Seventy-one out of 100 junior high school students in Kulon Progo consumed snacks with low cariogenic potential. Their caries risk should therefore have been low. Yet the reality was different: exactly half of them, 50 students, were classified as being at high risk of caries based on clinical assessment. This paradoxical finding prompted researchers from the Faculty of Dentistry, Universitas Gadjah Mada, to investigate more closely the relationship between school snacks and oral health among adolescents.
The study, published in the December 2021 issue of the Indonesian Dentistry Magazine, involved 100 seventh-grade students aged 12–15 years from several public junior high schools in Kulon Progo Regency, Special Region of Yogyakarta. The research team consisted of Yulita Subandari from Santa Elisabeth Bantul General Hospital, Prof. Dr. drg. Bambang Priyono from the Department of Community Dental Health, FKG UGM, and Prof. Dr. drg. Al. Supartinah, Sp.KGA, from the Department of Pediatric Dentistry, FKG UGM.
Assessing Snacks Using the Papas Table
For five consecutive days, the researchers recorded every snack consumed by the participants during the first and second recess periods. Cariogenicity was assessed using the Papas table, a scoring system that classifies foods based on carbohydrate content, physical texture, and their ability to stimulate acid production by oral bacteria.
The results showed that the snacks most commonly consumed by students in the school canteens were actually classified as having low cariogenic potential. Nasi kucing, tea, milk, batagor, and mendoan were among their most common choices. These foods contain water, fat, protein, and fiber, making them easier to clear from the tooth surfaces than hard and sticky foods such as candy, dodol, or gulali. None of the participants fell into the category of high-cariogenic snack consumption.
However, 29 students (29%) still consumed snacks with moderate cariogenic potential, such as wet and dry fried foods containing carbohydrates. This was a concern because such snacks can still promote bacterial fermentation and plaque formation on tooth surfaces.
Caries Risk Is Not Just About What We Eat
Caries risk was assessed using the Caries Assessment Tool (CAT), an instrument developed by the American Academy of Pediatric Dentistry (AAPD). CAT does not assess only the clinical condition of the teeth, but also considers social, biological, protective, and overall clinical indicators.
The Chi-Square statistical test produced an Asymp. Sig. value of 0.557, well above the 0.05 threshold. This means that there was no significant association between the cariogenicity of school snacks and students' caries risk.
The finding may sound surprising, but its explanation offers a broader perspective. Caries risk is not determined by a single factor. Oral bacteria, eating frequency, fluoride exposure, salivary conditions, and toothbrushing habits all contribute simultaneously.
“Students who are caries-free may still have a high risk due to snacking habits, family socioeconomic conditions, and high salivary flow rates, while children who already show signs of caries are immediately classified as being at high risk.”
The situation in the field reinforces this point: most students brushed only the occlusal surfaces rather than all tooth surfaces. A high eating frequency was also a contributing factor because the more frequently sugar comes into contact with the teeth, the longer the acidic conditions persist in the oral cavity.
When Habits Matter More Than the Menu
Another interesting finding from the study concerned gender. Of the 100 participants, 62 were female. At the age of 12–14 years, female students tended to pay more attention to personal hygiene, including oral health. The data showed that female students were more consistent in brushing their teeth twice a day, in the morning and at night before bed, compared with male students.
On the other hand, the study also found that 18 students (18%) had a low risk of caries. They generally used fluoride toothpaste and some even routinely rinsed their mouths with antiseptic mouthwash. This reinforces the finding that good oral hygiene habits can reduce caries risk, even among children who consume cariogenic foods.
The condition of the School Oral Health Program (Usaha Kesehatan Gigi dan Mulut Sekolah/UKGS) at the junior high school level in Kulon Progo was also an important consideration in this study. At the time the research was conducted, the UKGS program at the junior high school level was not yet operating regularly, unlike at the elementary school level, where it was more closely monitored. This gap could widen the lack of oversight of adolescent oral health, despite this being a critical period.
The Canteen Is Not the Only Guardian of Children's Teeth
This study does not conclude that school snacks are harmless to teeth. Instead, the findings serve as a reminder that attention should not focus solely on what is sold in school canteens. Eating frequency, the quality and consistency of toothbrushing, access to fluoride, and family socioeconomic conditions collectively shape caries risk.
The researchers recommend that schools not only monitor the types of snacks sold, but also provide facilities for rinsing or brushing teeth after meals. Visits by dental health professionals to schools to provide education about cariogenic foods and oral health practices are also considered urgent, particularly in areas where the UKGS program has not been optimally implemented.
Half of the junior high school students in Kulon Progo were at high risk of caries. That figure does not change simply because their snacks happened to be low in sugar. As long as toothbrushing habits remain inconsistent and school oral health programs do not reach students consistently, that risk will persist, hidden behind a school canteen menu that may appear healthy enough.
Source DOI: http://doi.org/10.22146/majkedgiind.58950
Authors: Nanda Ayu, drg. Achmad Zam Zam Aghasy, M.Kes.
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