RISK FACTORS FOR DENTAL CARIES IN ELEMENTARY SCHOOL CHILDREN AGED 6-12 IN INDONESIA ( SYSTEMATIC LITERATUR REVIEW )

The highest prevalence of dental caries was in the group of children aged 5-9 years (92.6%), and in the age group 3-4 years was 81.1%. Unhealthy teeth and mouth can affect a child's development because the condition of the milk teeth will determine the growth of the child's permanent teeth. Previous research has proven that caries is influenced by how to brush teeth, consumption of cariogenic foods and knowledge. The study aims to identify and analyze the risk factors for dental caries in Indonesian children aged 6-12 years. This study used the literature review method which began with searching research results in 3 databases, namely PubMed, ScienceDirect, and Google Scholar with inclusion criteria published articles from 2020 – 2023, research subjects aged 6 – 12, research conducted in Indonesia, research with cross-sectional, case-control and the cohort is not a review, case report, letters of editor or protocol, articles are presented in full text and can be downloadedThe articles obtained in this literature show that cariogenic food consumption, tooth brushing frequency, how to brush teeth, dental care visits, knowledge, attitude, dental hygiene, stunting, dietary habits, social practices, BMI, tooth brushing time, oral hygiene index, dental plaque index, salivary acidity level


Introduction
The development of caries disease in Indonesia according to basic health research data in 2018 that the prevalence of dental caries in Indonesia is 88.8% with a root caries prevalence of 56.6%.The prevalence of caries tends to be high (above 70%) in all age groups.The highest caries prevalence was found in the age group 55-64 years (96.8%).Meanwhile, the prevalence of dental caries in the group of children was highest at the age of 5-9 years (92.6%), and in the age group 3-4 years as much as 81.1% (RISEKDAS, 2018).
Unhealthy teeth and mouth can affect a child's development because the condition of the milk teeth will determine the growth of the child's permanently (O.F, 2018).In addition, if the child doesn't have teeth, it will be difficult for him to digest food so the child's growth process will be disrupted.As a result, children will be susceptible to disease.Dental and oral disease is an irreversible disease, that is, it cannot return to normal as before, so it will carry over for the rest of their life and affect their quality of life and health in general (Nurwati, 2019) (Nurwati, 2019).
Dental caries occurs due to damage to the hard tissues of the teeth which include enamel, dentin, and cementum.The process of tooth decay begins with a demineralization process followed by damage to organic matter resulting in the development of bacteria.Children aged 6-14 years are vulnerable to dental and oral diseases because in general these children still have the habit of snacking on food and drinks both at school and at home (Wulandari, 2019).
As much as 75.4% of a study stated that there were dental caries in children recruited from 11 elementary schools in Jakarta (Utami et al., 2020).As many as 68% of children experience caries in a sub-district in Aceh, and 64% in an elementary school in Mataram (Rekawati & Frisca, 2020) (Rekawati & Frisca, 2020).Caries are affected by tooth brushing (Jalante et al., 2020), how to brush teeth (Yasin et al., 2020) (Yasin et al., 2020), consumption of cariogenic foods (Rehena, 2020) (Rehena, 2020) , (Syafriani & Sihombing, 2019), knowledge (Ulfah & Utami, 2020)and possibly many other factors that can affect caries.Therefore this study aims to see the latest trends of risk factors that can affect dental caries in elementary school children in Indonesia.

Method
The study uses the literature review method which begins with searching research results in 3 databases, namely PubMed, ScienceDirect, and Google Scholar.The terms or keywords used in this search are in English in all databases and Indonesian in Google Scholar including risk factors, caries, elementary school, and Indonesian.The criteria used to select articles include: (1) published articles from 2020 -2023 to reflect the latest developments and the relevance of the current context, (2) research subjects aged 6 -12, (3) research conducted in Indonesia, (4) research with cross-sectional, case-control and the cohort is not a review, case report, letters of editor or protocol, (5) articles are presented in full text and can be downloaded.The strategy of collecting journals for various literature using accredited journal sites.The strategy is explained systematically through the PRISMA method (Figure 1):

Result and Discussion
The total number of articles obtained was 22,230 articles with details of 21,570 articles obtained from Google Scholar, 35 from Pubmed, and 625 from Science Direct.The article search results were then screened from 2021-2023 with a result of 5,137 articles.Furthermore, the elimination of duplicate articles was carried out and did not have suitability for the research objectives based on the title and abstract, namely 5,070 articles were obtained and then sorted to find duplicate articles, and 56 multiple articles were found, then the selection was carried out based on the research area and type of article, namely cross-sectional, case-control, and cohorts, resulting in 67 articles.Next, articles are selected based on the content of the article, its eligibility level, and can be accessed in full text.The total number of articles used in this study was 27 articles.The articles that have been obtained in the literature show that there are many variables in the process of dental caries in elementary school children in Indonesia.We divide these variables into several discussion groups.The first is individual characteristics: knowledge, attitude, stunting, BMI; The second is the characteristics of parents: parents' education level, number of family members, and role of parents; The third is consumption patterns: eating habits, frequency of consumption of sugar, food, and beverages, level of consumption of cariogenic foods; Fourth is dental and oral hygiene: frequency of brushing teeth, how to brush teeth, brush teeth in the morning and before going to bed, dental visits, time to brush teeth, suffer from toothache, oral hygiene index, dental plaque index, salivary acidity level; Fifth is social status: socioeconomic status, social practice, parental income level; The sixth is dental and oral health interventions: counseling and dental examinations.

A. Individual Characteristics:
1) Knowledge Knowledge about dental and oral health plays a role in the formation of an action to maintain dental and oral health.When someone knows the information, the person will likely act according to the information they know (Hardika, n.d.).

2) Attitude
Someone can think and try to maintain good dental and oral hygiene so that they are free from dental caries.In thinking the emotional and belief components come into play so that a person tends to act to prevent dental caries (Notoatmojo, 2007).

3) Stunting
Stunting conditions can cause children's development to be disrupted, including developmental disorders in the oral cavity.Stunted children are more susceptible to dental caries due to changes in the characteristics of their saliva (Lutfi, 2021).

B. Characteristics of Parents:
1) Parents' education level Higher education provides higher opportunities to gain better knowledge and insights about health issues (Kusparlina, 2020).Knowledge and information play a role as the basic capital for parents at home in guiding children to maintain healthy teeth and mouth (Harsyaf & Yandi, 2018).
2) The number of people's family members The greater the number of children and family members, the less time and attention will be paid to children and the greater the financial responsibility for obtaining health services (Amarasena, 2020) , (R. A. Ngantung, D. H. C. Pangemanan, 2015).
3) The role of parents Parents are the most important teachers and the first to provide education to their children and are fully responsible for their growth process including preventing caries (Ni Nyoman Dewi Supariani, 2023).

C. Consumption Pattern :
1) Eating Habits and Frequency of Consumption of Sugar, Food, and Drinks Students think that foods such as sweets, chocolate, and ice cream have a good and sweet taste so children like them compared to fibrous foods.Sticky foods such as milk, bread, and chocolate are examples of cariogenic foods (Mendur et al., 2017).2) Cariogenic food consumption rates Consuming cariogenic foods tends to increase the risk of children have dental caries.Cariogenic foods are sweet and sticky and these leftovers can stick in the mouth and then settle and ferment.The results of this fermentation are in the form of acids, causing plaque to form on the teeth which can increase the risk of dental caries (Nadyarani, 2022) (Winahyu, K. M., Turmuzi, A. dan Hakim, 2019).

D. Dental and Oral Hygiene:
1) How to Brush Teeth How to brush teeth that are not as recommended, is 6 times more at risk of having high caries status (Junarti et al., 2017).
2) Brush your teeth in the morning and before bed Brushing your teeth in the morning after breakfast aims to clean food debris attached to the tooth surface while brushing your teeth at night aims to clean food debris attached to the tooth surface.It the importance of brushing your teeth before going to bed because the germs in the mouth are active, and the activity of germs at night will usually increase 2-fold compared to during the day because, during sleep when the mouth does not carry out activities such as eating, drinking or talking, it is recommended in brushing teeth for a maximum of 5 minutes (Bakar, 2017) , (Ramadhan, 2019).

4) Tooth brushing time
When brushing their teeth, children who brush their teeth at the wrong time have a 2,3 times greater risk of experiencing dental caries compared to children who brush their teeth correctly (Jauhara & Febrianti, 2021).

5) Tooth brushing habit
Brushing teeth regularly 2 (two) times a day with a toothpaste containing fluoride is highly recommended for all patients to reduce the level of risk (Rosado, 2014).Such maintenance not only reduces the amount of plaque in the mouth but also facilitates the therapeutic process by fluoride (Featherstone, 2006).

6) Oral hygiene index
Students who experience dental caries are students whose oral hygiene index is not good.This means that by maintaining dental hygiene, the incidence of dental caries can be (Nadyarani, 2022).

7) Dental plaque index
Dental plaque is an accumulation of 3-dimensional attachment of microorganisms on certain surfaces.Many diverse microorganisms are found in dental plaque that can cause caries (Nadyarani, 2022).

8) Salivary acidity level
The demineralization process in the teeth can occur due to the low level of salivary acidity, a remineralization process that can benefit the teeth can occur if the salivary acidity level is high (Nadyarani, 2022).

E. Social status
In the search results, there is no relationship between socioeconomic status and dental caries (Melvani, 2021).The relationship between economic level and public health problems, especially dental and oral health, is usually not a direct cause but is more related to the family's ability to provide food, clothing, and shelter that meets health requirements and costs for health (Ariska, 2014)

F. Dental and oral health interventions:
1) Counseling Dental health education aims to create community behavior from bad to good, from those who lack attention to become concerned about the incidence of dental caries.By carrying out counseling, the community, especially children and the elderly, will gain knowledge regarding dental caries and how to handle it (Ginting, 2019).

2) Dental examination
A good dental examination is carried out every six months (Kesehatan, 2020).This routine examination is very important because regular dental checks, allow someone to detect problems in the teeth.

Conclusions and recommendations
Variable risk factors for dental caries were grouped into 6 discussion groups, namely individual characteristics, parental characteristics, consumption patterns, dental and oral hygiene, social status, and dental and oral health interventions.Variables that have been proven to be risk factors for caries are cariogenic food consumption, tooth brushing frequency, how to brush teeth, dental care visits, knowledge, attitude, dental hygiene, stunting, dietary habits, social practices, BMI, tooth brushing time, oral hygiene index, dental plaque index, salivary acidity level, dental and oral health education. .We suggest to future researchers to explore stunting as a variable related to the occurrence of caries because apart from caries they will focus on nutritional problems as well.

Acknowledgement
Appreciation is given to all parties who have helped collect data and select reliable articles and helped compile the results of the literature review obtained 6. Reference sikap anak kelas V terhadap terjadinya karies gigi di SD Negeri 131 Palembang. Harsyaf, C. C., & Yandi, S. (2018)