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   Table of Contents - Current issue
Coverpage
May-August 2019
Volume 3 | Issue 2
Page Nos. 41-74

Online since Tuesday, June 18, 2019

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ORIGINAL ARTICLES  

Factors influencing hand hygiene among dental personnel at the outpatient clinic of a Tertiary Hospital in Indonesia p. 41
Sylvia Fatridha Situngkir
DOI:10.4103/SDJ.SDJ_6_19  
Background: Nosocomial infections are acquired during hospitalization, and they are strongly influenced by the healthcare workers' hand hygiene. Many factors can affect hand sanitation compliance, including healthcare worker's perception, profession, high workload, lack of time, access to hand washing materials, presence of skin irritation, team of healthcare workers, and knowledge regarding the importance of hand sanitation. Objective: The aim of this study was to determine the influence of individual factors (knowledge, perception, and profession), the availability of hand sanitation facilities, and the hand hygiene workload on the hand sanitation compliance among dental personnel. Method: This quantitative observational study involved 36 dentists and 14 dental hygienists at the outpatient dental clinic of the Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, from July 2013 to January 2014. The data were obtained via observation and questionnaires, and it was analyzed using univariate and bivariate analyses (Chi-square test) and a multivariate analysis with a logistic regression. Result: There were no correlations between the knowledge (P = 0.086) or profession (P = 0.181) and the hand sanitation compliance. However, significant correlations were found between the hand sanitation compliance and the individual perception toward hand sanitation (P = 0.000), availability of hand sanitation facilities (P = 0.000), and hand hygiene workload (P = 0.029). Conclusion: The factors that influenced the dental personnel's compliance to the hand sanitation procedures at the outpatient dental clinic were the availability of the hand sanitation facilities and the individual perceptions of the dental personnel. However, further research is needed to determine the level of hand sanitation compliance when using hand rubs and liquid soap.
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Comparison of microleakage on Class V composite restoration: Study on total etch, self etch and selective etch technique p. 47
Josephine Amanda Karnady, Anastasia Elsa Prahasti
DOI:10.4103/SDJ.SDJ_7_19  
Background: A Class V restoration with composite resin poses a number of challenges, which can result in microleakage. Methods for minimizing microleakage include the use of adhesive materials and adhesive systems. Adhesive systems include total etch, self-etch, and selective etch. Each adhesive system has various advantages and disadvantages. Therefore, in a Class V cavity with little enamel attachment, research is needed to compare microleakage in total etch, self-etch, and selective etch systems to determine the best adhesion system to achieve treatment success. Objective: The purpose of this study was to compare total etch, self-etch, and selective etch adhesive systems in Class V composite resin restorations. Method: Class V cavities on premolar teeth (n = 24) were prepared on buccal and lingual surfaces. The teeth were divided into three groups: total etch, self-etch, and selective etch. All the samples of 3 mm mesiodistal, 2 mm occlusal–gingival, and 2 mm deep were prepared using a high-speed round bur. After the preparation of the samples, all the teeth were restored using a flowable composite resin. All the restored samples were immersed in 2% methylene blue for 24 h. They were then sectioned in a buccolingual direction and observed under a stereomicroscope at ×10 magnification. The data were analyzed using the Kruskal–Wallis test and post hoc Mann–Whitney U-test (P < 0.05). Result: There were significant differences in microleakage among the groups. The total etch group had the least microleakage, followed by the selective etch and self-etch groups. Conclusion: The use of phosphoric acid (37%) in total etch and selective etch technique reduced microleakage in composite restorations.
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Inhibitory effect of probiotic lactobacilli against Streptococcus mutans and Porphyromonas gingivalis biofilms p. 50
Armelia Sari Widyarman, Endang Winiati Bachtiar, Boy Muchlis Bachtiar, Chaminda Jayampath Seneviratne
DOI:10.4103/SDJ.SDJ_8_19  
Background: Lactobacillus reuteri and Lactobacillus casei have been proposed as probiotic bacteria that promote oral health. Objectives: The present study aimed to evaluate the in vitro effects of L. reuteri and L. casei on the biofilm formation of major oral pathogens, Streptococcus mutans and Porphyromonas gingivalis. Materials and Methods: L. casei strain Shirota and L. reuteri ATCC 55730 were isolated from the commercial products and cultured in de Man, Rogosa, and Sharpe broth. Polymerase chain reaction was used to confirm the identity of the species. S. mutans ATCC 25175 and P. gingivalis ATCC 33277 were cultured in brain–heart infusion broth and used for biofilm formation on 96-well microplate platform. The biofilms were treated with the probiotics and appropriate controls in a time-dependent experiment from 15 min to 24 h. The biofilm biomass was evaluated using crystal violet and safranin. Results: The statistical analysis showed a significant reduction in the S. mutans and P. gingivalis biofilms after treatment with the L. reuteri and L. casei probiotics at all incubation times (P < 0.05). Conclusion: The present study demonstrated the potential antibiofilm activity of L. casei strain Shirota and L. reuteri ATCC 55730 against S. mutans and P. gingivalis biofilms in vitro. The foregoing data have formed a basis for future clinical studies to evaluate the beneficial oral health effect of probiotic Lactobacilli strains.
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Effectiveness of Eugenia caryophyllus in toothpaste against oral microbial in the saliva of healthy subjects in Indonesia p. 56
Rosalina Tjandrawinata, Armelia Sari Widyarman, Dewi Liliany
DOI:10.4103/SDJ.SDJ_11_19  
Background: Toothpaste is essential in the process of oral care. One of the components of toothpaste, Eugenia caryophyllus, might have an anti-inflammatory and antibacterial effect. Objectives: The objective of this study is to analyze the effectiveness of E. caryophyllus in the toothpaste against Streptococcus mutans, Lactobacillus, and total microbial load in the saliva of healthy subjects after toothbrushing using E. caryophyllus toothpaste. Methods: Saliva (n = 10, aged 18–25 years) were collected before and 2 weeks after toothbrushing using toothpaste-containing E. caryophyllus (Antiplaque, Triple-Ace, Indonesia). The total microbial load of saliva was determined by the measurement of colony-forming unit (CFU) number on brain–heart infusion agar, at 37°C, for 24 h, in anaerobic-condition. Real-time polymerase chain reaction technique was used to quantify the S. mutans and Lactobacillus deoxyribonucleic acid using SYBR green and 16S-rRNA gene-specific primers for S. mutans and Lactobacillus. Primers were 5'-ATTCCCGCCGTTGGACCATTCC-3' (fwd); 5'-CCGACAAAGACCATTCCATCTC-3' (rvs) and 5'-CTTGTACACACCGCCC GT CA-3' (fwd); 5'-CTCAAAACTAAACAAAGTTTC-3' (rvs) for S. mutans and Lactobacillus, respectively. Data were analyzed using t-pair test with P < 0.05 set as the level of significance. Results: The result showed that there was a significant reduction of total microbial load, S. mutans, and Lactobacillus number in the saliva after toothbrushing. The total microbial number in the saliva was significantly decreased before (5.84 ± 0.43 log CFU/mL) and 2 weeks after toothbrushing (5.27 ± 0.61 log CFU/mL) (P < 0.05). The number of S. mutans and Lactobacillus was also significantly decreased before (8.27 ± 0.11 and 2.34 ± 0.71 log CFU/mL) and after toothbrushing (8.18 ± 0.11 and 1.91 ± 0.25 log CFU/mL) (P < 0.05). Conclusion: E. caryophyllus toothpaste may reduce the number of total microbial, S. mutans, and Lactobacillus in the saliva of healthy subjects. Further studies are needed to explore this result.
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CASE REPORTS Top

Anxiety and clenching as contributing factors of recurrent aphthous stomatitis p. 61
Wiwik Mayanti, Febrina Rahmayanti, Siti Aliyah Pradono
DOI:10.4103/SDJ.SDJ_5_19  
Background: Recurrent aphthous stomatitis (RAS) is a common oral mucosa disease. Anxiety plays a role in the development of RAS, as it can lead to parafunctional oral habits such as bruxism (teeth grinding or jaw clenching) that may injure the mucosa, and this physical trauma can trigger ulceration in susceptible individuals with RAS. This case report describes the parafunctional oral habits caused by anxiety as the contributing factors of RAS. Case Report: A 17-year-old female came to the Dental Hospital, Faculty of Dentistry, Universitas Indonesia, with the complaints of ulcers at the lateral aspect of the tongue for 4 days since the tongue was bitten while she was sleeping. From the patient history, clinical evaluation, and investigation of the questionnaire, we detected a bruxism habit. We assumed that clenching was a contributing factor for the ulcers in this case. Intra-oral examination revealed two irregular ulcers of about 3 mm and 0.5 mm that were surrounded by erythematous halos and were yellow at the floors of the 46 and 36 teeth. The patient completed the Hospital Anxiety and Depression Scale and the Hamilton Rating Scale for Anxiety; the results of both were moderate anxiety. The management we suggested to the patient to control the anxiety was referral to a psychologist and an orthodontist; we gave chlorhexidine 0.2% to compress the lesions three times a day. Conclusion: Anxiety can produce a parafunctional oral habit that is a contributing factor of RAS. Coping with anxiety is needed to improve the clenching activity and RAS.
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Periapical bone healing following endodontic treatment on the right lower premolar p. 66
Lydia Tadjudin, Juanita Gunawan, Dina Ratnasari
DOI:10.4103/SDJ.SDJ_9_19  
Background: Acute exacerbation represents a painful condition whereby the tooth becomes highly sensitive to percussion and bite testing, and it can be aggravated by traumatic occlusion. In general, it results from earlier acute apical periodontitis. Bone destruction can be detected via a radiographic examination, and it can be seen as a radiolucent area at the periapex. Bone resorption is caused by osteoclast activation, which results from pulp inflammation. Nonsurgical endodontic treatment is typically performed to resolve the condition. This study aimed to provide an overview of both the treatment protocol and the role of 2% chlorhexidine gluconate as an endodontic irrigant. Case Report: A 38-year-old woman presented with a major complaint regarding tenderness in her lower second right premolar. The patient reported having experienced similar pain approximately 8 months previously. Clinically, the tooth had lost 50% of its coronal structure, which indicated a Class II cavity. Radiographically, bone resorption was detected in the periapical area of the tooth. An analgesic had been consumed for approximately 3 days. The cavity was cleaned and opened, and working length measurements were performed using an electronic apex locator and conventional radiography. Biomechanical preparation was done using ProTaper NEXTTM files, until size X3. Irrigation was performed using 5.25% sodium hypochlorite at each file change and continued with 17% ethylenediaminetetraacetic acid and 2% chlorhexidine for final irrigation. Sterile Aqua Dest was used for each irrigation change to avoid interaction between irrigants. Obturation was performed by means of warm vertical compaction with an epoxy resin-based sealer. An endocrown composite was recommended for permanent restoration. Four months of follow-up revealed bone regeneration and healing. Conclusion: Bone resorption is a common finding in a diseased tooth, and it stems from the persistent inflammatory process. Osteoclasts are responsible for both bone demineralization and activated pro-inflammatory cytokines. The correct endodontic treatment protocol plays an essential role in periapical bone healing.
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Pleomorphic rhabdomyosarcoma of the tongue in adult mimicking oral squamous cell carcinoma p. 70
Rahmi Amtha, Firstine Kelsi Hartanto, Walta Gautama, Haizal Mohd Hussaini
DOI:10.4103/SDJ.SDJ_10_19  
Background: Oral cancer is one of the sixth most common cancers in human, and oral squamous cell carcinoma (OSCC) is the most common type of oral cancer. The clinical appearance of OSCC may resemble other types of oral cancer such as rhabdomyosarcoma (RMS). The definitive diagnosis is crucial as the management and prognosis of both lesions are quite different. Case Report: A 42-year-old male presented with a unhealed painful ulcer of the posterior right lateral border of the tongue for about 4 months. Restricted mobility of the tongue and positive submandibular lymph nodes were detected. Wide excision with regional neck dissection was performed. Discussion: Pleomorphic RMS (PRMS) was identifed by immunohistochemistry of positive desmin and smooth muscle actin. The clinical presentation of the lesion is exactly similar to OSCC. PRMS is a rare type of high-grade sarcoma of the oral cavity. It usually occurs in the deep of lower extremities of adult on the six decade. Conclusion: Although the management of OSCC and RMS is almost alike, the ability of metastasis is salient compared to OSCC. Therefore, the definitive diagnosis should be careful due to its characteristic.
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