215

Dental Journal
(Majalah Kedokteran Gigi)
2022 December; 55(4): 215–220

Original article

Strategy for improving the quality of School Dental Health Efforts 
at Tabanan Public Health Center

I Gusti Ayu Ari Agung, I Nyoman Panji Triadnya Palgunadi
Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, Universitas Mahasaraswati Denpasar, Denpasar, Bali, Indonesia

ABSTRACT
Background: The School Dental Health Efforts or Usaha Kesehatan Gigi Sekolah (UKGS) is a public health effort to maintain and 
improve the dental and oral health of elementary school students. UKGS is the strategy and the flagship of dental health in schools. 
The implementation of UKGS involves three elements, namely the Public Health Centre or Pusat Kesehatan Masyarakat (Puskesmas), 
schools, and parents. The three elements in UKGS are the driving force and restraining force, which greatly affect the quality of 
UKGS services. Purpose: This study aimed to analyze a strategy that can improve the quality of UKGS at Tabanan Puskesmas.                             
Methods: This research used evaluative research and was analyzed by Kurt Lewin’s Force Field Analysis. Results: The driving forces 
that have the highest score are good knowledge, the skill of personnel, and guidelines for implementing the UKGS at Puskesmas; 
whereas the restraining forces that have the highest score are the unavailability of guidebooks and health teacher skills, as well as 
lack of budget for the UKGS activities. Conclusion: Strategies that can improve the quality of UKGS at Tabanan Puskesmas can be 
done by utilizing the facilities at the Puskesmas for the UKGS activities in schools, transmitting knowledge and skills from Puskesmas 
officers to the UKGS staff in schools, and increasing the budget by means of self-help. 

Keywords: dental health education; dentistry; school dental health efforts

Correspondence: I Gusti Ayu Ari Agung, Department of Dental Public Health and Preventive Dentistry, Faculty of Dentistry, Universitas 
Mahasaraswati Denpasar, Jl. Kamboja No.11A Denpasar, Bali, 80233 Indonesia. Email: ayuariagung@unmas.ac.id

INTRODUCTION

The Global Burden of Disease Study 2019 estimated that 
dental diseases affect close to 3.5 billion people worldwide, 
with caries of permanent teeth being the most common 
condition. Globally, it is estimated that 2 billion people 
suffer from caries of permanent teeth and 520 million 
children suffer from caries of primary teeth.1 In most low-
income and middle-income countries, the prevalence of 
dental disease continues to increase as urbanization grows 
and living conditions change. This idea is mainly due to 
inadequate exposure to fluoride (in water supplies and 
dental hygiene products such as toothpaste), the availability 
and affordability of high-sugar foods, and poor access to 
dental healthcare services in the community.2 The World 
Health Assembly approved a resolution on dental health in 
2021 at the 74th World Health Assembly. The Resolution 
recommends a shift from the traditional curative approach 
toward a preventive approach that includes the promotion 

of dental health within the family, schools, and workplaces, 
which includes timely, comprehensive, and inclusive care 
within the primary healthcare system.3

Dental diseases in Indonesia are at the top of the list of 
the 10 most common diseases in Indonesia. The perception 
and the behavior of the Indonesian people toward dental 
health are still poor. It can be seen from a large number of 
dental caries diseases in Indonesia, which tend to increase, 
so dental health problems in Indonesia still need attention. 
The prevalence of caries and periodontal disease is still 
relatively high.4

The dental and oral problems of the people in Bali are 
higher than the national average, which is 58.4%. One of 
the reasons is that 95.7% of Balinese people have never 
visited a dental medical facility. Furthermore, only 5.3% 
of Balinese people brush their teeth at the right time, which 
should be twice a day, in the morning after breakfast, and 
at night before going to bed. It allows for other factors that 
influence the high level of dental and oral problems in the 

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v55.i4.p215–220

mailto:ayuariagung@unmas.ac.id
https://e-journal.unair.ac.id/MKG/index
https://doi.org/10.20473/j.djmkg.v55.i4.p215-220


216Agung and Palgunadi/Dent. J. (Majalah Kedokteran Gigi) 2022 December; 55(4): 215–220

Province of Bali, one of which is the behavior of brushing 
teeth that is not good and correct, and dental and oral health 
services are not evenly distributed.5 

To control dental and oral diseases by the Public 
Health Center or Pusat Kesehatan Masyarakat (Puskesmas) 
through the actualization of the local School Dental Health 
Efforts or Usaha Kesehatan Gigi Sekolah (UKGS) for both 
examination and treatment of dental and oral diseases is 
still low. Public awareness of dental and oral health is also 
still low, so it is necessary to develop a health improvement 
system through counseling and improving the quality of 
services.5,6

The Puskesmas program on UKGS is not yet optimal. 
This shows that the implementation of UKGS has not 
succeeded.7 The efforts to improve dental and oral health 
services, especially in elementary schools, face several 
obstacles which certainly require solutions. Obstacles 
faced include the limited number of dental health workers 
in elementary schools. The Health Law of the Republic of 
Indonesia Number 36 the Year 2009 about health states that 
improvements in health status can be realized by increasing 
integrated health facilities and public health services carried 
out by health workers according to their area of expertise. 
Therefore, there is a need to strengthen cross-program and 
cross-sectoral integration, the development of which is 
the responsibility of health workers, teachers, and parents. 
The Puskesmas play an important role as the UKGS’s 
development team at the district level, particularly in dental 
and oral health services such as screening for dental and 
oral health problems, regular dental health check-ups, and 
consultations. The role of teachers in schools is also crucial, 
that is, to monitor student behavior daily.8 

Tabanan Regency in Bali Province is one of the regencies 
in Indonesia that has a prevalence of dental caries experience 
that is higher than the national prevalence of 68.2%. Based 
on interviews with school principals, it was found that most 
UKGS in the Tabanan district were not active. This is in 
accordance with the results of a study in Denpasar which 
stated that more than 95% of UKGS were inactive,9 and 
when the research was conducted, it turned out that, during 
the COVID-19 pandemic, the UKGS program could not be 
implemented. Student learning is conducted online which 
worsens the condition of students’ consumption of sweet 
snacks during the online learning process. This will increase 
the occurrence of caries in students. Therefore, dental and 
oral health education counseling through the UKGS online 
program is highly needed.

Elementary school students (ages 6-12 years) are 
often referred to as a vulnerable period because the baby 
teeth begin to fall out one by one, and the first permanent 
growth begins. New teeth are immature and susceptible 
to decay.5 UKGS is a technical strategy for implementing 
dental and oral health for elementary school students. The 
scope of its activities is to carry out dental health checks, 
routine dental care, and dental and oral health counseling 
for school children.3 However, at the time of the study, the 
COVID-19 pandemic occurred, so the UKGS program in 

schools was suspended. It is necessary to have a strategy to 
improve services and human resources quality through the 
UKGS program. Therefore, the purpose of this study is to 
investigate the driving and restraining force in developing 
efforts to improve the quality of UKGS services

MATERIALS AND METHODS

This qualitative research used evaluative research and was 
analyzed by Kurt Lewin’s Force Field Analysis,10 which 
assesses and measures results with standard indicators. The 
population in this study was 40 UKGS officers at Tabanan 
Puskesmas. The research sample consisted of 15 UKGS 
officers who had signed an informed concern. The method 
of determining and selecting samples is by purposive 
sampling, of which one sample of UKGS officers was taken 
from each Puskesmas with the support of one elementary 
school. The population in this study were all Puskesmas 
in Tabanan district, while the target population was all 
Puskesmas in Tabanan district that foster UKGS. The 
research sample was UKGS officers at the Tabanan Health 
Center, while the intended sample was a sample that met the 
inclusion and exclusion criteria. The sample that is actually 
researched is the sample that really follows the research 
to completion. Inclusion criteria are UKGS Puskesmas 
Tabanan officers who are willing to be investigated by 
signing the Informed Consent. The exclusion criteria were 
UKGS Puskesmas Tabanan officers who were not willing 
to be investigated. The drop-out criteria are the research 
sample who for some reason cannot continue the research. 
The researcher absolutely guarantees that the identity of 
the research participants will be kept confidential and fully 
protected. Validity assessment is through cross-checking 
of information sources.11 Ethics approval was obtained 
from the Ethics Review Board of the Faculty of Dentistry 
at Mahasaraswati Denpasar University (No.356/A.17.01/
FKG-Unmas/III/2022).

The technique used is a Force Field Analysis (FFA) 
approach by analyzing inputs, including the condition of 
health centers and elementary schools, the availability 
of UKGS program tools and materials, UKGS program 
implementation guidelines, UKGS program planning, and 
UKGS program budget. In addition, the process analysis 
includes planning discussions, counseling to teachers, 
parents, and students, screening, plenary treatment, mass 
toothbrushing, recording and reporting, monitoring, 
evaluation, and feedback.12 The results of the input and 
process analysis are expected to provide input that can 
produce efforts to improve the quality of UKGS services. 
The data obtained were analyzed using FFA to determine 
the key restraining force (RF) and driving force (DF) of 
the study results.

A qualitative method study was carried out using 
the FFA regarding improving the quality of UKGS in 
Puskesmas Tabanan, Bali, in 2020. Implementation of the 
FFA using transparency overhead let’s all participants see 

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v55.i4.p215–220

https://e-journal.unair.ac.id/MKG/index
https://doi.org/10.20473/j.djmkg.v55.i4.p215-220


217 Agung and Palgunadi/Dent. J. (Majalah Kedokteran Gigi) 2022 December; 55(4): 215–220

the ongoing discussion process. This study included six 
steps for improving the quality of UKGS: first, discover 
DF and RF from references; second, select key DF and 
RF through focus group discussion; third, DF and RF 
assessment by the first group (UKGS officers); fourth, 
determine key DF and RF from head school perspective; 
fifth, determining the score of the strength of the influence 
on each of the agreed strength; and sixth, the largest factor 
value from the driving factors and restraining factors, is 
then used as a key success factor in formulating a strategy 
to improve the quality of UKGS in Tabanan Puskesmas.

RESULTS

Tabanan regency is divided into 10 sub-districts and 
consists of 133 villages. According to the results of the 
population registration carried out by the Central Statistics 
Agency (BPS) at the end of 2015, the population of Tabanan 
Regency reached 448,033 inhabitants. The population is 
spread over ten sub-districts in Tabanan Regency. Most 
of the Tabanan Regency area is a rural/mountainous area. 
Tabanan Regency has 20 Puskesmas, which covers UKGS 
in 310 Elementary Schools. The 15 Puskesmas where the 
research was carried out based on regional characteristics 
is shown in Table 1.

Questionnaires, field observations, suggestions, and 
expectations of UKGS staff (Puskesmas and school) are 
expected to improve the quality of UKGS program services 
at Tabanan Puskesmas. The procedures, efforts, and actions 
for improving the quality of UKGS program services based 
on the key driving and restraining forces are presented 
in Table 2. FFA efforts to improve the quality of UKGS 
program services in Tabanan Puskesmas are presented in 
Figure 1.

Table 1. Number of Puskesmas based on regional characteristics 
of research location, from Puskesmas to Elementary 
School

Puskesmas n %
In easily accessible locations:
Tabanan I, II, III

3 20

In locations that are difficult to reach:
Marga I, II; Kerambitan II; Pupuan I, II;
Selemadeg Timur I, II; Selemadeg Barat;
Baturiti I, II; Penebel I, II

12 80

Table 2. Efforts to improve the quality of UKGS program services based on the key driving forces and restraining forces

Key driving and restraining forces Efforts and activities made

Good knowledge and the skills of UKGS 
personnel at the Puskesmas

Providing skills and understanding of the meaning, objectives, targets of 
activities, and targets of the UKGS program for teachers and elementary 
school students, especially in the implementation of dental and oral health 
counseling and mass toothbrushing

There are guidelines for implementing the 
UKGS program at the Puskesmas

Distributing and explaining the UKGS implementation guidelines for school 
health teachers

There is a program planning at the Puskesmas
Utilizing the UKGS program planning at the Puskesmas as a reference for 
implementing UKGS in schools and making UKGS program planning together

There is no UKGS guidebook at school Organizing UKGS guidebooks for students and teachers

Lack of budget for UKGS program in schools
Implementing a healthy fund program through the Student Parents Committee 
Board

Lack of training for UKGS personnel in 
schools, and Puskesmas staff rarely go to 
school

Providing training and counseling on how to brush teeth properly and 
correctly, as well as practicing it to teachers and elementary school students; 
Improving the discipline of UKGS Puskesmas officers

 Force strength  

Driving Forces 
(Positives) +5 +4 +3 +2 +1 0 -1 -2 -3 -4 -5 

Restraining Forces 
(Negatives) 

(DF1) 
Good knowledge and 
skill of UKGS personnel 
at Puskesmas 

           

(RF1) 
There is no UKGS 
guidebook at school; 
and health teachers are 
not skilled 

(DF2) 
There are guidelines for 
implementing the 
UKGS program at the 
Puskesmas 

           

(RF2) 
Lack of budget for 
UKGS program in 
schools 

(DF3) 
There is a program 
planning at the 
Puskesmas 

           

(RF3) 
Lack of training for 
UKGS personnel in the 
school; and Puskesmas 
staff rarely go to school 

 Total scores: +12.5  Total scores: -11  

 
 Figure 1. FFA Strategy for improving the quality of UKGS at Tabanan Puskesmas.10

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v55.i4.p215–220

https://e-journal.unair.ac.id/MKG/index
https://doi.org/10.20473/j.djmkg.v55.i4.p215-220


218Agung and Palgunadi/Dent. J. (Majalah Kedokteran Gigi) 2022 December; 55(4): 215–220

The results showed that the driving factors were the 
availability of skilled and knowledgeable health workers 
and UKGS personnel who were willing to carry out the 
UKGS program. In addition, there were also restraining 
factors in the form of infrequent visits by officers to schools, 
lack of equipment and materials facilities, and lack of 
budget for UKGS activities. Efforts to improve the quality 
of UKGS program services based on the key driving forces 
are utilizing the guidelines, program planning, knowledge, 
and skills of UKGS personnel Puskesmas. Efforts to 
improve the quality of UKGS program services based on 
the key restraining forces are increasing the budget for the 
UKGS program by holding health funds.

Based on Figure 1, the total score for the force strength 
of the driving forces (+12.5) is higher than that of the 
restraining forces (-11). So the UKGS program is feasible 
to be developed. The driving forces that have the greatest 
value are DF1 and DF2, whereas the restraining forces that 
have the greatest value are RF1 and RF2.

DISCUSSION

Dental and oral health services in the province of Bali 
begin with basic dental health activities at the Puskesmas. 
The research report says the effectiveness of the utilization 
of the Dental Health Department of Puskesmas Tabanan 
is very low.13 This is in accordance with the results of 
research at the Karangasem Puskesmas. It is due to the road 
conditions which are difficult to reach.14  The results of this 
study are shown in Table 1, which shows that 80% of the 
road conditions are very difficult for UKGS Puskesmas 
officers to go to elementary schools. Moreover, since 
each Puskesmas only has two dentists, it does not meet 
the standards for services for the number of residents that 
must be handled. The rate of addition of Puskesmas in the 
Tabanan district is not proportional to the rate of population 
growth, so the UKGS program is difficult to implement due 
to the lack of existing facilities.15 This is consistent with 
the results of an evaluation of the UKGS implementation 
in the districts of Denpasar and Karangasem, Bali province, 
which found around 95% of UKGS were inactive. This can 
be overcome by multiplying the UKGS guidebook at the 
Puskesmas, distributing them to students and teachers, and 
training school health teachers through the implementation 
of the Student Parent Committee Board’s health fund 
program (Table 2 and Figure 1).16 The active UKGS was 
found to be around 5%, significantly improving the dental 
and oral health of elementary school students.9,14 Some 
aspects of the service can influence the utilization of 
the health services in Puskesmas Tabanan, including the 
activities being done for health such as factors of the health 
personnel doing the health service, facility, and factor of 
the services users. Puskesmas’ flagship program to prevent 
dental health problems in elementary school students is the 
UKGS program. It is conducted to maintain and improve the 
dental and oral health of all students in school. It is carried 

out through health education, dental health services, and 
fostering a healthy school environment. The impact of the 
UKGS is that, hopefully, there will be changes in students’ 
attitudes and behavior. In addition, students will understand 
when and how they should brush their teeth properly and 
correctly, and they can take advantage of available dental 
and oral health service facilities to improve their oral and 
dental health.17 

The lack of budget for the UKGS program in schools 
is the restraining power with the highest score (Figure 1). 
This is in accordance with the results of research at the 
Halmahera Health Center, Semarang, which stated that the 
UKGS activities were not successful because they were 
influenced by the lack of operational funds for UKGS 
activities.3 This is confirmed by the results of research in 
Saudi Arabia on increasing oral health literacy, as well as 
reducing organizational and financial barriers, resulting in 
better oral and dental health in school children.18  Therefore, 
the strategy for the success of the UKGS program is to 
implement it in an integrated manner, across programs and 
sectors that are targeted and sustainable.12

FFA analysis found the restraining force with the 
highest score is health teachers in schools are not skilled 
(Figure 1). Several research reports recommend that it is 
necessary to regularly conduct training for school health 
teachers to motivate teachers to actively take the initiative 
to develop various activities related to the promotion of 
dental health in schools.19–21 This activity is in the form of 
counseling for teachers on how to assess oral hygiene or oral 
condition, including dental caries and gum disease, as well 
as explanations about efforts or programs that need to be 
carried out.22,23 UKGS services for students are training for 
school health teachers on integrated dental and oral health 
knowledge.24–26 Dental health education and counseling 
are carried out by school health teachers by following 
the curriculum applicable to all students in grades I-VI. 
The teacher guides daily tooth brushing activities, at least 
for grades I, II, and III, by using toothpaste containing 
fluoride.27

Other UKGS program activities are duplicating, 
distributing, and training UKGS implementation guidelines 
in the Puskesmas to school UKGS teachers (Table 2). The 
UKGS implementation guidelines can be used as guidelines 
for implementing the UKGS program in elementary 
schools. Elementary school-age children are vulnerable to 
dental and oral health due to a lack of knowledge. The level 
of teachers’ knowledge about oral health affects students’ 
attitudes and behavior towards dental and oral health.19 

Applying the latest science, technology, and motivation to 
stimulate student participation and break the caries chain 
by preventing and protecting teeth. Primary prevention 
and protection technologies include the latest caries 
theory, such as demineralization versus remuneration, 
and minimum intervention, such as protecting caries-prone 
teeth. Principles of treatment and minimum intervention 
from an early age are proven to add value to be more 
effective and measurable. This is in accordance with the 

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v55.i4.p215–220

https://e-journal.unair.ac.id/MKG/index
https://doi.org/10.20473/j.djmkg.v55.i4.p215-220


219 Agung and Palgunadi/Dent. J. (Majalah Kedokteran Gigi) 2022 December; 55(4): 215–220

research results that the current UKGS development is the 
emergence of Innovative UKGS, which aims to increase 
students’ awareness of caries risk factors by teaching them 
how to overcome caries.12

United Nations Educational, Scientific, and Cultural 
Organization (UNESCO) and the World Health Organization 
(WHO) call on schools to play an important role in 
maintaining dental health education and equip students 
with skills for their future health and well-being. The results 
showed that dental health education improved the students’ 
knowledge, attitudes, and oral hygiene status.28 There 
is a significant correlation between knowledge, attitude, 
source of information, and teacher support with oral 
treatment behavior of oral hygiene in children. Source of 
information is the dominant factor that affects the behavior 
of oral hygiene in children aged 12 years old in Puskesmas 
I Baturiti, Tabanan.29

The results of the study indicate that it is important for 
educators to incorporate education on medicinal plants 
with nutrition for oral health into the school curriculum. 
This is reinforced by a reminder sticker book, which can 
increase knowledge of oral health. The results of the study 
indicate that it is important for educators to incorporate 
dental and oral health nutrition, as well as medicinal plant 
garden and dental health nutrition education, into the school 
curriculum.30,31  Reminder sticker books can increase oral 
health knowledge and reduce OHI-S scores in seven-to 
eight-year-old children.32 UNESCO proposes to prepare 
students to understand the reality to build individual student 
empowerment through improving curriculum content 
(focus on related to health, nutrition, and well-being) 
with collaboration between various sectors and actors 
to achieve an integrated system focused on students and 
teachers.28,33 

Good dental health contributes considerably to the health 
and quality of life of the population.34 Providing elementary 
school educators with web-based resource materials 
improves their attitudes, increases their knowledge, and 
leads to positive behavioral intentions concerning educating 
their students about dental health.32 Based on research, it 
is stated that the acquisition of learning outcomes through 
a combination of the senses of sight (visual) and hearing 
(audio) becomes higher.35

Based on the description above, it can be concluded 
that the strategy that can improve the quality of UKGS 
at the Tabanan Puskesmas can be done by utilizing the 
facilities at the Puskesmas for UKGS activities in schools, 
transmitting knowledge and skills from Puskesmas UKGS 
officers to school UKGS officers, and increasing the budget 
by the implementation of the Student Parent Committee 
Board’s health fund program. This research was carried 
out during the COVID-19 pandemic, which is the main 
limitation of this research, so respondents can only be 
taken from 15 UKGS Puskesmas officers. The findings 
of this study have important implications that the UKGS 
program is very important to be immediately noticed by 
parents, the health office, the government, research and 

community service institutions, and funders, considering 
that only about 5% of the UKGS program can be active. 
On the other hand, the condition of students’ dental health 
is getting worse. It is recommended for the development of 
an innovative UKGS program, namely the development of 
a few dentists with a garden of nutritious medicinal plants, 
which is the main focus of the physical education and health 
curriculum, and appears on the website. The findings of this 
study have very important implications, both for readers, 
students, parents of students, UKGS officers (schools and 
Puskesmas), principals, heads of health centers, leaders of 
the Puskesmas, as information that the UKGS program is 
more than 95% unable to be active because of constraints, 
such as lack of funds and lack of awareness to dental health 
for elementary school students.

REFERENCES

 1.  Global Burden of Disease Collaborative Network. Global Burden of 
Disease Study 2019 (GBD 2019). 2019. Available from: http://ghdx.
healthdata.org/gbd-results-tool. Accessed 2021 Nov 9.

 2.  World Health Organization. Oral health. 2020. Available from: 
https://www.who.int/news-room/fact-sheets/detail/oral-health. 
Accessed 2021 Aug 12.

 3.  Taftazani RZ, Rismayani L, Santoso B, Wiyatini T. Analisis program 
kegiatan usaha kesehatan gigi sekolah (UKGS) di Puskesmas 
Halmahera. J Kesehat Gigi. 2015; 2(1): 32–7. 

 4.  Suanda IW. Gerakan masyarakat hidup sehat dalam mencegah 
terjadinya penyakit gigi dan mulut. J Kesehat Gigi. 2018; 6(1): 
29–34. 

 5.  Badan Penelitian dan Pengembangan Kesehatan. Laporan Provinsi 
Bali Riskesdas 2018. Kementerian Kesehatan Republik Indonesia; 
2018. Available from: https://ejournal2.litbang.kemkes.go.id/index.
php/lpb/article/view/3751. Accessed 2021 Nov 9.

 6.  Pemerintah Republik Indonesia. Peraturan Pemerintah Republik 
Indonesia Nomor 47 Tahun 2016 tentang Fasilitas pelayanan 
kesehatan. 2016. Available from: https://peraturan.bpk.go.id/Home/
Details/4820. Accessed 2021 Nov 9.

 7.  Santoso B, Gejir N, Fatmasari D. Information system monitoring 
model implemented in school health dental unit. ARC J Dent Sci. 
2017; 2(4): 8–11. 

 8.  Galuh A, Supriyana, Rasipin, Sunarjo L, Fatmasari D. Management 
model of school dental health effort (SDHE) of website-based for 
improving quality of information system at elementary school. Int 
J Nurs Heal Serv. 2021; 4(2): 112–9. 

 9.  Wirata IN. Perbedaan derajat kesehatan gigi dan mulut pada siswa 
SD dengan program UKGS aktif dan tidak aktif di wilayah kerja 
PUSKESMAS Denpasar Utara II Tahun 2015. J Ilmu dan Teknol 
Kesehat. 2016; 3(2): 124–36. 

10.  Shrivastava S, Shrivastava P, Ramasamy J. Force field analysis: An 
effective tool in qualitative research. J Curr Res Sci Med. 2017; 3(2): 
139–40. 

11.  Sastroasmoro S. Dasar-dasar metodologi penelitian klinis. 5th ed. 
Jakarta: Sagung Seto; 2018. p. 89–298. 

12.  Kementrian Kesehatan RI. Pedoman usaha kesehatan gigi sekolah 
(UKGS). Jakarta: Kementerian Kesehatan Republik Indonesia; 2012. 
p. 11–14. 

13.  Dwiastuti SAP. Hubungan status kesehatan gigi dan mutu layanan 
dengan pemanfaatan Balai Pengobatan Gigi Puskesmas Kabupaten 
Tabanan. J Kesehat Gigi. 2013; 1(1): 10–5. 

14.  Su r ya n i N W, Ta mba I M, Ag ung IGA A. Eva luat ion of t he 
implementation of school dental health program in Karangasem 
Regency, Year 2017. Sci Reasearch J. 2018; 6(5): 31–4. 

15.  Dinas Kesehatan Provinsi Bali. Profil kesehatan provinsi Bali. 
2021. Available from: https://diskes.baliprov.go.id/profil-kesehatan-
provinsi-bali/. Accessed 2021 Nov 9.

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v55.i4.p215–220

http://ghdx
https://www.who.int/news-room/fact-sheets/detail/oral-health
https://ejournal2.litbang.kemkes.go.id/index
https://peraturan.bpk.go.id/Home/
https://diskes.baliprov.go.id/profil-kesehatan-provinsi-bali/
https://e-journal.unair.ac.id/MKG/index
https://doi.org/10.20473/j.djmkg.v55.i4.p215-220


220Agung and Palgunadi/Dent. J. (Majalah Kedokteran Gigi) 2022 December; 55(4): 215–220

16.  Kementrian Kesehatan RI. Puskesmas berperan penting wujudkan 
sekolah sehat. 2013. Available from: https://www.kemkes.go.id/
article/view/2411/puskesmas-berperan-penting-wujudkan-sekolah-
sehat.html. Accessed 2021 Nov 9.

17.  Lestari DR, Indarjo S. Evaluasi penerapan manajemen UKGS dalam 
perilaku perawatan gigi dan mulut siswa sekolah dasar. J Heal Educ. 
2016; 1(2): 8–11. 

18.  Al Agili DE, Farsi NJ. Need for dental care drives utilisation of 
dental services among children in Saudi Arabia. Int Dent J. 2020; 
70(3): 183–92. 

19.  Nugraheni H, Sunarjo L, Wiyatini T. Teacher’s role on oral health 
promoting school. J Kesehat Gigi. 2018; 5(2): 13–21. 

20.  Siswanto SH, Abraham JF, ‘Aini NQ, Damayanti M, Wulansari AA, 
Aprilia V, Guna IDAW, Sary HP, Nabella TI, Jatiatmaja NA, Setijanto 
RD. The effect of identification and management of dental health 
problems on kindergarten and elementary school teachers knowledge 
levels in Keputih Public Health Center (Puskesmas). Indones J Dent 
Med. 2020; 2(1): 16–8. 

21.  Bramantoro T, Santoso CMA, Hariyani N, Setyowati D, Zulfiana 
A A, Nor NA M, Nag y A, P rat a mawa r i DN P, I r ma l ia W R. 
Effectiveness of the school-based oral health promotion programmes 
from preschool to high school: A systematic review. PLoS One. 2021; 
16(8): e0256007. 

22.  Raiyanti IGA, Ratmini NK, Nyoman N, Supariani D. Perawat 
gigi dalam pelaksanaan program UKGS di Puskesmas Kabupaten 
Badung Tahun 2015. J Kesehat Gigi. 2017; 5(2): 42–51. 

23.  Pradnyadani IGA. Revitalisasi usaha kesehatan gigi sekolah (UKGS) 
dalam meningkatkan kesehatan gigi dan mulut anak usia sekolah. J 
Kesehat Gigi. 2014; 2(1): 190–4. 

24.  G e et ha P r iya PR, Asoka n S, Ja na n i RG, K a nd aswa my D. 
Effectiveness of school dental health education on the oral health 
status and knowledge of children: A systematic review. Indian J Dent 
Res. 2019; 30(3): 437–49. 

25.  Geetha Priya PR, Asokan S, Kandaswamy D, Shyam S. Impact of 
different modes of school dental health education on oral health-
related knowledge, attitude and practice behaviour: an interventional

  study. Eur Arch Paediatr Dent. 2020; 21(3): 347–54. 
26.  Marliny, Hasnita E, Silvia. Analisis pelaksanaan pelayanan usaha 

kesehatan gigi sekolah (UKGS) di masa pandemi Covid-19. J Hum 
Care. 2021; 6(3): 541–50. 

27.  Ari Agung IGA, Wedagama DM, Hervina. Dokter gigi cilik dengan 
taman sirih (Implementasi konsep tri hita karana). Denpasar: Unmas 
Press; 2021. p. 9. 

28.  World Health Organization. UNESCO and WHO urge countries 
to make every school a health-promoting school. 2021. Available 
from: https://www.who.int/news/item/22-06-2021-unesco-and-who-
urge-countries-to-make-every-school-a-health-promoting-school. 
Accessed 2021 Nov 19.

29.  Wulandari NNF, Handoko SA, Kurniati DPY. Determinan perilaku 
perawatan kesehatan gigi dan mulut pada anak usia 12 tahun di 
wilayah kerja Puskesmas I Baturiti. Intisari Sains Medis. 2018; 9(3): 
55–8. 

30.  Nicksic NE, Massie AW, Byrd-Williams CE, Kelder SH, Sharma S 
V, Butte NF, Hoelscher DM. Dietary intake, attitudes toward healthy 
food, and dental pain in low-income youth. JDR Clin Transl Res. 
2018; 3(3): 279–87. 

31.  Stein C, Santos NML, Hilgert JB, Hugo FN. Effectiveness of oral 
health education on oral hygiene and dental caries in schoolchildren: 
Systematic review and meta-analysis. Community Dent Oral 
Epidemiol. 2018; 46(1): 30–7. 

32.  Inglehart MR, Zuzo GA, Wilson JJ. Kindergarten/elementary 
school teachers and web-based oral health-related resources: An 
exploration. Oral Health Prev Dent. 2017; 15(3): 229–36. 

33.  Thomson S, Cylus J, Evetovits T. Can people afford to pay for health 
care? New evidence on financial protection in Europe. Switzerland: 
World Health Organization. Regional Office for Europe; 2019.             
p. 119. 

34.  Bernabé E, Masood M, Vujicic M. The impact of out-of-pocket 
payments for dental care on household finances in low and middle 
income countries. BMC Public Health. 2017; 17(1): 109. 

35.  Anwar AI. Buku ajar ilmu kesehatan gigi masyarakat: Teori dan 
praktik penyuluhan. Ester M, editor. Jakarta: EGC; 2019. p. 20.

Dental Journal (Majalah Kedokteran Gigi) p-ISSN: 1978-3728; e-ISSN: 2442-9740. Accredited No. 158/E/KPT/2021. 
Open access under CC-BY-SA license. Available at https://e-journal.unair.ac.id/MKG/index
DOI: 10.20473/j.djmkg.v55.i4.p215–220

https://www.kemkes.go.id/
https://www.who.int/news/item/22-06-2021-unesco-and-who-urge-countries-to-make-every-school-a-health-promoting-school
https://e-journal.unair.ac.id/MKG/index
https://doi.org/10.20473/j.djmkg.v55.i4.p215-220