p
ISSN 2723-6927-e ISSN 2723-4339
Dental Health
Care Model In Premature Contact Patients With Partial and
Complete Removable Denture Installation At Rsgm
Semarang Muhammadiyah University
Muhammad
Furqan1, Bedjo Santoso2, Diyah Fatmasari3,
Dika Agung Bakhtiar4, Bambang Sutomo5
Politeknik
Kesehatan Kemenkes Semarang, Indonesia1,2,3,5, Universitas
Muhammadiyah Semarang, Indonesia4.
Email: [email protected]
Prosthodontic specialist dentistry services are services for the
patient's rehabilitative needs with the aim of restoring the function of the
oral cavity such as teeth and mucosa by paying attention to the comfort and anxiety
of the patient during treatment. The complaints that often occur in premature
contact patients with partial and complete denture installation are discomfort,
pain, anxiety, and bad breath. There is no government policy in providing
guidelines for dental and oral health care for patients specifically for
prosthodontics. The preparation of a dental and oral health care model for
premature contact patients with partial and complete dentures in hospitals. The
design of this study uses Research and Development (R&D) with the Quasi
experimental method with a pretest posttest control group design. The number of
respondents was 10 dental and oral therapists, and 20 patients who used
removable dentures with premature contact. Dental and oral therapist respondents
were given a pretest, training, followed by a skill assessment by providing
care services to patients, and ended with a posttest. Patients were given a
pretest and posttest. The instrument of this research is a questionnaire that
has been carried out validity and reliability. Le test de validation expert du
mod�le de soins dentaires et bucco-dentaires a obtenu des r�sultats d�cents
avec une valeur p = 0.003 et son application a �t� efficace pour accro�tre les
connaissances des th�rapeutes dentaires et buccaux (p = 0,013), ameliorate
l'attitude des th�rapeutes dentaires et buccaux (p = 0.043), ameliorate les
comp�tences des th�rapeutes dentaires et buccaux (p = 0.01), r�duire l'anxi�t�
des patients (p = 0.001) et augmenter l'observance des patients (p = 0.001)
Mod�le de soins dentaires et bucco-dentaires pour les patients ayant un contact
dentaire pr�matur� Les polyproth�ses proth�tiques amovibles sont efficaces pour
am�liorer les connaissances, l'attitude et les comp�tences des th�rapeutes
dentaires et buccaux, ainsi que pour r�duire l'anxi�t� et am�liorer
l'observance du patient.
Keywords: Dental
Health Care, Prosthodonsia, Premature Contact Patients
Introduction
Oral and dental health is a part of body
health that cannot be separated from one another because it will affect overall
body health. Teeth are one of the body parts that function for chewing,
speaking and maintaining the shape of the face, so it is important to maintain
dental health as early as possible so that it can last long in the oral cavity.
Oral health means freedom from throat cancer, oral infections and wounds, gum
disease, tooth decay, tooth loss, and other diseases, resulting in restrictive
disorders in biting, chewing, smiling, speaking, and psychosocial well-being (Mararu et al., 2017). One of oral health is dental health,
oral health is very important because damaged and untreated teeth and gums will
cause pain, mastication disorders and can interfere with other body health (Marthinu &
Bidjuni, 2020).
The most common dental health problem in
Indonesia is dental caries. According to the Basic Health Research (Riskesdas)
in 2018, the proportion of cavities reached 45.3%. Dental caries is a chronic
disease that is common and quite high in children and adults. Dental caries
occurs due to multiple factors that influence each other, namely internal
factors, which are factors that are directly related to caries. External
factors are factors that are not directly related to the process of caries. The
high incidence of dental caries requires optimal action, especially in
preventing dental caries (Safela et al., 2021). If dental caries is left untreated, it
will have several complications such as abscesses in the gum tissue,
inflammation of the jawbone, death of the jawbone, sellulitis, swelling in the
esophagus which causes difficulty swallowing and can cause tooth loss (Karno et al., 2018).
Tooth loss is a dental health problem that
can interfere with masticatory function, speech, aesthetics, and even social
relationships. The loss of one or more teeth can cause functional and aesthetic
disturbances that can affect a person's quality of life (Siagian, 2016). In addition to dental caries, cavities
can also be caused by premature contact, a condition when the jaw contracts
(bites) suddenly feels sore, can cause pain or pain. Riskesdas 2018 states that
one of the dental and oral problems in Indonesia is cavities with the highest
prevalence at the age of 45-65 years. Tooth loss in the 45-54 age group was
23.6%, in the 55-64 age group it was 29% and then increased to 30.6% at the age
of 65 years and over. Missing teeth must be replaced immediately, dentures are
an option to overcome the problem of cavities.
Dentures are an alternative method of
treating tooth loss that replaces one or more missing teeth along with their
supporting tissues, restoring impaired function and limiting further damage. A
form of denture recommended for people with partial loss of natural teeth is
called a removable partial denture (GTSL). To replace the missing teeth and
function and preserve the remaining tissue structure, this denture can be
retracted and reinserted by the user (Kemenkes, 2016). A full denture (GTP) is defined as a
prosthesis that replaces all teeth and surrounding oral tissues. The purpose of
this denture is to rehabilitate the stomatognathic system (Chumairo, 2023).
The act of installing a denture, both
partial and complete removable, is carried out by a prosthodontist, who in
carrying out his duties collaborates with dental and oral therapists as dental
assisting. According to Kepmenkes No. 284 of 2006, dental and oral therapists
perform oral health care services according to their field of expertise, (Nopiah Epi dkk, 2020). �namely with the stages: assessment, diagnosis,
planning, implementation and evaluation.
The standard of specialized prosthodontie
dental care services in hospitals is implemented according to SOAPIE
(Subjective, Objective, Assessment, Planning, Intervention and Evaluation)(Ratnasari et al.,
2019). Assessment (subjective-objective), includes the
collection of subjective and objective data about what the patient feels.
Dental health care diagnosis (assessment), includes determining the diagnosis
based on the results of the assessment. Planning, including both independent
and collaborative implementation planning. Implementation (intervention),
including chair side assistant and independent actions. Evaluation
(evaluation), including evaluation actions after implementation (Kaliey et al., 2016).
Based on observations made at the RSGM
Universitas Muhammadiyah Semarang, it was found that dental and oral therapists
only played a role in the implementation stage (assisting prosthodontists) in
making dentures, while the assessment, diagnosis, planning and evaluation
stages of care services were carried out by general nurses. This is because
there is no dental health care model for premature contact patients with
partial and complete removable dentures as a reference, while the SOAPIE stages
must be carried out to document patient progress notes and to facilitate
monitoring and evaluating patient progress.
Based on the background of the problem,
the researcher will examine the dental health care model in patients with
premature contact cases with partial and complete removable dentures at RSGM
Universitas Muhammadiyah Semarang.
1.
�General Purpose
Produce a
dental health care model for patients with premature contact cases with partial
and complete removable dentures as an effort to reduce patient anxiety and
analyze patient compliance to visit a prosthodontist.
2. Specific
Objectives
a.� Collecting information and data as a study
material for the design of a dental health care model in premature contact
patients for partial and complete removable denture installation at RSGM
Universitas Muhammadiyah Semarang.
b. To
design a dental health care model for premature contact patients with partial
and complete removable dentures at RSGM Universitas Muhammadiyah Semarang.
c. Conducting
expert validation tests of dental health care models in patients with premature
contact cases with partial and complete removable denture installations at RSGM
Universitas Muhammadiyah Semarang.
d. Analysis
of the effectiveness of the dental health care model in premature contact case
patients with partial and complete removable dentures at RSGM Universitas
Muhammadiyah Semarang on the knowledge of dental and oral therapists compared
to the control group.
e. Analysis
of the effectiveness of the dental health care model in premature contact case
patients with partial and complete removable dentures at RSGM Universitas
Muhammadiyah Semarang on the attitude of dental and oral therapists compared to
the control group.
f. Analysis
of the effectiveness of the dental health care model in premature contact case
patients with partial and complete removable dentures at RSGM Universitas
Muhammadiyah Semarang on the skills of dental and oral therapists compared to
the control group.
g. Analysis
of the effectiveness of the dental health care model in patients with premature
contact cases with partial and complete removable dentures at RSGM Universitas
Muhammadiyah Semarang on patient anxiety compared to the control group.
h. Analysis
of the effectiveness of the dental health care model in patients with premature
contact cases with partial and complete removable dentures at RSGM Universitas
Muhammadiyah Semarang on patient compliance to visit a prosthodontist compared
to the control group.
Research Methods
A.� Research Type and Design
This type of research is a
mix method, which is a combination of descriptive and analytical research. This
research design uses Research and Development (R&D). This study aims to
develop dental health care-based educational media (booklet) as a medium in
improving dental health maintenance behavior in prosthodontie patients. The
R&D research method is one of the research methods used to produce products
and test their effectiveness.
The research and
development procedure has 5 main steps, as follows: 1) information gathering,
2) product/model design, 3) expert validation and revision, 4) product/model
trial, and 5) product/model results.
1.� Information gathering
At this stage the
researcher conducts a preliminary or exploratory study to review, investigate
and collect information through efforts:
a. Observation and interview methods to the head of the hospital,
dental and oral health workers, and prosthodontie patients.
b. Literature study was conducted to support the data or
information obtained.
c. The results of observation data are used as a reference in
making what kind of dental health media is suitable to be developed for
prosthodontie patients.
2. Product/model design
After the researcher has
studied the literature completely and obtained the necessary information, the
next step is for the researcher to make a design design of product development.
The stages in product development are as follows:
Results and Discussion
Research results are
divided into five stages, namely: information gathering, model product design,
expert validation and revision, product/model testing, and model product
results which are described as follows.
A. Information Gathering
In the early stages of this research, information collection was
carried out to find out the existence of problems, needs and potential for
problem solving. information collection that has been carried out is by using
the interview method, the interview method is used to collect information
related to problems that commonly occur in the target group. This was done to
further explore and seek consideration in developing a model of oral health
care for prosthodontia specialty targets. Interviews were conducted with the
Deputy Director of RSGM UNIMUS, Prosthodontia Specialists, and Dental and Oral
Therapists who work at RSGM UNIMUS.
|
Topic |
Conclusion |
|
What are the most common problems or complaints of premature
contact patients with partial or complete removable dentures? |
Denture users often experience discomfort,
tartar problems, bad breath, and swollen gums. Patients with premature
contact generally complain of pain, anxiety, and discomfort when using a
denture. In general, patients often feel anxious when they first use a
denture and do not understand how to clean it. |
|
What are the patient's needs during the fitting of partial and
full dentures |
The main goal of treatment is to restore the
patient's ability to chew, speak and smile comfortably. During treatment,
patient comfort is prioritized so that the artificial device can function
properly. |
|
"What is the government policy regarding oral health care
service guidelines for premature contact patients?" |
Currently, there are no specific guidelines for the management
of denture patients with premature contact problems. Dentists and dental and
oral therapists who treat these cases generally refer to the applicable oral
health service guidelines. More specific guidelines are needed to handle this
case, so that treatment is more optimal and according to patient needs. |
|
Do oral therapists need an oral health care model in
prosthodontia dentistry specialty services? |
Oral health care is a strong foundation for providing optimal
dental health services. With good care, patients can receive appropriate and
quality treatment. |
Based on the results of information collection through interviews,
it can be concluded that complete denture care must be carried out in a
comfortable and safe atmosphere by helping dental and oral therapists carry out
treatment in accordance with SOPs and collaborate well with prosthodontia
specialists, especially in the treatment of patients with premature contact.
Discussion
Dental and Oral Health Care Model for Premature
Contact Patients with Partial and Full Dentures
Based on the results of observations through interviews,
information was obtained that dental services specializing in prosthodontics
are dental and oral health services that specifically serve the rehabilitative
needs of patients with the aim of restoring oral cavity functions such as teeth
and mucosa by paying attention to patient comfort and anxiety during treatment.
The complaints that often occur in premature contact patients in the
installation of partial and complete removable dentures at UNIMUS RSGM are
discomfort, pain, anxiety, and bad breath. there is no government policy in
providing oral health care guidelines for special prosthodontics patients.
While oral health care needs to be in service because it helps dental and oral
therapists carry out treatment in accordance with SOPs and collaborate well
with prosthodontia specialist doctors, especially in the treatment of patients
with premature contact. the existence of this need led researchers to develop a
model of care services for premature contact patients with partial and complete
removable dentures.
The results of expert validation showed a p-value = 0.003, which
means that the oral health care model for premature contact patients at the
prosthodontia dentistry specialty clinic is relevant as a model of oral health
care for premature contact patients. The expert validation process is important
in product/model development which is useful in improving the quality of a
developed product.
1.
Model Design
Information collection conducted to 3 respondents and data from
existing scientific articles to create a model design obtained the results of
information collection data collecting that there is no oral health care model
for premature contact patients in the installation of partial and complete
removable dentures at the prosthodontia dentistry specialty clinic RSGM
Muhammadiyah University Semarang, so that the entire stages of oral health care
are not implemented. existing. So the researcher made a model of oral health
care that was adjusted to a method suitable for premature contact patients.
Table 1 Model
Design
|
Stage 1 Assessment |
1. Initial assessment
of patient needs 2. The operator gets
acquainted with the patient and builds rapport with the patient 3. Operator reconfirms
patient identity 4. Subjective examination 5. Objective assessment 6. The dental therapist
begins to prepare the related needs for diagnosis enforcement. 7. Pretest to premature
contact patients with partial and complete removable dentures. 8. Education on the general
medical plan of action regarding partial and complete removable denture
fitting. |
|
|
|
|
|
|
Stage 2 Diagnosis |
1. Establish a trusting
relationship between operator and patient 2. Dental and oral
therapist diagnosis based on assessment 3. Develop a treatment plan
in the form of independent and collaborative actions 4. Provide counseling to
patients and families regarding their anxiety before the installation of
partial and complete removable dentures. |
|
|
|
|
|
|
Stage 3 Planning |
1. Establish a trusting
relationship between operator and patient 2. Self-implementation,
providing education on maintaining oral health after partial and complete
removable dentures. 3.
Therapeutic communication before denture molding |
|
|
|
|
|
|
Stage 4 Implementation |
1.
Carry out oral health care 2. Collaborative implementation
(chairside assistant): preparation of tools and materials, room. 3.
Implement collaborative action 4. Therapeutic communication during denture treatment |
|
|
|
|
|
|
Stage 5 Evaluation |
1. Assess the achievement of recovery of patient needs
during treatment and post-treatment 2. Evaluation post partial
and complete removable denture insertion, risk of discomfort, risk of pain. 3. Therapeutic communication after denture treatment 4. Re-assessment
of patient needs 5. Plan an oral health care follow-up plan |
2.
Expert Validation
The validators amounted to 3 (three) people namely Manzilina Hani
Baity Jannaty, S.Psi., M.Psi., Psychologist, drg. Rahmat Hidayat Sp. Pros., and
Deru Marah Laut., S.SiT., M.Kes. the following are the results of the expert
assessment: Validation is the process of assessing the model to validators who
are experts in their fields. This is done to be the basis for the feasibility
of the oral health care model in patients with complete denture care. There
were 3 validators, namely 1 dentist specializing in prosthodontics, 1 care
service expert, and 1 psychology practitioner/Anxiety Expert. Validation was
carried out using a model assessment questionnaire containing 15 question
indicators.
Results of Expert Validity Test of Dental and Oral Health Care
Model Development in Patients with Complete Denture Care (Assessment
Indicators)
|
Indicator |
V |
Indicator |
V |
Indicator |
V |
|
1a |
0,83 |
2b |
0,83 |
4a |
0,69 |
|
1b |
0,75 |
2c |
0,92 |
5a |
0,88 |
|
1c |
0,83 |
2d |
0,92 |
5b |
0,94 |
|
1d |
0,83 |
3a |
0,69 |
5c |
0,94 |
|
2a |
0,83 |
3b |
0,69 |
5 |
0,94 |
|
6a |
0,83 |
6b |
0.92 |
7 |
0.92 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Average value V0��� .86
Based on the table above, it shows that the results of content
validity using the Aiken V index obtained an average of 0.86 which has a value
range of 0.69-0.94 with the categories of quite valid (0.4 < V ≤ 0.8)
and very valid (V > 0.8).
Reliability Test Results of Expert Development of Dental and Oral
Health Care Model for Patients with Complete Denture Care
|
Validator |
n |
Value |
Average |
ICC |
Sig |
|
Validator
1 |
18 |
79% |
|
|
|
|
Validator
2 |
18 |
87% |
88,6
% |
0,778 |
0,003 |
|
Validator
3 |
18 |
100% |
|||
|
|
|
|
|
|
|
Based on the table above, it shows that the results of the
interrater reliability test using the ICC (Intraclass Correlation Coefficients)
analysis obtained an average measure value of 0.778 with a model reliability
level of good reliability category.
So it can be concluded that the development of a model of oral
health care in patients with complete denture care is considered valid and
reliable so that it is suitable for use by dental and oral therapists.
3.
Model Test
The implementation of the "Oral Health Care Model for
patients in the Prosthodontia Dentistry specialty clinic of RSGM UNIMUS"
test will be carried out data analysis which is divided into uninvariate,
bivariate and multivariate data analysis.
1.� Univariate
Analysis
The model trial in this study was conducted on 20 patients with
premature contact at RSGM UNIMUS consisting of 10 patients with premature
contact as a control group and 10 patients with premature contact from RSGM
UNIMUS as an Intervention Group. before the intervention of the care model
developed for patients, the behavior of dental and oral therapists was first
measured. as for this stage, a sampling technique in the form of total sampling
was used to determine the number of dental and oral therapists who would be
involved in the implementation of the care model so that a total of 10 dental and
oral therapists were involved. The sampling technique for implementing the
model on patients used purposive sampling technique, namely the criteria for
patients using dentures with premature contact.
Data Normality Test on Dental
Therapists in Intervention and Control Groups
|
|
p-value* |
|
|||
|
Variables |
Intervention |
Control |
|||
|
Dental and Oral Therapist |
|
|
|||
|
Knowledge Pre Test |
0,025 |
0,026 |
|
||
|
Post test Knowledge |
0,003 |
0,001 |
|
||
|
Attitude Pre Test |
0,001 |
0,001 |
|
||
|
Post Test Attitude |
0,027 |
0,011 |
|
||
|
Skill Pre Test |
0,001 |
0,002 |
|
||
|
Skills Post Test |
0,003 |
0,036 |
|
||
|
Premature Contact Patient |
|
|
|||
|
Anxiety Pre Test |
0,008 |
0,016 |
|||
|
Anxiety Post Test |
0,035 |
0,012 |
|||
|
Compliance Pre Test |
0,012 |
0,012 |
|||
|
Compliance Post Test |
0,023 |
0,041 |
|||
����������������������� *Shapiro-Wilk
Based on the results of the normality test, it shows that for
pre-post knowledge, pre-post attitudes, pre-post skills, pre-post anxiety, and
pre-post compliance are not normally distributed p>0.05. The existence of
non-normally distributed data, the test to be carried out is a non-parametric
test, namely the Wilcoxon test for paired tests and Mann-Whitney for unpaired
tests.
2.
Bivariate Analysis
Bivariate analysis is used to test the difference between two
variables, at the initial stage of the model trial, the normality test is
carried out first, then the effectiveness test of paired and unpaired variables
is carried out.
Model Effectiveness Test
The hypothesis test in this study is explained in the following
table:
Differences in knowledge before
and after intervention in intervention and control groups
|
Statistics |
|||||
|
Variables |
Group |
Mean�SD |
Mean�SD |
Delta�SD (Δ) |
p |
|
Pre test |
Post test |
||||
|
Knowledge |
Intervention |
5,20�0,83 |
8,00�1,22 |
2.80�0,038 |
0,042* |
|
Control |
3,50�0,53 |
3,80�0,82 |
0,30�0,67 |
0,102* |
|
|
|
|
|
|
p=0,013** |
|
����������������������� *
Wilcoxon ** Mann-Whitney���������������
The results of the effectiveness test of paired data on the
knowledge variable of Dental and Oral Therapists showed that the p-value was
0.039 (p <0.05), meaning that the care model developed was effective in
increasing the knowledge of Dental and Oral Therapists. The p-value of the
control group's knowledge was 0.102 (p>0.05), meaning that the care model
used in the control group did not increase knowledge. The results of the
unpaired data effectiveness test of the pre-post test change value (Δ)
with a p-value of 0.013 (p <0.05) which means that there is a significant
difference in increasing knowledge in the control and intervention groups with
a difference (Δ) in the intervention group of 2.80 and in the control
group of 0.30.
Differences in attitudes before
and after intervention in intervention and control groups
|
Statistics |
||||||
|
Variables |
Group |
Mean�SD |
Mean�SD |
Delta�SD (Δ) |
p |
|
|
Pre test |
Post test |
|||||
|
Attitude |
Intervention |
8,20�0,44 |
9,00�0,89 |
0,80�0,18 |
0,046* |
|
|
Control |
7,000�1,00 |
7,60�1,14 |
0,60�0,14 |
0,083* |
||
|
|
|
|
|
p=0,040** |
|
|
����������������������� *Wilcoxon **Mann-Whitney
The results of the effectiveness test of paired data on the attitude
variables of Dental and Oral Therapists showed that the p-value of the
intervention group was 0.046 (p <0.05), meaning that the developed care
model effectively improved the attitude of Dental and Oral Therapists. The
p-value of the attitude of the control group was 0.083 (p>0.05), meaning
that the care model used in the control group did not provide changes in
attitude. The results of the unpaired data test of the change value (Δ)
pre-post test with a pvalue of 0.040 (p <0.05) which means a significant
change in attitude improvement in the control and intervention groups with a
difference value (Δ) in the intervention group of 0.80 and in the control
group 0.60.
Differences in skills before and
after intervention in intervention and control groups
|
Statistics |
|||||
|
Variables |
Group |
Mean�SD |
Mean�SD |
Delta�SD (Δ) |
p |
|
Pre test |
Post test |
||||
|
Skills |
Intervention |
5,00�0,70 |
8,40�0,89 |
3,4�0,18 |
0,039* |
|
Control |
4,6�0,89 |
4,82�1,30 |
0,2�0,40 |
0,317* |
|
|
|
|
|
|
p=0,01** |
|
����������������������� * Wilcoxon **
Mann-Whitney
The results of the effectiveness test of paired data on the Dental
and Oral Therapist Skills variable showed that the p-value of the intervention
group was 0.039 (p <0.05), meaning that the developed care model was
effective in improving the skills of Dental and Oral Therapists. The p-value of
the control group skills was 0.317 (p>0.05), meaning that the care model
used in the control group did not provide changes in dental therapist skills.
The results of the unpaired data effectiveness test of the pre-post test change
value (Δ) showed a significant change in the skills of Dental and Oral
Therapists in the control and intervention groups with a difference value
(Δ) in the intervention group of 3.40 and in the control group of 0.20.
Differences in patient anxiety
before and after intervention in intervention and control groups
|
Statistics |
|||||
|
Variables |
Group |
Mean�SD |
Mean�SD |
Delta�SD (Δ) |
p-value |
|
Pre test |
Post test |
||||
|
Anxiety |
Intervention |
31,6�1,42 |
17,5�2,54 |
14,1�3,10 |
0,005* |
|
Control |
31,3�1,05 |
2,56�1,34 |
5,70�1,33 |
0,005* |
|
|
|
|
|
|
p=0,001** |
|
*Wilcoxon ** Mann-Whitney
The results of the effectiveness
test of paired data on anxiety variables in prosthodontia patients showed that
the p-value of the intervention group was 0.005 (p <0.05), meaning that the
developed care model was effective in reducing the anxiety of prosthodontia
patients. The p-value of the control group is 0.005 (p<0.05), meaning that
the care model used in the control group is also effective in reducing the
anxiety of prosthodontia patients. The results of the unpaired data
effectiveness test of the pre-post test change value (Δ) showed a
significant change in patient anxiety in the control and intervention groups
with a selective value (Δ) in the intervention group of 14.1 and in the
control group of 5.7.
Differences in patient compliance
before and after intervention in intervention and control groups
|
Statistics |
|||||
|
Variables |
Group |
Mean�SD |
Mean�SD |
Delta�SD (Δ) |
p-value |
|
Pre test |
Post test |
||||
|
Compliance |
Intervention |
17,9�0,999 |
22,2�1,98 |
4,3�1,83 |
0,005* |
|
Control |
17,7�1,888 |
19,7�2,11 |
2,0�1,69 |
0,016* |
|
|
|
|
|
|
p=0,001** |
|
������������������ * Wilcoxon
**Mann-Whitney
The results of the effectiveness
test of paired data for compliance variables in pre-postodontia patients showed
that the p-value of the intervention group was 0.005 (p <0.05), meaning that
the developed care model was effective in improving patient compliance. The
p-value in the control group was 0.016 (p<0.05), meaning that the care model
used in the control group was also effective in improving patient compliance.
The results of the unpaired data
effectiveness test of the pre-post change value (Δ) showed a significant
change of 0.001 (p <0.05) in increasing compliance of prosthodontia patients
in the control and intervention groups with a difference value (Δ) in the
intervention group of 4.3 and in the control group of 2.0. The results of the
analysis also showed a value of p = 0.001, meaning that there was an effect of
knowledge, attitudes and skills of Dental and Oral Therapists on reducing the
anxiety level of prosthodontia patients.�
TGM Behavioral Test on Anxiety of
Premature Contact Patients
|
Variables |
B |
P value |
R |
R Square |
Adjusted R Square |
C |
|
Knowledge |
0,572 |
0,320 |
|
|
|
|
|
Attitude |
0,701 |
0,001 |
0,9250������ .������������������������ 8450������������������� ,8343.�������������� 116 |
|||
|
Skills |
0,736 |
0,337 |
|
|||
It can be seen that the constant
value is 3.116 with a knowledge coefficient of 0.572, meaning that an increase
in the knowledge value of Dental and Oral Therapists 1 point will reduce the
anxiety level of prosthodontia patients by 0.572. The attitude coefficient
value of 0.701 means that an increase in the attitude value of Dental and Oral
Therapists by 1 point will reduce the anxiety level of prosthodontia patients
by 0.746. The coefficient value of Skills is 0.746, meaning that an increase in
the value of Dental and Oral Therapist Skills by 1 point will reduce the
anxiety level of prosthodontia patients by 0.746.
The results of the analysis show R
= 0.925, meaning that there is a very strong correlation and a very significant
effect between the knowledge, attitudes and skills of Dental and Oral
Therapists with the anxiety level of prosthodontia patients while the results
of R2 (R Square) are 0.845 or (84.5%), meaning that the knowledge, attitudes,
skills of Dental and Oral Therapists have an 84.5% influence on reducing the
anxiety level of prosthodontia patients.
TGM Behavioral Test on Compliance
of Premature Contact Patients
|
Variables |
B |
P value |
R |
R Square |
Adjusted R Square |
C |
|
Knowledge |
1,012 |
0,265 |
|
|
|
|
|
Attitude |
1,022 |
0,001 |
0,9310����������� ,������������������������ 8670���������� ,8424,������������������������ 726 |
|||
|
Skills |
1,509 |
0,136� |
|
|||
It can be seen that the constant
value is 4.762 with a knowledge coefficient of 1.012, meaning that an increase
in the knowledge value of Dental and Oral Therapists by 1 point will increase
the compliance of prosthodontia patients by 1.012. The attitude coefficient
value of 1.022 means that an increase in the attitude value of Dental and Oral
Therapists by 1 point will increase the compliance of prosthodontia patients by
1.022. The skill coefficient value of 1.509 means that an increase in the Oral
and Dental Therapist skill value of 1 point will increase prosthodontia patient
compliance by 1.509.
The results of the analysis show R
= 0.931, meaning that there is a very strong correlation and a very significant
effect between the knowledge, attitudes and skills of Dental and Oral
Therapists with the level of compliance of prosthodontia patients while the
results of R2 (R Square) are 0.867 or (86%), meaning that the knowledge,
attitudes, skills of Dental and Oral Therapists have an 86% influence on
reducing the anxiety level of patients with premature contact of removable
dentures.
Discussion
Dental and Oral Health Care Model for
Premature Contact Patients with Partial and Full Dentures
Based on
the results of observations through interviews, information was obtained that
dental services specializing in prosthodontics are dental and oral health
services that specifically serve the rehabilitative needs of patients with the
aim of restoring oral cavity functions such as teeth and mucosa by paying
attention to patient comfort and anxiety during treatment. The complaints that
often occur in premature contact patients in the installation of partial and
complete removable dentures at UNIMUS RSGM are discomfort, pain, anxiety, and
bad breath. there is no government policy in providing oral health care
guidelines for special prosthodontics patients. While oral health care needs to
be in service because it helps dental and oral therapists carry out treatment
in accordance with SOPs and collaborate well with prosthodontia specialist
doctors, especially in the treatment of patients with premature contact. the
existence of this need led researchers to develop a model of care services for
premature contact patients with partial and complete removable dentures.
The
results of expert validation showed a p-value = 0.003, which means that the
oral health care model for premature contact patients at the prosthodontia
dentistry specialty clinic is relevant as a model of oral health care for
premature contact patients. The expert validation process is important in
product/model development which is useful in improving the quality of a
developed product.
The oral
health care model for premature contact patients at the prosthodontics
dentistry specialty clinic, is a development model with the aim that Dental and
Oral Therapists can carry out all stages which ultimately affect the patient's
anxiety level and patient compliance during treatment, compared to the oral
health care model of Kepmenkes No. 284 of 2006 Dental and Oral Therapists only
carry out simple assessment and implementation (Chair Side Assistant) in the
Dentistry specialty dental clinic because nurses have previously carried it out,
while the stages of diagnosis, planning, and evaluation are not carried out.
The SOAPIE stages are standard care services so all stages must be implemented.
This model
was developed from the oral health care model according to Kepmenkes No. 284 of
2006 and is also supported by dental and oral health journals that describe the
need for care to reduce anxiety and compliance in denture-using patients with
premature contact. In the implementation of oral health care so far, referring
to Kepmenkes No. 284 of 2006 is used for the entire specialty service poly and
not specifically for denture-using patients with premature contact. Problems
that are often found in premature contact patients are pain and discomfort.
The role
of Dental and Oral Therapists is needed in the implementation of this
development model so that the intervention to reduce anxiety and increase
compliance of premature contact patients with dentures in service / treatment
runs well. Dental and Oral Therapists will be given training in advance with
the aim of increasing knowledge, attitudes and skills about the oral health
care model for premature contact patients with dentures at the prosthodontia
dentistry specialty clinic in order to provide a complete treatment process in
accordance with SOAPIE, thus providing patient comfort and compliance with
services/treatment at the clinic.
Model Testing
Dental Health Worker Pilot Test
The trial
on health workers in the implementation of the dental health care model in
premature contact patients with partial and complete removable dentures at the
prosthodontia dentistry specialty clinic, was carried out to improve knowledge,
attitudes and skills for dental health workers so that they are able to
maximally reduce anxiety levels and increase compliance with patients with
premature contact dentures in service / treatment. Implementing oral health
care and development results, with the hope of providing comfort for premature
contact patients with partial and complete removable dentures during service /
treatment.
The
results of the effectiveness test of data on paired variables of knowledge,
attitudes, and skills show that the p-value is 0.001 <0.05, meaning that the
training module for oral health care in premature contact patients with partial
and complete removable dentures at the prosthodontia dentistry specialty clinic
effectively improves the knowledge, attitudes, and skills of dental health
workers in carrying out dental health care in premature contact patients with
partial and complete removable dentures.
The
increase in knowledge is due to the training given an understanding of the
material for implementing the oral health care model in patients with premature
contact of removable dentures. According to Fitri et al., (2019), knowledge is the result of human
sensing, or the result of someone knowing objects through their senses (eyes,
nose, ears, etc.) proven by research by Rostini et al., (2022), training can increase knowledge. The
results of the effectiveness test of paired data on the knowledge variable of
Dental and Oral Therapists showed that the p-value of the intervention group
was 0.042 (p <0.05), which means that the developed care model is effective
in increasing the knowledge of Dental and Oral Therapists.
An
increase in attitude occurs when given information and then considering taking
action in accordance with the information provided. According to previous
research, attitude is defined as a reaction or response that arises from an
individual to an object which then leads to individual behavior towards the
object in certain ways (Putri & Sirait,
2014). The results of the effectiveness test of paired data
on the attitude variables of Dental and Oral Therapists showed that the p-value
of the intervention group was 0.046 (p <0.05), which means that the
developed care model effectively improves the attitude of Dental and Oral
Therapists.
The
improvement of dental and oral therapist skills is accompanied by an increase
in knowledge and attitudes obtained through the training provided (Janssens et al., 2018). The results of the paired data
effectiveness test of the Dental and Oral Therapist skills variable showed that
the p-value of the intervention group was 0.039 (p <0.05), which means that
the developed care model is effective in improving the skills of Dental and
Oral Therapists.
The
implementation of the training program can be said to be successful if
participants experience a process of increasing understanding of the material,
which is reflected in their attitudes and actions. Training on the model of
oral health care in removable denture premature contact patients is said to be
successful because health workers are given an understanding of the
implementation of oral health care in removable denture premature contact
patients, perform simulations and take action according to the information
provided (Gaber et al., 2018).
Trial in Premature Contact Patients
The
implementation of the oral health care model for patients with premature
contact with removable dentures at the prosthodontia dentistry specialty clinic
is said to be effective in reducing anxiety levels and increasing patient
compliance during treatment/service. The results of the paired variable data
validity test on the anxiety level of patients with premature denture contact
showed that the p-value of the intervention group was 0.005 (p-value <0.05),
meaning that the oral health care model for premature contact patients is
effective.
The role
of dental and oral therapists needs to establish a good relationship with
patients during services at the prosthodontia dentistry specialty clinic
followed by an assessment including the patient's identity and general health,
continuing to the assessment stage of determining the diagnosis of patient
needs by adjusting health problems with existing diagnoses. The diagnosis that
has been determined also comes out the intervention planning, then after the
intervention planning stage is complete, the dental and oral therapist will
carry out the chair side assistant (CSA) process and collaborate with specialty
doctors during patient care. Evaluation is carried out after implementation and
is adjusted to the patient's needs.
The
results of the validity test of paired variable data on the level of compliance
of patients with premature contact of lepasa dentures show that the p-value of
the intervention group is 0.005 (p <0.05), meaning that the oral health care
model for patients is effective. In research conducted by Diskha Mazrzaweny, et
al (2012) the quality of health services has a direct influence on patient
compliance. Therefore, to improve patient compliance, it can be started by
improving the quality of health services (Marzaweny &
Hadiwidjojo, 2012).
Conclusion
����������� Based on the
results of the study, it can be concluded that the oral health care model is
feasible and its application is effective for services at the prosthodontia
dentistry specialty clinic for premature contact patients with partial and
complete removable dentures. This is proven:
1. The oral health care model for
prenatal contact patients with partial and complete removable dentures is
feasible as oral health care for prenatal contact patients in the prosthodontia
dentistry specialty clinic of RSGM Universitas Muhammadiyah Semarang. This is
proven statistically and significantly getting a p-value of 0.001 (p <0.05).
2. The oral health care model for
premature contact patients with partial and complete removable dentures is
feasible as oral health care for premature contact patients in the
prosthodontia dentistry specialty clinic of RSGM Universitas Muhammadiyah
Semarang effectively increases the knowledge of Dental and Oral Therapists
compared to the control group, this is evidenced statistically and
significantly getting a p-value of 0.039 (p <0.05), as evidenced by the mean
value of the intervention group difference of 2.80.
3. The oral health care model for
prenatal contact patients with partial and complete removable dentures is
feasible as oral health care for prenatal contact patients in the prosthodontia
dentistry specialty clinic of RSGM Universitas Muhammadiyah Semarang effectively
improves the attitude of Dental and Oral Therapists compared to the control
group, this is proven statistically and significantly getting a p-value of
0.046 (p <0.05). Evidenced by the mean value of the intervention group
difference of 0.80.
4. The oral health care model for
prenatal contact patients with partial and complete removable dentures is
feasible as oral health care for prenatal contact patients in the prosthodontia
dentistry specialty clinic of RSGM Universitas Muhammadiyah Semarang effectively
improves the skills of Dental and Oral Therapists compared to the control
group, this is evidenced statistically and significantly getting a p-value of
0.039 (p <0.05). Evidenced by the mean value of the intervention group
difference of 3.40.
5. The oral health care model for
premature contact patients with partial and complete removable dentures is
feasible as oral health care for premature contact patients in the
prosthodontia dentistry specialty clinic of RSGM Universitas Muhammadiyah
Semarang effectively reduces the anxiety level of premature contact denture
patients compared to the control group, this is evidenced statistically and
significantly getting a p-value of 0.005 (p <0.05) as evidenced by the mean
value of the intervention group difference of 14.1.
6. The oral health care model for
premature contact patients with partial and complete removable dentures is
feasible as oral health care for premature contact patients in the
prosthodontia dentistry specialty clinic of RSGM Universitas Muhammadiyah
Semarang effectively improves compliance of premature denture contact patients
compared to the control group, this is evidenced statistically and
significantly getting a p-value of 0.005 (p <0.05) as evidenced by the mean
value of the intervention group difference of 2.0.
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|
Muhammad
Furqan1, Bedjo Santoso2, Diyah Fatmasari3,
Dika Agung Bakhtiar4, Bambang Sutomo5
(2024) |
|
First Publication Right: Journal of Health Science |
|
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