UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3749
1
Braz Dent Sci 2023 Apr/Jun;26 (2): e3749
Caregiver perception of children’s dental caries and experience of
accessing dental health services for their children
Percepção do cuidador sobre a cárie dentária infantil e experiência no acesso a serviços de saúde bucal para seus filhos
Darmawan SETIJANTO
1
, Baleegh Abdulraoof ALKADASI
2
, Luqman Adi Wiratama NURROBI
3
,
Felia Laksita DEWI
3
, Fikri Febrian FIRMANSYAH
3
1 - Universitas Airlangga, Faculty of Dental Medicine, Department of Dental Public Health. Surabaya, Indonesia.
2 - Ibb University, Faculty of Dentistry, Department of Periodontology and Oral Medicine. Ibb city, Yemen.
3 - Universitas Airlangga, Faculty of Dental Medicine. Surabaya, Indonesia.
How to cite: Setijanto D, Alkadasi BA, Nurrobi LAW, Dewi FL, Firmansyah FF. Caregiver perception of children’s dental caries and
experience of accessing dental health services for their children. Braz Dent Sci. 2023;26(2):e3749. https://doi.org/10.4322/bds.2023.e3749
ABSTRACT
Objective: this study aims to know the caregiver’s perception of children’s dental caries and their experience of
accessing dental health services in children. Material and Methods: this research was an analytic observational
study with a cross-sectional method and used a purposive sampling technique with a sample of 56 respondents.
Data were obtained through a questionnaire and the sampling technique used purposive sampling with samples
were all caregivers at Cahaya Tazkia Kindergarten, Yapita Kindergarten, and Aisyiah 52 Kindergarten Surabaya.
Data were analyzed using a correlation Spearman test. Results: perceived benet and self-efcacy had a signicant
correlation with the experience of accessing dental health services (p-value ≤ 0.05) with coefcient correlations
were 0.168 and 0.936 respectively. Meanwhile, perceived susceptibility, perceived severity, and the perceived
barrier had no correlation with the experience of accessing dental health. Most male respondents in this research
had a proper job to manage their children to go to dental health. Perceived susceptibility, perceived severity,
perceived benet, and self-efcacy of women caregivers in productive age were good but the perceived barrier
showed a high mean. Respondents with that characteristics did not have steady jobs. Conclusion: women
caregiver between the age of 21-40 years old believes that maintaining oral health is benecial and will result
in an increased number of accessing dental health services for their children. But caregivers who were women
and also did not have a steady job had barriers to accessing dental health for their children.
KEYWORDS
Child health; Caregiver; Dental caries; Accessing dental health service; Perception.
RESUMO
Objetivo: este estudo tem como objetivo conhecer a percepção do cuidador sobre a cárie na primeira infância
e sua experiência de acesso aos serviços de saúde bucal em crianças. Material e Métodos: esta pesquisa foi um
estudo observacional analítico transversal e utilizou uma técnica de amostragem intencional com uma amostra
de 56 entrevistados. Os dados foram obtidos por meio de um questionário e a técnica de amostragem utilizou
amostragem intencional com todas as amostras sendo cuidadores do Jardim de infância Cahaya Tazkia, Jardim
de infância Yapita e Jardim de infância Aisyiah 52 Surabaya. Os dados foram analisados por meio de um teste de
correlação de Spearman. Resultados: o benefício percebido e a autoecácia tiveram correlação signicativa com
a experiência de acesso aos serviços de saúde bucal (p-valor ≤ 0,05), com coecientes de correlação de 0,168 e
0,936, respectivamente. Enquanto isso, a suscetibilidade percebida, a severidade percebida e a barreira percebida
não tiveram correlação com a experiência de acesso à saúde bucal. A maioria dos entrevistados do sexo masculino
nesta pesquisa tinha um trabalho adequado para gerenciar a saúde bucal de seus lhos. A suscetibilidade percebida,
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3749
Setijanto D et al.
Caregiver perception of children’s dental caries and experience of accessing dental health services for their children
Setijanto D et al.
Caregiver perception of children’s dental caries and experience
of accessing dental health services for their children
INTRODUCTION
According to Riskesdas in 2018, the
prevalence of dental caries in children was
90.2% in Indonesia, with def-t mean index was
8.1 in children under 5 years old [1]. However,
according to Control Disease Center in 2007,
dental caries cases had increased, especially in
toddlers and preschoolers, from 24% to 28%.
Meanwhile, dental health association was trying to
reduce the number of dental caries in children [2].
Therefore, there is a need for early education, as
a preventive measure, regarding dental and oral
health. In this education, various components are
involved. Caregiver is one of the main components,
can be interpreted as many people, but mainly
parents and teachers. In children, caregiver has an
important role especially parents play a major role
when the child is out of school, while the teacher
plays a major role when the child is entering the
school area [2,3].
Nowadays, most children’s time is a time
for school. According to that condition parent in
school or teacher has high responsibility in children.
All caregivers including teachers who have good
education and knowledge should influence the
welfare of their children. However, as previously
explained, the prevalence of caries is still high,
especially in children. Further research is needed
to determine the understanding and perception
of caregivers, especially on good tooth-brushing
behavior. Previous studies showed that the role of
caregivers in maintaining the oral health of children
is important [3]. The problem is the emergence of
some wrong perceptions of dental and oral health,
especially in children [4,5]. Some of them are poor
oral and dental health indicated only by pain in the
teeth. In addition, there is a perception that primary
teeth are only temporary and will be replaced by
permanent teeth, so there is an assumption that
damage to primary teeth is not something that must
be considered, etc. This ultimately affects the child’s
tooth-brushing behavior [2,6].
According to Health Belief Model Theory,
parents are most likely to associate with childcare,
if these parents feel that their children are prone
to developing problem behaviors in the future
(perceived susceptible) [3]. Parents can also believe
that these problems will have a very unwanted
impact (perceived severity). The perception that the
parenting program implemented will be effective
in reducing the formation of risky behavior in
their children (perceived benets), not considering
the parenting program implemented to be too
demanding (perceived barrier), and feel condent
that parents will be able to carry out and apply the
healthy behavior they have (self-efcacy) [3,5].
Experience is one of the things that can shape
perception of people. In this case, the experience
of accessing dental and oral health services is an
important factor in the caregiver’s perception [5].
How the caregiver acts and educates their children
depends on their experience and knowledge about
oral health [3,4]. Therefore, what will be discussed
further in this study is the caregiver’s perception
of children’s dental caries and tooth brushing
behaviour in terms of experiences in accessing
children’s dental and oral health services [2,7].
Based on previous studies, the perception of
caregivers needs to be considered more. So that
caregivers will have good perception of accessing
dental health services. When the caregivers have
good perception, the oral health problem in
children can be reduced and children can receive
an early diagnosis and prompt treatments [4,6].
Based on this background, the purpose of this
study was to know the caregiver’s perception of
children’s dental caries and their experience of
accessing dental health services in children.
MATERIAL AND METHODS
Study design and samples
This research was an analytic observational
with a cross-sectional study approach. Written
a severidade percebida, o benefício percebido e a autoecácia de cuidadores mulheres em idade produtiva foram
bons, mas a barreira percebida apresentou uma média alta. Os entrevistados com essas características não tinham
empregos xos. Conclusão: mulheres cuidadoras na faixa etária de 21 a 40 anos acreditam que a manutenção
da saúde bucal é benéca e resultará em maior número de acessos aos serviços de saúde bucal de seus lhos.
No entanto, cuidadoras que eram mulheres, mas que não tinham emprego xo, apresentavam barreiras para o
acesso à saúde bucal de seus lhos.
PALAVRAS-CHAVE
Saúde da criança; Cuidador; Cárie dentária; Serviço de saúde bucal; Percepção.
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Braz Dent Sci 2023 Apr/Jun;26 (2): e3749
Setijanto D et al.
Caregiver perception of children’s dental caries and experience of accessing dental health services for their children
Setijanto D et al.
Caregiver perception of children’s dental caries and experience
of accessing dental health services for their children
informed consent was obtained from all the
respondents. All of the subjects were able to
comprehend and have given written informed
consent. The study design used in this research
was analytic observational with a cross-
sectionalal approach. This study used a sampling
technique that was purposive sampling with
respondents included in this study were all
caregivers at Cahaya Tazkia Kindergarten, Yapita
Kindergarten, and Aisyiah 52 Kindergarten
Surabaya. The total number of respondents in
this study was 56 respondents. The inclusion
criteria were; all caregivers attending the specic
kindergarten that had been mentioned and
willing to follow all the research procedures.
Exclusion criteria were caregivers who had
children with disability or special needs.
Data collection
The data in this study were obtained through
a questionnaire based on the Health Belief
Model Theory to determine the perception of
the caregiver and the experience in accessing
dental and oral health services in children.
The questionnaires had been validated using
validation test statistically. The questions were
asked according to each aspect of the health belief
model theory and the behavior of accessing the
dental health of their children. It was written as
below:
1. Does your child have dental health insurance?
2. Currently, my child has dental caries
3. My child’s dental caries will become more
widespread next year
4. If my child has dental caries, it is something
that needs attention
5. If my child has dental caries, he will feel pain
6. If my child has dental caries, he will lose
teeth
7. If my child has dental caries, the caries will
affect his general health
8. If my child brushes his teeth properly, he
will avoid dental caries
9. If my child brushes his teeth properly, then
his teeth won’t fall out/deer
10. My child doesn’t like brushing his teeth
11. In my opinion, toothbrushes are expensive
12. In my opinion, toothpaste is expensive
13. My son doesn’t like the taste of toothpaste
14. I am sure that I can get my child to brush
his teeth 2x a day
15. I am sure that I can make my child consume
sweet foods/drinks in the right portion
16. I believe that I can teach my child how to
maintain good dental and oral health
17. Have you ever taken your child to the
dentist?
18. When was the last time your child visited
the dentist for dental treatment?
19. Where was the last time your child had
dental treatment
20. Does your child visit the dentist when your
child has pain in the teeth?
All the questionnaires were shared to all
caregivers and all the caregivers were asked to
ll out the questionnaires.
Statistical method
The data that was obtained then was
analyzed. The analysis of this study used statistical
analysis software (
IBM Statistical Program
for Social Science 21
). The test used was the
Spearman correlation test to know the correlation
between caregiver perception on children’s
dental caries and their experience of accessing
dental health services for their children. After
the statistical analysis, the data were presented
in table.
RESULTS
The result showed that the majority of
respondents were 31-40 years old. Based on
the characteristic distribution of respondents,
almost all of the respondents were women and
the occupation of respondents who does not
have a steady job or housewives mostly. More
than half of the respondents were parents.
The frequency of caregiver behavior in their
children’s toothbrushing showed that most of
the caregivers helped their children brush their
teeth twice a day (Table I). While most of the
respondents drove their children to visit dental
health services twice a year (Table II).
The occupation of caregivers that had the
highest mean of perceived severity was another
occupation such as housewife or did not have
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Setijanto D et al.
Caregiver perception of children’s dental caries and experience of accessing dental health services for their children
Setijanto D et al.
Caregiver perception of children’s dental caries and experience
of accessing dental health services for their children
a steady job. The respondents with the highest
perceived benefit were caregivers who were
31-40 years old. Meanwhile, men had higher
perceived benets than women. Most women
who had proper jobs also had high perceived
benets, meanwhile, caregivers who were also
women in productive age who did not have jobs
or only housewives had low perceived benets.
Caregivers who were women had a higher
mean of a perceived barrier than men. This result
reported that most of the respondents which
were of productive age and also women had high
perceived barriers because they did not have
proper occupations to support their children’s oral
health and drive their children to the oral health
service. Most men in this research had a proper
job so they could manage their children to go to
dental health service, while women in this research
mostly were housewives or does not have a steady
job so they had lower self-efcacy to maintain
the oral health of their children including taking
children to the dentist (Table III).
Table IV showed that there is no correlation
between the characteristics of respondents and
perceived susceptibility, perceived severity,
perceived benet, perceived barriers and, self
efcacy (p value>0.05). Respondents who had
highest perceived susceptibility on dental caries
had accessing dental health service twice a year,
and highest perceived severity on dental caries
had accessed dental health service twice a year
also but the mean different was slight between
each category of accessing dental health service.
Caregiver who had highest perceived benefit
had accessed dental health service twice a
year. The table above, it was also known that
perceived benet had signicant correlation with
experience of accessing dental health service
with p value was 0.024 (p-value ≤ 0.05) and
the correlation between perceived benet and
experience of accessing dental health services
was low (Table V).
Caregivers who had lowest perceived
barriers was caregiver that their children
experience accessing dental health service once
a year, even though there was no correlation
between perceived barriers and the experience
of accessing dental health services in their
children. Meanwhile, the highest self efcacy
was owned by caregivers whose their children
had accessed dental health services twice a year,
and self-efficacy had a significant correlation
with the experience of accessing dental health
services of their children with p-value was 0.000.
The coefcient correlation was strong (0.936)
(Table V), the caregiver who had high self-
efcacy had their children to access dental health
service routine (twice a year).
DISCUSSION
In addition to the 5 aspects of the health
belief model (HBM) theory, one variable is
added in the form of experience in accessing
children’s oral and dental health services as a
modifying factor. In this study, the characteristic
of respondents may also have a role to determine
their perceptions of dental caries of their children.
As represented in the result, the perceived
susceptibility of the caregiver in all characteristics
was only slightly different. Occupation as a
private employee and relation as a relative had
the highest perceived susceptibility. Private
employees showed that they believed that their
children were more susceptible to dental caries.
Moreover, in other occupations and relations, the
perceived susceptibility was lower. This can be
caused by a lack of knowledge of dental caries.
The lack of knowledge also affects the perceived
severity. The score difference of perceived
severity was also affected by the knowledge of
respondents about their children’s caries was
also low [8,9]. Characteristics of respondents
might be contributing factors in knowledge.
Respondents in productive age might seek many
pieces of information about their children’s
Table I - Frequency of caregiver behavior in toothbrushing their
children
Frequency of toothbrushing teeth Percentage
Never/rare 10.71%
Once a day 17.86%
Twice a day 57.14%
Three times or more a day 14.29%
Table II - Distribution of experience in accessing dental health
services
Experience of accessing
dental health services
N Percentage
Never 12 21.42%
Once a year 16 28.7%
Twice a year 28 50.01%
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Caregiver perception of children’s dental caries and experience of accessing dental health services for their children
Setijanto D et al.
Caregiver perception of children’s dental caries and experience
of accessing dental health services for their children
Table III - Distribution of caregiver’s characteristics and caregiver’s perception of dental caries of their children
Variable
Perceived susceptibility Perceived severity Perceived benefit Perceived barriers Self efficacy
Mean ± SD OR (95% CI) Mean ± SD OR (95% CI) Mean ± SD OR (95% CI) Mean ± SD OR (95% CI) Mean ± SD OR (95% CI)
Age
20-30 5.47±2.52 4.26–6.69 15.58±1.89 14.67–16.49 8.00±1.76 7.15–8.85 15.16±2.73 13.84 – 16.48 11.63±2.56 10.40 – 12.87
31-40 5.96±2.22 4.99–6.92 15.26±2.59 14.14–16.38 8.30±1.63 7.60–9.01 16.13±2.11 15.21 – 17. 05 11.22±1.73 10.47 – 11.97
41-50 5.00±1.5 3.85–6.15 15.33±2.69 13.26–17.40 7.78±1.48 6.64–8.92 14.56±1.94 13.06 – 16.05 10.89±1.45 9.77 – 12.01
51-60 5.20±3.03 1.43–8.97 15.40±1.94 12.98-17.82 8.00±1.22 6.48–9.52 15.00±1.87 12.68 – 17.32 10.80±2.38 7.84 – 13.76
Sex
Men 4.67±2.08 -50–9.84 15±1.00 12.52-17.48 9.00±1.00 6.52–11.48 13.67±0.57 12.23 – 15.10 13.00±1.73 8.70 – 17.30
Women 5.62±2.29 4.99–6.26 15.42±2.34 14.77-16.06 8.04±1.61 7.59 – 8.48 15.55±2.35 14.90 – 16.19 11.17±2.02 10.61 – 11.73
Occupation
Housewife 5.19±2.05 4.44–5.95 15.23±2.10 14.45-16.00 7.84±1.55 7.27–8.41 15.23±2.17 14.43 – 16.02 11.13±1.97 10.40 – 11.85
Private employee 8.4±1.51 6.52–10.28 13.00±2.55 9.83-16.17 8.00±2.00 5.52–10.48 17.00±2.23 14.22 – 19.78 10.80±2.16 8.11 – 13.49
Entrepreneur 4.00±0 - 16.00±0 - 8.00±0 - 16.00±0 - 10.00±0 -
Teacher 5.38±2.24 4.18–6.57 16.19±2.07 15.08–17.29 8.56±1.59 7.72–9.41 14.75±2.29 13.53 – 15.97 11.56±2.12 10.43 – 12.70
Does not have a steady job/housewife 6.33±3.51 -2.39–15.06 16.67±3.05 9.08–24.26 8.33±2.08 3.16–13.50 18.67±1.52 14.87 – 22.46 12.33±2.88 5.16 – 19.50
Relation
Parent 5.66±2.36 4.91-6.40 15.12±2.08 14.46-15.78 8±1.59 7.50-8.50 15.59±2.37 14.84-16.34 11.27±2.15 10.59-11.95
Teacher 4.57±1.51 3.17-5.97 17.14±2.47 14.85-19.44 8.57±1.13 7.52-9.62 14.86±1.34 13.61-16.10 10.57±1.27 9.39-11.75
Relative 8.5±2.12 -10.56-27.56 15.5±0.7 9.15-21.85 9±1.04 -3.71–21.71 16.5±2.12 -2.56-35.56 12.5±2.12 -6.56-31.56
Other 5.57±2.27 3.13-7.20 15.39±2.28 11.82-18.51 8.09±1.59 5.49-10.17 15.45±2.32 11.55-18.11 11.27±2.04 9.50-13.83
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Setijanto D et al.
Caregiver perception of children’s dental caries and experience of accessing dental health services for their children
Setijanto D et al.
Caregiver perception of children’s dental caries and experience
of accessing dental health services for their children
caries and oral health. Perceived severity is the
caregiver’s perception of the severity of dental
caries. According to the results of this study, it
was found that respondents have the perception
that caries is a serious/dangerous disease. This
result was in line with a previous study from
Kasmaei et al. [10], in 2014. That showed the
perception of caregivers or parents on dental
caries of their children was good [10, 11].
Perceived barriers are the caregiver’s
perception of behavior, whether in carrying out
the behavior the respondent experiences obstacles
or not. Perceived benets and perceived barriers
of the caregiver in this study showed differences
by the mean. Perceived benets are the caregiver’s
perception of behavior, whether the behavior is
benecial or not [7]. In this result the perceived
benet correlated with the experience of accessing
dental health services, so it means that caregiver
believes they had a high benet in maintaining
oral health in their children due to the knowledge
was good and they believe there was none of the
obstacles in maintaining oral health and accessing
dental health services [10].
The high perceived benefit should be
represented by the low perceived barriers.
This belief occurs due to the role of perceived
benefit, perceived benefit has to outweigh
perceived barriers so that it can be effective in the
behaviour change. Meanwhile, the self-efcacy
of the caregiver should be high. In this result,
the self-efficacy of respondents was various.
Self-efcacy or self-condence is the perception
of the respondent’s beliefs about their ability to
change the behavior of their children to dental
caries. A study from Burglar M.E., 2010 reported
that self-efcacy is an appropriate and signicant
predictor of tooth brushing behavior [12].
So when self-efficacy is bad, behavior also
follows. Parents and relatives had high self-
efficacy, self-efficacy interacts with people to
determine their readiness of taking preventative
behavior. It means that caregivers in this result
were ready to take preventive behavior and access
dental health services. From this result, men
respondents believe that they could maintain the
oral health of their children. They also believe
that maintenance of oral health and accessing
dental health services are beneficial for their
children. Productive age, between 20-40 years
old have high self-efcacy in maintaining oral
health of their children and they tend to think that
accessing dental health service for their children
is important [9,13].
In this study, we also nd out the relationship
between the perception of caregivers and the
experience of accessing dental health services in
their children. In this study, the results showed
that the perceived benet and self-efcacy of
caregivers had a correlation with the experience
Table IV - Correlation between characteristic and perception of caregiver
Variable
Perceived susceptibility Perceived severity Perceived benefit Perceived barriers Self efficacy
P-value
Correlation
Coefficient
P-value
Correlation
Coefficient
P-value
Correlation
Coefficient
P-value
Correlation
Coefficient
P-value
Correlation
Coefficient
Age 0.414 -0.30 0.496 0.001 0.424 -0.026 0.396 -0.036 0.137 -0.149
Sex 0.233 0.100 0.273 0.083 0.138 -0.148 0.060 0.210 0.058 -0.213
Occupation 0.233 0.099 0.109 0.167 0.088 0.184 0.226 0.102 0.206 0.112
Relation 0.408 -0.032 0.144 0.144 0.269 0.084 0.243 -0.095 0.411 -0.31
Table V - Correlation between perception of caregiver and accessing dental health service experience of their children
Variable
Experience of Accessing Dental Health Service
P-Value
Correlation
Coefficient
Never Mean ±SD
Once a year
Mean ±SD
Twice a year
Mean ±SD
Perceived susceptibility 4.58±1.83 5.38±1.78 6.11±2.58 0.067 0.246
Perceived severity 15.08±2.61 15.19±2.76 15.64±1.87 0.215 0.168
Perceived benefit 7.58±1.92 7.56±1.59 8.61±1.31 0.024 0.302
Perceived barriers 15.50±1.83 14.88±1.96 15.75±2.68 0.480 0.096
Self efficacy 8.42±0.996 10.63±0.50 12.86±1.20 0.000 0.936
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Setijanto D et al.
Caregiver perception of children’s dental caries and experience of accessing dental health services for their children
Setijanto D et al.
Caregiver perception of children’s dental caries and experience
of accessing dental health services for their children
of accessing dental health for their children.
Respondents who had never been to the dentist,
the majority perceived that they were prone to
dental caries and belief that caries is a serious
disease. The majority also perceived that brushing
their teeth was beneficial to their children.
The majority also perceive that brushing teeth
was not a signicant obstacle and the child tended
to experience of accessing dental health services,
this result is in accordance with the study from
Lee et al. in 2017 [14]. And lastly, the majority
of respondents who have never been to the
dentist have the perception that they were not
sure that they could make their children behave
properly in maintaining oral health. However, in
another study according to Notoatmodjo [15],
a person’s experience is a very important factor
in interpreting the stimulus we get [15]. Past
experience or what we learn will cause differences
in interpretation/perception [16].
Based on the result of this study, caregivers
who were women and of productive age already
had well-perceived susceptibility, perceived
severity, perceived benet, and self-efcacy toward
maintaining oral health for their children. But, the
perceived barrier of respondents who were women
and of productive age showed high due to their
occupation. They mostly did not have a steady
job. This factor can be a barrier for caregivers in
maintaining the oral health of children. Caregivers
who do not have a steady job will postpone their
children to access dental health. Based on this
study can help to promote increased oral health
in children and reduce dental caries in early
childhood. This condition can lower the number of
dental visits for children and reduce the oral health
problem of their children [10,15,16]. The result
from this study can be used to give an appropriate
dental health program for the caregiver to ensure
children will have good oral health and receive
prompt treatment at the right time. The limitation
of this study was that the clinical evaluation of
oral health status was not conducted in children
and also caregivers. Even though the perceptions
have been studied based on the theory of the
health belief model, they needed to be justied
by examining the oral health of caregivers and
children.
CONCLUSION
The women caregiver between the age of
21-40 years old believes that maintaining oral
health is benecial and will result in an increased
number of accessing dental health services for
their children. But caregivers who were women
and also did not have a steady job had barriers to
accessing dental health for their children.
Acknowledgements
All the authors would like to express their
gratitude to all the parties who helped and
supported this research including the Rector,
Dean, and staff of the Department of Dental
Public health, Faculty of Dental Medicine,
Universitas Airlangga.
Author’s Contributions
DS: Conceptualization. LAWN, FLD, FFF:
Methodology. FLD, FFF: Software. BAA: Validation.
DS: Formal Analysis. LAWN: Investigation.
LAWN, FLD, FFF: Resources. DS, LAWN: Data
Curation. LAWN, FLD, FFF: Writing – Original
Draft Preparation. DS, BAA: Writing – Review
& Editing. BAA: Visualization. DS: Supervision.
FLD, FFF: Project Administration. LAWN: Funding
Acquisition.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
Funding
The authors declare that no nancial support
was received.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies of:
Health Research Ethics Committee of the Faculty
of Dental Medicine, Universitas Airlangga,
Surabaya, Indonesia. The approval code for this
study is: 568/HRECC.FODM/VIII/2019.
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Darmawan Setijanto
(Corresponding address)
Universitas Airlangga, Faculty of Dental Medicine, Department of Dental Public
Health, Surabaya, Indonesia.
Email: r-darmawan-s@fkg.unair.ac.id
Date submitted: 2022 Dec 22
Accept submission: 2023 Mar 30
