Relationship between Consumption Behavior of Vegetables High in

Vitamin a and Vitamin C with Gingivitis in Mixed Dentition Children

Muhammad Izzul Widad Fahmi

, Risya Cilmiaty

and Ida Nurwati

Postgraduate Student of Human Nutrition Sciences, Universitas Sebelas Maret, Surakarta, Indonesia

Department of Dental and Mouth, Faculty of Medicine, Universitas Sebelas Maret, Universitas Sebelas Maret Hospital,

Surakarta, Indonesia

Department of Biomedical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

Keywords: Mixed Dentition Child, Vegetables, Vitamin A, Vitamin C, Gingivitis.

Abstract: Lack of consumption of vegetables that contain high vitamins is one of the factors for the occurrence of

periodontal problems, including in children. This study aims to determine the relationship between the

behavior of consuming vegetables high in vitamins A and C with gingivitis in children with mixed dentition.

The study used a cross sectional approach. The subjects of this study were 100 students of Madrasah

Ibtidaiyah (MI) in Situbondo district. Data analysis using Chi Square test. The results showed that 48% of

children had moderate gingival index and 6% severe. As many as 62% of children consume vegetables high

in vitamin A less than 1.5 servings per day and 62.7% children consume vegetables high in vitamin C less

than 1.5 servings per day. The results of statistical tests showed that there was a positive correlation between

the behavior of consuming vegetables high in vitamin A and the gingival index (p=0.038) and there was a

positive correlation between the behavior of consuming vegetables high in vitamin C and the gingival index

(p=0.020). In conclusion, the less consumption of vegetables high in vitamins A and C, the higher the risk of

children experiencing gingivitis.

INTRODUCTION

The mixed dentition phase, which occurs in children

between the ages of 6 and 12, serves as a transitional

period between the replacement of primary teeth and

the replacement of permanent teeth (Proffit, 2013).

The characteristic of the dental period can be seen in

the appearance of permanent teeth and the loss of

deciduous teeth. Furthermore, oral health issues are

more likely to develop at this time (Ilyas and Putri,

2012).

Oral health is an integral part of general health

that requires attention since it can affect the health of

other organs (Endang, 2012). A healthy oral cavity

will have an impact on one's activities, such as

enjoying all kinds of food, increasing the quality of

life, being fluent in communication, and having a

better social life. One of the dental health issues that

still frequently affect elementary school students is

gingivitis (Zefanya et al, 2021). Gingivitis is swelling

of the gingival margin which is reddish to bluish red,

enlargement of the gingival contour due to edema,

and easy bleeding (Fatmasari et al, 2020).

According to Riskesdas data, the prevalence of

dental and oral problems in Indonesia was 25.9

percent in 2013, 28.9 percent in the 5 to 9 age group,

and 25.2 percent in the 10 to 14 age group. This

number increased to 45.3 percent in 2018, 54 percent

in the 5 to 9 age group, and 41.4 percent in the 10 to

14 age group. According to the features of swollen

gingiva and easy-to-bleed gingiva, the proportion of

oral health issues in Indonesia is 14.0 percent and

13.9 percent, respectively (Riskesdas, 2018).

Situbondo District Health Profile data in 2010

showed that the proportion of dental caries at the age

of preschool children and elementary school students

was 77.37%, while in 2018 the proportion of the

population aged 3 years who had dental and oral

problems and required treatment by medical

personnel teeth in Situbondo Regency by 65.37%

(Riskesdas, 2018). Situbondo District Health Profile

data in 2019 showed that the 4 sub-districts with the

highest dental and oral health cases were Arjasa

(16.6%), Jangkar (11%), Asembagus (9.2%), and

Banyuputih (7.6%) (Situbondo District Health

Office, 2019).

Fahmi, M., Cilmiaty, R. and Nurwati, I.

Relationship between Consumption Behavior of Vegetables High in Vitamin a and Vitamin C with Gingivitis in Mixed Dentition Children.

DOI: 10.5220/0011643000003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 27-31

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

The main risk factors for gingivitis are dental

plaque retention and other factors such as specific

malnutrition (Murakami et al., 2018). Consuming

vegetables that are rich in fiber will stimulate and

increase saliva production, the flow of saliva that

comes out can clean food debris on the teeth so that it

can prevent oral health problems (Kidd and Bechal,

2013). Vegetables are also one of the sustenance that

contain high vitamins A and C, however, in the mixed

dentition period, children rarely consume them

(Mohammad, 2015; Indry et al., 2013). Vitamin A

helps maintain oral health and prevents dental plaque

while vitamin C plays a role in curing infections in

the oral cavity (Soediatama, 2012). Deficiency of

vitamin A and vitamin C can cause gingivitis

(Ghutaimel et al, 2014, Soediatama, 2012).

Furthermore, vegetables are foods that are high in

vitamins A and C, although children rarely eat them

during the mixed dentition phase (Mohammad, 2015;

Indry et al., 2013). The proportion of less

consumption of vegetables in Indonesia in the 5–9-

year age group in Indonesia was 96.9% in 2018

(Riskesdas, 2018). Therefore, this study aimed to

investigate the relationship between the habit of

consuming vegetables high in vitamins A and C with

mixed gingivitis in children.

METHOD

This research is a cross-sectional analytic study. The

population of this study was students of Madrasah

Ibtidaiyah (MI) in Situbondo Regency. The results of

the preliminary study showed that the prevalence of

MI students who had dental caries was higher than

elementary school students, namely 59.3% compared

to 46.5%. The number of study samples was

calculated using the OpenEpi program, with the

following criteria: children aged 6-12 years, had not

had their teeth checked for the last 6 months, did not

use fixed orthodontic appliances, and were willing to

be researched subjects. Based on these criteria, the

minimum total sample required is 98 subjects. Then

by rounding to 100 subjects.

The sampling technique in this study used a

cluster random sampling technique to determine the

school as a place of research. The number of MI

schools studied was 50% of the total MI in each sub-

district where the selection of schools was randomly

selected using Microsoft Excel. This research was

conducted in 9 Islamic elementary schools out of a

total of 19 MI in the sub-districts of Arjasa, Jangkar,

Asembagus, and Banyuputih, Situbondo district. The

schools selected were MI Al Falah, MI Makarimal

Akhlaq, MI Sunan Bonang, MI Darurrahmah Pillow,

MI Nahdlatul Ulama, MI Muhammadiyah, MIN 2

Situbondo, MI Miftahun Najah, and MI Al-Ikhlas

Situbondo Regency. Determination of the proportion

of subjects per school using proportional random

sampling and the subject selection used simple

random sampling.

Data collection was done using questionnaires

and interviews with respondents and their parents.

This includes characteristic data, consumption

behavior of vegetables high in vitamin A and vitamin

C. Vegetables are considered to be high in vitamin A

if the vitamin A content is 300 RE/100 g, aside from

that vegetables are considered high in vitamin C if the

vitamin C content is 30 mg/100 g (Amalia, 2008).

Vegetable consumption is categorized as sufficient if

2.5 servings or 250 grams per day is consumed, and

is categorized as less if the consumption is less than

the above-mentioned figure (Permenkes, 2014). The

vegetable high in vitamin A and vitamin C

consumption in the last 6 months were observed using

a Semi-qualitative Food Frequency questionnaire

whose validity has been tested and the Cronbach

alpha value is 0.79.

The cariogenic food consumption in the last 6

months were observed using a Semi-qualitative Food

Frequency questionnaire whose validity has been

tested and the Cronbach alpha value is 0.89.

Consumption of cariogenic food is categorized as

frequent if it is consumed 3 or more times a week,

rarely if it is consumed less than 3 times per week,

and never if it is not consumed at all (Rekawati and

Frisca, 2020). The data on brushing habits were

obtained from filling out a questionnaire whose

validity had been tested and the Cronbach alpha value

was 0.83. This questionnaire includes 25 questions

and the assessment is done using a Likert scale of 0-

4 (never, rarely, often, always). A gingival index

examination was carried out by a dentist.

Behavioral data on the consumption of vegetables

high in vitamin A and vitamin C, as well as gingival

index, were processed using SPSS version 23

software and analyzed using the Chi-Square test. The

data is significant if the p-value is <0.05. This

research has received ethical approval from the Ethics

Commission Health Research (KEPK) Universitas

Sebelas Maret No: 107/UN27.06.6.1/KEP/EC/2021.

ICSDH 2022 - The International Conference on Social Determinants of Health

RESULTS

3.1 Respondent Charateristics

Table 1: Frequency Distribution of Respondents

Characteristics.

Variable N %

6 4 4%

7 12 12%

8 12 12%

9 11 11%

10 20 20%

11 22 22%

12 19 19%

Gender

Male 43 43%

Female 57 57%

The habit of brushin

teeth

Goo

79 79%

Poo

21 21%

Table 2: Overview of the glycemic index.

Variable N %

Indeks Gingiva

Mild 45 45%

Moderate 49 49%

Severe 6 6%

Table 3: Overview of the distribution of consumption habits

of vegetables and cariogenics foods.

Variable N %

The habit of consuming vegetables high in vitamin

Less 38 38%

Adequate 62 62%

The habit of consuming vegetables high in vitamin

Less 36 36%

Adequate 86 86%

Consumption of Cariogenic Foods

Never 0 0%

Rarely (<3x/week) 12 12%

Often (≥3x/week) 88 88%

Table 1 shows the characteristics of respondents

according to age and sex. The results showed that

most of the respondents were 10 years old (20%) and

the least respondents were 6 years old (4%). Most of

the respondents are female (57%). The majority of

respondents have a good tooth-brushing habit (79%)

and often consume cariogenic foods (88%). Table 2

shows most of the respondents have a moderate

glycemic index (49%).

The majority of respondents have a habit of

consuming vegetables high in vitamin A in less than

2 servings per day (62%) and have a habit of

consuming vegetables high in vitamin C in less than

2 servings per day (64%). The majority of

respondents often consume cariogenic foods (88%)

and all respondents have at least consumed cariogenic

foods.

3.2 Relationship of High Vitamin a

Vegetable Consumption Habits

with Gingival Index

Table 4: Relationship of High Vitamin A Vegetable

Consumption Habits with Gingival Index.

High Vitamin A

Vegetable

Consumption

Habits

Gingival Index

Mil

Moderate Severe

N % N % N %

Ade

uate 22 47.8 16 32 0 0

Less 24 52,2 34 68 6 100

Pvalue 0.038

Table 4 shows that there is a relationship between

vegetable consumption high in vitamin A and the

gingival index (p-value 0.038). The results showed

that the majority of respondents with high levels of

vegetable consumption in vitamin A had a moderate

gingival index (47.8%) and the majority of

respondents with high levels of vegetable

consumption in vitamin A lacked a moderate gingival

index (68%).

3.3 Relationship of High Vitamin C

Vegetable Consumption with Gingival

Index

Table 5: Relationship of HighVitamin C Vegetable

Consumption Habits with Gingival Index.

High Vitamin

C Vegetable

Consumption

Habits

Gingival Index

Mil

Moderate Severe

N % N % N %

Ade

uate 22 48.9 14 28 0 0

Less 23 51.1 35 71.4 6 100

Pvalue 0.020

Table 5 shows that there is a relationship between the

consumption of vegetables high in vitamin C and the

gingival index (p-value 0.020). The results showed

that the majority of respondents with high levels of

vegetable consumption in vitamin C had a moderate

gingival index (48.9%) and the majority of

respondents with high levels of vegetable

Relationship between Consumption Behavior of Vegetables High in Vitamin a and Vitamin C with Gingivitis in Mixed Dentition Children

consumption in vitamin C lacked a moderate gingival

index (71.4%).

DISCUSSION

4.1 Analysis of the Relationship

between the Behavior of

Consuming Vegetables High in

Vitamin a with Gingivitis

The results of this study indicate that the behavior of

consuming vegetables high in vitamin A is associated

with gingivitis. This study is in line with the research

of Kidd and Bechal (2013), which states that

consuming vegetables will stimulate and increase

saliva production, the flow of saliva that comes out

can clean food debris on the teeth to prevent oral

health problems. Vegetables are a good source of

various nutrients, including vitamins and dietary

fiber. These compounds can affect periodontal health

because they function as antioxidants and

antibacterial agents such as Streptococcus mutans to

prevent plaque formation (Zare et al., 2014). Park et

al, (2017), stated that low vitamin A intake is

associated with oral health.

Vitamin A is important for maintaining oral

mucous membranes and oral mucosal tissue,

maintaining epithelial tissue and defense against

infection, and preventing plaque (Tarigan, 2012). In

the salivary glands, vitamin A deficiency causes

salivary gland atrophy and results in increased plaque

formation due to a lack of salivary flow (Sadioetama,

2012). This collection of plaque on the surface of the

teeth can cause inflammation of the gums, thus

worsening the gingival index (De Vries, 2015).

4.2 Analysis of the Relationship

between the Behavior of

Consuming Vegetables High in

Vitamin C with Gingivitis

In this study, it was shown that the behavior of

consuming vegetables high in vitamin C was

associated with gingivitis in children with mixed

dentition. This study is in line with research by

Ghutaimel et al (2014), which states that vitamin C

deficiency is associated with scorbutic gingivitis. The

results of this study are also in line with the study of

Shimabukuro et al., (2015), who reported that vitamin

C had a significant effect on patients with chronic

gingivitis. The study of Munday et al (2020), also

stated that vitamin C deficiency is associated with

severe periodontal disease and with systemic

inflammation of the gingiva. Vegetable diets that

contain lots of vitamin C have a positive effect on

periodontal tissue health (Chapple, et al., 2012).

Research by Brahmavar et al., (2021), stated that

vitamin C injected into the gingival tissue through

mesotherapy can treat inflammation of the gingiva.

The relationship between the mechanism of action

of vitamin C and gingival health is related to its

antioxidant properties that help reduce the production

of reactive oxygen radicals formed during the

inflammatory process (Iwasaki et al., 2013). The role

of vitamin C in overcoming inflammation is to protect

immune cells against oxidative stress generated

during infection (Mitmesser et al., 2016).

Haryani et al., (2016), emphasized that adequate

intake of vitamin C is very important in preventing

excessive permeability of the gingival tissue,

stimulating salivary secretion and collagen synthesis.

Vitamin C plays a role in the formation of collagen,

especially in the oral cavity (Soediatama, 2012).

Collagen attaches and seals tissue exposed by injury.

Vitamin C in the formation of collagen plays a role in

the hydroxylation of the amino acids proline and

lysine into hydroxyproline and hydroxylysine. These

two compounds are the two main components of

collagen. The optimal function of vitamin C in the

formation of collagen is influenced by whether or not

the content of vitamin C in the body is sufficient

(Soediatama, 2012).

CONCLUSIONS

This study concludes one thing: there is a relationship

between the behavior of consuming vegetables high

in vitamin A and vitamin C with gingivitis in mixed

dentition phased children. The less consumption of

vegetables high in vitamin A and vitamin C, the more

severe the glycemic index of children experiencing

gingivitis.

ACKNOWLEDGEMENTS

The authors would like to thank the school, students

and parents for their willingness to be involved in this

research.

ICSDH 2022 - The International Conference on Social Determinants of Health

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Relationship between Consumption Behavior of Vegetables High in Vitamin a and Vitamin C with Gingivitis in Mixed Dentition Children