problems in dental and oral health of children is caries.[3] According to the Basic Health Research, there are 28.9% of children younger than 12 years in Indonesia with dental and oral disease.[4] Other data indicate a high caries severity in children aged 12 years.[5] One that influences the high severity of dental caries is the habit of children in maintaining oral and dental hygiene. Dental and oral hygiene should be noted because keeping good dental and oral hygiene will prevent the occurrence of oral disease such as dental caries, and it is important in the development of facial bones, jaws, and teeth.[6]

Dental and oral hygiene of children is influenced by several factors: socioeconomic, diet, dental behavior, gender, age, and intraoral circumstances.[7] One of the most influencing factors of oral hygiene in children is the habit of consuming food or eating pattern, which is not good, such as consuming cariogenic food.[8] Generally, snacks are traded and consumed by elementary school-age children.[9] The food traded is mostly included in foods that are cariogenic. The cariogenic food is sticky and sugar-containing food, which has the potential to leave plaque and debris in the oral cavity.[10],[11]

Another factor that can affect oral hygiene is consuming mineral water.[12],[13],[14] Consuming mineral water can help to reduce the remaining food debris left in the oral cavity by dissolving the sugar content in the snack.[15] In addition, gargling mineral water can also help to reduce the food debris that is left in the oral cavity with the help of the oral cavity muscles[16] such as the muscles of the cheeks, lips, and tongue, which causes particles and debris to escape the oral cavity.[17]

On the basis of preliminary survey conducted on 30 students at one of the schools in West Surabaya, Indonesia, it was found that 97.4% of students have a habit of consuming cariogenic snack. Even though the school has provided water facilities for consumption by students, 60.5% of students still have poor oral hygiene. In addition, schools as a place for students to interact a lot can be used as a means of counseling dental health, including introducing food and drinks that can cause dental caries, the process of dental caries occurrence, and prevention. The results of this preliminary survey contradict with the theory, which stated that consuming mineral water can help in reducing the food debris in the oral cavity.[18] Incompatibility theory can be caused by the way a person is drinking mineral water. Not everyone drinks mineral water with the purpose of cleansing teeth and oral cavity from the food debris, but more likely to relieve thirst. So when drinking mineral water after consuming snacks, sometimes it is not followed with gargling, and mineral water that is drunk does not reach the entire surface of the tooth. Does consuming only drinking water reduce debris on the tooth surface? If consuming mineral water alone can reduce the remaining food attached to the teeth, then this method is one practical way that students can easily replicate in order to reduce the food debris in the mouth after consuming snack. The children who were 12 years old were chosen as a sample for this study because the age of 12 years is the age group that is the indicator in measuring oral health status of the child.[4]

However, to the best of our knowledge, there is still no research that proves the effectiveness of drinking mineral water by students after consuming snack in reducing the food debris attached to the teeth. Therefore, we wanted to research on the effectiveness of drinking mineral water after consuming snacks in improving dental and oral hygiene of students in Surabaya, Indonesia.


  Materials and Methods Top


This was a quasi-experimental study with pretest–posttest control group design, which was performed among 105, 12-year-old students of the elementary school in Surabaya, Indonesia. This research was conducted in the duration of six months, from August 2018 to January 2019, and was approved for ethical clearance by the board of Ethical Committee, Faculty of Dental Medicine, Universitas Airlangga with certificate number 65/KKEPK.KG/VII/2014.

A random sampling technique was used, with formula P1 = 0.7, P2 = 0.15, P = 0.425, 1 – α = 1.64, 1 – β = 1.282. Sample size was calculated as around 12 students per group.

The sample size of this study was 36 students; inclusion criteria consisted of 12-year-old students who had their first molar fully erupted. All the respondents agreed and signed the informed consent, guided by their parent or guardian. The exclusion criteria included students with partially erupted molar.

A total of 36 students was divided into three groups: Group 1: eating group, Group 2: eating and drinking mineral water without gargling group, and Group 3: eating and drinking mineral water with gargling group.

Independent variable in this research was drinking 250 mL of mineral water, meanwhile, the dependent variable was student’s Debris Index (DI). Students were gathered in the school and divided into three different groups. Each group consisted of 12 students. The first group was the control group (no treatment), the second and third groups were the groups with different treatments. For the initial data, oral examination was conducted, right before the respondents consumed the snack. After they finished their snack, the first group underwent posttest oral examination, whereas the second and third groups were given special treatment: one group had to drink mineral water, and the other group had to gargle the water. The oral examination was conducted following this treatment for the remaining two groups.

Three scores[13] were used for DI examination: score 0 for no debris left, score 1 for the debris that covered 1/3 of the tooth surface with a change in color, score 2 for the debris that covered up to 2/3 of the tooth surface, and score 3 for debris that covered more than 2/3 of the tooth surface. The examination was only conducted in several tooth: posterior tooth (fully erupted tooth) and anterior (upper and lower central incisors).

The collected data were analyzed with the Statistical Package for the Social Sciences (SPSS) software (IBM, Chicago, Illinois, version 17, 2007) with one-way analysis of variance (ANOVA) test.


  Results Top


As per [Table 1], the difference between the first DI value (pretest) and the second DI value (posttest) can be determined. The results of normality test data analysis showed normal distributed results. After knowing the data are normally distributed, then homogeneity tests are performed to determine whether the data are homogeneous, and the results are homogeneous data (P <0.05). The conclusion obtained was that the dental and oral hygiene status group is homogeneous.
Table 1: Results of difference in Debris Index data before and after treatment

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One-way ANOVA test was conducted to analyze the data. This test is used to determine whether there is a difference in dental and oral health status of each group. The results obtained are Fcount = 72.101 with P value of 0.000. To analyze the result, we needed to compare it with Ftable that has a value of 2.90. In this research, the Fcount > Ftable, which means that H0 was rejected. H0 rejected means a significant difference was observed in respondent’s DI.

To find the results of the comparison between the three groups, post hoc test (multiple comparisons) was used. After analysis, the significance value was known. In the control group (Group 1) and Group 2, it was 0.00; in Group 1 and Group 3, it was 0.000, whereas in Group 2 and Group 3, it was 0.498. It can be concluded that significant differences were observed between Group 1 and 2 and Group 3. However, no significant differences were found between Group 2 and 3 [Table 2].
Table 2: Comparison of significance value between the groups

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[Table 2] explained that eating and drinking with gargling group had a significance value of –0.4250, the eating and drinking group had a significance value of –0.2250, and the eating group had a significance value of 1.4833. These data interpreted that the best dental and oral hygiene status was obtained in the group that consumed mineral water and gargled after consuming snack.

As per [Table 3], Group 3 had a significance value of –0.4250, Group 2 had a significance value of –0.22250, and Group 1 had a significance value of 1.4833. It can be interpreted that the status of oral hygiene as measured by the DI was best obtained in Group 3.
Table 3: Significance value of mean Debris Index from three groups

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  Discussion Top


Dental and oral hygiene (oral hygiene) is the hygiene maintenance of the teeth and oral structure with the help of toothbrushes and other procedures that serve to maintain teeth and oral health.[19] Dental and oral hygiene, especially in children, has a very important role in the health of teeth and oral cavity. By maintaining dental and oral hygiene, will help increase the sense of comfort when chewing, and reduce the risk of dental caries.[20]

Snacks are foods and beverages processed by food craftsmen at the place of sale and/or served as ready-to-eat food for sale to the public.[4] Most snacks consumed by school-aged children contain a lot of sugar and are cariogenic.[9] The cariogenic food is sticky and sugar-containing food, which has the potential to leave plaque and debris in the oral cavity.[10],[11] In this study, the given snacks were Oreo snacks. We chose this snack because the ingredients of this snack contained mostly sugar and carbohydrates.

Foods that are cariogenic will leave debris or food debris in the oral cavity, if this condition is maintained then it can affect the occurrence of dental and oral diseases. However, dental and oral diseases can be prevented by maintaining oral hygiene. One way to maintain oral hygiene is to consume mineral water after consuming snacks; it is because mineral water has properties that can reduce the food debris in the oral cavity.[15]

In addition to consuming only mineral water, gargling with mineral water after consuming snacks also has an effect in reducing the remaining food debris left behind with the help of movement of the muscles of the oral cavity,[4] such as the muscles of the cheeks, lips, and tongue, which move the particles and food debris out of the oral cavity.[17]

In this study, different dental and oral hygiene statuses were found between the group who consumed only snack without drinking mineral water, the group who consumed snack and drank mineral water, and the group who consumed snack and drank mineral water while gargling. In a sample group that consumed only snacks, an average DI of 1.4833 was noted. In the sample group that consumed snack and drank mineral water, an average DI of –0.22250 was reported. In the sample group who consumed snack and drank mineral water while gargling, an average DI of –0.4250 was observed. From the results of this study, it can be observed that cleaning of debris (food waste) by the group that consumed water while gargling was more effective than that by the other two groups. This is consistent with the theory that consuming mineral water can help to reduce the residual food debris left behind by its ability in dissolving substances such as carbohydrates and sugars in the oral cavity.[15] In addition, the group that consumed water while gargling had the highest debris cleaning power because of the help of the masticatory muscle, which can release the food residue attached to the tooth surface.[4] Although the eating and gargling group had the best value, but when compared with the group who only consumed water without gargling, a very significant difference was not observed.

On the basis of statistical test, it was observed that there was a significant difference between the group who only consumed snacks without drinking mineral water and the other two groups. Eating snacks with drinking mineral water group had a significance value of 0.000. Eating and drinking mineral water with gargling group had a significance value of 0.000. Where the two comparisons had a value of significance < α value (0.05), it was concluded that there was a significant difference in dental and oral hygiene status.

Although eating and drinking with gargling group had a significance value of 0.494, where the value of significance > α value (0.05) meant that no significant difference was observed in dental and oral hygiene status between the two groups. This can be due to both groups consume mineral water, where the mineral water can dissolve the remaining food debris left behind. So no significant difference was observed in dental hygiene status between the two groups.

The conclusion that can be obtained from the result of this study, which has been conducted in accordance with the predefined hypothesis, was that there is a difference in dental and oral hygiene status between the three groups (group of children consuming snack only without drinking water, group of children consuming snack and then drinking 250 mL of water, and group of children consuming snack and drinking 250 mL of water while gargling).

As this is a quasi experimental study, which lacks of random assignment, the confounding factors may affect the results, and therefore the causal inference cannot be definitive.

Ethical policy and institutional review board statement

The ethical clearance for this research was approved by the Ethical Clearance Committee in the Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia, with registration number 65/KKEPK.KG/VII/2014.

Data availability statement

The data set of this study is available on request from Dini Setyowati (dinisetyowati2012@yahoo.com).

Acknowledgement

We would like to thank the staff at the Department of Dental Public Health, Faculty of Dentistry, Universitas Airlangga, Surabaya, Indonesia.

Financial support and sponsorship

This study was self-funded by the authors.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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