The Correlation between Tooth Health Care with Number of Caries

in Autistic Students at Elementary and Junior High School for

Disabled Students Bhakti Luhur Malang

Juwitasari

, Ahsan

and Rita Rosita

Departement of Nursing, Faculty of Health Science, University of Muhammadiyah Malang, Jalan Bendungan Sutami 188,

Malang, Indonesia 65145

Department of Nursing, Medical Faculty of Brawijaya University, Jalan Veteran Malang, Lowokwaru, Malang, Indonesia

65145

Department of Anatomy, Medical Faculty of Brawijaya University, Jalan Veteran Malang, Lowokwaru, Malang, Indonesia

65145

Keywords: Autistic Student, Number of Caries, and Tooth Health Care.

Abstract: The student with autistic disorder may lead to severe tooth caries worse than normal people. Autistic students

experience complex brain development disorders. The increased age of students with an autism spectrum

disorder, cannot guarantee the ability to maintain tooth hygiene that causes the emergence of caries. This

research identified the correlation between tooth health care with the number of tooth caries in autistic

students. This observational analysis design with a cross-sectional method was applied in this research. The

participants of this research were 24 students who met inclusion criteria. The result showed that all 24 autistic

students suffering tooth caries. Students with poor dental health care tend to have a moderate number of dental

caries in 1 student (4.17%). Whereas for students with moderate dental health care, they have 6 moderate

dental caries (25%) and 12 mild dental caries (50%). Then for 5 students with good dental health care tend to

have mild caries (20.83%). The Spearman correlation showed that there was a significant relationship between

tooth health care with the number of dental caries in autistic students. It is suggested to prevent dental caries

in autistic students by involving role of parents, teachers and healthcare providers.

1 INTRODUCTION

Autistic children generally experience dental hygiene

problems compared to the normal population

(Hussein et al., 2018). The prevalence of dental caries

in autistic children is higher than in non-autistic

children (Du et al., 2019). Dental health problems in

autistic children can increase due to autism-related

behaviors such as communication limitations, self-

neglect, self-injurious behavior, eating habits,

treatment effects, refusal to receive dental care,

hyposensitivity to pain, and the possibility of

avoiding social contact (Mansoor et al., 2018).

Parents of autistic individuals consistently report that

dental care is one of the primary needs of their

children (Hariyani et al., 2019)

The problem of dental caries in autistic children is

important to be chosen as the subject of research

given the limited studies that report on the dental

health (Leiva-García et al., 2019). If autistic children

do not have good dental health, their subsequent

growth and development will be hampered by

problems that arise later in life They will experience

self-image disturbances, difficulty eating, and can be

attacked by diseases due to bacterial infections that

enter together with dental caries into their bodies

(Morales-Chávez et al., 2019).

As a provider of nursing care that aims to meet

basic human needs, nurses should know whether the

tooth health care in autistic children is closely related

to a decrease in the number of dental caries (Haber

and Hartnett, 2019). This is useful to improve the

quality of care for autistic children, additional

knowledge for those who want to know further about

maintaining dental health and the number of dental

caries in autistic children.

Juwitasari, ., Ahsan, . and Rosita, R.

The Correlation between Tooth Health Care with Number of Caries in Autistic Students at Elementary and Junior High School for Disabled Students Bhakti Luhur Malang.

DOI: 10.5220/0009122600770082

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 77-82

ISBN: 978-989-758-462-6

2 METHODS

This research uses observational analysis descriptive

research using a cross-sectional study approach,

where observations on all study samples are carried

out at one time and without giving treatment.

The population in this study were all autistic spectrum

disorder students in SDLB (Extraordinary

Elementary School) and SMPLB (Extraordinary

Middle School) Bhakti Luhur Malang. The sample in

this study was the entire population of autistic

students in SDLB and SMPLB Bhakti Luhur Malang

who were in the age range of 7-31 years (school age

to young adults) to identify the relationship between

increasing age and improving the quality of tooth

health care. To reduce the bias of research results,

samples were taken by determining the sample

criteria

Inclusion criteria are the general characteristics of

research subjects from an affordable target population

to be studied. The inclusion criteria in this study are:

a) Autistic spectrum disorder students at SDLB

and SMPLB Bhakti Luhur Malang.

b) Children who agree became respondents (with

the consent of parents/guardians).

c) Children who were in a healthy condition

(without complaints).

Exclusion Criteria were eliminated or excluded

from the study for various reasons. Exclusion criteria

in this study were:

a) Children who didn’t come when the

implementation takes place.

b) Children who arrived late when the

implementation takes place.

c) Children who left the place when the

implementation takes place.

d) Children who refused during implementation.

The sampling technique that was used in the study

was total sampling. The location of the study was at

the center of therapy for students of autistic spectrum

disorder SDLB and SMPLB Bhakti Luhur Malang in

December 2009.

The independent variable of this study was

identified using a questionnaire with a closed

questionnaire instrument. The respondents in this

study were parents of autistic students. This closed

questionnaire contained 10 questions according to

existing guidelines, using closed-ended questions

where the respondent's parents just choose one

answer using the predetermined mark. The available

answers are often, rarely, never. The answers that

have been received have been tested for validity and

reliability.

The method of collecting systematic observation

data (direct observation using guidelines as an

observation instrument) is used for the dependent

variable, with the instrument being a checklist.

Observations were made according to existing

guidelines, based on the criteria of signs and

symptoms of dental caries in children (Pribadi, 2009).

3 RESULT AND DISCUSSION

Respondent characteristics will be distributed based

on age, sex, level of education and occupation of the

respondent's parents.

Diagram 1: Characteristics of Respondents by Age.

From the diagram 1, it can be seen that of the 24

respondents, the highest number of respondents

(20.83%) were 12-year-old students of 5 students.

Diagram 2: Characteristics of Respondents by Gender.

From the diagram 2, it can be seen that there are

24 respondents (100%) consisting of male and female

respondents, and the majority (87.5%) of respondents

are male, namely 21 children. The rest (12.5%) of 3

children are female students. The ratio between

female respondents and male respondents is 1: 7.

From the diagram 3, it can be seen that of the 24

respondents, the highest number of respondents

HSIC 2019 - The Health Science International Conference

(33.33%) were in grade 1 SDLB, as many as 8 autistic

students.

Diagram 3: Characteristics of Respondents by Education

Level.

From the diagram 4, it can be seen that the

majority (51%) of respondents' parents have non-

professional occupational backgrounds such as in the

field of domestic servant services.

Diagram 4: Characteristics of Respondents Based on

Parents' Work.

In this study, the characteristics of dental caries

were examined based on the child's educational

history, age of the child, and the gender of the child.

The educational levels of autistic students in this

study are grades 1, 2, 4 SDLB (Extraordinary

Elementary Schools) and grades 2, 3 SMPLB

(Extraordinary Junior High Schools). From the

research data, all autistic students had dental caries.

The difference lied in the number of dental caries

suffered by each child. Where most dental caries (8

students) experienced by students in grade 1 SDLB.

It was also seen that the higher the class, the number

of dental caries experienced did not experience a

significant decrease. This is in line with a study, that

there was no significant difference in oral health

status in both autistic and non-autistic as the ages

increased (Kuter and Guler, 2019)

With the more mature age of individuals with

autism spectrum disorders, no guarantee will increase

the ability to maintain dental and oral hygiene. Each

autistic individual has different abilities and levels of

development depending on the type and severity of

the disorder they are experiencing. Autistic

individuals experience complex developmental

disorders, caused by damage to the brain, resulting in

disturbances to the development of communication,

behavior, socialization abilities, sensory, and

learning. The difference resulted from the study of

Arief Fajar Pribadi (2009) in normal students at

Elementary School Gedangan 04 Malang Regency

grades 1, 2 and 3. The results of the study showed that

the higher the grade, the number of dental caries

decreased as they progressed in their development

take care of his teeth health.

The results showed that the age of autistic students

who experienced the most dental caries (5 students)

suffered by students aged 12 years. This is supported

by data from the Malang City Health Office in 2008

that the proportion of people with dental caries most

of the population of the city of Malang is in the age

range of 5-14 years, as many as 593 people.

Based on research, dental caries is experienced by

both girls and boys. In this study, most (21 students)

suffered by boys due to the influence of the number

of male autistic students more than female students

(Mansoor et al., 2018). This is in line with what was

stated by Elvi Andriani Yusuf (2003) that autism is

more common in men with a male to female ratio of

5: 1. It was also seen that the comparison of the

number of teeth affected by caries in male and female

students was equal, not showing more in male

students or in female students. The results of this

study indicate that the incidence of dental caries in

autistic students is not influenced by gender (Al-

Fatlawi and Radhi, 2017).

Based on research data it can be seen that the tooth

health care in autistic students based on dental and

oral hygiene, periodic examinations and types of

food, in either category there is a small portion

(2.83%) or 5 students, most students are 18 children

(75%) maintenance his dental health was in the

medium category, and (4.17%) tooth health care

behavior was categorized as not good.

From the data above, it can be concluded that the

average tooth health care for autistic students is at a

moderate level. That is because internal and external

factors in maintaining their dental health have not

been effective. Internal factors include behavior, age,

The Correlation between Tooth Health Care with Number of Caries in Autistic Students at Elementary and Junior High School for Disabled

Students Bhakti Luhur Malang

sex, the severity of autism, autistic student education

and the role of parents in tooth health care.

Internal factors such as the behavior of autistic

students in SDLB and SMPLB Bhakti Luhur Malang

which are unable to maintain their teeth

independently. Very few autistic students who check

their teeth to the doctor regularly every 6 months or

at least when experiencing tooth pain. Autistic

students also have behaviors that support an increase

in the number of their dental caries. Their behavior

that is difficult to control makes tooth health care

which includes daily dental examinations and

toothbrushes difficult to do (Du et al., 2019). Not all

of them want to open their teeth, understand

instructions or understand the wishes of

parents/caregivers or health workers to clean their

teeth. Factors of their daily habits such as eating

habits held in their mouths, treatment effects, refusal

to receive dental care, hyposensitivity to pain, and the

possibility of avoiding social contact. There are also

those who behave to damage their teeth by gouging

themselves. this is as expressed by Mae Chin et. all.

in 2008 in the Practical Oral Care for People with

Autism article that obsessive habits, repetitive

behavior, unpredictable body movements, and self-

injurious behavior may be symptoms that complicate

their dental care.

Internal factors, as well as the level of education

of autistic students, have less effect on improving

tooth health care due to autistic spectrum disorders

that are experienced causing obstacles in intellectual

power, perception, and censorship. Autistic students

do not have the awareness and understanding of the

importance of maintaining dental health. Internal

factors of autism severity influence tooth health care.

The more severe the autism, the more difficult the

process of cleaning teeth. Students who are still able

to be trained to do motor activities will certainly

facilitate them to be trained to brush their teeth.

However, in more severe autism where they are truly

unable to be trained to receive stimulation of external

sensory perception, they are not able to participate at

all in maintaining their own teeth. Internal factors in

the role of parents in maintaining the dental hygiene

of autistic students greatly affect the tooth health care

of autistic students. Parents of students who have

strong intentions, knowledge, and abilities in

maintaining their son's dental health, will give their

best in their son's dental care. They will routinely

check their sons to the dental specialist, take care of

their son's teeth properly and correctly at home, and

monitor a good diet for their son's dental health.

External factors in maintaining dental health are those

who help in maintaining the dental health of autism

students. With the limitations possessed, autistic

students cannot control their own dental hygiene, so

if they want optimal dental hygiene to be realized, it

is needed assistance from experts, parents or

caregivers. The role of health workers is very

influential in dental health and prevention of dental

caries in autistic students. Dental care in autistic

individuals is a specialization in dental care for

children with special needs who need further

education to be able to master the techniques that are

different from taking care of normal individuals.

There are still limited institutions that provide special

education for the dental care of individuals with

special needs, as well as the high cost and time

required to undertake the study. Parents of

students/guardians are sometimes unable to fund the

cost of dental care for autistic students because the

costs are different and much higher than dental health

care in normal individuals.

In daily life, external factors that support the

maintenance of dental hygiene for students who live

with their parents at home are assisted by parents,

while those who live in the dormitory are assisted by

caregivers/nuns owned by each child.

Not all parents understand how to care for their

son's dental health and hygiene properly. From the

results of the study note that most students who stay

at home rarely check their dental health to the doctor

regularly, so that the maintenance of clean teeth in the

medium level. Their efforts are still limited to regular

brushing. This can be caused by the influence of the

background of parents who are busy working and do

not understand about dental health. During this time

they also have never received counseling regarding

the tooth health care for children with autism. But for

students whose parents have a background as a doctor

(1 student), they have made efforts to maintain dental

health by examining and caring for their son's teeth

well, so that the condition of the teeth and mouth are

maintained.

For students who live in the dormitory, their

dental health conditions are poorly maintained and

their dental health is maintained at a moderate level.

In maintaining dental hygiene they were

accompanied by nurses who did not have in-depth

knowledge about dental health for autism students.

The work done is only limited to brushing teeth twice

a day. The boarding house also never brought in a

dental health specialist to regularly check his health.

Health workers also have never come to provide

health education at the school. Plus the factor of

students apart from the supervision of parents who

mostly live far outside the island, thus making the

health condition of their teeth less monitored. But

HSIC 2019 - The Health Science International Conference

there is an autistic student who lives in a dormitory

whose parents always send fees to have regular dental

hygiene checks every month and do maintenance.

This is very different from the condition of the other

friends in the hostel. So during the examination, the

condition of the student's teeth was quite clean,

although there were still mild caries that made

cavitation.

Understanding of cariogenic food is lacking, both

by caregivers and their parents. There are times when

they understand that the consumption of food must be

avoided but when students want it, they will give it

food. This is one of the factors that triggers the

presence of dental caries in those who have received

regular dental treatment by a dental specialist (2

students) and is a factor that aggravates dental caries

in other students who do not get an examination by a

dentist.

Caregivers and parents of students also pay less

attention to the diets of autistic students. They do not

yet know the importance of foods containing calcium

(in foods or drinks containing milk or seafood) and

fluorine (in grains, supplements, vegetables and fresh

fruit) as nutrients for the teeth of autistic students and

prevention of dental caries.

Based on the Spearman correlation test for the

relationship between tooth health care with the

number of dental caries, has a correlation coefficient

of -0.584 with a significance level (p) of 0.003 which

is smaller than (α = 0.05). The significance of 0.003

(<α = 0.05) means that there is a real and convincing

correlation between the 2 research variables, because

the significance of the calculation is in the area of

acceptance of the two-sided hypothesis test using α =

0.05. Because the significance of the count <α, then

Ho is rejected or H1 is accepted. Thus there is a

significant relationship between the tooth health care

with the number of dental caries. The relationship

between tooth health care with the number of dental

caries has a moderate level of association, with a

negative correlation direction. This means that the

better the tooth health care, the less the number of

dental caries.

The dental health of autistic students is influenced

by the different conditions of each child. There are

several factors that affect dental health, such as the

habits of students who cannot control sweet foods,

rarely do dental health checks to the nearest dentist or

health center and the ability to maintain their own

teeth hygiene is lacking.

4 CONCLUSIONS

The results of measurement of tooth health care for

students based on dental and oral hygiene, periodic

examinations, and types of food indicate that the

average tooth health care and prevention of dental

caries in autistic students in class 1,2,4 SDLB and in

class 2,3 SMPLB Bhakti Luhur Malang is classified

as moderate. So with these results it is expected to

foster awareness of the parties concerned namely

parents / guardians and health workers to improve

dental health to be even better because of it affects the

growth and development of autistic students in the

future. Autistic students in class 1,2,4 SDLB and class

2,3 SMPLB all suffer from dental caries. Both male

and female students have the same chance of dental

caries. The highest number of dental caries was found

in autistic students in grade 1 SDLB and the highest

incidence of dental caries was in autistic students who

were 12 years old. It is hoped that the relevant parties,

namely parents / guardians and health workers, will

have an active role in preventing the progression of

dental caries, or doing restoration if they have reached

the stage of severe caries.

There is a significant relationship (p = 0.003)

meaning that at 95% confidence interval (α = 0.05) a

significant relationship is found between the

maintenance of dental health and the number of

dental caries. Large correlation (r = -0.584) or have a

moderate relationship, with a negative correlation

direction. This means that the better the maintenance

of dental health, the less the number of dental caries.

With the knowledge of the relationship is expected to

increase primary prevention so that dental caries can

be prevented.

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HSIC 2019 - The Health Science International Conference