Ratih Ariningrum
National Institute for Health Services and Technology Research, Ministry of Health

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ANALISIS PEMBIAYAAN PROGRAM KESEHATAN IBU DAN BAYI DI KABUPATEN/KOTA Aryastami, Ni Ketut; Ariningrum, Ratih
Buletin Penelitian Sistem Kesehatan Vol 10, No 3 Jul (2007)
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The Ministry of Health had set target it and obligatory for minimum health standard (KW-SPM) that has to be implemented in each district/municipality. Maternal and neonatal health (MNH) services is one of the services in district health system that has to be delivered by puskesmas to improve the maternal and neonatal health towards reducing the maternal and neonatal mortality. It was a cross sectional study on health policy and financing. The study was conducted in three districts/municipality, namely Badung District, Bali; Tanah Datar District, West Sumatera and Kupang Municipality in East NusaTenggara. Time of the study was February to November 2006. Results showed that the highest allocation of budgetting according to the district health competency was for basic health services, the preventions of communicable diseases, and nutrition program. Budget allocation for investation in maternal and neonatal health was relatively low, only 2-7%. except for Badung District that was 47.2%. The allocated budget for the basic health services has a similar pattern among theareas under study, except for Tanah Datar District, the proportion of operational costs for immunization seem lower than two other districts. There gap between budget allocation and budget necessity. The budget was hardly used to serve the community. Indirect budget, most of provided for staff trainings, building capacity, as well as facility improvements. Per capita allocation for MNH varied among the districts/municapality. Badung District got the lowest (Rp. 20,000) per capita allocation, albeit it had the highest fiscal capacity; meanwhile Tanah Datar District, the middle fiscal capacity had the highest (Rp. 47,000). Kupang Municipality. the lowest fiscal capacity had the middle per capita allocation, which was Rp. 40,000. According to the health services function, the proportion allocating for training was the highest, more than 70% (Kupang and Tanah Datar Districts), and basic health services achieving 50% of the budget was in Badung. In conclusion, budget allocation was varied among the districts, the proportion was burden to public administration and only small part for the operational. Of the total health budget, the highest proportion or 30-35% was financing to the MNH programs. Unfortunately, the allocalton was not so specified, distributed to other programs and tended for routine activites. Key words: Optimalization, budget allocation, maternal and neonatal health, financing.
STUDI KUALITATIF PENYELENGGARAAN PELAYANAN KESEHATAN IBU DAN BAYI SETELAH PENERAPAN KW-SPM DI KABUPATEN BADUNG, TANAH DATAR, DAN KOTA KUPANG Ariningrum, Ratih; Aryastami, NK.
Buletin Penelitian Sistem Kesehatan Vol 11, No 1 Jan (2008)
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The Ministry of Health had set targets and obligatoried for minimum health standards that have to be Implemented in each district/municipality. The maternal and neonatal health (MNH) services is one of services in the district health system that has to be delivered by puskesmas to enhance the maternal and neonatal health towards reducing the maternal and neonatal mortality. It was a cross sectional study health policy. The study was conducted in three districts/municipality, namely district of Badung, Bali; District of Tanah Datar, West Sumatera and Kupang Municipality in East Nusa Tenggara. February to November 2006. Every area had to make special strategy and specified activity priority to execute the policy on mother and baby healthy program. The roles of other and private sectors need continuality. Attainment of mother and baby healthy program activity year 2005 in general were still under the goals. Constraints to execute the policy on mother and baby healthy program had limitation on the quality and quantity of human resources, availibility of equipments, knowledgeof community concerning health was still lower, attention of local government was very limited on budget allocation; and also the expectation of community to soothsayer was high, especially in Municipality of Kupang and District of Tanah Datar. The other limitation was of training on mother and baby healthy program. The access of community to public health services is good enough. Network with the other sectors in general worked well. There were some areas faced coverage goals so high, that difficult to achieve pregnant mother visit coverage (4) and high referral. Target of coverage that were achieved better were the coverage diving birth by midwifes or healthy staffed midwifery compentency. There were some coverage needs re-socializing as definition, because of the difference perception between the right definition and the perception of health staffs on the coverage of neonatus visit and baby with BBLR. Key words: mother and baby healthy program, maternal and child health, district offices
HUBUNGAN PENGETAHUAN, SIKAP, DAN PERILAKU TENTANG KARIES GIGI TERHADAP INDEKS DMF-T PADA SISWA SD KELAS VI DI DAERAH KUMUH DAN TIDAK KUMUH KECAMATAN PENJARINGAN JAKARTA UTARA Ariningrum, Ratih; Indriasih, Endang
Buletin Penelitian Sistem Kesehatan Vol 9, No 4 Okt (2006)
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In Indonesia town people are being increase almost twofold. Than many people have to stay in the slum areas. The health of teeth and mouth service in health centres (puskesmas) is given toothache for low income people and specially for anxious people to toothache. The percentage of the toothache, pulpitis and periapical membrane diseases for people took the fourth rank from nine non contagious diseases at Kecamatan Penjaringan are 2.9% in 1999. The objectives of the research were to determine the relations of knowledge, attitude, and behavior aspect about dental caries with DMF-T index. The other objecllves were to determine the classification of slum and non­ slum areas regarding  the knowledge, attitude, and behavtor about caries on the elementary school students 6th class. Results by simple linear regression showed that DMF-T index were influenced by variables of knowledge (p = 0.041). Results by multiple linear regression showed that DMF-T index is influenced by variable of knowledge and attitude about dental (p knowledge = 0.010 and p attitude = 0.046). Results by t test proved there were the significant differences in the knowledge and attitude between elementary school students 6th class in the slum and non-slum area (p knowledge= 0.001 and p attitude= 0.029). Dental healthy of elementary school students 6th class were mfluenced by knowledge. If the variables of knowledge, attitude, and behavior were analyzed together, just variables of knowledge and attitude that influenced caries dentis (DMF-T index). The classification slum and non-slum areas influenced the knowledge and attitude of the students about dental caries.   Key words:  knowledge, attitude, practice, index DMF- T. slum and non-slum area
PERSEPSI DAN TANGGAPAN MASYARAKAT TERHADAP SISTEM KESEHATAN, JANGKAUAN DAN KUALITAS PELAYANAN KESEHATAN DI PUSKESMAS KABUPATEN BANYUASIN Tarigan, Ingan; Ariningrum, Ratih
Buletin Penelitian Sistem Kesehatan Vol 11, No 3 Jul (2008)
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This cross sectional study was conducted in Banyuasin District, South Sumatera Province. The general objective of the study is to assess the community perceptions on the health system responsiveness, access to services and quality of health care in Puskesmas. Data collection was conducting by exit interviews using structured instruments on 242 outpatients in selected Puskesmas and Focus Group Discussion in Petaling village. Interview was carried out to assess respondent perception in  4 dimensions: Good Public Image; Access to Health Services; Personnel Performance; and Client Preference. In general, most of Respondents were not satisfied with the health services in Puskesmas. The aspects which assessed not good were on physical performance of Puskesmas building and personnel performance. The effort to improve and maintain patient s satisfaction is should be continuously programmed in order to achieve good quality of health care in Puskesmas. Key words: quality, health service, perception and responsiveness
DETERMINAN PENYAKIT DIARE PADA ANAK BALITA DI PROVINSI NANGGRO ACEH DARUSSALAM, JAWA BARAT, NUSA TENGGARA BARAT, NUSA TENGGARA TIMUR, GORONTALO DAN PAPUA Ariningrum, Ratih; Sundari, Siti; Riyadina, Woro
Buletin Penelitian Sistem Kesehatan Vol 12, No 2 Apr (2009)
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Background: Diarrhoeal diseases become the second caused of death of the under-fives, the third in infant, and the fifth at all people in Indonesia. WHO indicated that every year an average of 100.000 children in Indonesia dead because of diarrhoea and Sub directorate of Diarrhoea, MOH indicated that about 301-347 per 1000 people still infected by diarrhoea from year 2000 up to 2003. Methods: This study analyzed the Basic Health Research data collected in 2007 to determine the prevalence, characteristic determinants including its Odd Ratio (behavioral, environmental sanitation, household characteristic, and specific condition of child), of the 20245 under-fives children in 6 provinces having diarrhoea prevalence above the 2007 national diarrhea prevalence rates (16.7%). (NAD: 27%, Gorontalo: 24%, NTB: 23%, NTT: 22%, Papua: 21%, and West Java: 18%). Results: The result showed that the highest prevalence of diarrhoea rates was found at the family with having lower level of percapita expenditure (kuintil 1 and 2); in mother who worked as a farmer/fisherwoman/labour and did not used latrine as well as lack of control for contamination of water available at home. The specific conditions of the under-fives that related to the increase prevalence of diarrhea are the existence of typhoid and measles, frequency of OPT immunization and over weight condition. The Odds of having diarrehea occurred in the under-fives having measles 1 month earlier (OR. 2.61) followed by the lack of control of the quality of the water condition available at home (OR 2.19), open water tank (OR 1.40), Defecate not in WC (OR1.36), Not receiving meales immunization (OR 1.37) and OPT immunization less than 3 times (OR 1. 19). It is concluded that to prevent diarrhea, it is important for children to have full coverage of immunization, to improve health behavior of mothers and children especially to wash hand before eating or preparing meals, and to improve housing condition and sanitation. For the next Basic Health Research data collection, it is recommended to improve quality of questions in order to get more specific information related to the childs habits and practices to prevent diarrhoea. Key words: diarrhea, determinants, behaviour, under-fives, basic health research
IDENTIFIKASI WILAYAH DENGAN PERMASALAHAN KESEHATAN ANAK BALITA DI PROVINSI JAWA TIMUR Indriasih, Endang; Ariningrum, Ratih
Buletin Penelitian Sistem Kesehatan Vol 14, No 1 Jan (2011)
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Background: Government Regulation no. 38 year 2007 about the distribution of governmental power between central, provincial and district/town was one reference for government. Despite of decentralization was expected to remain the relevance from the administration. Meanwhile, to view the performance or measured the success of development held by local districts, especially in the field of health has issued the Ministerial Regulation Rl No. 741/Menkes/Per/VII/2008 on Minimum Service Standards (SPM) in the Health Sector which is an effort to accelerate the achievement of the MDGs in 2015. Child health problems focused on the decline in mortality because even the trend was declining but the achievement is still rae from target, particularly the MDGs in 2015, either RPJPM or Minimum Service Standards (SPM). When in handling found of resource limitation, it is necessary to scale the priority to handle with the regional approach or program. The objective of the study is to know distribution areas and offers an alternative method of diagnosing the area of Children under 5 health problems so that it shows children under 5 priority areas. Methods: The data for this analysis from a survey called RISKESDAS 2007 with sample unit is children under 5. Variables used are; state of poor and malnutrition, the completed Immunization coverage, posyandu utilization, morbidity (diarrhea, pneumonia and TB), clean and healthy lifestyle. lack of clean water, lack of sanitation in the districts of East in Java. Results: This result is several thematic maps when it is overlay; find the two districts in the eastern part is relatively problematic area among the districts and other towns in East Java. Key words: Spatial analysis, children under 5 health, East Java
PROFIL KESEHATAN GIGI PENDUDUK USIA 12 TAHUN KE ATAS DI INDONESIA TAHUN 2007 Ariningrum, Ratih
Buletin Penelitian Sistem Kesehatan Vol 15, No 2 Apr (2012)
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ABSTRACT Background: The general objective of this study is to describe dental health condition of Indonesian aged 12 years or over using Basic Health Research 2007 data. The specific objective is (1) to determine the prevalence of dental caries among the study population based on their socio-demographic characteristics (2) to determine determinants of their dental health, (3) to determine magnitude of each determinant in term of Odds ratio and (4) to determine their DMFT - index. Methods: This is a combination of descriptive (estimatian and prevalence) study and analytic (using Odds ratio to describe relation between independent and dependent variable). In the year 2007, the provinces of highest prevalence of dental caries in lndonesia are Jambi, Bangka Belitung, Kalimantan Barat, Kalimantan Selatan, dan Sulawesi Utara. Results: Dental caries prevalence in urban (38%) is not far different from that in rural (35%). The same is true between men (37.4%) and women (35%). Rural community have caries risk 1,329 times more than urban community Woman have dental caries risk 2,186 times more than man. Non regular tooth brusher have caries risk 1,66 times more than the regular tooth brush er. Non filtered cigarette use increasing dental caries risk. Non filtered cigarette use increasing dental caries risk have caries risk 1,461 times more than non smoker. The last determinant that causing the level of caries after multivariate analysis test are the type of area, all the level of age, 26-44 years old, <::: 45 years old, education in senior high school and university, the habit use tobacco without filter, and man community Key words: people dental of health, DMFT-index, dental caries ABSTRAK Tujuan Umum analisis lanjut ini menentukan gambaran kesehatan gigi pada penduduk usia 12 tahun ke atas di lndonesia. Tujuan Khususnya adalah menentukan prevalensi karies gigi di tingkat provinsi pada penduduk usia 12 tahun ke atas di lndonesia, menentukan prevalensi karies gigi berdasarkan karakteristik sosiodemografi pada penduduk usia 12 tahun ke atas di lndonesia, menentukan determinan yang berhubungan dengan kesehatan gigi pada penduduk usia 12 tahun ke atas di lndonesia, menentukan besarnya determinan yang berhubungan dengan kesehatan gigi pada penduduk usia 12 tahun ke atas di lndonesia, menentukan besaran risiko (Odd Ratio) dari determinan yang berhubungan dengan kesehatan gigi pada penduduk usia 12 tahun ke atas di lndonesia, dan menentukan angka DMF- T pada penduduk lndonesia yang berumur 12 tahun ke atas di lndonesia. Desain analisisnya adalah deskriptif (estimasi prevalensi) dan analitik (hubungan variabel independen terhadap variabel dependen serta besaran risiko/OR). Beberapa provinsi yang menunjukkan prevalensi terbanyak pada tingkat keparahan karies sangat tinggi adalah provinsi: Jambi, Bangka Belitung, Kalimantan Barat, Kalimantan Selatan, dan Sulawesi Utara. Hasil analisis univariat mengenai tingkat keparahan karies gigi masyarakat di daerah perkotaan dan perdesaan, menunjukkan bahwa di kedua daerah tersebut prevalensi tertinggi adalah karies sangat rendah (perkotaan 38% dan pedesaan 35%). Tingkat keparahan karies gigi masyarakat di daerah perkotaan dan perdesaan, menunjukkan bahwa di kedua daerah tersebut prevalensi tertinggi adalah karies sangat rendah (perkotaan 38% dan pedesaan 35%). Hasil analisis bivariat berdasarkan karakteristik sosiodemografi menunjukkan bahwa penduduk yang tinggal di wilayah perdesaan berisiko untuk mengalami karies berat sebesar 1,329 kali dibandingkan penduduk yang yang tinggal di wilayah perkotaan. Perempuan lebih berisiko 2,186 kali dari pria untuk terjadinya karies berat. Orang-orang yang tidak teratur menggosok gigi mempunyai risiko menderita karies berat sebesar 1, 166 kali dibandingkan mereka yang teratur menggosok gigi. Penggunaan rokok/tembakau tanpa filter ternyata sangat memengaruhi kejadian karies berat. Mereka yang mempunyai kebiasaan tersebut berisiko untuk menderita karies berat sebesar 1,461 kali dibandingkan masyarakat yang menggunakan rokok/tembakau dengan filter. Determinan akhir yang berpengaruh terhadap tingkat keparahan karies gigi,   setelah beberapa kali dilakukan uji analisis multivariat, adalah: tipe wilayah, umur secara keseluruhan umur 26-44 tahun umur -: 45 tahun, pendidikan penduduk yang tamat SLTA dan pendidikan perguruan tinggi, penggun~an rokok/tembaka~ tanpa filter (5), dan penduduk laki-laki. Kata kunci; profil kesehatan gigi, indeks DMFT, karies gigi
STUDI KUALITATIF PELAYANAN KESEHATAN UNTUK KELOMPOK ADAT TERPENCIL (KAT) DI KABUPATEN KEPULAUAN MENTAWAI Ariningrum, Ratih; Sukoco, Noor Edi Widya
Buletin Penelitian Sistem Kesehatan Vol 15, No 3 Jul (2012)
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ABSTRACT Background: The Government has some intentions to increase the social welfare of Remote Indigenous Communities. Firstly, prevented the disintegration of social vulnerability Secondly, protected from economic and social exploitation. Finally, ensuring the rights and obligations as othercitizens outside the Remote Indigenous Communities. The research objectives are to know the operational policies which is applied to improve health services to Remote Indigenous Communities in Mentawai IsIan ds District; to determine targets and priorities of health programs for Remote Indigenous Communities; to determine the pattern of empowerment in health to Remote Indigenous Communities; to determine the constraints in carrying out the pattern of empowerment in health to Remote Indigenous Communities; to determine the mechanism of cooperation with relevant inter-sector; to determine patterns of health services to Remote Indigenous Communities. Methods: The research, which was designed as across-sectional, conducted in April-November 2009. The research was implemented in the Sub-District of North Siberut and South Siberut, Mentawai IsIan ds District. In each sub-disrict which was selected purposively, has 4 villages research area with criteria coastal habitat. Data were collected through in-depth interviews of several informants, namely Director of Remote Indigenous Communities (Ministry of Social Affairs); Head of Sub Directorate of the backward area, borderland, and the island; Head of District Health Office of the Mentawai Islands; Head of Social Services of the Mentawai Islands District; Head of North Siberut and South Siberut Sub Districts; Head of Community Health Center of North Siberut and South Siberut; midwifes of North Siberut and South Siberut; Head of selected villages; and one who responsible of auxiliary community health center. Results: The results shown as follow: firstly, operation al policies in remote areas are the same as non remote areas, but non remote areas receive more attention; secondly, health program priority is malaria eradication, patients treatment, immunization, monthly weighing (in posyandu), health and sanitazion, diarrhea, check up and services for pregnant women, expanding of auxiliary community health center programs, maternal and child health, mother delivery, treatment baby and children under five years, clean and safe drinking water; thirdly, most comm on diseases that encountered in Remote Indigenous Communities are fever, malaria, gastritis, diarrhea, headache, chikungunya, acute respiratory infection. Conclusion: Indeed, health services of the Remote Indigenous Communities have specificity in the Mentawai IsIan ds District. First of all, mapping problem is conducted by community health center. Then, the constraints are frequent earthquakes, bad weather, transportation, difficulty to carry out activities based on community empowerment. Finally, there are several NGOs working with government agencies. Suggestions, ln addition to fulfil! human resources needs for short term objective, health care should pay attention at posyandu program and other related activities. Key words: remote indigenous communities, mentawai isIandsABSTRAK Latar Belakang: Pemerintah perlu melaksanakan pembinaan kesejahteraan sosial untuk KAT supaya KAT tercegah dari kerentanan disintegrasi sosial, terlindungi dari eksploitasi sosial dan ekonomi, terjaminnya hak dan terlaksananya kewajiban warga KAT sebagaimana yang seharusnya diberikan dan dilaksanakan oleh seperti warga negara lainnya di luar KA T. Tujuan penelitian adalah mengetahui kebijakan operasional yang diterapkan untuk meningkatkan pelayanan kesehatan pada KAT di Kab. Kepulauan Mentawai, menetapkan program prioritas dan target program kesehatan bagi KAT, mengetahui pembentukan peta masalah kesehatan, menentukan jalannya pola pemberdayaan KAT di bidang kesehatan, menentukan kendala yang dihadapi dalam menjalankan pola pemberdayaan KAT di bidang kesehatan, menentukan mekanisme kerjasama dengan instansi lain yang terkait, dan menentukan pola pelayanan kesehatan KAT Metode: Penelitian dilaksanakan pada Bulan April-November 2009 secara cross sectional. Lokasi penelitian di Kabupaten Kepulauan Mentawai Provinsi Sumatera Barat, di 2 (dua) Kecamatan yang dipilih secara purpasif dan 8 (delapan) desa, 4 desa di kecamatan Siberut Utara dan 4 desa di kecamatan Siberut Selatan dengan lokasi dan kriteria inklusi habitat pinggiran pantai. Informasi didapatkan dengan wawancara mendalam (indepth interview) terhadap Direktur Pemberdayaan Komunitas Adat Terpencil (Kementerian Sosial), Kasubdit Pengembangan DTPK (Daerah Terpencil, Perbatasan, dan Kepulauan), Kadinkes Kabupaten Kepulauan Mentawai, Kadinsas Kabupaten Kepulauan Mentawai, Camat Siberut Utara dan Siberut Selatan, Kepala Puskesmas Siberut Utara dan Muara Siberut (Siberut Selatan), Bidan Puskesmas Siberut Utara dan Muara Siberut (Siberut Selatan), Kepala desa di desa-desa yang terpilih sebagai sampel, dan penanggung jawab pustu atau polindes yang terpilih sebagai lokasi sampel. Hasil: Hasil penelitian menunjukkan sebagai berikut: pertama, kebijakan operasional secara umum sama untuk daerah terpencil maupun daerah tidak terpencil, tapi yang diutamakan daerah terpencil; kedua, prioritas program kesehatan adalah pemberantasan malaria, pengobatan pasien, imunisasi, penimbangan bulanan (di posyandu), kesehatan dan sanitasi, diare, pelayanan kesehatan dan pemeriksaan bagi ibu hamil, ibu bersalin, pengobatan bayi dan balita, kebersihan air minum; ketiga, penyakit yang banyak diderita komunitas adat terpencil adalah demam, malaria, gastritis, diare, sakit kepala, ngilu tulang, dan infeksi saluran pernafasan akut (ISPA). Kesimpulan: Pelayanan kesehatan komunitas adat terpencil mempunyai kekhususan di Kabupaten Kepulauan Mentawai. Pertama, pemetaan masalah dilakukan oleh puskesmas. Kemudian, kendala yang dihadapi adalah seringnya kejadian gempa, cuaca buruk, kendala transportasi, sulit melaksanakan kegiatan yang berbasis pemberdayaan masyarakat. Terakhir, ada beberapa bentuk kerjasama dengan instansi pemerintah maupun LSM. Kesimpulan: Pemenuhan SDM dan peralatan, baik kuantitas maupun kualitas sangat diperlukan untuk peningkatan pelayanan kesehatan dalam jangka pendek. Untukjangka panjang, perlu diperhatikan mengenai pengembangan fungsi posyandu dan polindes, serta penanganan kasus rujukan. Selain untuk memenuhi kebutuhan sumber daya manusia untuk tujuan jangka pendek, perawatan kesehatan harus memperhatikan pada program posyandu dan kegiatan lainnya yang terkait. Key words: Komunitas Adat Terpencil (KAT), Kepulauan Mentawai
Kebutuhan Sarana Kesehatan Gigi dan Mulut pada Rumah Sakit Kelas B Non Pendidikan Andayasari, Lelly; Ariningrum, Ratih; Anorital, Anorital
Journal of Dentistry Indonesia Vol 11, No 2 (2004): August
Publisher : Faculty of Dentistry, University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1971.501 KB) | DOI: 10.14693/jdi.v11i2.649

Abstract

Improvement of human resources has the purpose of increasing the quality of service for patients in every treatment unit, which should be anticipated by the oral health unit in every hospital. Improvement of service quality can be obtained by increasing the number of dental units. Along with the increasing knowledge in the society, the need for special services as also expanding. This problem can be solved by increasing the number of specialists in dentistry through scholarships, provided for dentists with high achievements. The samples for this cross sectional designed research were taken from all non-educational class B government hospitals in Indonesia. The data were gathered by using questionaire and guided in depth interviews. The data were analyzed descriptively. The results showed that most hospitals have no completely with the dental unit is 78.8%. There are 14 hospital (42.4%) needs oral laboratory.
Studi Evaluasi Kebutuhan Pelayanan Kesehatan Gigi dan Mulut pada Rumah Sakit Kelas B Non Pendidikan Ariningrum, Ratih; Andayasari, Lelly
Journal of Dentistry Indonesia Vol 9, No 2 (2002): August
Publisher : Faculty of Dentistry, University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14693/jdi.v9i2.688

Abstract

The aim of the hospital development is to increase the quality, snatching, and efficiency accomplishment referral medic and referral healthy according to make a unity and also to increase and constant the hospital management. The development means to increase the quality attendance from the unit therapy in the hospital. The teeth and mouth healthy which are the part of all health, and one of the unit attendance therapy in the hospital. The increasing of the activities attendance the teeth and mouth healthy in the hospital is done by seeing the total of day working time working, time visiting, and also the attendance unit under the teeth and mouth therapy unit. Many kinds therapy attendance under the teeth and mouth therapy unit need to get attention too about the standard therapy in the mansion parts. Attendance illustration in the teeth and mouth therapy unit can be got by doing interview with the director of hospital and the teeth and mouth therapy chiefman.