Effect of Quality of Dental Health Services to Patient Satisfaction in Indonesia 2019: Importance-Performance Analysis

ABSTRACT Objective: To determine the effect of the quality of dental health services based on dimensions of empathy and responsiveness to patient satisfaction in urban and rural areas in Bone District, Indonesia. Material and Methods: This survey used an analytical observational method with a pilot pathfinder survey design. The total of participants included in this survey was 442, with 223 in the urban area and 219 in the rural area. This survey was held on 25 February - 1 March 2019. The Mann-Whitney test was applied, adopting a significance level of 5%. Results: Empathy and responsive dimensions in urban (3.58 ± 0.94 and 3.50 ± 0.94) and rural (3.43 ± 0.99 and 3.63 ± 0.86) areas were in the moderate category. The administration staff was able to complete administrative procedures, and the Dental assistant responded promptly to the patient's request and needs. Conclusion: The quality of empathy and responsiveness dimensions in dental treatment fall in the moderate category for urban and rural areas; this means that empathy and responsiveness dimensions in dental service in hospital/public health need to be improved.

Factors that Influence the Use of Teledentistry in Indonesia During the COVID-19 Pandemic

ABSTRACT Objective: Evaluate the factors that influence the use of teledentistry during the COVID-19 pandemic in Indonesia. Material and Methods: An analytical observational study with a cross-sectional design with 163 respondents was conducted. The factors of using teledentistry studied in this study were knowledge, attitudes, beliefs, technology, benefits, and needs. The original questionnaire was constructed in English, later translated into Bahasa Indonesia, and modified to conform with Indonesian. Data analysis used univariate and bivariate (Chi-square test). Results: Respondents who have used teledentistry were 23.3%, while respondents who have never used teledentistry were 76.7%. There is no relationship between knowledge about teledentistry and the use of teledentistry (p>0.05). There is no relationship between the use of teledentistry and knowledge (p>0.05), attitudes (p>0.05), and beliefs (p>0.05). Conclusion: There were no factors associated with the use of teledentistry. The most influencing factor is the benefit of using teledentistry, which can affect the increase in the use of teledentistry during the COVID-19 pandemic.

Dynamic Self-Determination of Self-Care and Positive Deviance Model for Stunting Prevention in Indonesia

ABSTRACT Objective: To describe the dynamic self-determination of self-care (DSDoSC) and positive deviance (PD) models in changing stunting prevention behavior. Material and Methods: This research is a quasi-experimental study with a sample of 90 mothers taken by purposive sampling. Thirty mothers were given the DSDoSC intervention, 30 were given the PD intervention, and another 30 were in the control group. This research was conducted in July - October 2019. The variables studied were feeding behavior, nurturing behavior, personal hygiene behavior, environmental cleanliness and air sanitation, and behavior seeking health services. To analyze the difference in mother behaviour before and after test, we used Paired t-test. Analysis of Variance (MANOVA) was used to analyze the difference of mother behaviour among groups. The level of significance was p<0.05. Results: The PWD group showed that eating behavior, parenting behavior, personal hygiene behavior, environmental hygiene and water sanitation, and behavior seeking health services had significant numbers. In the DSDoSC group, eating behavior, parenting behavior, environmental hygiene, water sanitation and health service-seeking behavior were significantly (p<0.05). The results of the Manova test showed that there was an effect of PD and DSDoSC on stunting prevention behavior. Conclusion: Self-dynamic for self-care model and the positive deviance model both can change a mother's behavior for the better in feeding, parenting, environmental hygiene, and water sanitation, seeking health services, but not changing behavior about personal hygiene behavior.

Toothache experiences: findings from 21 years longitudinal survey

Aim: To describe the pattern of toothache experience in a cohort of children aged 2-5 over 21 years and to find the relationship between previous toothache experience and later reports of toothache to get finding on the most critical period of toothache as a problem in life. Methods: This is a secondary data analysis from Indonesia Family Life Survey (IFLS). A total of 1,927 children from IFLS-1 with complete data were included as baseline participants. They were followed up four times within 21 years (age 6-9y, age 9-12y, age 16-19y, age 23- 26y). Toothache was based on the question of self-reported toothache experience during the last four weeks. After 21 years, a total of 1,098 individuals could be traced and completed every cohort of the survey. Toothache experiences were reported for frequencies in every cohort and accumulative experiences over 21 years. Logistic regression tests were performed to analyze the association of previous toothache experience and later toothache experience. Results: Almost 40% of the respondents reported toothache at least once in their life. The age of 6-9 years is the period when a high percentage of children had teeth-related pain. The experience of toothache at this period was significantly related to every period of age in life. Conclusions: The period of early mixed dentition is important. Oral health status in this period is associated with future oral health. A comprehensive dental health prevention program targeting this population is essential to increase the quality of life

Differences in Early Childhood Caries Status on Parental Stress Levels and Socioeconomic Status in Makassar City, Indonesia, During the COVID-19 Pandemic

Abstract Objective: To analyze the differences in early childhood caries status on parental stress levels and socioeconomic status in Makassar City, Indonesia, during the COVID-19 pandemic. Material and Methods: This type of analytical observational study with a cross-sectional design was conducted in North Rantepao, Toraja City, South Sulawesi Province, Indonesia. The research subjects of this study were parents who met the criteria, were willing to participate in the study, and had children aged 6-17 years. The questionnaire instrument with the criteria for assessing children's dental and oral health was assessed based on parents' perceptions. Each item is rated on a scale from 1 (never) to 5 (always). Then the total score was divided into three categories, namely low (score 3-6), moderate (score 7-10), and high (score 11-15). Comparative test analysis using Chi-Square test. Results: Parents with high-stress levels had more children with poor oral health. There is a significant difference according to the level of stress and socioeconomic status of the parents. Conclusion: There is a significant difference between caries status in early childhood based on socioeconomic status and parental stress level (AU).

Sucrose, Lactose, and Xylitol Exposures Affect Biofilm Formation of Streptococcus mutans

Abstract Objective: To determine the level of biofilm formation of S. mutans after being exposed to 5% sucrose, 8% lactose, or 1% xylitol. Material and Methods: This research was a laboratory-based experimental study with post-test only control group design. S. mutans was grown in test tubes containing tryptose soy broth (TSB) medium supplemented with 1% glucose. They were incubated at 37° C for 24 hours to grow the biofilms. The culture was then exposed to 5% sucrose, 8% lactose or 1% xylitol, incubated for 24 hours at 37° C, and examined using ELISA at a wavelength of 625 nm. The statistical analysis was performed using a one-way analysis of variance followed by the least significant difference test (a=0.05). Results: There were some differences in the biofilm formation of S. mutans after exposure to 5% sucrose, 8% lactose, or 1% xylitol (p<0.05). An LSD test indicated significant differences among the biofilm formations after exposure to 5% sucrose and 8% lactose and between 5% sucrose and 1% xylitol. In comparison, there were no significant differences (p>0.05) between 8% lactose and 1% xylitol. Conclusion: Sucrose, lactose and xylitol can form biofilms and the formation of lactose biofilms is the same as xylitol.

Periodontal Comparison on Systemic Lupus Erythematosus Patients and Healthy Subjects: A Cross-Sectional Study

ABSTRACT Objective: To analyze periodontal comparison between Systemic Lupus Erythematosus (SLE) subject and healthy control. Material and Methods: This descriptive cross-sectional study included 122 subjects, 61 SLE patients and 61 healthy subjects who visited the Rheumatology Department, Dr. Saiful Anwar General Hospital, Malang, during 2017-2018. Clinical examination of SLE was using Mexican SLE Disease Activity Index and oral cavity conditions were assessed using the periodontal index, gingival index, calculus index, bleeding on probing, clinical attachment loss and mobility teeth. Results: The age of SLE patients ranged from 18-55 years old with the mean age of 29.50 ± 9.57 years old. Periodontitis was higher in SLE patients (88.5%) than healthy subjects (22.95%). In addition, periodontitis occurrence in SLE (2.66 ± 1.02) was significantly different (p<0.001) compared to healthy subjects (0.51 ± 0.81). Conclusion: This study found higher rates of periodontitis, gingivitis, bleeding on probing, clinical attachment loss, and mobility tooth among SLE patients compared to healthy subjects. Periodontitis was also found to be higher along with more severe SLE group.

Vertical Mandibular and Trunk Symmetry in Indonesian Orthodontic Patients

Abstract Objective: To analyze differences in vertical mandibular and trunk symmetry in orthodontic patients. Material and Methods: This was a cross-sectional study of 129 growing orthodontic patients who sought orthodontic treatment at the Dental Hospital Universitas Sumatera Utara, Indonesia. Mandibular symmetry index was observed with pre-treatment panoramic radiography based on Kjellberg's technique and trunk symmetry was evaluated based on questionnaires and visual observation. Vertical mandibular asymmetry was decided if the index of asymmetry was lower than 93.7%. The bivariate analysis used the chi-squared and Fisher's exact tests, with a significance level of 5%. Results: There was a significant association between vertical mandibular and trunk symmetry (p<0.05). The prevalence odds ratio for the association with vertical mandibular asymmetry was 3.007 (95% CI = 1.016-8.905) for trunk asymmetry. Conclusion: The necessity to consider trunk symmetry could be included in orthodontics treatment of any malocclusion with vertical mandibular asymmetry that might require a multidisciplinary approach in the future.

Immunoglobulin G Levels in the Gingival Crevicular Fluid of Menopausal Patients with Periodontitis

Abstract Objective: To measure the level of immunoglobulin G (IgG) in the gingival crevicular fluid (GCF). Material and Methods: A total of 158 patients aged >45 years were examined for periodontitis and interviewed regarding their menopausal status. The non-menopause group entailed female patients with periodontitis without menopause (n=23). The menopause group included females who stopped menstruating since >1 year, had a pocket depth of 4-5 mm, and did not have other systemic conditions (n=40). Samples were selected based on periodontal and menopausal status. In total, 63 samples of GCF were collected from the participants and tested using an enzyme-linked immunosorbent assay kit for IgG. Results: The median level of IgG in the menopause group was 39.50 (g/mL, whereas that of the non-menopause group was 41.08 (g/mL. There was a positive correlation between the plaque index and IgG level in both groups. In contrast, there was a negative correlation between age and IgG level. However, there was no correlation between plaque index and age regarding the IgG level in both groups (p>0.05). Conclusion: The IgG levels in the menopause group were lower than those in the non-menopause group. As such, menopausal females should take great care of their overall health, including the periodontium.

Relationship Knowledge Transmission of COVID-19 and Fear of Dental Care During Pandemic in South Sulawesi, Indonesia

ABSTRACT Objective: To determine the relationship of transmission of COVID-19 virus knowledge with dental care during a pandemic. Material and Methods: Online questionnaire using Google forms distributed through social media (WhatsApp groups, Facebook, line groups) using a combination of convenience and snowball sampling. The level of knowledge about coronavirus transmission was measured using a questionnaire consisting of 5 statement items. This questionnaire uses the Guttman scale with 3 response and anxiety categories for dental care as measured using a modified questionnaire from the Dental Fear Survey. This questionnaire consisted of 9 question items using a Likert scale. Results: 285 respondents came from WhatsApp media users (89.9%) with an average age of 29.91 years. Respondents who experienced "dental health problems" during the pandemic were 44.7%. The knowledge of respondents about the transmission of the COVID-19 virus in dental care was 79.9% and the knowledge of the fear of caring during the pandemic period was 31.85% afraid. Statistical analysis showed a significant relationship between knowledge about transmission of the COVID-19 virus and fear of dental care (rs=0.388, p<0.001). Conclusion: The results obtained have a significant relationship between knowledge about transmission and fear for dental care during the COVID-19 pandemic in South Sulawesi Province.

Spectrophotometric Analysis of Streptococcus mutans Growth and Biofilm Formation in Saliva and Histatin-5 Relate to pH and Viscosity

ABSTRACT Objective: To analyze the ability of saliva in controlling the growth and the biofilm formation of Streptococcus mutans (S. mutans) as well as the effect of histatin-5 anti-biofilm relate to pH and saliva viscosity. Material and Methods: The S. mutans biofilm assayed by crystal violet 1% and its growth measured by spectrophotometer. The saliva viscosity was analyzed by viscometer, and pH of saliva was measured by pH meter. Results: Based on the optical density values, growth of S. mutans in saliva ranged <300 CFU/mL (0.1 nm) at concentrations of 25%, 12.5% and 6.25% for 24 hours. Whereas at the 48 h and 72 h period of incubation shown an increase in growth of S. mutans ranged 300-600 CFU/mL (0.2-0.36 nm). The inhibitory biofilm formation of S. mutans in saliva was significantly higher at concentrations of 12.5% and 6.25% at 24 h incubation times on a moderate scale, whereas the histatin-5 was effective to inhibit S. mutans biofilm on the 50 and 25 ppm. The saliva possessed a higher inhibitory of biofilm S. mutans than histatin-5 and good level viscosity (0.91-0.92 cP). Conclusion: The saliva was able to control the growth of S. mutans, and histatin-5 can inhibit the biofilm formation S. mutans. Furthermore, the saliva was also able to respond to the pH change with good viscosity of saliva.

Human Umbilical Cord Mesenchymal Stem Cells Over Platelet Rich Fibrin Scaffold for Mandibular Cartilage Defects Regenerative Medicine

ABSTRACT Objective: To evaluate the regeneration of mandibular cartilage defect after implantation of human umbilical cord mesenchymal stem cells (hUCMSC) over platelet rich fibrin (PRF) as scaffold. Material and Methods: 20 male Wistar rats were randomly divided into four experimental groups consisting of: a control group featuring untreated mandibular defects (C), experimental groups whose mandibular defects were implanted with hUCMSC (E1), mandibular defects implanted with PRF (E2), mandibular defects implanted with hUCMSC and PRF scaffold (E3). The subjects were sacrificed after six weeks of observation for immunohistochemical examination in order to evaluate the expression of Ki67, Sox9, FGF 18, type 2 collagen, and aggrecan, in addition to histology examination to evaluate chondrocyte number and cartilage thickness. Data was analyzed with univariate analysis (ANOVA). Results: The implantation of hUCMSC and PRF scaffold proved capable of regenerating mandibular cartilage defect through the expression of FGF 18, Sox9, Ki67, chondrosis counts, type 2 collagen, aggrecan, and cartilage thickness. The regeneration were significantly higher in group E3. Conclusion: Human umbilical cord mesenchymal stem cells in platelet rich fibrin scaffold proved capable of regenerating mandibular cartilage defect.

Difference of Chemical Bonds Between UDMA Bonding Agents with Ethanol Solvent and Acetone Solvent on Dentin Collagen

ABSTRACT Objective: To investigate the difference of chemical bonds between urethane dimethacrylate (UDMA) bonding agents with ethanol solvent and acetone solvent on dentin collagen. Material and Methods: This experimental comparison study used three groups: G1 (Control): UDMA and collagen; G2: UDMA, collagen and ethanol; and G3: UDMA, collagen and acetone. The groups were then pelleted and analysed with FTIR, then the peak value of carbonyl absorption band from each study group was calculated. The result of FTIR analysis and the peak of carbonyl absorption band (P) was calculated using the formula: P = (BC / AB) X 100; AB. BC is measured in centimeters. The study of chemical bond differences between ethanol-solvent UDMA agents compared with acetone-solvent on dentin collagen resulted in a graph of peak of carbonyl absorption bands of UDMA and dentin collagen groups. To determine the chemical bonds of UDMA from the top of the carbonyl ester absorption bands with wavenumber absorption in range 1700-1750 cm-1, the decreasing peak of the carbonyl absorption bands is assumed as more chemical bonds that formed. Data were analysed using Anova one way and Tukey HSD test. Results: There were significant differences between the three study groups (p<0.05). Conclusion: UDMA bonding agents' chemical bonds with acetone solvent are much higher than the chemical bonds between UDMA bonding agents with ethanol solvent on dentin collagen.

Difference in Orthodontic Patients' Perceptions of Essix and Hawley Retainers

Abstract Objective: To determine differences in how orthodontic patients perceive the aesthetics relating to the use of Essix and Hawley retainers. Material and Methods: Photographs of a female patient using an Essix retainer and a Hawley retainer, respectively, were assessed by 70 orthodontic patients aged between 21 and 55 years. All participants were provided with the same images of the two retainer types being worn and were asked to grade the aesthetics of each retainer using a visual analog scale. The significance of differences in orthodontic patient perceptions of aesthetics in the use of Essix and Hawley Retainers in the young adult and adult age groups were tested using the Mann-Whitney test with assumed significance p<0.01. Results: There were differences in participants' perceptions between the two retainers that were statistically significant, with responses varying between young adults aged 21 to 35 years and adults aged 36 to 55 years. According to the VAS, the two retainers' average scores in the total population are 82 for Essix Retainer and 60 for Hawley Retainer in both groups. Conclusion: The Essix retainer as a retention appliance is considered more aesthetically pleasing than the Hawley retainer among both young and middle-aged adults.

Association of a Polymorphism in the Gene Encoding Methylenetetrahydrofolate Dehydrogenase 1 (MTHFD1) 1958G> A with Orofacial Cleft

ABSTRACT Objective: To evaluate the possible association of a polymorphism in the gene encoding methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), 1958G>A, with the susceptibility to orofacial cleft in an Indonesian population. Material and Methods: A total of 200 stored secondary biological samples from 30 cases of orofacial cleft and 170 unaffected controls were analyzed to determine the polymorphism status at base 1958. The analysis was conducted using the PCR-restriction fragment length polymorphism technique after digestion with the Msp1 restriction enzyme. The samples were then subjected to agarose gel electrophoresis to investigate the presence or absence of the following fragments: genotype GG, 196, 86 and 40 base pairs (bp); genotype AA, 282 and 28 bp and genotype AG, 282, 196, 86, 40 and 28 bp. The test groups were compared using the Chi-square test. Results: The wild-type allele containing 1958G, as well as the genotype GG, were significantly more common in the control group than in the orofacial cleft group. Conclusion: The MTHFD1 1958G>A polymorphism was significantly associated with orofacial cleft susceptibility in the tested Indonesian population.

Gonial Angle Characteristics of Class III Malocclusion in Javanese Ethnic

ABSTRACT Objective: To describe the gonial angle characteristics in class III skeletal malocclusion in Javanese ethnic. Material and Methods: Pretreatment lateral cephalometric radiographs of 43 Javanese ethnic patients were measured: upper (Go1) and lower gonial angle (Go2), anterior (AFH) and posterior face height ratio (PFH), maxilla-mandibular length difference, mandibular plane angle (FMA), Y axis, ramus position, ANB angle, posterior cranial base/ramus height and mandibular body length/anterior cranial base. The relation between Go1, Go2 and other variables were analysed using correlation and regression analysis. Results: The total gonial angle is within normal range, but Go1 is below normal and Go2 is above normal. There is no difference between male and female gonial angle measurements (p=0.939 and p=0.861, respectively). Ramus position is positively correlated to Go1 (p=0.003), while AFH (p=0.000), maxilla-mandibular length difference (p=0.000), FMA (p=0.000), Y axis (p=0.000), and posterior cranial base/ramus height (p=0.018) are positively correlated to Go2. PFH is negatively correlated to Go2 (p=0.018). Conclusion: The upper gonial angle is influenced by the position of mandibular ramus, while the lower gonial angle is affected by the posterior and anterior lower facial height and mandibular size and rotation. Javanese with class III malocclusion tends to have hypodivergent facial type, with more posteriorly located mandibular ramus and excess mandibular length.

Evaluation of Masticatory Performance and Patient Satisfaction Before and After Posterior Implant Restoration

ABSTRACT Objective: To evaluate the improvement in masticatory performances two weeks after posterior implant restoration. Material and Methods: Nine patients with missing first and second molars were included in the study. Masticatory performances were evaluated using subjective and objective methods utilizing color-changeable chewing gum and the visual analog scale (VAS) assessment. The subjects were asked to chew the color-changeable chewing gums before and two weeks after the posterior implant restoration. Their expectations regarding aesthetics and function were verified on the VAS before implant placement. Additionally, the VAS was used for the posttreatment completion rating two weeks after the implant restoration. Results: Significant differences in masticatory performance were noted at baseline (before implant posterior restoration) and two weeks after implant restoration (p<0.05). The posttreatment aesthetic and functional expectations ratings significantly exceeded the expectations (p<0.05). Conclusion: Masticatory performances were improved two weeks after implant restoration. In addition, the significant posttreatment ratings of the patients exceeded their initial expectations. In particular, patients with poor masticatory functions demonstrated significant improvements and satisfaction following implant restoration compared to those with good mastication. These findings indicate that a posterior implant restoration can increase the masticatory performance.

Comparison of Transforming Growth Factor 1 (TGF-β 1) Expression in Various Lysate Platelet-Rich Fibrin (L-PRF) Concentrations on Human Dental Pulp Stem Cell Differentiation

ABSTRACT Objective: To compare Transforming growth factor-β1 (TGF-β1) expression in various L-PRF concentrations on the hDPSC differentiation process. Material and Methods: hDPSC cell cultures were subjected to serum starvation by reducing FBS levels in the hDPSC culture media. Lysate PRF was obtained from the PRF gel, which was then incubated at 4°C for 24 h. The supernatant was dried, transferred to a 2-ml Eppendorf tube, and stored at −20°C. The evaluation of TGF-β1 expression in 1%, 5%, 10%, and 25% L-PRF samples and 10% FBS (control) during the process of hDPSC differentiation was quantified using an ELISA reader on day 7. The expression of TGF-β1 was subjected to a one-way ANOVA test, followed by Bonferroni's post hoc test with significant values (p<0.05). Results: Significant differences were noted in TGF-β1 expression between 1%, 5%, 10%, and 25% L-PRF and the control group (10% FBS). The highest TGF-β1 expression occurred with 25% L-PRF (0.645 ± 0.048), followed by 10% L-PRF (0.461 ± 0.035), 10% FBS (0.374 ± 0.013), 5% L-PRF (0.275 ± 0.045), and the lowest expression was with 1% L-PRF (0.160 ± 0.045). Conclusion: The best result of TGF-B1 expression in hDPSC differentiation was in the 25% L-PRF group.

Assessment of Patient Satisfaction Level to Dental Health Care Services in Indonesia

Abstract Objective: To know the level of patient satisfaction with dental healthcare services in Bantaeng, Indonesia. Material and Methods: This pilot pathfinder survey was conducted at Dental and Oral Health Services in Bantaeng and Pa'jukukang Sub-districts of Bantaeng Regency of South Sulawesi Indonesia. The Short-Form Patient Satisfaction Questionnaire (PSQ-18) scaled was used and it consists of 18 questions and seven subscales. The t-test and ANOVA were used with a significance level set at 5% (p<0.05). Results: The female participation (72.8%) was greater than the male (27.2). Regarding age, 74.6% were <40 years, 21.1% were between 40-60 years old and 4.4% were over 60 years old. On the subscale of technical quality, there was significant value in the age variable (p=0.45), education level (p=0.031), job (p=0.026), waiting time (p=0.46), distance to dentist=0.026), and location (p=0.007). There were significant values on the interpersonal aspect subscale that were present at age (p=0.016), education level (p=0.038), and occupation (p=0.007). The highest satisfaction score was found on the technical quality subscale (13.04 ± 1.75) and the lowest satisfaction score was seen on the general satisfaction subscale (4.11 ± 1.75). There was a significant difference between the value of patient satisfaction with age, education, and occupation. Conclusion: Patients from the District Bantaeng and Pa'jukukang Bantaeng regency of South Sulawesi were more satisfied with the service provided. The highest satisfaction score was found on the technical quality subscale and the lowest satisfaction score was found in the general satisfaction subscale (AU).

Sucrose and Xylitol-Induced Streptococcus mutans Biofilm Adherence

Abstract Objective: To study the adherence of Streptococcus mutans biofilm after induction with sucrose and xylitol. Material and Methods: Laboratory experimental study incorporating posttest-only control group design. S. mutans biofilm was generated for 24 hours at a temperature of 37°C using BHIB with 5% sucrose and BHIB with 1% xylitol. An adherence assay was conducted in accordance with the method applied previously. The quantity of adhered bacteria was measured by means of a spectrophotometer at 570 nm. The data were presented as mean and standard deviation. Results: A biofilm induced with sucrose has a higher adherence level (0.9294 ± 0.0431) compared with one induced with xylitol (0.5095 ± 0.0392). Sucrose induces adherence levels by increasing glucan binding protein and glucosyltransferase of the bacteria, whereas xylitol will inhibit the glycolysis process of the bacteria. Conclusion: The adherence of sucrose-induced S. mutans biofilm is higher than that of xylitol-induced S. mutans biofilm.