The effect of braille 3g modified audio tactile media on dental health status of visually impaired children

Background : The poor condition of the visually impaired’s mouth is in consequence of unsupervised brushing teeth, technical errors in brushing the teeth, motor skill and guidance that are still neglected. To overcome these things, it requires special media namely braille media and an innovative technique known as audio tactile technique. Method: This study used quasi-experimental method with pre-test and post-test one group design which population and sample were visually impaired children in Special Needs School: Rehabilitation Center for the Blind and Visually Impaired (SLB-A PRPCN) Palembang. The total of the sample was 21 children which divided into three treatment groups (Braille 3G Media, Audio Tactile, and Braille 3G Modified Audio Tactile). The status of Dental and Oral Health of children was assessed by using plaque score assessment in the form of Patient Hygiene Performance Index for one month and two month with Anova-test analysis. Results : The result shows that there is a very striking difference in plaque after one month (0.019) and after two months (0.030). Further analysis with the Post Hoc test shows that the groups that differed significantly in the plaque index after one month and two months are braille with modification and audio tactile with modification. Conclusion : From the evidence, we can see that the braille 3G modified audio tactile media is more effective in reducing the plaque index because it can improve the dental health status of visually impaired children.


INTRODUCTION
Visually impaired people have become a challenge in many countries that are experiencing an increase. They have to rely on tactile sensation or the sense of touch. 1 They really depend on senses such as sound, smell, and touch (tactile) to adjust to their environment. Therefore, various techniques have to be tailor-made to teach them in order to facilitate them to perform daily tasks. 2 Visual impairment accounts for a numerous proportion of children with disabilities. There are about more than 1.4 million of children in the worldwide that living with the visual impairment. 3  These children are prone to have much worse oral hygiene than the normal children 2

. Basic Health
Research (Riskesdas) 2013 shows that 17% of Indonesia's population is visually impaired. 4 Research conducted in India shows that the prevalence of the visually impaired in dental and oral hygiene of is 25% that fall into the poor category. 5 The poor condition of visually impaired's mouth is in consequence of unsupervised brushing teeth, technical errors in brushing the teeth, motor skills and guidance that are still neglected. 6 Brushing teeth is a common way to clean teeth from plaque and other dental debris. 7 Plaque in teeth raises to an essential role in the etiology of dental caries and gingivitis which lead to periodontitis. 8 Adapting new oral hygiene measurement using a normal toothbrush needs a special technique of communication for these children. 2 The prevalence of caries in visually impared children aged 7-18 years in the Provinces of Yogyakarta and Central Java is 94.3% due to the fact that they have a high caries tendency and poor oral hygiene 9 . Children with physical disabilities experience difficulties when carrying out dental care, either at home or at a dental clinic, so they need the help of other people or special tools. 10 The inability of visually impaired children to visualize plaque on the tooth surface is a cause of progressive caries. 11 The visual limitations of visually impaired children result in a decrease in their attention and awareness of their appearance. 9 Braille media is widely used to provide education for visually impaired people. An innovative technique known as audio tactile technique was introduced to teach tooth brushing techniques with the fone's method to visually impaired adolescents with the aim of improving knowledge, behavior, and attitudes related to oral health. 12 The problem that occurs in visually impaired children is that they have difficulty practicing the method of brushing their teeth as previously taught compared to normal. 13     As we can see in Table 1 above, it shows that the frequency distribution based on male gender is 48%, age 10 -14 years is 38%, totally vision criteria is 57%, parent's education graduated from elementary school is 38%, and parent's occupation as private employee is 57%. Table 2 shows the results of the normality test. The PHP Index before and after treatment with braille 3G media, audio tactile, and braille 3G modified audio tactile in visually impaired children are normally distributed (p>0.05). Next, the data were analyzed by using an ANOVA Test method. Table 3 shows the results of the homogeneity test or uniformity of plaque score data (PHP Index) before and after treatment with braille 3G media, audio tactile, and braille 3G modified audio tactile in visually impaired children were obtained a significant value (p>0.05). Therefore, it can be concluded that the data are homogeneous or uniform.
In the comparison among groups using one-way ANOVA (Table 4), the plaque index before treatment (p > 0.005) is not statistically significant.
However, there is a statistically significant difference in the plaque index after 1 month of treatment (p < 0.005) with the lowest mean in group 3 (braille modified audio tactile) ( Table 6).
Furthermore, there is a statistically significant difference in plaque index after 2 months of treatment (p < 0.005) with the lowest mean in group 3 (braille modified audio tactile) ( Table 6).
In Table 5

The results of further analysis with the Post
Hoc test shows that the groups that differed significantly in the plaque index after one month and two months are braille with modification, audio tactile with modification ( Table 6). The conclusion of the follow-up test results is that the group of braille 3G media modified audio tactile is an effective medium in reducing the plaque index, because it has the smallest value with an average (mean) plaque index of 1.128 and 0.614 (Table 5).

DISCUSSION
The research found that efforts to improve dental health status with a variety of innovative The results showed that the groups of braille 3G media and audio tactile media were proven to be able to reduce the plaque index, which means that there was an increase in dental health status in visually impaired children. Braille 3G media is made of paper that uses raised dots by presenting a touch method using fingertips, so that it can make easier for the visually impaired children to read and learn about dental health. Audio media is a hearing aid, which can be played repeatedly to achieve the desired result for visually impaired children learning about dental health. Tactile media such as dental models (dental phantoms) and Various studies on oral health education have shown that when tactile aids are used alongside Braille media and appropriate verbal instructions (audio aids), the visually impaired can undertake the techniques of oral hygiene more effective, thus they can maintain the oral hygiene very well. 20 The visually impaired can keep up the acceptable levels of oral hygiene when they were taught using combined techniques of Braille and ATP, even though this combination is actually proved more effective individually than grouply. 1 Notodatmodjo (2018) stated that media is as a tool to convey messages about health, serves to arouse target interest, can achieve more targets, and can also help to overcome many barriers to understanding. Furthermore, media can stimulate targets to forward messages received by others and facilitate the delivery of health information 21 .
According to Shrivastava, et al. (2022), the keys behind the success in maintaining the status of dental health in visually impaired children are appropriate education, motivation, and periodic reinforcement. 19

CONCLUSION
Based on the results of this study, it can be concluded that braille 3G modified audio tactile media is more influential or effective than braille 3G media and audio tactile because it can enhance the status of dental health in children with visual impairment.

ACKNOWLEDGMENT
On this great opportunity, we would like to express our gratitude to Palembang Health Polytechnic of Ministry of Health especially the Director and related officials who have provided material and spiritual supports so that this study can run smoothly.