







































Boy et al                                                                                                                                          Asian Journal of Dental and Health Sciences. 2023; 3(4):8-10 

[8]                                                                                                                                                                                                                                                 AJDHS.COM 

 

 

Available online at ajdhs.com 

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 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided 

the original author and source are credited  

 

 

The Effectiveness of Using Apples and Papayas in Reducing the Debris 
Index Score in Children with Mild Mental Retardation 
Hendry Boy*, Muhammad Al Faridho, Yesi Nurmawi 

Department of Dental Health, Health Polytechnic Jambi, Indonesia 

Article Info: 
_____________________________________________ 
Article History: 

Received   21 September 2023     
Reviewed  03 November 2023 
Accepted   27 November 2023 
Published 15 December 2023 

_____________________________________________ 
Cite this article as:  

Boy H, Faridho MA, Nurmawi Y, The Effectiveness 
of  Using Apples and Papayas in Reducing the 
Debris Index Score in Children with Mild Mental 
Retardation, Asian Journal of Dental and Health 
Sciences. 2023; 3(4):8-10 

DOI: http://dx.doi.org/10.22270/ajdhs.v3i4.54          

Abstract 
_________________________________________________________________________________________________________________ 
One of the supporting factors causing dental caries is debris or leftover food around the teeth. The 
fiber and water content of apples can stimulate the speed of salivary secretion and neutralize acidic 
substances in the mouth and also have an effect on reducing the debris index. Consumption of fresh 
fruit rich in vitamins and minerals and water can encourage self-cleaning of the teeth, papaya is a 
plant source of vitamins, minerals and water. The aim of the study was to determine the 
effectiveness of using apples and papayas in reducing the debris index score in mildly mentally 
retarded children at SLBN 2 Jambi City. The type of research used in this study was quasi-
experimental while the research design used was two group pre-test and post-test debris index 
observed twice, namely before treatment and after treatment with a total sample of 32 people with 
a total sampling technique. Based on the results of the study there was a significant difference in the 
average debris index between before and after chewing apples p value 0.000 and papayas p value 
0.000. There is a significant difference in the average difference in debris index reduction between 
the use of apples compared to papayas with a p value of 0.000. 

Keywords: Apple, papayas, debris indeks, mildly mentally retarded 

*Address for Correspondence:   

Hendry Boy, Department of Dental Health, Health Polytechnic Jambi, Indonesia 

 

INTRODUCTION  

Health is one of the elements of a prosperous society, namely 
achieving the right to a healthy life for all levels of society 
through a health system that can guarantee community 
protection from various risks that can affect health as well as 
the availability of quality, affordable health services and 
equitable distribution of health services. Health as an 
investment to produce a healthy and productive population as 
human resources for sustainable development and global 
competitiveness.1–3 

Dental and oral health are parts of body health that cannot be 
separated from each other. A healthy mouth allows individuals 
to talk, eat, and socialize without pain, discomfort, or 
embarrassment. Teeth are a part of the body that functions for 
chewing, speaking and maintaining the shape of the face.4,5 

One of the contributing factors that causes dental caries is 
debris or leftover food around the teeth. Debris is a soft 
material found on the surface of teeth consisting of a layer of 
biofilm, white material and food debris. Debris has quite a big 
influence on the caries process. Debris index is a score of debris 
attached to the surface of the determining tooth. This debris 
index measurement is carried out to measure the tooth surface 
that is covered with debris.6–8 

According to the World Health Organization (WHO), dental and 
oral health problems are increasing every year, as evidenced by 
the results of the 2018 Basic Health Research, dental and oral 
health problems have doubled compared to 2013, namely 
25.9% to 57.6 %. As many as 20 provinces have a prevalence of 
dental and oral problems above the national problem.9,10 

Clinically, the level of oral hygiene is assessed using the Oral 
Hygiene Index Simplified criteria. This criterion is assessed 
based on the condition of soft deposits or debris and tartar or 
calculus. Most food residues are liquefied by bacterial enzymes 
and disappear 5-30 minutes after eating, but it is possible that 
some may still remain on the surface of the teeth and mucous 
membranes. Chewing fibrous fruit such as apples, watermelon, 
guava and papaya can help clean teeth. Apart from that, fruit 
also has the ability to self-clean the oral cavity. Physiologically, 
fibrous foods will encourage saliva secretion, thereby helping 
to clean food residue stuck to the surface of the teeth.11–13 

The fiber and water content of apples can stimulate the speed 
of saliva secretion and neutralize acidic substances in the 
mouth and also have an effect on reducing the debris index. 
Apart from containing lots of fiber and water, apples also 
contain flavonoids which function as anti-bacterials in the 
mouth.8 

Consuming fresh fruit rich in vitamins, minerals, fiber and 
water can encourage self-cleaning of teeth, thereby reducing 
the surface area of dirt and ultimately preventing dental caries. 
Papaya is a plant source of vitamins, minerals, fiber and 
contains enzymes that are useful for digestion.14 

Mentally retarded children are children whose intelligence is 
below average and are classified as children who can be trained. 
The existing limitations and abilities possessed by mentally 
retarded children give rise to various problems, one of which is 
difficulty in caring for their dental health.15 

Based on observations at SLBN 2 Jambi City, it was found that 
many mentally disabled children do not regularly consume 

                     Open Access                                                                                                                                                                                                       Research Article                                                                           

http://jddtonline.info/
http://dx.doi.org/10.22270/ajdhs.v3i4.54
https://crossmark.crossref.org/dialog/?doi=10.22270/ajdhs.v3i4.54&amp;domain=pdf


Boy et al                                                                                                                                          Asian Journal of Dental and Health Sciences. 2023; 3(4):8-10 

[9]                                                                                                                                                                                                                                                 AJDHS.COM 

fibrous foods such as fruit and vegetables. This is one of the 
factors in children's limited abilities and lack of knowledge 
about the importance of consuming fruit and vegetables with 
fiber. Apples and papayas both contain fiber and water, where 
the fiber in apples is higher than in papayas, while the water 
content in papayas is higher than in apples. 

METHOD AND MATERIAL  

The type of research used in this research is quasi experiment. 
The research design used was two group pretest and posttest. 
The debris index was observed twice, namely before treatment 
and after treatment. The sampling technique used a total 
sampling of 32 mildly mentally disabled children in SLBN 2 
Jambi City.  The research was carried out in May 2023 on 
mentally disabled children at SLBN 2 Jambi City. 

The measuring instrument used in this research is the Debris 
Index (DI) and the research materials are apples and papaya 

which have been weighed weighing 100 grams and packaged in 
plastic. The stages of data collection were carried out as follows: 
All samples were first given biscuits with the aim of equalizing 
the condition of their oral cavity, then the first measurement 
was carried out on all samples. After the first measurement, the 
samples were divided into two groups, The first group 
consumed apples and the second group consumed fruit. 
papaya, both groups received fruit with the same weight, 
namely 100 grams and finally, after both sample groups had 
eaten the fruit, a second measurement would be carried out 
again. 

Data analysis for effectiveness before and after chewing apples 
and chewing papaya was carried out by the Wilcoxon test. The 
effectiveness of chewing apples and papaya in reducing the 
debris index score using Mann Whitney so that later it can be 
seen whether there is a difference between chewing apples and 
chewing papaya in reducing the debris index score.

 

RESULT 

Table 1: Debris Index score before and after chewing apples and papaya 

Group Mean SD p value 

Apples Pre-test 2,113 0,3862 
0,001 

 Post-test 0,431 0,2056 

Papaya Pre-test 2,088 0,3263 
0,001 

 Post-test 1,094 0,0929 

Based on table 1, it shows that a different average value was obtained for the apple group before 2.113 and after 0.431. In the papaya fruit 
group, the average value before and after was 2,088 and 1,094. This means that it indicates there is a difference in the average debris index 
score before and after chewing apples and papaya in children with mild mental retardation at SLBN 2 Jambi City with a p value of 0.001. 

 

Table 2: Effectiveness of Using Apples and Papaya in Reducing Debris Index Scores 

Variable n Mean Rank SD p value 

Apples 16 23,53 
0,4647 0,001 

Papaya 16 9,47 

Based on table 2, after carrying out the Mann-Whitney statistical test, it was obtained that the Mean Rank decrease in the debris index score 
was higher for the use of apples than papaya, namely 23.53 compared to 9.47. Statistically there is a significant difference between the 
effectiveness of using apples and papaya in reducing debris index scores in children with mild mental retardation in SLBN 2 Jambi City 
(p=0.001). 

DISCUSSION 

Based on the research results, before chewing the apple, the 
average value was 2.113 in the apple group, after chewing the 
apple, the average value was 0.431, based on the Wilcoxon test, 
the significance value was 0.001 < 0.05. This means that there 
is a difference between the pre-test and post-test in the apple 
group. 

Based on the results of statistical tests, it was found that the 
lowest debris index value before chewing an apple was 1.5 and 
the highest debris index value was 2.8. Meanwhile, after 
chewing an apple, the debris index value was the lowest, 
namely 0.1 and the highest debris index value, namely 1.0. It can 
be seen that there is a decrease in the debris index value of the 
sample after chewing the apple, which also shows that the 
dental hygiene of the sample has increased. The factor that 
causes a decrease in dental hygiene after chewing apples is that 
the fruit consumed contains fiber which can control debris 
mechanically, because the chewing process directly causes a 
cleaning effect.16,17 The fiber and water content of apples can 
stimulate the speed of saliva secretion and neutralize acidic 
substances in the mouth and also have an effect on reducing the 

debris index.8,18 Primary prevention in children who are at high 
risk of caries is that eating more fibrous and watery vegetables 
and fruit will cleanse and stimulate saliva secretion so that 
dental caries can be prevented.19,20 

Based on data analysis before chewing the papaya, the average 
value was 2,088, after chewing the papaya the average value 
was 1,094, based on the Wilcoxon test, the significance value 
was 0.001 < 0.05. This means that there is a difference between 
the pre-test and post-test in the papaya group. It can be 
concluded that the papaya fruit group also experienced a 
decline. 

Based on the results of statistical tests, it was found that the 
lowest debris index value before chewing papaya fruit was 1.5 
and the highest debris index value was 2.6. Meanwhile, after 
chewing papaya, the debris index value was the lowest, namely 
1.0 and the highest debris index value, namely 1.3. This also 
shows a decrease in the debris index of the papaya fruit group, 
but the decrease is quite low because the fiber content in 
papaya fruit is lower than in apples but the water content in 
papaya fruit is higher. Papaya contains quite highwater content 
which can help produce more saliva which can have a self-
cleaning effect on the teeth (self-cleansing effect).21 



Boy et al                                                                                                                                          Asian Journal of Dental and Health Sciences. 2023; 3(4):8-10 

[10]                                                                                                                                                                                                                                                 AJDHS.COM 

Based on the results of the Mann-Whitney statistical test, the 
Mean Rank value for the apple group was 23.53 and the Mean 
Rank for the papaya group was 9.47, and a significance value of 
0.001 < 0.05 was obtained. This means that there is a significant 
difference between the initial and final debris index values in 
the apple group (which received treatment by chewing apples) 
and the papaya group (which received treatment by chewing 
papaya). 

This shows the effectiveness of using apples and papaya in 
reducing the debris index score. There is an increase in dental 
hygiene in mildly mentally disabled children in SLBN 2 Jambi 
City, between apples and papaya in reducing the debris index 
score, apples are more effective in reducing the debris index 
score. The results of this research are in accordance with the 
statement by Penda, et al, that apples can reduce the debris 
index effectively. Apples contain high concentrations of tannin 
which can prevent tooth decay caused by plaque buildup. The 
fiber content in apples can help clean food debris stuck to the 
teeth, because apples are a fibrous fruit so chewing apples can 
be called a natural toothbrush. Eating or consuming apples by 
biting and chewing the apple can stimulate saliva in the mouth. 
Apples can also be used as a medium to clean and freshen the 
mouth. This is because apples contain tannin, a substance that 
functions to clean and freshen the mouth so that it can prevent 
tooth decay and gum disease.22–24 

CONCLUSION 

From the results of the research and discussion regarding the 
effectiveness of using apples and papaya in reducing debris 
index scores in mildly mentally disabled children in SLBN 2 
Jambi City, it can be concluded that there is a significant 
difference in the average difference in debris index reduction 
between the use of apples compared to papaya. 

ACKNOWLEDGEMENTS 

The authors thank to all participants and research assistants. 

CONFLICT OF INTEREST 

The authors declare that they have no conflict interests. 

REFERENCES 

1. Organization WH. Health systems resilience toolkit: A WHO global 
public health good to support building and strengthening of 
sustainable health systems resilience in countries with various 
contexts. 2022; 

2. Erlyn P, Hidayat B, Cahyo A, Saksono H. Investment in Human 
resources to increase achievement levels of sustainable 
development. J Bina Praja J Home Aff Gov. 2022;14(1):135-46. 
https://doi.org/10.21787/jbp.14.2022.135-146 

3. Huang Y-K, Chang Y-C. Oral health: the first step to sustainable 
development goal 3. J Formos Med Assoc. 2022;121(7):1348-50. 
https://doi.org/10.1016/j.jfma.2021.10.018 PMid:34732302 

4. RE PR, Purnama T, Tauchid SN, Prihatiningsih N. Knowledge of oral 
and dental health impacts the oral hygiene index simplified (OHI-
S) of primary school children. Indian J Forensic Med Toxicol. 
2021;15(4):2179-83. 

5. Scheid RC, Weiss G. Woelfel's dental anatomy. Jones & Bartlett 
Publishers; 2020. 

6. Nurilawaty V, Purnama T, Zahra MF. Carbohydrate Diet during the 
Covid-19 Pandemic (Case Study: 4 th Grade Students of 
Elementary School 02 Meruya Utara, West Jakarta). Int Res J 
Pharm Med Sci. 2021;4(4):37-40. 

7. Øilo M, Bakken V. Biofilm and dental biomaterials. Materials (Basel). 
2015;8(6):2887-900. https://doi.org/10.3390/ma8062887 
PMCid:PMC5455733 

8. Hartari N, Lendrawati L, Ristiono B. Perbandingan Efektivitas 
Mengunyah Buah Apel (Malus Sylvestris Mill) dan Buah Semangka 
(Citrullus Lanatus) Sebagai Self-cleansing Terhadap Perubahan 
Indeks Debris Pada Siswa Kelas VII SMPN 30 Kota Padang. 
Andalas Dent J. 2021;9(2):60-6. 
https://doi.org/10.25077/adj.v9i2.175 

9. Kemenkes RI. Hasil utama riskesdas 2018. Jakarta Kemenkes RI. 
2018; 

10. RISKESDAS. Riset Kesehatan Dasar; Badan Penelitian dan 
Pengembangan Kesehatan Kementerian Kesehatan RI Tahun2010. 
Lap Nas 2010. 2013;1-446. 

11. Musa N. The Relationship between Oral Hygiene Status and Dental 
Caries was Assessed using ICDAS II Criteria. J Dent Med Public 
Heal. 2021;1(1):23-33. 

12. Andriani A, Wilis R, Liana I, Keumala CR, Mardelita S, Zahara E. The 
effect of dental health education and the total quality management 
approach on the behavior of dental and oral health maintenance 
and the status of the oral hygiene index simplified in elementary 
school students in aceh besar. Open Access Maced J Med Sci. 
2021;9(F):47-51. https://doi.org/10.3889/oamjms.2021.5576 

13. Nurjannah N, Herijulianti E, Putri MH. Ilmu Pencegahan Penyakit 
Jaringan Keras dan Jaringan Pendukung Gigi. Jakarta EGC. 2012; 

14. Mandalika WC, Wicaksono DA, Leman MA. Pengaruh Konsumsi 
Pepaya (Carica Papaya) Dalam Menurunkan Indeks Debris Pada 
Anak Usia 10-12 Tahun Di SDN 103 Manado. e-GiGi. 2014;2(2). 
https://doi.org/10.35790/eg.2.2.2014.5778 

15. Agustiningsih AA. Pelatihan menggosok gigi untuk meningkatkan 
kemampuan bina diri anak tunagrahita sedang di SLB. J Pendidik 
Khusus. 2016;9(1):1-10. 

16. Kidd EAM, Fejerskov O. Essentials of dental caries. Oxford 
University Press; 2016. 
https://doi.org/10.1093/oso/9780198738268.001.0001 

17. Sihombing KP, Irma S, Manta R, Tiurlan SR. Comparing the Effect of 
Pineapple Fruit and Star Fruit to Reduce the Dental Plaque in 
Children Aged 10-12 Years: A Cross Sectional Study. Int J 
Gastroenterol. 2020;4(1):11-4. 
https://doi.org/10.11648/j.ijg.20200401.13 

18. Sulistyanti AD, Kamelia E, Miko H, Ambarwati T, Setiana R. 
Chewing Royal Gala Apples On The Formation Of Plaque And PH 
Saliva In Grade VI Students Of Sdit Assunnah Cirebon. JDHT J Dent 
Hyg Ther. 2021;2(1):27-33. 
https://doi.org/10.36082/jdht.v2i1.214 

19. Zafar N, Ali A, Imtiaz S, Afzal MY, Nazir U, Sikandar M, et al. The 
role of nutrition in tackling dental caries. Pure Appl Biol. 
2020;9(4):2233-49. https://doi.org/10.19045/bspab.2020.90239 

20. Van Loveren C, Lingström P. Diet and dental caries. Dent caries Dis 
its Clin Manag. 2015;3:136-7. 

21. Syifa N, Utami NK, Nurwati B, Ulfah R, Habibah SS. Effect of 
Consuming Papaya Fruit (Carica papaya) on pH Saliva in Students 
Class X and XI Madrasah Aliyah (MA) Puteri Al-Amin Martapura, 
Indonesia. In: International Conference on Health Sciences. 2021. 
p. 58-61. 

22. Penda PAC, Kaligis SHM. Perbedaan indeks plak sebelum dan 
sesudah pengunyahan buah apel. e-GiGi. 2015;3(2). 
https://doi.org/10.35790/eg.3.2.2015.9631 

23. Braud A, Symoneaux R, Patron C, Brasse C, Forgerit V, Lourtioux F, 
et al. How oral health and food sensory properties impact oral 
comfort during consumption of apples: a comparative approach in 
seniors and young adults. J Texture Stud. 2019;50(4):271-84. 
https://doi.org/10.1111/jtxs.12450 PMid:31145468 

24. Zainur RA, Trawijaya A, Cahyati SA. The Effect of Apples as Self-
Cleansing to Reduce Plaque Scores on Madrasah Ibtidaiyah 
Tarbiyah Islamiyah Students Palembang. In: First International 
Conference on Health, Social Sciences and Technology (ICOHSST 
2020). Atlantis Press; 2021. p. 13-6.

 

https://doi.org/10.21787/jbp.14.2022.135-146
https://doi.org/10.1016/j.jfma.2021.10.018
https://doi.org/10.3390/ma8062887
https://doi.org/10.25077/adj.v9i2.175
https://doi.org/10.3889/oamjms.2021.5576
https://doi.org/10.35790/eg.2.2.2014.5778
https://doi.org/10.1093/oso/9780198738268.001.0001
https://doi.org/10.11648/j.ijg.20200401.13
https://doi.org/10.36082/jdht.v2i1.214
https://doi.org/10.19045/bspab.2020.90239
https://doi.org/10.35790/eg.3.2.2015.9631
https://doi.org/10.1111/jtxs.12450

