Background: Pomegranate (Punica granatum) fruits are commonly regarded as medicinal plant in Indonesia, and the polyphenols found in pomegranate juice (punicalagin and ellagic acid) have been shown to have antibacterial properties. Objectives: Using monospecies and multispecies biofilms, we sought to examine the effects of pomegranate juice on the viability of three periodontal pathogens: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Treponema denticola. Methods: Biofilm assays were performed using crystal violet. Pomegranate juice was obtained from pomegranates using a juicer, and the juice was then diluted into different concentrations with phosphate saline buffer. The three pathogens were cultured in both monospecies and multispecies plates. Pomegranate juice was then added to each biofilm well. These were then incubated for 1h, 6h, or 24h, after which the optical density (OD) of the biofilm mass was measured using a microplate-reader (490 nm). Biofilm without treatment was used as a negative control and 0.2% chlorhexidine gluconate as a positive control. Data were analyzed with a one-way ANOVA; the level of significance was set at p<0.05. Results: Compared to the negative control, biofilm mass was significantly decreased after treatment with pomegranate juice across all concentrations and incubation times, for both monospecies and multispecies abiofilm (p<0.05). The best results were achieved with P. gingivalis biofilm, with 100% concentration (OD 0.34 ± 0.03); A. actinomycetemcomitans, 50% concentration (OD 0.22 ± 0.01); and T. denticola, with 25% concentration (OD 0.87 ± 0.08), as well as with a multispecies biofilm with a 50% concentration in 1h incubation time (OD 0.09 ± 0.02). Conclusion: Pomegranate juice effectively inhibited the biofilm formation of P. gingivalis, A. actinomycetemcomitans, and T. denticola. Pomegranate juice may therefore be used as an alternative therapy in preventing periodontal disease. Additional research should explore this effect in an environment that mimics oral cavities.

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Background: Probiotic bacteria is commonly used as a food supplement intended to benefit the host by improving intestinal bacterial balance. Probiotics have also been investigated from the perspective of oral health. Objectives: The purpose of this study was to investigate the effect of daily intake of yogurt containing probiotic Bifidobacterium animalis subsp. lactis BB-12 (B. lactis) on salivary Streptococcus mutans (S. mutans) counts in patients undergoing fixed orthodontic treatment. Methods: Saliva samples were collected from each subject (n = 7; mean age, 21 years) using spitting method in centrifuge tubes at baseline and two weeks after daily probiotic yogurt consumption. B. lactis BB-12 and S. mutans ATCC 25175 were cultured in BHI-broth (37°C, anaerobic conditions). After 48 hours incubation, the number of colonies on each dilution plate was used to extrapolate a standard curve. The total number of target DNA molecules were identified using Real-Time PCR followed by SYBR Green reagents and 16S rRNA gene specific primers S. mutans and B. lactis BB-12. Data were analyzed statistically using paired-sample t-tests. Results: Statistical evaluation indicated that there was a significant reduction in the presence of S. mutans before probiotic yogurt consumption, (4.73 ± 1.43) log10 CFU/mL and after two weeks of daily consumption of probiotic yogurt, (4.03 ± 0.77) log10 CFU/mL, p = 0.001. Moreover, no B. lactis was found in the saliva of any of the subjects before probiotic consumption, but after two weeks of consumption, B. lactis was found in the saliva of four subjects. Conclusions: Consuming probiotic yogurt containing B. lactis reduced the quantity of S. mutans in the saliva of subjects during fixed orthodontic treatment. Thus, the probiotic bacteria could be beneficial in improving oral health.

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Background: Biofilms are involved in a wide variety of microbial infections, including dental caries and periodontitis. The use of probiotics has been a promising prevention and treatment modality with which to combat biofilm-related diseases in the oral cavity. The probiotic Lactobacillus reuteri has been proven to reduce gingivitis and plaque index inside the oral cavity. These bacteria can be found in the digestive system and also in the human oral cavity. Objective: The aim of this study was to identify L. reuteri in the saliva of Indonesian young adults. Methods: Forty saliva samples were collected from 18–24 year-old Indonesian subjects. DNA extraction was performed, and then, the identification of L. reuteri was accomplished using PCR. Six subjects showed positive results. The positive samples were cultured in Rogosa Agar for 24 hours at 37°C anaerobically. Several single colonies were further cultured separately in broth medium before DNA extraction and PCR identification were performed. The four thickest bands were selected for DNA sequencing. Results: An analysis performed using BLAST showed that two of the L. reuteri strains obtained from the Indonesian saliva isolates had 96% (isolate 3.11) and 95% (isolate 5.14) values. This confirmed the presence of new strains based on average nucleotide identity (ANI). The isolate strains of 3.11 and 5.14 have been registered at DDBJ/EMBL/GenBank under the accession number LC382415 and LC382416, respectively. Conclusion: L. reuteri novel strain can be isolated from the saliva of Indonesian young adults. Further studies involving biochemical tests and phenotypic analysis are needed to better understand these new L. reuteri strains.

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Background: Angiosarcoma is a rare malignant tumor, which most often occurs in the skin and soft tissue. Its occurrence in the head and neck region, and the intraoral region in particular, is uncommon. The aim of this case report is to highlight the importance of histopathological examination and to underscore the characteristic features of angiosarcoma. Case report: A 52-year-old female presented with a growth in the right maxillary portion of the interdental region of her molar teeth. The growth had been present for approximately one month. A computerized tomography (CT) scan showed metastatic tumors in the lungs, liver, bone, and soft tissue of maxillary gingiva. Intraoral examination found a soft and mobile pedunculated ovoid mass at the right palatal gingiva; the mass was reddish-blue in color. An incisional biopsy was performed to confirm the diagnosis and plan for further treatment. Histopathologic examination revealed malignant endothelial cells in a vasoformative growth pattern, with numerous vascular channels lined with neoplastic endotheliumforming intraluminal buds, projections, and papillae. These projections were interspersed with the tumor cells. Immunohistochemistry analysis showed these endothelial cells demonstrated strong positive immunoreactivity with CD31, factor VIII, and FLi-1. A diagnosis of angiosarcoma was made. Discussion: Because intraoral angiosarcoma is rare and its clinical presentation can resemble other vascular lesions, it can be a challenging diagnosis for clinicians and pathologists. In the present case, the diagnosis of intraoral angiosarcoma was made based on clinical and histopathology findings. The microscopic features of malignant endothelial cells and the presence of intraluminal projections, supported by positive immunoreactivity with CD31, factor VIII, and FLi-1, confirmed the diagnosis. Conclusion: Angiosarcoma poses a diagnostic challenge to dental practitioners and oral pathologists due to the rarity of occurrence in the oral cavity. Histopathological examination is critical for an accurate diagnosis.

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Background: Dentists often encounter patients with worn dentures that still feel comfortable even though the patients have lost the supporting tissue heights due to physiological and pathological resorption. Loss of denture retention, stability, and occlusal vertical dimension are most often caused by alveolar bone resorption. Dentures that are loose because of poor adaption to the supporting tissues should be relined. Chair-side procedures provide immediate resolution, avoiding the edentulous period of time accompanying laboratory relines. Case Report: A 70-year-old male edentulous patient came to the Prosthodontic Clinic, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia. The patient had been wearing the upper and lower dentures for approximately eight years. The patient had alveolar ridge resorption, which causes loss of retention, stability and vertical dimension. After the problems were thoroughly diagnosed and corrected, a chair-side denture relining with an open-mouth technique was used. Conclusion: Direct relining in a single visit helped the complete denture to regain its retentiveness, allowing for prolonged the use of the worn denture. It also adjusted occlusal vertical dimension to improve the occlusal support and esthetics.

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Background: Standard edgewise and preadjusted Roth are two bracket types widely used for orthodontic treatment. Whether one of these bracket types offers better treatment results than the other requires further evaluation. The Objective Grading System created by the American Board of Orthodontics (ABO) is one of the most reliable indices used to evaluate treatment outcomes. Objectives: To determine the effects of using two different bracket types on treatment outcomes by using the Objective Grading System. Methods: The sample for this study consisted of 64 randomly selected post-treatment dental casts and panoramic radiographs. Of these samples, 32 were treated with a standard edgewisebracket, and the others were treated with a preadjusted Roth bracket. Patient samples were included if they had nonextraction Class I malocclusion (minor crowding < 4 mm for both bracket types, ANB = 2° ± 2°), no history of dental trauma, complete teeth (except third molars), and no growth or development disturbances. All samples were evaluated using eight parameters of the Objective Grading System and statistically analyzed using Mann–Whitney and chi-squared tests. The score range for each tooth in each parameter was 0 – 2. Results: The total score was 19.00 ± 12.00 for the standard edgewise bracket and 15.00 ± 7.00 for the preadjusted Roth bracket, with no statistically significant differences between the two bracket types (p = 0.149). There were also no statistically significant differences in the scores of the eight parameters of the Objective Grading System between these brackets (p > 0.05). The highest score was found for the buccolingual inclination parameter, and the lowest score was for interproximal contacts. Conclusion: According to the Objective Grading System, there are no statistically significant differences between the orthodontic treatment outcomes obtained using a standard edgewise or a preadjusted Roth bracket.

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Background: The storage condition of a toothbrush can influence the growth of bacteria. Indonesia as a developing country has a low awareness of the importance of toothbrush hygiene. Thus, an efficient and economic toothbrush storage solution is needed. Objective: The aim of this study was to evaluate the effect of soaking toothbrushes in mouthwash solution on the total number of Streptococcus mutans and Fusobacterium on the toothbrush. Methods: Eighteen toothbrushes were provided to healthy individuals aged 19–23-years. For 1 month, each toothbrush was soaked in disinfectant solution (25 mL) for 20 min after brushing, with Group 1 using mouthwash and Group 2 using sterile tap water. The real-time polymerase chain reaction (PCR) method was used to evaluate the number of microorganisms on each toothbrush. The total number of DNA targets was identified using real-time PCR followed by SYBR Green reagents and 16S rRNA-gene specific primers for S. mutans and Fusobacterium. A paired sample t-test was used for statistical analysis, and the level of significance was set at P < 0.05. Results: There were significant differences in the total bacterial numbers of S. mutans and Fusobacterium on toothbrushes after soaking with mouthwash solution. The average scores (Log10-CFU/mL ± standard deviation) of the total bacteria (2.66 ± 0.39), S. mutans (1.21 ± 0.18), and Fusobacterium (10.35 ± 6.02) on toothbrushes in Group 1 were significantly decreased compared to the average scores of the total bacterial load (5.19 ± 0.41), S. mutans (2.71 ± 1.59), and Fusobacterium (18.96 ± 4.26) in Group 2. Statistical evaluation brought statistically significant difference of total bacteria numbers and S. mutans between Group 1 and Group 2 (P < 0.05). Conclusion: Soaking toothbrushes in mouthrinse solution reduce the total number of bacterial load, S. mutans, and Fusobacterium. Further studies are needed to explore the effects of mouthwash solution against other oral pathogens.

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Background: Enterococcus faecalis is the frequent cause of oral infections, such as periodontitis, infected root canals, and peri-radicular abscesses. Pineapple (Ananas comosus) fruit contains bromelain, one of proteolytic enzymes associated with several health benefits. Bromelain has been shown to promote healthy digestion, stimulate the immune system, improve cardiovascular conditions, and accelerate wound healing. Bromelain compounds possess antiinflammatory and anticancer properties and exhibit antibacterial activity. Objectives: To analyze the enzymatic activity of bromelain extracted from pineapple hump and investigate the antibacterial effect of bromelain against E. faecalis. Methods: Pineapple hump was dried and extracted with maceration technique. Further purification was obtained by ammonium sulfate fractionation, dialysis and ion exchange chromatography. Minimum inhibitory concentration (MIC) test using diffusion and dilution techniques tested the antibacterial activity of the bromelain extract towards E. faecalis. A one-way analysis of variance (ANOVA) test analyzed the significance of the differences in the E. faecalis inhibition zones after treatment with a range of bromelain extract concentrations. Differences were considered statistically significant if p < 0.05. Results: The specific activity of bromelain in the crude extract was 62.89 U/mg. Furthermore, bromelain activity using ammonium sulfate fractionation was 50.99 U/mg, dialysis was 54.59 U/mg, and ion exchange chromatography was 152.38 U/mg. The bromelain extract showed effective inhibitory and bactericidal activity against E. faecalis. The results of the inhibition test using a bromelain extract purified by ion exchange chromatography demonstrated that a concentration as small as 12.5% was effective in inhibiting the growth of E. faecalis (p < 0.05). Conclusion: The highest enzymatic activity of bromelain was found after purification with ion exchange chromatography. Bromelain exerted an antibacterial effect against a potent endodontic pathogen, but further studies are needed to explore this effect.

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Background: Pain is a common problem encountered after fixed orthodontic appliance placement. Pain from orthodontic treatment can come from ischemia, inflammation, and edema in the periodontal ligaments that were depressed. Objectives: To determine whether there are differences in the pain reduction associated with chewing gum, taking acetaminophen, and gargling green tea after fixed orthodontic appliance placement. Methods: This study is a quasiexperimentwith a controlled randomized post-treatment approach using 40 subjects. The subjects were consecutively selected and then randomly assigned into four equal groups: a group assigned to chewing gum, a group assigned to take acetaminophen, a group assigned to gargle green tea, and a control group. The level of pain was measured using a Visual Analogue Scale (VAS). A one-way ANOVA test was used to analyse differences between the groups. Results: The VAS scores of the chewing gum and acetaminophen groups were lower than the green tea and control groups. At 24 hours after fixed orthodontic appliance placement, only the chewing gum group reported a decrease in the amount of pain experienced. Overall, the chewing gum group reported the lowest pain scores compared to other groups. However, there was no overall statistically significant difference between the chewing gum and acetaminophen group (p>0.05). Additionally, there was no statistically significant difference in the amount of pain reduction experienced by the green tea group and the control group (p>0.05). There was a significant difference in the amount of pain reduction reported between the chewing gum or acetaminophen groups and the green tea group (p<0.05). Conclusion: There was no significant difference between chewing gum and taking acetaminophen in the amount of pain reduction experienced after fixed orthodontic appliance placement, but gargling with green tea was found to be significantly less effective in reducing pain. Because it has fewer side effects, chewing gum may be a more preferable alternative to taking acetaminophen to reduce pain after fixed orthodontic appliance placement.

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Background: Periodontal disease is common chronic adult condition. Antioxidants are present in the body fluid as protection against free radical. Uric acid is one of antioxidants that can be found in saliva. Moreover, the relationship among the antioxidant enzymes activities and clinical periodontal status were investigated. Objectives: The aim of the study was to observe uric acid level activities in the saliva of gingivitis and periodontitis patients. Methods: Six patients with gingivitis and six patients with periodontitis in Dental Hospital Trisakti University were included in the study. Clinical condition of each subject, the plaque index, and probing depth were determined. The salivary uric acid level was measured using the Folin-Wu method. Result: Salivary uric acid levels in the periodontitis patients with a mean ± SD 7.40 ± 0.31 (p = 0.004) were found to be higher compared to the gingivitis patients (mean ± SD = 6.84 ± 0.19). In addition, there were no significant differences in salivary uric acid levels between gender (p = 0.641). Conclusion: Uric acid levels in periodontitis patients were found to be higher than in gingivitis patients. Moreover, uric acid has more role on periodontitis than in gingivitis as an antioxidant agent.

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