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Eduvest – Journal of Universal
Studies Volume 4 Number
07, July, 2024 p- ISSN 2775-3735- e-ISSN 2775-3727 |
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Vega
Roosa Fione, Jeane d'Arc Zavera Adam, Ni Made Ayu Sri Lestari 1,2,3Poltekkes
Kemenkes Manado Department of Dental Health Email: : vegaroosafione@gmail.com |
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ABSTRACT |
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Background:
The main cause of dental and oral disease is plaque. Plaque control can be
done mechanically, namely by brushing your teeth regularly and chemically by gargling.
Plaque control by gargling can use traditional plant materials. It can be
made decoctions such as green betel leaves and guava leaves because they
contain compounds that are antibacterial. The purpose of this study was to
determine the effectiveness of gargling using a decoction of green betel
leaves (Piper betle Linn) and decoction of guava leaves (Psidium Guajava)
against plaque index. Method: This is the true experiment method with a
two-group pre and post test design.
This research was carried out in the last week of March to the second
week of April 2023 at the Department of Dental Health, Poltekkes, Ministry of
Health, Manado. The number of subjects of this study was 32 people divided
into 2 groups, namely 16 people who received gargling treatment of green
betel leaf decoction and 16 people who received gargling treatment of guava
leaf decoction. The data obtained were then tabulated and analyzed using
paired sample t-test. This research
instrument uses diagnostic tools and PHP plaque index examination format.
Results: The results showed that the average value of plaque index in the
group that received gargling treatment using green betel leaf decoction was
3.38 before gargling and 1.33 after gargling. This value has a decreasing
difference of 2.05. Furthermore, the average value of plaque index in the
group that received gargling treatment using guava leaf decoction was 3.39
before gargling and 2.41 after gargling. This value has a decreasing
difference of 0.98. The paired test results of the t-test sample obtained a
value of p-value = 0.000. This value indicates that the treatment given
provides effective in reducing plaque index.
Conclusion: It can be concluded that the gargling a decoction of green
betel leaves and guava leaves can reduce the plaque index where the decoction
of green betel leaves is more effective in reducing the plaque index. |
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KEYWORDS |
Leaf;
Green Betel; Guava; Plaque Index |
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This work
is licensed under a Creative Commons Attribution-ShareAlike
4.0 International |
INTRODUCTION
Dental
and oral health is important to the general health and well-being of the body
and greatly affects the quality of life including speech function, mastication,
and self-confidence. In Indonesia,
dental and oral diseases, especially caries and periodontal disease, are still
suffered by many Indonesians both by children and adults (Putri
et al., 2018). The main cause of such dental and oral
disease is plaque. Plaque is a soft,
sticky coating that adheres to teeth.
Plaque consists of proteins and bacteria, bacteria are 70% derived from
saliva. This plaque itself is formed
after brushing your teeth, if the plaque has hardened caused by calcium,
phosphorus and other minerals will become tartar within 48 hours after its
formation. Plaque attached to the surface of the
teeth is the main source of nutrients for bacteria to grow and colonize and
create acidic shades in the oral cavity which can cause enamel to dissolve and
cause dental caries (Mumpuni
and Erlita, 2013).
Based on the WHO global oral health status report (2022) estimates
that oral diseases affect nearly 3.5 billion people worldwide and globally it
is estimated that 2 billion people suffer from permanent dental caries and 514
million children suffer from deciduous dental caries (World Health Organization,
2022). The results of Basic Health Research (2018),
stated that the proportion of dental and oral problems in Indonesia is 57.6%,
daily brushing behavior is 94.7% and the proportion of correct brushing
behavior is 2.8%, while for the people of North Sulawesi province the
proportion of dental and oral problems is 66.5%, daily brushing behavior is
96.3% while correct brushing behavior is 3.5% and especially in Manado city the
proportion of health problems teeth and mouth by 56.9%, daily brushing behavior
by 98.7% while correct brushing behavior by 5.3% (Ministry
of Health, 2018) And
there are still many people who have not done the habit of brushing their teeth
at the right time.
According
to Putri
et al., (2018), plaque control
with gargle solution can use materials like traditional plants. As for traditional plants that can be made
decoction to be mouthwash such as betel leaves and guava leaves where the plant
contains compounds that can be antibacterial. According to Yanuar,
(2019), betel leaf
contains an essential oil consisting of Bethlephenol, Cavikol, Sesquiterpenes, hydroxycavikol,
Cavibetol, Estragol,
Eugenol and Carvakrol. It also contains carotene, thiamine, riboflavin, nicotinic acid, vitamin C, Tanninssugar starch and amino acids. Guava leaves contain tannins, flavonoids, essential oils and Alkaloids (Kartini,
2022). Based on
previous research conducted Nurmeida
et al., (2020), about the effect
of betel leaf cooking water on reducing plaque scores said that betel leaf
cooking water can reduce plaque index because of the essential oil content
possessed by betel leaves which has antibacterial power that can reduce the
formation of dental plaque. Likewise on
guava leaves, based on previous research conducted Darsono
and Sumantri, (2020), about the
antibacterial activity test of ethyl acetate fraction of guava leaves (Psidium Guajava L) against the bacteria
that cause dental caries Streptococcus Sanguis says that compounds flavonoids contained in guava leaves has an antibacterial role.
According
to Aziz
and Ridwan, (2016), a decoction of
guava leaves can be used as a mouthwash for wounds inside the mouth and
bleeding gums. According to Ifitri
and Eriyati (2019), the essential
oil present in guava leaves (0.365%) functions as an anti-bacterial, can
inhibit plaque growth. In addition,
essential oils contained in guava leaves are also contained cineol and Tritepenic Acids which is also a nature or has high anti-bacterial activity,
not only as an anti-bacterial essential oil can increase secretion and increase
the amount of saliva production. Increased speed and decreased viscosity of
saliva and inhibited plaque formation.
According
to Putri
et al., (2018), to measure
dental and oral hygiene an index is used.
Index is a number that shows the clinical condition obtained at the time
of examination, by measuring the area of the tooth surface covered by plaque or
calculus, thus the number obtained based on objective assessment. There are several types of indices that can
be used to measure a person's plaque, including Patient Hygiene Performance Index or PHP Index. This study aims to
determine the effectiveness of gargling green betel leaf decoction (Piper Betle L) and decoction of guava
leaves (Psidium Guajava) against
plaque index.
RESEARCH
METHOD
This study used
research True Experiment by design Two Group Pre and Post Test. This study
conducted plaque index examination conducted before and after intervention with
2 intervention groups. This research was carried out in March-April 2023 at the
Dental and Oral Health Care Service Laboratory, Department of Dental Health,
Poltekkes, Ministry of Health, Manado. The subjects of this study were 32
students of the 1st level of the Department of Dental Health. The study
subjects were divided into two groups, namely the gargling group of green betel
leaf decoction (16 people) and the guava leaf decoction group (16 people).
Research subjects meet the criteria, namely willing to participate in research
as evidenced by filling out informed consent, present at the time of the study,
have a DMF-T Index ≤ 3, calculus-free, not under treatment orthodontics, and have no history of
allergies to herbal plants. A decoction
of green betel leaves and guava leaves is made with a concentration of 10% made
by boiling 60 gr of green betel leaves in 600 ml of aquadest. Leaves are taken that are young or half old
from the shoots of green betel leaf stems, the time of taking in the morning to
prevent the color of the leaves from fading.
The leaf decoction water is waited for it to boil, then waited for it to
cool at room temperature, and then filtered to separate the leaves with a
solution (Tandelilin
et al., 2020). Gargle the decoction of leaves as much as 20
ml of cooking water and gargle for 30 seconds.
Plaque index is the difference between plaque score before gargling and
plaque score after gargling green betel leaf decoction and guava leaf decoction
measured using PHP plaque index (Personal
Hygiene Performance) according to Podshadley and Haley. With criteria Very good 0, Good
0.1-1.7, Medium 1.8-3.4, Bad 3.5-5. The analysis in this study is analysis univariate and bivariate.
RESULT AND DISCUSSION
Univariate analysis
Univariate
analysis was conducted to distribute respondents by age and sex. This can be
seen in Table 1.
Table 1. Distribution of research subjects by age and
sex
|
Characteristic |
Category |
n |
(%) |
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Age (years) |
17 |
2 |
6 |
|
18 |
11 |
34 |
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19 |
9 |
28 |
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20 |
10 |
31 |
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Total |
32 |
100 |
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Gender |
Woman Men |
26 6 |
81 19 |
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Total |
32 |
100 |
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Table 1 shows that
the most study subjects were 18 years old (34%) and female sex was 26 people
(81%). Furthermore, the distribution of research subjects based on plaque score
categories before and after treatment was given. This can be seen in Table 2.
Table
2. Distribution of Research Subjects by Plaque Score Category
|
|
Measurement Time |
Plaque Score
Categories |
||||
|
Treatment |
Very Good |
Good |
Fair |
Bad |
Total |
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||||||
|
Gargling decoction of
green betel leaves |
Before |
0 |
0 |
6 |
10 |
16 |
|
After |
0 |
13 |
3 |
0 |
16 |
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Total |
0 |
13 |
9 |
10 |
32 |
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|
Gargling decoction of
guava leaves |
Before |
0 |
0 |
7 |
9 |
16 |
|
After |
0 |
3 |
12 |
1 |
16 |
|
|
Total |
0 |
3 |
19 |
10 |
32 |
|
Table 2 data shows
that the plaque score category of the study subjects showed that before
gargling the decoction of green betel leaves in the Bad category as many as 10
people and after the most in the Good category as many
as 13 people. Furthermore, in the gargling group, guava leaf decoction before
gargling was most in the Bad category as many as 9 people and after gargling in
the Medium category as many as 12 people.
Results of
bivariate analysis
Bivariate
analysis was performed to analyze the effect of treatment on plaque scores.
Test selection begins by performing a normality analysis with the Shapiro-Wilk
test and obtaining significant values all > 0.05 so that it is stated that
all data are normally distributed. Based on the results of this test, a
different test was carried out with the Paired Sample t-test. The test results
can be seen in Table 3.
Table
3. Paired Sample t-test results
|
Group |
Mean |
SD |
t count |
df |
α |
p-value |
|
Before – After
Gargling Green Betel Leaf Decoction |
2.0500 |
0.5933 |
13.821 |
15 |
0.05 |
0.000 |
|
Before – After
Gargling Guava Leaf Decoction |
0.9812 |
0.2994 |
13.111 |
15 |
0.05 |
0.000 |
Based on the Paired Sample T-test on the effectiveness of gargling green betel
leaf decoction and guava leaf decoction on plaque index, a value of ρ = 0.000
(ρ<0.05) means that there is a significant difference between before
and after gargling green betel leaf decoction and guava leaf decoction on the
Plaque Index.
Discussion
The results of this study showed in the group gargling a decoction of
green betel leaves (Piper Betle L)
obtained average results before gargling green betel leaf decoction 3.38 and
after gargling green betel leaf decoction 1.33, there was a decrease in plaque
index by 2.05 which means gargling with green betel leaf decoction can reduce
plaque index. The difference in the
average plaque index formed due to gargling decoction of green betel leaves
contains essential oils consisting of kavikol and contains antiseptic substances that play a role in killing bacteria.
The antiseptic properties of betel leaf are caused by phenol derivatives,
namely cavikol, where the antiseptic properties are
five times more effective when compared to ordinary phenols work by denaturing
proteins in fungi, namely damage to the tertiary structure of proteins that
make up the fungal cell wall which can cause weakness in the function of cell
wall proteins. In addition, betel leaves
also have antibacterial effects against Streptococcus
mutans, Streptococcus viridansand Streptococcus sanguis. Betel leaf also contains antioxidants and
eugenol which has antifungal properties (Center for
Biopharmaceutical and Accomplished Studies, 2014).
The results of this study are in line with previous research conducted
by Nurmeida
et al., (2020), about the effect
of betel leaf cooking water on reducing plaque scores said that betel leaf
cooking water can reduce plaque index because of the essential oil content
possessed by betel leaves which has antibacterial power that can reduce the
formation of dental plaque. Research conducted Owu
et al., (2020), It is said that
betel leaf ethanol extract contains tannin compounds and effectively inhibits
bacteria Streptoccus mutans Where these bacteria are the
main bacteria that cause caries.
In the group of decoction of guava leaves
(Psidium Guajava L) obtained average
results before gargling guava leaf decoction 3.39 and after gargling guava leaf
decoction 2.41, there was a decrease in plaque index by 0.98 which means
gargling guava leaf decoction can reduce plaque score. The difference in the
average plaque index formed because in guava leaves contains compounds such as flavonoids which is very high especially
Quercetin Useful as an anti-bacterial
(Maigoda, 2022).
Guava leaves also contain essential oils that function as anti-bacterial
to inhibit plaque formation, besides that essential oils can increase secretion
and increase the amount of salivary production (Ifitri and
Eriyati, 2019).
On research conducted by Chakraborty
et al., (2018) Based on the
results of phytochemical tests on guava leaves contain tannins as
antibacterial. Tannins have an antibacterial mechanism by contracting cell
membranes, enzyme inactivation, and cell walls; (Handarni
et al., 2020). Based on research Darsono
and Sumantri., (2020) About
Antibacterial Activity Test of Ethyl Acetate Fraction of Guava Leaves (Psidium Guajava L) against the bacteria
that cause dental caries Streptococcus Sanguis says that compounds flavonoids contained in guava leaves has an antibacterial role
contained in plaque formation, especially in the early stages.
The results of the analysis used the Paired Sample T-test mean value before and after gargling
green betel leaf decoction 2.0500 and p value = 0.000 (<0.05) with t valuecount
= 13.821, then before and after gargling guava leaf decoction mean value 0.9812 and p value = 0.000 (<0.05) with t valuecount
= 13.111, while at t valueTable DF
(Degree of Freedom) is 15, in
statistical table value is ttable = 1.753.
Thus, since tcounts > ttable it can be concluded that H0
is rejected and H1 is accepted. So there is a difference in
effectiveness between gargling green betel leaf decoction with guava leaf
decoction, where both stews can both reduce plaque score, but gargling green
betel leaf decoction is more effective than gargling guava leaf decoction in
reducing plaque score, because in the process of making decoction with the same
concentration, guava leaf stew results are more concentrated than green betel
leaves, The possibility of concentration
is one of the causes of betel leaves being more effective than guava leaves
against plaque index. In addition, it is also supported by differences in
chemical components in essential oils in green betel leaves consisting of kavikol derivatives of phenol. Kavikol has
antibacterial power five times stronger than ordinary phenol. These components
play an important role in the mechanism of plaque formation because of the
strong bactericidal properties that can reduce plaque scores.
The results of this study are in line with
previous research conducted by Oktariani
et al., (2020), where gargles of
green betel leaf boiled water (Piper
betle L) slightly decreased plaque scores more than guava leaf cooking
water (Psidium guajava L).
Maintaining dental hygiene is very mandatory for us to do many ways to maintain
dental and oral hygiene, one of which is by brushing their teeth, but sometimes
at certain times many people have not had time to brush their teeth because of
rush or laziness, gargling with green betel leaves and guava leaves can be an
easy alternative to do (Putri
et al., 2018).
CONCLUSION
The conclusion of this study was the
average plaque index before gargling green betel leaf decoction of 3.38 and
after gargling green betel leaf decoction of 1.33. The average plaque index
before gargling guava leaf decoction was 3.39 and after gargling guava leaf
decoction was 2.41. The results of statistical tests show that gargling
decoction of green betel leaves is more effective in reducing plaque than
gargling decoction of guava leaves. Further research is needed, especially the
levels of active substances contained in green betel leaves and guava leaves
that can affect the growth of dental plaque.
REFERENCES
Aziz,
S. A., & Ridwan, T. (2016). Daun Jambu Biji Sebagai Bahan Baku Obat.
IPB Press. Bogor.
Chakraborty, S.,
Afaq, N., Singh, N., & Majumdar, S. (2018). Antimicrobial activity of
Cannabis sativa, Thuja orientalis and Psidium guajava leaf extracts against
methicillin-resistant Staphylococcus aureus. Journal of Integrative Medicine
16(5), 352. (diakses pada tanggal 12 Juni 2023). https://doi.org/10.1016/j.joim.2018.07.005
Darsono,
O., & Sumantri. (2020). Uji Aktivitas Antibakteri Fraksi Etil Asetat Daun
Jambu Biji (Psidium Guajava L.)
Terhadap Bakteri Penyabab Karies Gigi Streptococcus
Sanguis. Indonesia Natural Research
Pharmaceutical Journal. Vol 5, No.1, 87. (diakses Pada Tanggal 14 Desember
2022).
Fitri,
I. & Humairoh, D. (2021). Activity Test Guava Leaf Extract (Psidium Guajava
L.) On The Growth Of Streptococcus Sp. Jurnal Matematika dan Sains,1(1).
(diakses pada
tanggal 1 Februari 2023).
Handarni, D., Putri, S. H., & Tensiska, T. (2020).
Skrining Kualitatif Fitokimia Senyawa Antibakteri pada Ekstrak Daun Jambu Biji
(Psidiium guajava L.). Jurnal Keteknikan
Pertanian Tropis dan Biosistem, Vol. 8, No. 2, 183. (diakses pada tanggal 12 Jumi 2023).
https://doi.org/10.21776/ub.jkptb.2020.008.02.08
Ifitri, I., & Eriyati. (2019). Pengaruh Berkumur
Air Rebusan Daun Jambu Biji Terhadap Indeks Plak Pada Murid Sdn 10 Kubu Ampek
Angkek Kabupaten Agam. Ensiklopedia Of
Journal. Vol. 1, No. 4. (diakses Pada Tanggal 14 Desember 2022).
Kartini, S. (2022). Mengenal Tanaman Obat
Tradisional Kahedupa. Nas Media Pustaka. Yogyakarta.
Kasuma, N. (2016). Plak
Gigi. Andalas University Press. Padang.
Kementerian Kesehatan RI. (2018). Riset Kesehatan
Dasar 2018. Badan Penelitian dan Pengembangan Kesehatan RI. Jakarta.
Maigoda, T. C. (2022). Gel Ekstrak Daun Jambu dan Daun
Senduduk Dampaknya Terhadap Penanda Inflamasi, Bakteriologis, Diameter Luka,
dan Kolagen pada Luka Kaki dengan Diabetes. PT Nasya
Expanding Management. Jawa Tengah.
Mumpuni,
Y., & Erlita, P. (2013). 45 Masalah dan Solusi Penyakit Gigi dan Mulut. Rapha Publishing. Yogyakarta.
Notoatmodjo, S. (2014). Metodologi Penelitian
Kesehatan. Rineka Cipta. Jakarta.
Nugroho, E. D., & Rahayu, D. A. (2018). Penuntun
Praktikum Bioteknologi. CV Budi Utama. Yogyakarta.
Nurmeida, E., Herijulianti, E., Laut, D. M., &
Nurnaningsih, H. (2020). Pengaruh
Air Rebusan Daun Sirih Terhadap Penurunan Skor Plak. Jurnal Kesehatan Siliwangi. Vol.1,
No.1, 62. (diakses pada tanggal 31 Januari 2023).
Oktanauli,
P., Taher, P., & Aulia, D. M. (2020). The Effect Of Herbal Mouthwash (Betel
Leaf) Against Halitosis In Elderly. Jurnal
Ilmiah Dan Teknologi Kedokteran Gigi Fkg Updm (B). Vol. 16, No. 1, 25. (diakses Pada Tanggal 31 Januari 2023).
Oktariani, Z., Deynilisa, S., & Zainur, R. A.
(2020). Perbandingan Efektivitas
Kumur-Kumur Air Rebusan Daun Sirih Hijau (Piper Betle L) Dengan Daun Jambu Biji
(Psidium Guajava L) Terhadap Penurunan Skor Plak. Jurusan Kesehatan Gigi Poltekkes Kemenkes Palembang. Vol. 2, No. 2, 37. (diakses pada tanggal
11 Juni 2023).
Owu, N. M., Fatimawali, ., & Jayanti, M. (2020).
Uji Efektivitas Penghambatan Dari Ekstrak Daun Sirih (Piper Betle L.) Terhadap
Bakteri Streptococcus Mutans. Jurnal
Biomedik. Vol. 12, No.3. (diakses Pada Tanggal 31
Januari 2023).
Pusat
Studi Biofarmaka, & Ulung, G. (2014). Sehat Alami dengan Herbal 250
Tanaman Berkhasiat Obat. Gramedia Pustaka Utama. Jakarta.
Putri, M. H. (2021). Mikrobiologi Keperawatan Gigi.
PT. Nasya Expanding Management.
Putri,
M. H.,
Herijulianti., E & Nurjannah, N. (2018). Ilmu Pencegahan Penyakit Jaringan Keras dan Jaringan
Pendukung Gigi. Buku
Kedokteran EGC. Jakarta.
Rachmatiah, T., Syafriana, V., & Elfira, L. (2018). Aktivitas
Daya Hambat Minyak Atsiri Dan Ekstrak Etanol Daun Sirih Merah (Piper Crocatum Ruiz & Pav.) Terhadap Candida
Albicans. Sainstech Farma. Vol.
11, No. 2. (diakses Pada Tanggal 31 Januari 2023).
Rahayu, C., & Salikun. (2020). Efektivitas Rebusan
Daun Sirih Merah (Piper Betle Crocatum) Dan Rebusan Daun Sirih Hijau (Piper
Betle Linn) Terhadap Puberty Gingivitis. Jurnal
Ilmiah Keperawatan Gigi (Jikg). Vol. 1, No. 1, 31. (diakses Pada Tanggal 31
Januari 2023).
Santoso, H. B. (2019). Seri Mukjizat Daun Daun Sirih Merah. Pohon Cahaya Semesta. Yogyakarta.
Setyaningsih, D. (2019). Menjaga Kesehatan Gigi Dan
Mulut. Loka
Aksara. Tanggerang.
Susanto, A. (2018). Kesehatan Gigi dan Mulut. PT Sunda Kelapa. Jakarta.
Tandelilin, R. TC., Sandy, L. P. A., & Hondro, M.
J. (2020). Derajat Keasaman (pH) Saliva Meningkat Setelah Berkumur Rebusan Daun
Sirih Merah (Paper Crocatum) Konsentrasi 10% pada Lansia Penderita Diabetes
Melitus Tipe 2. Jurnal Teknosains,
9(2). (diakses pada tanggal 10 Februari 2023).
World
Health Organization. (2022). Global Oral Health Status Report.
https://www.who.int/news-room/fact-sheets/detail/oral-health. (diakses pada tanggal 1 Februari 2023).
Yanuar, A. (2019). Manfaat Daun Sirih. Mutiara
Aksara. Semarang.
Yulisma, L. (2018). Uji Efektivitas Anti Bakteri
Ekstrak Daun Jambu Biji Lokal (Psidium Guajava L) Terhadap Pertumbuhan
Staphylococcus Aureus Dan Bacilus Subtilis Secara In Vitro. Jurnal Pendidikan Dan Biologi. Vol. 10,
No. 2. (diakses Pada Tanggal 14 Desember 2022).