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Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2023 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
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original author and source are credited  

 

 

Tooth Brushing Skills and Personal Hygiene Performance Modified (PHP-
M) Index in preschool children 

Tedi Purnama 

Department of Dental Health, Health Polytechnic of Jakarta I, Jakarta, Indonesia 

Article Info: 
_______________________________________ 
Article History: 

Received 23 July 2023      
Reviewed  14 August 2023 
Accepted 02 September 2023 
Published 15 September 2023 

_______________________________________ 
Cite this article as:  

Purnama T, Tooth Brushing Skills and Personal 
Hygiene Performance Modified (PHP-M) Index 
in preschool children, Asian Journal of Dental 
and Health Sciences. 2023; 3(3):10-13 

DOI: http://dx.doi.org/10.22270/ajdhs.v3i3.47        

_______________________________________
*Address for Correspondence:   

Tedi Purnama, Department of Dental Health, 
Health Polytechnic of Jakarta I, Jakarta, 
Indonesia. 

Abstract 
___________________________________________________________________________________________________________________ 
Background: The prevalence of caries in children aged 5-6 years is 92.6% with a def-t index of 8.43, 
meaning that young children in Indonesia have experienced 8-9 cavities per child. The high number of 
dental and oral diseases currently is greatly influenced by several factors, one of which is the behavior 
of people who do not realize the importance of maintaining dental and oral health. Brushing teeth is a 
simple act of removing plaque and food residue with a brush and toothpaste, because plaque and food 
residue are the main causes of dental caries. The Personal Hygiene Performance Modified (PHP-M) 
Index is an indicator for measuring dental hygiene status in mixed dentition. Objective: The aim of this 
research is to analyze the relationship between tooth brushing skills and the Personal Hygiene 
Performance Modified Index in preschool children in Pondok Labu Village, Cilandak District, South 
Jakarta in 2023. Method: This research uses observational analytical methods with a cross-sectional 
design. The sampling technique for this research used a purposive sampling technique of 66 
respondents. The data collection instrument uses a tooth brushing observation sheet to measure teeth 
brushing skills and the Personal Hygiene Performance Modified Index. Data analysis used the chi-square 
test with the SPSS application. Results: Chi-square test results show that tooth brushing skills influence 
the Personal Hygiene Performance Modified Index in Preschool children (p=0.022). Conclusion: there is 
a relationship between tooth brushing skills and the Personal Hygiene Performance Modified Index in 
preschool children 

Keywords: Tooth brushing skills, PHP-M Index, Preschool Children 

 

INTRODUCTION  

Dental and oral health is part of a person's overall body health. 
The dental and oral health of the Indonesian people is still 
something that needs serious attention from health workers, 
both dentists and dental therapists. It can be seen that dental 
and oral diseases are still suffered by 90% of the Indonesian 
population. According to WHO (World Health Organization) in 
2013, throughout the world 60-90% of school children and 
almost 100% of adults experience dental caries, which often 
causes pain and discomfort. Dental and oral health problems 
for children in Indonesia are still very low, as evidenced by the 
Results of basic health research in 2018, reporting that 92.6% 
of young children aged 5-6 years experienced dental health 
problems; with a national def-t figure of 8.43, this means that 
the average number of tooth decay is 8 to 9 teeth per child.1–3 

Dental disease can affect the body's health, if left untreated it 
will have an impact on more dangerous diseases, such as: 
heart attack, stroke, diabetes, respiratory and gastrointestinal 
infections, etc. Tooth decay at an early age can affect tooth 
growth. The function of teeth is very necessary in childhood, 
namely as a chewing tool, helping in speaking, facial balance, 
supporting the aesthetics of the child's face. If a child cannot 
chew well then malnutrition will occur, and the learning 
process will be disrupted.4–6 

The high number of dental and oral diseases currently is 
greatly influenced by several factors, one of which is the 
behavior of people who do not yet realize the importance of 
maintaining dental and oral health. It can be seen that the 

tooth brushing behavior of the population aged ≥ 3 years is 
2.8% who brush their teeth correctly.3 

One way that children's independence can be seen is through 
daily activities, namely instilling independence in young 
children through cleanliness. Early childhood independence 
can be done such as brushing one's own teeth. Brushing teeth 
is a simple act of removing plaque and food residue with a 
brush and toothpaste, because plaque and food residue are the 
main causes of dental caries. According to Arianto et al stated 
that children's tooth brushing behavior must be carried out in 
everyday life without feeling forced. The ability to brush your 
teeth properly and correctly is an important factor for oral 
health care.7–9 

The benefits of brushing your teeth are to clean your teeth 
from dirt, especially plaque from food remains, prevent 
cavities and avoid toothache, as well as eliminate bad breath 
and keep your teeth healthy. Pain in the child's teeth and 
mouth which will reduce the child's appetite, another impact 
is that the child's learning ability is reduced so that it affects 
the child's learning achievement. Early childhood (3-6 years) 
still do not understand and understand how to care for their 
teeth properly. Tooth decay can be prevented by brushing 
your teeth before sleeping and after eating. According to 
Purnama et al, preschool children are not yet skilled at 
brushing their teeth.10–12 

Several studies prove that the relevant research results of Razi 
et al show that the mean value of independence in brushing 
teeth before intervention was given was 4.34, meaning that 
young children do not yet have the independence to brush 

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Tedi Purnama                                                                                                                             Asian Journal of Dental and Health Sciences. 2023; 3(3):10-13 

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their teeth. Another study Zulfikri and Huda, showed that 
dental and oral hygiene status with moderate criteria was 31 
people (51.7%), with poor criteria was 29 people (48.3%), and 
very good criteria was (0%) and good criteria (0%) because 
there are no students who have very good criteria and good 
criteria. Purnama's research on tooth brushing skills on dental 
hygiene status p=0.001 (p<0.05), meaning that there is a 
significant relationship between tooth brushing skills and the 
dental hygiene status of preschool aged children.13–15 

METHOD AND MATERIAL  

This research is an analytical observational study with a cross-
sectional approach. The study was conducted in June-July 
2023. The research was conducted on children aged 5-6 years 
at Pertiwi VI Kindergarten and Bina Harapan Kindergarten, 
Pondok Labu Village, South Jakarta City. The research sample 
was taken using a total purposive sampling technique of 66 
respondents. The dependent variable in this research is tooth 

brushing skills and the independent variable is the Personal 
Hygiene Performance Modified Index. Data collection on 
toothbrushing skills was measured using a toothbrushing 
observation checklist, validity and reliability tests were 
carried out by the same previous researchers who examined 
toothbrushing skills and the Personal Hygiene Performance 
Modified Index was a standardized plaque index measuring 
tool. The stages of the activity include: first, the 
companion/parent fills out the informed consent form first as 
an agreement to be willing to become a research respondent. 
Then check the child's Personal Hygiene Performance 
Modified Index in turn and continue making observations 
about brushing their teeth. 

Data analysis was carried out using the SPSS statistical 
program for univariate analysis and presented in the form of a 
frequency distribution and bivariate analysis with chi-square 
to measure the relationship between tooth brushing skills and 
the Personal Hygiene Performance Modified Index. 

 

 

RESULT  

Table 1: Frequency Distribution based on respondent characteristics, tooth brushing skills and the Personal Hygiene Performance 
Modified Index 

Variable n % 

Age 
5 years 25 37.9 

6 years 41 62.1 

Gender 
Man 33 50.0 

Women 33 50.0 

Tooth brushing skills 
Good 7 10.6 

Less 59 89.4 

Personal Hygiene Performance Modified Index 

Very good 2 3.0 

Good 15 22.7 

Moderate 47 71.2 

Bad 2 3.0 

 

Table 1 shows that the characteristics of respondents based on age are mostly 6 years old and with the same proportion of men and 
women. Teeth brushing skills are mostly poor and have a Personal Hygiene Performance Modified Index in the moderate category. 

 

Table 2: Results of Analysis of tooth brushing skills and the Personal Hygiene Performance Modified Index 

Variabel Criteria 

Brushing skills 
Total 

p-value Good Less 

n % n % n % 

Personal Hygiene 
Performance Modified 
Index 

Very good 1 1.5 1 1.5 2 3.0 

0.022 
Good 4 6.1 11 16.7 15 22.7 

Moderate 2 3.2 45 68.2 47 71.2 

Bad 0 0 2 3.0 2 3.0 

 

Table 2 Results of chi-square analysis of toothbrushing skills on the Personal Hygiene Performance Modified Index p=0.022 (p<0.05), 
meaning that there is a significant relationship between toothbrushing skills and the Personal Hygiene Performance Modified Index 
of preschool children. 

 



Tedi Purnama                                                                                                                             Asian Journal of Dental and Health Sciences. 2023; 3(3):10-13 

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DISCUSSION 

Dental and oral hygiene is a condition where the teeth in the 
oral cavity are clean, free from plaque and other dirt on the 
surface of the teeth such as debris and tartar. Oral hygiene has 
a big influence on preventing cavities or caries, gingivitis, 
periodontitis, and also preventing bad breath. Maximum 
dental and oral hygiene can be achieved by cleaning the teeth 
and mouth from food residue left between the teeth or 
fissures. Good oral hygiene has an impact on dental and oral 
health, conversely, poor oral hygiene can cause various 
diseases in the oral cavity as a result of the emergence of 
debris and tartar or calculus. The skill of brushing your teeth 
properly and correctly is an important factor for oral health 
care.16,17 

Based on the results of the research conducted, it was found 
that the proportion of respondents who had poor teeth 
brushing skills and a moderate Personal Hygiene Performance 
Modified Index was 68.2%, while the proportion of 
respondents who had good teeth brushing skills and a good 
Personal Hygiene Performance Modified Index was 6.1%. 
Based on the statistical test chi-square analysis of 
toothbrushing skills on the Personal Hygiene Performance 
Modified Index p=0.022 (p<0.05), meaning that there is a 
significant relationship between toothbrushing skills and the 
Personal Hygiene Performance Modified Index of preschool 
children. 

This research is in line with Kasihani et al research which 
shows that there was a significant relationship (p <0.001) 
between the independence of brushing teeth and the free 
plaque score. Apart from that, this is also in line with research 
conducted by Purnama et al which states that there is a 
significant relationship between tooth brushing skills and 
dental hygiene status with p=0.001.7,15 

Brushing teeth is cleaning teeth from food debris, bacteria and 
plaque. Cleaning teeth must pay attention to implementing the 
right time for cleaning teeth, using the right tools to clean 
teeth and the right way to clean teeth, so that the habit of 
brushing teeth is a human behavior in cleaning teeth from 
food debris which is carried out continuously. The habit of 
caring for your teeth by brushing your teeth at least twice a 
day at the right time in the morning after breakfast and in the 
evening before bed as well as the behavior of eating sticky and 
sweet foods can influence the occurrence of dental caries.18,19 

Efforts to maintain dental and oral health should be carried 
out from an early age. Preschool age is an ideal time to train a 
child's motor skills, including brushing their teeth. The ability 
to brush your teeth properly and correctly is an important 
factor for maintaining your teeth and mouth. Tooth brushing 
skills must be taught and applied to children of all ages, 
especially school age children because that age easily accepts 
and instills basic values. Preschool children need learning to 
improve their teeth brushing skills.20,21 

According to the Ministry of Health it is necessary to 
implement self-care practices in schools by brushing your 
teeth every day at school. Apart from that, it is also possible 
because there is no toothbrushing equipment (toothbrush, 
toothpaste and mouthwash cup) stored at school. Brush, 
toothpaste and mouthwash cup as well as a personal storage 
place can make it easier for children to take and store their 
toothbrush without the help of other people. Facility support 
is one of the successes of dental health programs in 
schools.22,23 

CONCLUSION 

Based on the results of the study, it can be concluded that 
there is a relationship between tooth brushing skills and the 

Personal Hygiene Performance Modified Index in preschool 
children. 

ACKNOWLEDGEMENTS 

The authors thank to all participants and research assistants. 

CONFLICT OF INTEREST 

The authors declare that they have no conflict interests. 

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