Prediksi Dan Pencegahan Early Childhood Caries (ECC) Berdasarkan Lisozim Saliva, sIgA, Koloni S.mutans dan Faktor Life Style pada Anak (Kajian Longitudinal 9 Bulan)

Abstract

The prevalence of Early Childhood Caries (ECC) in various countries is quite high, even in children aged 2 years the incidence of caries is quite a concern. One of the best prevention strategies is the identification of characteristics associated with a child's risk to ECC. Moreover, the simple and effective ECC prevention can be done by brushing using lysozyme toothpaste without fluoride but has antibacterial. The purpose of this study was to analyze the role of sIgA protein, salivary lysozyme, S.mutans colony and children's lifestyle as a predictor of ECC events and also to know the effect of the use of 0.1% lysozyme toothpaste without fluoride for 5 weeks in children aged under 2 years. The study was an observational cohort for 9 months and clinical trials. The sample size of this study was 68 caries-free children aged under 2 years. The subjects were obtained from the community health center in Medan Districts. The inclusion criteria were healthly children and have 2 primary incisors erupted. Lifestyle factors of children were assessed as 18 risk factors while the factors that examined were salivary sIgA level, lysozyme level, lysozyme activity and colonies of S.mutans. Data retrieval and saliva samples were done three times, specifically 0 months, 3 months, and 9 months. Clinical trials of 0.1% lysozyme toothpaste were examined for saliva before and after the use of toothpaste for 5 weeks. The ECC criteria are based on the American Association of Pediatric Dentistry (AAPD). The longitudinal analysis used a test of general estimating equation and analysis used in clinical trials was paired t-test with p <0.05.The results of the study were ECC prediction model consisting of seven risk: the number of children, exclusive breastfeeding, milk consumption during sleep, sweet drinking habits, S.mutans colony categories, sIgA categories, and lysozyme activity categories. The addition of 0.1% lysozyme in toothpaste could reduced the number of S. mutans colonies by 3.25 times, helps the role of sIgA and lysozyme activity as an antibacterial and reduced the defs by 50%. Concluded that ECC prediction model could be used as an item assessment of caries risk and item prediction of ECC. 0,1% lysozyme toothpaste could be used as alternative toothpaste children aged under 2 years to prevent ECC.

Prevalensi Early Childhood Caries (ECC) diberbagai negara cukup tinggi, bahkan pada anak usia 2 tahun kejadian karies ini cukup memprihatinkan. Salah satu strategi pencegahan terbaik berupa identifikasi karakteristik yang berhubungan dengan risiko anak untuk terjadinya ECC. Disamping itu pencegahan ECC yang sederhana namun efektif dapat dilakukan dengan penyikatan gigi menggunakan pasta gigi lisozim tidak mengandung fluor, namun bersifat antibakteri. Tujuan penelitian ini adalah menganalisis peran protein sIgA, lisozim saliva, koloni S.mutans dan life style anak sebagai prediktor kejadian ECC dan mengetahui pengaruh penggunaan pasta gigi lisozim 0,1% tidak mengandung fluor selama 5 minggu pada anak usia dibawah 2 tahun. Jenis penelitian ini adalah observasional kohort selama 9 bulan dan uji klinis. Besar sampel penelitian ini adalah 68 orang anak bebas karies berusia dibawah 2 tahun. Subjek penelitian diperoleh dari Puskesmas Kecamatan kota Medan. Kriteria inklusi adalah anak sehat yang memiliki 2 gigi insisif atas sulung yang telah erupsi. Faktor life style anak yang dinilai ada 18 faktor risiko, sedangkan faktor saliva yang diperiksa adalah konsentrasi sIgA, konsentrasi lisozim, aktifitas lisozim dan koloni S.mutans. Pengambilan data dan sampel saliva dilakukan 3 kali yaitu 0 bulan, 3 bulan, dan 9 bulan. Uji klinis pasta gigi lisozim 0,1% dilakukan pemeriksaan saliva sebelum dan sesudah penggunaan pasta gigi selama 5 minggu. Kriteria ECC berdasarkan American Association of Pediatric Dentistry (AAPD). Analisis longitudinal digunakan uji general estimating equation dan analisis uji klinis digunakan uji t-test berpasangan dengan p<0,05. Hasil penelitian diperoleh model prediksi ECC yang terdiri atas tujuh faktor risiko yaitu jumlah anak, konsumsi ASI eksklusif, konsumsi susu sewaktu tidur malam, kebiasaan minum manis, kategori koloni S.mutans, kategori sIgA, dan kategori aktifitas lisozim. Penambahan lisozim 0,1% dalam pasta gigi dapat mengurangi jumlah koloni S.mutans sebesar 3,25 kali, membantu peran sIgA dan aktifitas lisozim sebagai antibakteri serta mengurangi pertambahan karies permukaan sebanyak 50 %. Disimpulkan model prediksi ECC tersebut dapat digunakan sebagai item penilaian risiko karies dan item prediksi ECC. Pasta gigi lisozim 0,1% dapat digunakan sebagai pasta gigi anak usia dibawah 2 tahun untuk mencegah terjadinya ECC.