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"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 435-438Heat Shock Protein (HSP) is a molecular chaperone that prevents stress induced aggregation of partially denatured proteins and promotes their return to native confimations when the condition is favorable. Asmolecular chaperones, the HSP protect protein structure and activity, thereby preventing disease, but they may contribute to cell malfunction if they are perturbed. In inracellular quantities and cellular localizalion of HSP was changed in response to anoxia/hypoxia, heat and oxidation, and in relation to pathological status. This review discuses the role of HSP in several human medical condition particularly in oral mucosa."

"Inflammasi neurogenik berperan pada penyebaran infeksi oral. Teori infeksi fokal rongga mulut telah diusulkan sejak awal 1900an, infeksi gigi menyebabkan berbagai penyakit sistemik. Namun, teori ini mulai ditinggalkan setelah banyak gigi telah dicabut tanpa memberikan hasil yang memuaskan. Penelitian terbaru membuktikan bahwa infeksi rongga mulut dapat menyebar secara sistemik. Walaupun demikian, penemuan terdahulu tidak dapat membuktikan bagaimana terapi periodontal “assisted drainage” (ADT), dapat mengurangi gejala migren dan asma dalam hitungan menit. Penelitian terkait interaksi keradangan imunogenik dan neurogenik yaitu mediator proinflamasi calcitonin gene-related peptide (CGRP), TNF-α dan vasoactive intestinal peptide (VIP) masih jarang dilakukan. Tujuan: Melakukan verifikasi penyebaran keradangan neurogenik mulut ke organ yang jauh setelah melakukan ADT melalui ekspresi CGRP, VIP dan TNF-α. Metode: 24 tikus wistar jantan disuntik intragingival dengan lipopolisakarida Porphyromonas gingivalis (PgLPS1435/1450). Setelah empat hari, 12 tikus diberikan ADT, kemudian semua sampel dikorbankan 40 menit setelah ADT. Ekpresi CGRP, VIP dan TNF-α dianalisis dengan imunohistokimia. Analisis statistik menggunakan ANOVA dilakukan untuk menganalisis perbedaan nilai ekspresi CGRP, VIP, dan TNF-α tiap kelompok uji. Hasil: Injeksi PgLPS meningkatkan CGRP, VIP an TNF-α walau tidak selalu bermakna pada kelompok kontrol. Ekspresi CGRP dan TNF-α menurun, tetapi ekspresi VIP meningkat pada kelompok ADT. Simpulan: Peradangan neurogenik terlibat dalam penyebaran keradangan rongga mulut ke seluruh tubuh yang dimungkinkan karena ADT mengurangi peradangan organ lain melalui stimulasi VIP.

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Focal infection theory proposed in early 1900’s stated that dental infection caused systemic disorders. Nevertheless, the theory was abandoned since large number of teeth were extracted with no satisfying result. Recent reports revealed that oral infections were able to spread systemically. However, there is no rationalization available toexplain how assisted drainage therapy (ADT), a periodontal therapy that could relief migraine and asthma within minutes. Oral neurogenic and immunogenic inflammation interaction involving pro-inflammatory markers such as calcitonin gene-related peptide (CGRP), TNF-α; and antiinflammatory vasoactive intestinal peptide (VIP) was still under investigation. Objective: To verify the spread of oral inflammation to distant organ after performing ADT by analysing CGRP, VIP and TNF-α expressions. Methods: Two different concentration of Porphyromonasgingivalis lipopolysaccharide (PgLPS1435/1450) was injected intragingivally into two groups of 12 Wistar rats. After four days, 12 rats were given ADT and all samples were subsequently sacrificed 40 mins after ADT. Immunohistochemistry analysis using CGRP, VIP and TNF-α on the nasal and bronchus tissue was performed. ANOVA was used for statistical analyisis of the difference between CGRP, VIP and TNF-α expression between experimental groups. Results: PgLPS injections slightly increased CGRP, VIP and TNF-α expressions in the control group. Rats undergone ADT had lower CGRP and TNF-α but higher VIP expressions. Conclusion: Neurogenic inflammation involved in systemic spread of oral infection. ADT was able to downregulate inflammation in distant organ posibly by stimulating VIP."

"Penatalaksanaan kasus pemfigus vulgaris pada pasien lansia dengan riwayat penyakit kronis. Pemfigus vulgaris (PV) adalah sekelompok penyakit vesikulobulosa yang dapat mengenai kulit dan membran mukosa. PV merupakan penyakit autoimun dengan karakteristik adanya ikatan antara autoantibodi IgG dengan desmoglein 3 pada desmosom. Lesi PV merupakan bula berdinding tipis yang timbul pada kulit dan mukosa yang terlihat normal. Bula pada mukosa oral sangat mudah pecah dan dan membentuk ulser. Terdapat beberapa faktor yang dapat mencetuskan PV meliputi faktor genetik, usia, pemakaian obat-obatan dan makanan. Tulisan ini melaporkan penatalaksanaan kasus yang diduga adalah PV yang terjadi pada lansia dengan riwayat penyakit kronis. Kasus adalah wanita berusia 75 tahun dengan riwayat adanya lesi bula di kulit sejak 2 bulan dan ulserasi oral yang menetap sejak 1 bulan yang lalu. Ulserasi terlihat ditutupi oleh lapisan fibrin dan erosif eritema pada mukosa labial, bukal, dan gingiva. Terdapat riwayat hipertensi, diabetes mellitus, hepatitis, dan trombositopenia. Diagnosis PV ditegakkan berdasarkan keluhan subjektif dan klinis yang dapat dibedakan dengan penyakit vesikobulosa yang lain. Kortikosteroid sistemik diberikan bersama hepato protektor, obat kumur, terapi suportif, dan krim bibir. Bula pada kulit dan ulserasi yang menetap pada mukosa oral adalah manivestasi PV. Pada pasien lansia ini keadaan sistemiknya membutuhkan penatalaksanaan yang lebih intensif dan komprehensif.

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Pemphigus vulgaris (PV) is a group of vesicobullous disease that affects skin and mucous membranes. PV is associated with autoimmune diseases, characterized by binding of IgG autoantibodies to desmoglein 3 on desmosome. The lesion of PV is a thin-walled bulla arising on the normal skin or mucosa. The bulla of oral mucous are more fragile and rapidly break down, forming irreguler ulcers. There are several factors that can trigger PV including genetic factors, age, drugs and food. The purpose of this paper was to report the treatment of suspected pemphigus vulgaris in elderly patient with history of chronic diseases. A 75-year-old woman with 2 months history of bulla formation on skin and about a month history of persistent oral ulceration. Ulcers were covered with fibrin and erosive erythematous on labial mucosa, buccal mucosa and gingival. The patient has a story of hypertension, diabetes mellitus and hepatitis. On routine complete blood count was found thrombocytopenia. Diagnosis was confirmed by anamnesis, clinical examination and complete blood investigation. It should be distinguished from other vesicobullous disease. Systemic corticosteroid therapy was given concurrently with hepato-protector, mouthwash, supportive therapy and topical lip cream. Bulla on skin and persistent erosive ulcers of the oral mucosa are the manifestations of PV. Elderly patient with history of chronic diseases is a complex care of PV and this require more intensive and comprehensive treatment."

"Mekanisme berkurangnya gejala rinosinusitis alergi setelah terapi assisted drainage. Rinosinusitis terutama disebabkan oleh virus dan alergi, serta akan sembuh dengan sendirinya tanpa antibiotik. Akan tetapi, antibiotik masih sering dipakai sebagai obat pilihan untuk rinosinusitis. Bila terapi konservatif gagal maka perlu dilakukan tindakan bedah. Selain alergi, keradangan neurogenik juga terlibat dalam rinosinusitis. Beberapa laporan kasus menduga bahwa gingivitis kronis memicu rinosinusitis dan suatu terapi yang disebut sebagai assisted drainage (ADT) dapat mengurangi gejala dalam hitungan menit. Terapi periodontal temuan baru tersebut merupakan pembersihan karang gigi yang disertai dengan pemijatan subgingiva, namun demikian mekanismenya masih perlu diverifikasi. Tujuan: Untuk melakukan verifikasi mekanisme kerja ADT dalam mengurangi gejala rinosinusitis dengan cepat. Metode: Studi eksperimental randomized control time series design dilakukan pada dua kelompok tikus Wistar. Sensitisasi alergi dilakukan dengan injeksi dan inhalasi ovalbumin (OVA). Gingvitis diinduksi dengan lipopolisakarida Porphyromonas gingivalis (PgLPS1435/1450) sintetis. Pada satu kelompok dilakukan ADT sebelum inhalasi dan kelompok lain tanpa ADT. Pemeriksaan jaringan hidung dilakukan dengan pemeriksaan imunohistokimia pada biomarker reaksi alergi (LTC4 dan ECP) serta keradangan neurogenik (CGRP dan VIP). Analisa data menggunakan ANOVA. Hasil: Beberapa menit setelah inhalasi OVA, ekspresi biomarker reaksi alergi dan keradangan neurogenik lebih rendah secara signifikan (p=0,001) pada tikus yang mendapat perlakuan ADT sebelum inhalasi dibandingkan tanpa inhalasi. Simpulan: ADT mampu secara signifikan mengurangi biomarker reaksi alergi dan keradangan neurogenik dalam hitungan menit, sehingga dapat diusulkan sebagai terapi ajuvan rinosinusitis alergi.

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Rhinosinusitis is mostly affected by viral infections and allergy and resolves without antibiotics usage. However, antibiotics are still frequently used as drug of choice for rhinosinusitis. If conservative treatments failed, surgical procedures had to be done. Neurogenic inflammation is involved in rhinosinusitis. Possibly because rhinosinusitisinduced chronic gingivitis successfully relieved by the “assisted drainage therapy” (ADT). This new periodontal therapy consists of scaling and root planing followed by subgingival massage. However, the mechanism had not been clearly verified. Objective: To verify the mechanism of allergic rhinosinusitis symptoms relief by ADT.Methods: Randomized control time series design experimental study was conducted in two groups of Wistar rats. Allergic sensitization was performed by injections and inhalation of ovalbumin (OVA). Gingivitis was induced by synthetic Porphyromonas gingivalis lipopolysaccharide (PgLPS1435/1450). One group was subjected to ADT before inhalation and another groups without ADT. Immunohistochemistry for biomarkers of allergic reaction (LTC4 and ECP) and neurogenic inflammation (CGRP and VIP) performed. Results: After OVA inhalation, allergic reaction and neurogenic inflammation biomarkers had significantly lower in rats subjected to ADT before inhalation than without ADT (p=0.001). Conclusion: ADT significantly decreased nasal allergic reaction and neurogenic inflammation biomarkers, therefore could be proposed as an adjunct therapy of allergic rhinosinusitis."

"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 215-220The purpose of this study was to disclose one of the etiopathogenesis of recurrent aphthous stomatitis (RAS) at molecular level by analyzing the expression of protein anomaly in oral mucosa. This was a cross-sectional explorative and analytic observational study. Samples, who met inclusion and exclusion criteria, were taken from total population. Samples of protein swab were obtained from oral mucosa, serum weretaken from 15 patients with major RAS, 20 patients with minor RAS and 15 were control. The characterization of protein anomaly expressed on the surface of oral mucosa epithelium was carried out using SDS-PAGE 12% and Westemblot methods. The result of oral mucosa protein anomaly expression analysis in patients with major RAS using SDS-PAGE 12% revealed five protein bands with molecular weights of 87,65, 30, 25, and 20 kDa. In minor RAS cases with protein anomaly expression there were four proteins with molecular weights of 87, 65, 25, and 20 kDa, and the protein in remission RAS had four proteins bands with molecular weight of 87, 65, 25 and 20 kDa. The band disappearances by using Westemblot test, of 30 kDa of major cases, 87 and 20 kDa of minor cases and 20 and 25 kDa of remission cases, indicated that those patients were not reacted with polyclonal antibodies of rabbit serum; therefore they had no role in the induction of RAS. ln conclusion, the antigenic protein expressed in oral mucosa of major, minor, and remission RAS was predominantly 65 kDa molecular weight."

"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV:239-242Oral squamous cell carcinorna ( OSCC ) is the most common malignant tumor of the oral cavity, and its account for 80-90% of all malignancies in oral cavity. The aim of this study was to detemine the presenceof p53 mutations and to associate these mutations with the histopathological type of OSCC such as well differentiated and poorly differentiated. Analitycal observational comparative study by cross sectional design was used. Forty untreated well and poorly differentiated OSCC biopsy sample and normal tissue biopsy material taken from 16 normal patients were analyzed for the presence of mutation in the conserved region of the p53 gene especially in exon 5 by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). The results of this study showed that p53 gene mutations were detected in exon 5; 11/40 (27,5%) with heterozygous mutation 9/11 (81,8%). The incidence in exon 5 of p53 gene mutation was significantly accociated with well differentiated 2/20 (l0%) and poorly diferentiated 9/20 (45%) OSCC(P=0,013). This study concludes that 1) mutation in exon 5 of p53 gene occured frequently in OSCC; 2) exon 5 of the p53 gene could be one of the the specific targets for histopathological grade of OSCC; 3) mutation in exon 5 of p53 gene could be important prognostic factor in OSCC."

"Selection of the whitening technique for tooth whitening in pediatric use should be based on the types of the stains and discoloration, and depth of the stains. if superficial, stains can be removed by microabrasion, but for deeper stains bleaching materials must be used. Use the bleaching materials or bleaching product should also be based on the concentration of active ingredient, the viscosity of the product, and tooth sensitivity."