The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?

Objective: Many previously reported publications mentioned that oral lesion in COVID-19 patients was varied. The term oral manifestations refer to pathognomonic features that are found consistently with a specific cause and effect. In this context, the oral manifestation of COVID-19 was inconclusive. This systematic review aimed to analyse previously reported publications related to oral lesions in COVID-19 patients to define as oral manifestations or not. The PRISMA guidelines were implemented in this review. Methods: All umbrella reviews, systematic reviews, systematic reviews and meta-analyses, comprehensive reviews, and original and non-original studies were included. Twenty-one of systematic review, 32 original studies and 68 non-original studies reported the oral lesion in COVID-19 patients. Results: Most of the publications mentioned that ulcers, macular, pseudomembranes and crusts were frequent oral lesions. The reported oral lesions in COVID-19 patients did not show any pathognomonic features and might be unrelated directly to COVID-19 infections, however, more likely due to gender, age, underlying diseases, and medication. Conclusion: The oral lesions found in previous studies do not have pathognomonic features and are inconsistent. Therefore, the reported oral lesion, in present time, cannot be defined as an oral manifestation.

Oral Conditions as Risk Factors for Low Oral Health-Related Quality of Life Among the Elderly Population in Yogyakarta, Indonesia.

OBJECTIVE: Approximately 70% of the elderly population living in Yogyakarta, Indonesia, has a low oral health-related quality of life (OHRQoL). This study aimed to identify the risk factors for low OHRQoL in the elderly population of Yogyakarta. MATERIALS AND METHODS: Oral Hygiene Index Simplified (OHI-S), Community Periodontal Index, Decayed, Missing, and Filled Teeth (DMFT) Index, and the number of natural occluding pairs (NOP) were assessed for 153 participants aged ≥ 60 years. Xerostomia, hyposalivation, and OHRQoL were also examined using Xerostomia Inventory (XI), unstimulated spitting whole saliva collecting method, and Geriatric Oral Health Assessment Index (GOHAI) questionnaire, respectively. OHRQoL was categorized as low, moderate, and high. STATISTICAL ANALYSIS: Bivariate and multivariate tests were conducted to identify the risk factors for low OHRQoL. RESULTS: Initial analysis of characteristics of participants revealed that hyposalivation, xerostomia, periodontal pocket, high DMFT, NOP ≤ 5, poor OHI-S, and low OHRQoL were experienced by 40 (26.1%), 92 (60.1%), 39 (25.5%), 110 (71.9%), 112 (73.2%), 44 (28.8%), and 108 (70.6%) participants, respectively. Relative risk (RR) and p values for hyposalivation, xerostomia, periodontal pocket, high DMFT, NOP ≤5, and poor OHI-S were found to be at 1.573 (CI 0.681-3.637) and 0.225; 2.532 (CI 1.255-5.108) and 0.006; 0.846 (CI 0.391-1.830) and 0.606; 1.759 (CI 0.843-3.670) and 0.110; 1.133 (CI 0.522-2.461) and 0.008; and 2.723 (CI 1.293-5.734) and 0.632, respectively. Multivariate tests showed that xerostomia and NOP ≤5 had RR of 2.519 (CI 1.221-5.195) and 2.536 (CI 1.175-5.477), respectively. CONCLUSIONS: Overall, elders with xerostomia or NOP ≤ 5 had 2.5 times higher risk of having a low OHRQoL.

Induction of protein specific antibody by carbonated hydroxy apatite as a candidate for mucosal vaccine adjuvant.

Buccal mucosae are considered as a site for vaccine delivery since they are relatively abundant with antigen-presenting dendritic cells, mainly Langerhans cells. In this study, we formulated carbonated hydroxy apatite (CHA) with ovalbumin (OVA) (denoted as CHA-OVA), incorporated it into bilayer buccal membrane to form hydrogel films containing CHA-OVA complex for vaccination via buccal mucosae. Ethylcellulose blend with polyethylene glycol 400 were used as impermeable backing layer. Physical properties of all tested buccal membranes were found suitable for mucosal application. In vitro and ex vivo release study showed there was no burst release of OVA found from all tested formula. From the in vivo examination, rabbit buccal mucosae vaccinated by mucoadhesive membranes containing CHA-OVA complex demonstrated mucosal specific antibody induction, represented the potential of CHA as a candidate of needle-free vaccine adjuvant. Future research is awaiting to investigate proper CHA crystallinity in complex with protein against targeted diseases.

The Influence of Diode Laser Intensity Modulation on Photoacoustic Image Quality for Oral Soft Tissue Imaging.

Introduction: Imaging technologies have been developed to assist physicians and dentists in detecting various diseases. Photoacoustic imaging (PAI) is a new technique that shows great applicability to soft tissues. This study aimed to investigate the effect of diode laser intensity modulation on photoacoustic (PA) image quality. Methods: The prototype of the PAI system in this study utilized a non-ionizing 532 nm continuouswave (CW) diode laser illumination. Samples in this study were oral soft tissues of Sprague-Dawley rats fixed in 10% formalin solution. PA images were taken ex vivo by using the PAI system. The laser exposure for oral soft tissue imaging was set in various duty cycles (16%, 24%, 31%, 39%, and 47%). The samples were embedded in paraffin, and PA images were taken from the paraffinembedded tissue blocks in a similar method by using duty cycles of 40%, 45%, 50%, 55%, 60% respectively to reveal the influence of the laser duty cycle on PA image quality. Results: The oral soft tissue is clearly shown as a yellow to red area in PA images, whereas the nonbiological material appears as a blue background. The color of the PA image is determined by the PA intensity. Hence, the PA intensity of oral soft tissue was generally higher than that of the nonbiological material around it. The Kruskal-Wallis test followed by Mann-Whitney post-hoc analysis revealed significant differences (P<0.05) in the quality of PA images produced by using a 16%-47% duty cycle of laser intensity modulation for direct imaging of oral soft tissue fixed in 10% formalin solution. The PA image quality of paraffin-embedded tissue was higher than that of direct oral soft tissue images, but no significant differences in PA image quality were found between the groups. Conclusion: The PAI system built in this study can image oral soft tissue. The sample preparation and the diode laser intensity modulation may influence the PA image quality for oral soft tissue imaging. Nonetheless, the influence of diode laser intensity modulation is not significant for the PA image quality of paraffin-embedded tissue.

Influence of residential characteristics on the association between the oral health status and BMI of older adults in Indonesia.

OBJECTIVE: To assess the possible effects of residential characteristics on the association between oral hygiene and body mass index (BMI) of elderly people in Indonesia. METHODS: This cross-sectional study involved 186 participants (87 males, 99 females) aged ≥60 years who were randomly recruited from 8 community health stations for the elderly people. Dentition status, oral hygiene index (OHI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed in accordance with WHO guidelines. Salivary condition was assessed through the unstimulated whole saliva collection method. Education status and oral health behaviours were evaluated using a standardised questionnaire. BMI was calculated as weight in kilograms divided by height in metres squared. Participants were grouped in accordance with their OHI status (poor, moderate or good) combined with their residential characteristic (rural or urban) to assess the independent effect of OHI and residential characteristic on BMI through linear regression analysis with confounder adjustment. RESULTS: In the crude model of linear regression analysis, the poor OHI group is associated with low BMI regardless of their residential characteristic (rural/urban) when compared to the "good OHI, urban" group with P-values of .045 and <.01 and regression coefficients (ß) of -2.1 and -4.5, respectively. However, in the adjusted model, only the "poor OHI, rural" group showed a significant association with low BMI when compared to the "good OHI, urban" group (ß = -3.4; P < .01). CONCLUSION: Low BMI is significantly associated with poor OHI and rural residential characteristic among elderly people in Indonesia.

Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis.

BACKGROUND: Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA. METHODS: A full-mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 Indonesians with RA and 75 age-, sex-, and smoking-matched Indonesian controls. A validated questionnaire was used to assess smoking, body mass index, education, and medical conditions. In addition, in all participants, the use of drugs was noted, and erythrocyte sedimentation rates and serum levels of high-sensitivity C-reactive protein (hsCRP), rheumatoid factor, and anti-citrullinated protein antibodies were measured. Differences in periodontitis prevalence and 12 measures of periodontitis severity between patients with RA and controls were analyzed using univariate analyses. RESULTS: No significant differences in periodontitis prevalence and 11 measures of periodontitis severity between patients with RA and controls were observed. Conversely, patients with RA had a significantly lower surface area of healthy pocket epithelium versus controls (P = 0.008), and a tendency toward higher hsCRP levels was observed in patients with RA with severe periodontitis compared with patients with RA with no mild or moderate periodontitis (P = 0.063). It has to be noted that all patients with RA were on anti-inflammatory drugs, whereas none of the controls used such drugs. CONCLUSION: Prevalence and severity of periodontitis in Indonesian patients with RA is comparable to controls but with less healthy pocket epithelium than in controls and a tendency toward a higher inflammatory state in patients with RA and severe periodontitis.

Periodontal inflamed surface area and C-reactive protein as predictors of HbA1c: a study in Indonesia.

UNLABELLED: Periodontitis may exert an infectious and inflammatory burden, evidenced by increased C-reactive protein (CRP). This burden may impair blood glucose control (HbA1c). The aim of our study was to analyze whether periodontitis severity as measured with the periodontal inflamed surface area (PISA) and CRP predict HbA1c levels in a group of healthy Indonesians and a group of Indonesians treated for type 2 diabetes mellitus (DM2). A full-mouth periodontal examination, including probing pocket depth, gingival recession, clinical attachment loss, plaque index and bleeding on probing, was performed in 132 healthy Indonesians and 101 Indonesians treated for DM2. Using these data, PISA was calculated. In addition, HbA1c and CRP were analyzed. A validated questionnaire was used to assess smoking, body mass index (BMI), education and medical conditions. In regression analyses, it was assessed whether periodontitis severity and CRP predict HbA1c, controlling for confounding and effect modification (i.e., age, sex, BMI, pack years, and education). In healthy Indonesians, PISA and CRP predicted HbA1c as did age, sex, and smoking. In Indonesians treated for DM2, PISA did not predict HbA1c. Periodontitis may impair blood glucose regulation in healthy Indonesians in conjunction with elevated CRP levels. The potential effect of periodontitis on glucose control in DM2 patients may be masked by DM2 treatment. CLINICAL RELEVANCE: periodontitis may impair blood glucose control through exerting an inflammatory and infectious burden evidenced by increased levels of CRP.

Periodontitis prevalence and severity in Indonesians with type 2 diabetes.

BACKGROUND: The prevalence of diabetes mellitus type 2 (DM2) in Indonesia is high and still rising. Periodontitis is associated with DM2. No study has investigated this association in Indonesia, nor has any study investigated this association using a variety of methods to operationalize periodontitis. The present study compares prevalence and severity of periodontitis in patients with DM2 to healthy controls, using different methods to operationalize periodontitis. METHODS: A total of 78 subjects with DM2 and 65 healthy control subjects underwent a full-mouth periodontal screening assessing probing depth, gingival recession, plaque index, and bleeding on probing. Using these measurements, the prevalence and severity of periodontitis was operationalized in various ways. Differences in the prevalence and severity of periodontitis between subjects with DM2 and healthy subjects were analyzed using univariate analyses. In regression analyses, the prevalence and severity of periodontitis were predicted on the basis of DM2 presence, controlling for confounders and effect modification. RESULTS: Prevalence of periodontitis was significantly higher in subjects with DM2 compared to healthy subjects, showing odds ratios of 5.0 and 6.1. Likewise, periodontitis severity was significantly higher in subjects with DM2. CONCLUSION: Indonesian subjects with DM2 had more prevalent and more severe periodontitis than healthy Indonesian subjects, independent of confounding factors or the methods used to operationalize periodontitis.