For six weeks, three children with moderate intellectual disabilities at SLB Negeri Pembina Yogyakarta participated in a specially designed toothbrushing training programme tailored to their individual needs. The study, published in the August 2016 edition of Indonesian Dentistry Magazine, was initiated by Leny Pratiwi Arie Sandy, S.Kp.G., MDSc., together with a research team from the Department of Preventive and Community Dentistry, Faculty of Dentistry, Universitas Gadjah Mada. The results showed that the plaque scores of all three children decreased, demonstrating that with the right approach, children with intellectual limitations can learn to maintain their own oral hygiene.<\/p>\n\n\n\n
Children with intellectual disabilities (ID) face challenges beyond academic learning. They may also struggle with activities that appear simple to most people, including brushing their teeth. Limited fine motor skills, underdeveloped hand muscles, and reduced adaptive abilities can make this routine activity far more challenging than expected.<\/p>\n\n\n\n
As a result, children with ID often have greater oral healthcare needs compared with typically developing children. Accumulated dental plaque becomes a major cause of periodontal disease, an inflammatory condition affecting the supporting tissues of the teeth. Plaque itself is a thin, yellowish layer formed by bacterial accumulation that adheres firmly to tooth surfaces. If left untreated, bacteria within plaque can damage the gum tissue and eventually affect the bone supporting the teeth.<\/p>\n\n\n\n
Data from Statistics Indonesia (BPS) in 2003 recorded approximately 1.48 million children with special needs in Indonesia. This figure increased in a 2007 survey conducted by the Ministry of Social Affairs, which estimated that they represented 3.11% of the total population. Despite this substantial number, this group often receives limited attention in conventional oral health programmes.<\/p>\n\n\n\n
What distinguishes this research from conventional dental education programmes is its individualised approach. Instead of applying the same method to all participants, researchers implemented the Individual Learning Programme (ILP), an approach that designs learning strategies based on each child\u2019s condition, abilities, and motivation.<\/p>\n\n\n\n
The process involved a small team consisting of parents, teachers, and researchers. They first assessed each child\u2019s basic needs, established short- and long-term goals, and then designed the most appropriate training strategy. Evaluations were conducted weekly for six weeks, measuring oral hygiene status using the Patient Hygiene Performance-Modified (PHP-M) index developed by Martens and Meskin.<\/p>\n\n\n\n
The three participants had very different characteristics.\nR1, a child with an IQ of 48, tended to be quiet and had difficulty adapting to unfamiliar people but demonstrated good fine motor skills.\nR2, with an IQ of 65, was more communicative; however, fine motor movements remained stiff, and coordination between the right and left hands was still unstable.\nMeanwhile, R3, with an IQ of 61, was highly active and socially engaged but had difficulty maintaining focus during toothbrushing.<\/p>\n\n\n\n
\u201cToothbrushing training using the Individual Learning Programme (ILP) approach improved oral hygiene status among children with moderate intellectual disabilities, as demonstrated by a reduction in plaque scores.\u201d<\/em><\/p>\n\n\n\n After six weeks of training, the average reduction in plaque scores among the three children reached approximately seven points per week. R1 and R2 successfully achieved a \u201cmoderate\u201d oral hygiene category, while R3 remained in the \u201cpoor\u201d category despite showing improvement compared with the initial condition.<\/p>\n\n\n\n The most difficult tooth surfaces to clean were the lingual surfaces (the inner surfaces facing the tongue), palatal surfaces (the inner surfaces of the upper jaw), and buccal surfaces (the surfaces facing the cheeks). The three children generally found it easier to clean occlusal surfaces (chewing surfaces) and labial surfaces (the front surfaces facing the lips).<\/p>\n\n\n\n Researchers identified several factors influencing these outcomes. Insufficient brushing pressure, inadequate brushing frequency on each surface, and the habit of skipping certain tooth areas were the main obstacles. In R3, despite having good motor abilities, difficulty maintaining attention became a significant challenge.<\/p>\n\n\n\n These findings emphasise that fine motor ability is not the only factor determining successful toothbrushing among children with intellectual disabilities. Focus and consistency during the process also play important roles, and both can be gradually developed through training.<\/p>\n\n\n\n One of the most interesting aspects of this study was the involvement of parents as part of the ILP team. Parents were not merely responsible for bringing their children to school; they became active partners in the training process. This approach is essential because toothbrushing habits cannot be developed through weekly practice at school alone\u2014they require daily reinforcement at home.<\/p>\n\n\n\n For children with intellectual disabilities, consistent repetition in a familiar environment is the key. Parental involvement ensures that skills learned at school do not stop at the gates of SLB Negeri Pembina Yogyakarta.<\/p>\n\n\n\n This study highlights a perspective that is often overlooked: access to oral health is a right that belongs not only to individuals without disabilities. With a patient, personalised, and consistent approach, children with intellectual disabilities can also learn to care for their own smiles.<\/p>\n\n\n\n Authors: Achmad Zam Zam Aghasy, DDS, M.Kes.; Hazra Alifia Muharam<\/p>\n\n\n\n Photo: Pexels<\/p>\n\n\n\nPlaque Reduction Was Achieved, but Challenges Remained<\/h2>\n\n\n\n
When Parents Become Part of the Training Team<\/h2>\n\n\n\n