Introduction

The Health is an investment to support economic development and has an important role in poverty alleviation efforts. The success of health development is largely determined by the continuity between program and sector efforts and the continuity with efforts that have been carried out in the previous period, including dental and oral health [1].

Dental and oral health is often the umpteenth priority for some people. The problem of cavities is still widely complained of by both children and adults and can’t be left to severe because it will affect the quality of life which causes high medical costs and reduced time to study at school, especially in school-age children [2].

School-age children are children who are considered to have begun to be able to take responsibility for their own behavior and begin to try to place themselves in the surrounding environment. The process of self-placement in the family, school, and neighborhood. So that parents are needed support in the process of growth and development of children in school [3].

The health and cleanliness of a person's oral cavity can be measured from an indicator called an index. An index to determine one's oral hygiene status, one of which is the Oral Hygiene Index Simplified (OHI-S), is obtained by measuring the debris and calculus covering the surface [4]. Based on 2018 Basic Health Research data, recording the proportion of the population covered brushing teeth every day is 94.7% while those who do tooth brushing correctly 2.8% [5].

The results of the examination Debris Index on 10 5th grade students at Pakis VIII Surabaya Elementary School showed that the average value of the debris index was 2.01. Based on the existing Debris Index standard, the dental and oral hygiene of grade 5 students at Public Elementary School Pakis VIII Surabaya is included in the poor category. The results of a preliminary study that was conducted with a questionnaire on December 16, 2019 related to 10 questions regarding the knowledge of brushing teeth to 10 5th grade students at Public Elementary School Pakis VIII Surabaya, obtained 26% of  the  total  students correctly answered the questions given. According to previous study, the category of a person's knowledge level, 26% included in the low category [3,4].        

Based on the description above, it can be concluded that students' knowledge is in the low category. it can be concluded that the problem in this study is the lack of knowledge of brushing teeth because 74% of grade 5 students at Public Elementary School Pakis VIII Surabaya do not yet know the right knowledge of brushing their teeth, so obtained poor oral hygiene.

The low percentage of tooth brushing knowledge is strongly influenced by several factors, namely the UKGS that is not running, counseling from health workers which is held once a year at Public Elementary School Pakis VIII Surabaya and the delivery of the counseling material in the form of lecture methods and has not provided intensive information related to how to teeth maintenance and implementation of proper brushing so students have not implemented activities to maintain dental health properly.

Realizing the importance of maintaining oral health needs to be done through health approaches to health promotion (promotive), one example is to provide a variety of learning using a medium both visual and audiovisual media. Visual and audiovisual media that can be used in this research are comic media and educational video media.

Comic media including visual media which are in accordance with the characteristics of 5th grade students at Public Elementary School Pakis VIII Surabaya who are fond of reading. The advantages of comics as a medium that can increase individual desires as learning motivation. The pictures presented in the comics play a role in stimulating the reader so they are interested in reading often. More flexible to carry and to read over and over. Messages are easier to convey so that they can be used as alternative learning. The advantages of educational video media are learning media that are audible and can be seen, which can help attract students' attention in capturing learning [3].

The ability of students to capture dental and oral health material using video extension media is greater than extension media flip chart. This is because the video medium has the advantage of being able to stimulate the motion effects that look more attractive and easier to stimulate the students' understanding [6].

Based on the description above, it is necessary to conduct research on the Effectiveness of the Use of Comic Media and Video Media on the Knowledge of Teeth Brushing of Students in Grade 5 at Public Elementary School Pakis VIII Surabaya. This research is expected to motivate students to maintain dental hygiene.

 Materials and Method

This type of research is a Quasi Experiment using a pretest-posttest design control group design. Using random sampling obtained a sample of 75 students, with a division of 25 students to a group experiment using the media of comics, 25 students for the experimental group using the media of video, and 25 students for the control group (without using the media). This study aims to compare the effectiveness of the use of comic and video media on the knowledge of brushing teeth of grade 5A and 5B students of Public Elementary School PAKIS VIII Surabaya. The data collection method used was a questionnaire. Data analysis used Paired T-test to determine differences in knowledge before and after counseling with comic media and video media, then using the Independent T-test to determine differences in students' knowledge about brushing their teeth with comic media and video media

Results and Discussion

The results of research on students of class 5A, 5B, and 5C SDN Pakis VIII Surabaya obtained as follow:

Table 1: Distribution of Respondents Based on the Age of 5th Grade Students at SDN Pakis VIII Surabaya

Based on Table 1, most of the respondents in the study were announced 11 years, 55 respondents (73.3%).

Table 2: Distribution of Respondents Based on the Gender of 5th Grade Students at SDN Pakis VIII Surabaya

Based on Table 2 : Most respondents were female, 38 respondents (50.66%).

Table 3: Average Pretest and Posttest Result of 5th Grade Students at SDN Pakis VIII Surabaya

Based on Table 3, an increase in the average value of students' correct answers before and after counseling using comic media, video media, and without media.

Table 4: Questionnaire Results Data Before and After Counseling of 5th Grade Students at SDN Pakis VIII Surabaya

Based on Table 4, an increase in the average value of student knowledge before and after counseling using comic media, video media, and without media (lecture method).

Table 5: Knowledge Analysis Before and After Counseling Using Video Media (Paired T-test)

Based on table 5 : Significant value is smaller than Sig. (Sig. <0.05), i.e. (0.00 <0.05), the knowledge before and after intervention is given, meaning that there is a significant difference between knowledge before and after counseling with comic media.

Table 6: Knowledge Analysis Before and After Counseling Using Video Media (Paired T-test)

Based on Table 6: Significantly value is smaller than Sig. (p <0.05), i.e. (0.00 <0.05), the knowledge before and after intervention is given, meaning that there is a significant difference between knowledge before and after counseling with video media.

Table 7: Knowledge Analysis Before and After Counseling Without Using Media or Lecture Method (Paired T-test)

Based on Table 7, the significantly value is smaller than Sig. (p <0.05), i.e. (0.00 <0.05), the knowledge before and after intervention is given, meaning that there is a significant difference between knowledge before and after counseling without using media.

Table 8: Analysis of Counseling Results Using Comic Media on Class 5A Student Knowledge and Counseling Results Using Video Media on Class 5B Student Knowledge (Independent t-Test)

Based on Table 8 the significant value is greater than the value of 0.05. (Sig.> 0.05), i.e. (0.365> 0.05) in knowledge of class 5A and 5B, meaning that there is no significant difference between the results of knowledge in class 5A and class.

School age is the ideal time to train a child's motor skills, including brushing teeth, brushing teeth requires knowledge so that these actions will be lasting. Knowledge is influenced by health promotion in the achievement of material using counseling media and counseling methods. One of the factors that influence knowledge is the presence of interesting media used to convey material, according to this study using comic media and video media.

Elementary school children are easily accessible targets because they are well organized and are an age group that is sensitive and easy to accept change. Primary school age is the ideal time to practice a child's motor skills, including brushing teeth. Fine and gross motor development are progressing towards progress. Therefore more children can be taught how to maintain oral and dental health in more detail, so that it will cause a sense of responsibility for cleanliness itself so that it can improve the degree of oral and dental health [7].

Based on data analysis results of the questionnaires pretest and posttest, in class 5A before being counseled with comic media get an average of 52 and after counseling to 75, class 5B before being given counseling with video media get an average of 50.75 and after counseling being 78.25, class 5C before being given counseling with the lecture method gained 44.75 and after counseling it became 68.5. Based on this statement, it can be concluded that video media is more effective than comic media. This is because video media has the advantage of being able to stimulate the effects of motion so that it looks more interesting and easier to provide understanding to students. Another study that supports this study states that the average score of students' knowledge before being given counseling using video is 8.35 which then increases to 16.47 after giving counseling using video [1].

This change is supported by the results of the Paired T-test, showing ρ value = 0.00 (ρ<0.05) meaning that there is a significant difference between knowledge before and after counseling with comic and video media. knowing the difference between comic media and video media is supported by the results of the independent T-test, showing that there is no significant difference between counseling using comic media and video media.

In this case there are many ways that can be done to minimize the lack of knowledge that can be applied to school-age children, especially students in grade 5 at Public Elementary School Pakis VIII Surabaya, namely the need for health efforts with a health maintenance approach according to the Republic of Indonesia Ministry of Health in 2009, one of them with health promotion is promotive [8].

Counseling is very important in maintaining the dental health of early childhood, parents and teachers to be applied in everyday life [9]. Counseling activities and mass toothbrushes can improve the knowledge and skills to brush teeth grade IV and V students in Kukuh Village, Marga District, Tabanan Regency [10]. It can be concluded that dental and oral health education is an effort or activity that can influence individual knowledge to have good dental and oral health behaviors so as to have good oral hygiene.

Conclusion

Based on the analysis of different tests, it is known that there are no significant differences, meaning that no there is an average difference between the results of counseling after using comic media and the results of counseling after using video media in grade 5A and 5B students of Public Elementary School Pakis VIII Surabaya. The difference in knowledge analysis after counseling using comic media obtained an average knowledge result of 12.00, while in the analysis of knowledge after counseling using video media obtained an average result of knowledge of 12.52. Based on this statement, it can be concluded that video media is more effective than comic media.