Twelve years is a considerable length of time. Over that period, the Faculty of Dentistry, Universitas Gadjah Mada, established partnerships with 26 elementary schools in Depok District, Yogyakarta, implementing oral health promotion and disease prevention programs for their students. Yet one question remained: did a program that had been running for more than a decade actually change the dental health of the children it targeted? Dr. drg. Sri Widiati, MPH, from the Department of Community and Preventive Dentistry, FKG UGM, sought to answer this question through a study whose findings proved less straightforward than expected.
Surprising Figures from Fifth- and Sixth-Grade Classrooms
Published in The Indonesian Journal of Dental Research, the study involved 196 fifth- and sixth-grade students. A total of 106 students came from nine schools participating in the FKG UGM partnership program, while the remaining 90 students came from schools that were not involved in the program. Their dental health status was assessed using two standard indicators: OHI-S (Oral Hygiene Index-Simplified) to evaluate oral hygiene and DMF-t to measure the caries experience of permanent teeth that had been decayed, filled, or extracted.
The results revealed something both interesting and concerning. The mean OHI-S score among students from partner schools was slightly better, at 1.096, compared with 1.201 among students from non-partner schools. The DMF-t score was also slightly lower: 3.280 versus 3.227. Although differences were observed, they were not statistically significant. In other words, clinically, the oral hygiene and caries status of the two groups were nearly comparable.
Knowledge Improved, but Behavior Did Not Follow
This is where the paradox emerged. Although the physical condition of the students’ teeth did not differ significantly between the two groups, students from partner schools demonstrated substantially better knowledge and attitudes. Their mean knowledge score reached 12.25, while students from non-partner schools scored only 9.76. The difference in attitudes toward oral health was also significant: 62.08 versus 57.90. Both differences were statistically significant, with p < 0.001.
“Partnership between primary schools in Depok Subdistrict with Faculty of Dentistry, Universitas Gadjah Mada improved knowledge and attitude concerning oral and dental health, but failed to decrease OHI-S and DMF-t, indicating that more comprehensive interventions are needed.” — Dr. drg. Sri Widiati, MPH
Further path analysis showed that the partnership did contribute to reductions in OHI-S and DMF-t, but the coefficients were very small: −0.086 and −0.076, respectively. This means that more than 99% of the variation in oral hygiene and caries status among the children was influenced by other factors not measured in the study, including dietary habits, parental education, fluoride exposure, and access to dental services.
The Gap Between Knowing and Doing
This phenomenon is not new in community dental health. A similar study from Korea cited in the research showed that oral health education programs successfully increased knowledge but failed to foster self-efficacy, or the confidence that individuals can effectively maintain their own oral health. Without such confidence, knowledge does not automatically translate into action.
Another study from Brazil also reported that sociodemographic factors, such as mothers’ educational levels, had a stronger correlation with children’s caries experience than school-based educational programs. This highlights the fact that children’s oral health is not solely a matter for schools or clinics but is shaped by a much broader ecosystem.
Interventions Beyond Education
Dr. drg. Sri Widiati’s study does not end as a criticism but instead offers a roadmap. The FKG UGM partnership program proved effective in building cognitive foundations and positive attitudes among children. That is no small achievement. However, producing tangible improvements in dental health requires more concrete interventions that directly address daily behavior, including practical toothbrushing instruction at school, regular fluoride application, limiting sugar consumption, and providing basic dental diagnosis and treatment services within the school environment.
Twelve years of partnership have taught one important lesson: telling children about the importance of taking care of their teeth is necessary, but it is not enough. What is needed are interventions that change habits rather than merely increase knowledge. Ultimately, healthy teeth are not built from what children know, but from what they do every day.
Authors: Achmad Zam Zam Aghasy, DDS, M.Kes.; Hazra Alifia Muharam
Photo: Freepik