Dewi Agustina

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.

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

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.

The Effect of Jamblang (Syzygium Cumini (L) Skeels) Leaves Ethanolic Extract on the Adhesion of Streptococcus Mutans to Hydroxyapatite

Streptococcus mutans plays an important role in the pathogenesis of caries. This bacterium has virulence properties involve in the formation of biofilm on tooth surface. Surface protein antigen peptide (SpaP) is one of the virulence properties of S. mutans that play role in adhesion of S. mutans to the tooth structure (hydroxyapatite). Due to its antibacterial effect, Jamblang leaves may be used as an agent to reduce the adhesion S. mutans to the tooth surface. This study proposed to examined effects of Jamblang leaves ethanolic extract on the adhesion of S. mutans to hydroxyapatite (HA). Streptococcus mutans was obtained by isolating the bacteria from carious lesion of pediatric patient. Identification of S. mutans was done by observe the characteristic of colony, carbohidrate fermentation test and biochemical test. Adhesion test was done by soaking blocks of HA in the mucine. The HA was immersed in bacterial culture that has been mixed with extract concentration of 15%, 20%, and 22.5%. Bacterial adhesion to the HA was vortexed for 60 seconds, spread on Muller Hinton Agar, and incubated for 48 hours. Colonies of S. mutans were counted. Aquadest was used as a negative control. Kruskall-Wallis test showed significant differences (p<0.05) among the groups, indicating that Jamblang leaves ethanolic extract decreased the adhesion of S. mutans to HA. The higher concentrations of the extract, the less number of S. mutans colonies adhered to HA. In conclusion, Jamblang leaves ethanolic extract reduces adhesion of S. mutans to HA. Keywords–extract Jamblang’s leaves, streptococcus

THE INFLUENCE OF NIFEDIPINE INDUCTION TO GINGIVAL EPITHELIAL CELL PROLIFERATION (in vivo study in rat)

It is well known that nifedipine administration in hypertensive patients results in gingival hyperplasia. The aim of this study was to study the pattern of nifedipine-induced gingival hyperplasia, based on morphometric and histogical changes as well as on PCNA (Proliferating Cell Nuclear Antigen) expression in the gingival epithelium. In total, 36 male Sprague Dawley rats at the age of 6-8 weeks were divided into nine experimental groups and three control groups. Each animal received daily DMSO (dimethyl sulfoxide) via oral intubation at a dosage of 0 (for control groups), 15, 30, or 60 mg/kg (experimental groups) of body weight for 7, 21 or 42 days. After the animals were sacrificed, impression of the lower gingival tissue was taken to measure mesio-distal distance, labio-lingual distance and papilla height. The number of blood vessels and the thickness of gingival epithelium were assessed from hematoxylin and eosin stained sections. Proliferative activity of the epithelial cells was determined by immunohistochemical analysis using PCNA monoclonal antibody. Significant increase in the mesio-distal and labio-lingual distance of the lower gingival tissue was detected morphometrically (p<0.05). There were more blood vessels in the experimental groups than in the control groups, however there was no specific pattern based on the dosage or duration of nifedipine administration. On the other hand, significant differences were found in the gingival epithelial thickness and proliferative activity between the experimental and the control groups. PCNA-positive cells were observed in basal and suprabasal layers, but nearly none in lamina propria.