At a community health centre (puskesmas) in Pundong District, Bantul, medical records from 2016 revealed an intriguing pattern: patients suffering from severe gum disease mostly came from the same area\u2014the limestone mountainous highlands of Seloharjo Village.\nThe question was: why?\nPrayudha Benni Setiawan, S.Kp.G, M.P.H., a lecturer from the Dental Hygiene Study Program, Faculty of Dentistry, Universitas Gadjah Mada, together with his research team, attempted to answer this question through a study combining dental health science with digital mapping technology.\nThe results, published in the 2019 edition of the Indonesian Journal of Environmental Health, revealed a surprising finding: the drinking water consumed by residents was one of the major contributing factors.<\/p>\n\n\n\n
Periodontal disease\u2014the medical term for diseases affecting the supporting structures of teeth, from the gums to the jawbone\u2014has long been associated with poor oral hygiene. Plaque and calculus (tartar) are indeed the primary causes.\nHowever, this study introduced a new perspective: environmental factors, including residential conditions, also play a significant role that cannot be ignored.<\/p>\n\n\n\n
Periodontal disease develops through three stages. It begins with gingivitis, an inflammation of the gums that can still be reversed. If left untreated, it progresses into periodontitis, where the connective tissues supporting teeth become damaged and cannot fully recover.\nIn its most severe stage, the jawbone begins to deteriorate, eventually causing teeth to become loose and require extraction.\nData from the 2013 Basic Health Research (RISKESDAS) showed a concerning figure: the prevalence of periodontal disease in Indonesia reached 96.58% across all age groups.<\/p>\n\n\n\n
In Bantul Regency itself, 20.7% of the population experienced dental and oral health problems. Ironically, only 8% of total visits to the Pundong Community Health Centre involved dental and oral health services.<\/p>\n\n\n\n
The research team applied an unconventional approach for dental health research: Geographic Information Systems (GIS).\nThis technology allows health data to be integrated into digital maps, making disease distribution patterns visible based on geographical location, elevation, and environmental conditions.<\/p>\n\n\n\n
A total of 152 periodontal disease patients treated at Pundong Community Health Centre between January and December 2016 became the subjects of the study.\nThe researchers recorded each patient\u2019s home coordinates using GPS and mapped them alongside elevation data and the pH levels of the drinking water sources they consumed.<\/p>\n\n\n\n
The results were clear.\nResidents who consumed alkaline water with a pH above 7.6 had a 41-fold higher risk of developing generalized periodontitis\u2014a severe form of gum disease affecting multiple areas throughout the mouth\u2014compared with those consuming water with normal pH levels.\nMeanwhile, residents living in highland areas (above 100 metres above sea level) had a 54-fold higher risk of developing generalized periodontitis compared with those living in lowland areas.<\/p>\n\n\n\n
Both findings were statistically significant, with p-values below 0.05.<\/p>\n\n\n\n
The mechanism behind these findings is relatively logical.\nLimestone mountainous regions such as Seloharjo Village contain high levels of minerals in their groundwater, including calcium and phosphorus. Dug well water in these areas tends to be alkaline and hard, meaning it contains abundant dissolved minerals.<\/p>\n\n\n\n
When this water is consumed daily, these minerals enter the saliva. High calcium concentrations in saliva accelerate the formation of calculus on tooth surfaces.\nAccumulated calculus that is not removed becomes a breeding environment for bacteria, which subsequently triggers gum inflammation and progressive damage to the supporting tissues of the teeth.<\/p>\n\n\n\n
Spatial analysis using the Purely Spatial Poisson Model confirmed these findings. The analysis identified a periodontal disease cluster centred in Seloharjo Village, consisting of 49 patients within a 2.24-kilometre radius.\nThe annual incidence rate reached 11.2 cases per 100,000 residents.<\/p>\n\n\n\n
\u201cCross-sector collaboration is needed, including between community health centres and regional drinking water companies, to ensure the availability of clean and safe drinking water that can be accessed by all communities.\u201d\n\u2014 Prayudha Benni Setiawan, S.Kp.G, M.P.H., et al., in the research publication<\/em><\/p>\n\n\n\n These findings demonstrate that addressing gum disease cannot rely solely on advice to \u201cbrush your teeth regularly.\u201dAs long as the quality of drinking water remains a concern, the risk of calculus formation and periodontitis will continue\u2014even among individuals who maintain good oral hygiene.<\/p>\n\n\n\n The research team recommended collaboration between community health centres, regional drinking water companies, and public works agencies to ensure that water quality standards are met, including in remote villages.Education regarding the importance of safe drinking water, including through health volunteers and family welfare groups (PKK cadres), was also highlighted as an important preventive measure.<\/p>\n\n\n\n This study also opens significant opportunities for using GIS technology in dental health surveillance at the district and provincial levels. With accurate mapping, local governments can identify high-risk areas earlier\u2014long before residents begin losing their teeth one by one.<\/p>\n\n\n\n Ultimately, a person\u2019s dental health is determined not only by what they do in front of the mirror every morning, but also by the water flowing from the well in their own backyard.<\/p>\n\n\n\n Authors: Achmad Zam Zam Aghasy, DDS, M.Kes.; Hazra Alifia Muharam<\/p>\n\n\n\n Photo: Freepik<\/p>\n\n\n\n Source DOI: https:\/\/doi.org\/10.14710\/jkli.18.2.98-103<\/p>","protected":false},"excerpt":{"rendered":" Di sebuah puskesmas di Kecamatan Pundong, Bantul, catatan rekam medis tahun 2016 menyimpan pola yang menarik: pasien dengan penyakit gusi parah sebagian besar berasal dari wilayah yang sama \u2014 dataran tinggi pegunungan kapur Desa Seloharjo. Pertanyaannya, mengapa? Prayudha Benni Setiawan, S.Kp.G, M.P.H, dosen dari Program Studi Higiene Gigi Fakultas Kedokteran Gigi Universitas Gadjah Mada, bersama […]<\/p>\n","protected":false},"author":615,"featured_media":21225,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[359,136],"tags":[298,307,289,294,297],"class_list":["post-21223","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artikel","category-berita-terbaru","tag-sdg-10-mengurangi-ketidaksetaraan","tag-sdg-17-kemitraan-untuk-mencapai-tujuan","tag-sdg-3-kesehatan-dan-kesejahteraan-yang-baik","tag-sdg-6-air-bersih-dan-sanitasi","tag-sdg-9-industri-inovasi-dan-infrastruktur"],"gutentor_comment":0,"yoast_head":"\nWhen Dental Health Is Not Only the Dentist\u2019s Responsibility<\/h2>\n\n\n\n