A Review of the Factors Associated with Periodontal Disease in the Elderly

The world’s elderly population is growing faster than other age groups. The World Health Organization states that in 2020, Indonesia’s elderly population will reach 11.34% of the total population, or around 28.8 million people. The increasing number of elderly people can be a challenge for clinicians due to the degenerative changes caused by chronic diseases, treatment of chronic diseases, systemic conditions, and oral health care accessibility. The purpose of this study was to analyze the factors that increase the risk of periodontal disease in the elderly. Over the last few years, a lot of research has focused on identifying the relationship between periodontal disease and systemic disease as well as the link between periodontal disease and aging. Increased age relates directly and proportionally with increased prevalence and severity of periodontal disease. Furthermore, an increase in age causes a decrease in motoric function and an increase in comorbidities and their treatments in the elderly. The aging process causes cementum surface irregularities, inhibition of osteoblast activity, and reduction in the number of fibroblasts. Loss of attachment and alveolar bone resorption was affected by frequent exposure to other risk factors. The risk factors that influence the development of periodontal disease in the elderly include systemic diseases, such as diabetes mellitus and osteoporosis, systemic conditions, such as obesity, metabolic syndrome, and stress, treatment of systemic diseases, and limited access to oral health care. Although the potential link between periodontal disease and systemic disease has been established, the extent of this relationship has not yet been clearly explained. Understanding the factors that influence periodontal disease in the elderly is important because it may provide a better understanding of the treatment. The multiple risk factors that cause periodontal disease in elderly patients require special attention involving multidisciplinary teams.

The Effectiveness Differences Between Watermelon (Citrullus lanatus) Extract 100% and Carbamide Peroxide Gel 10% in Tooth Whitening (ex vivo)

Introduction: Discoloration can be caused by intrinsic or extrinsic factors. One of the discoloration treatments is teeth whitening. Teeth whitening process usually uses chemicals such as hydrogen peroxide or carbamide peroxide which can cause side effects, namely gingival irritation. Previous research has found that malic acid in strawberries can whiten teeth. Watermelons contain greater malic acid than strawberries. Objective: To analyze the effectiveness of 100% watermelon (Citrullus lanatus) extract on teeth whitening. Methods: The study was a laboratory experimental study with a total of 15 anterior post-extraction teeth which were discolored using black tea, divided into 3 groups. Group 1 was immersed in 100% watermelon extract, group 2 was immersed in 10% carbamide peroxide as positive control and group 3 was immersed in sterile aquades as negative control, for 56 hours, measured using a shade guide and spectrophotometer. Data were analyzed using one way Anova. Results: The 100% watermelon extract was effective for teeth whitening. There was a significant difference between 100% watermelon extract compared to negative control (p < 0.05). However, there was also a significant difference between 100% watermelon extract, and 10% carbamide peroxide gel (p = 0.003). Conclusion: The watermelon extract has the ability as teeth whitening agent. However, further study is still needed to explore this result and determine the proper concentration for teeth whitening.

The Effect of Mouthwash Containing Alcohol on Flexural Strength of Polymethylmethacrylate and Thermoplastic Nylon

Introduction: Polymethylmethacrylate (PMMA) and thermoplastic nylon are materials used for making denture bases. Denture users use various methods in order to keep clean their denture. Mouthwash can be an option for cleaning dentures because it is easier to find. Objective: The objective of this research was to investigate the effect of mouthwash containing alcohol as a denture cleanser on flexural strength of polymethylmethacrylate and thermoplastic nylon. Methods: Eighteen samples of polymethylmethacrylate and eighteen samples of thermoplastic nylon with a bar shape (65x10x3 mm) are being used in this research. Each materials are randomly divided into 3 groups (n=6) so there will be six research groups incuded : (A1) PMMA immersed aquades, (A2) PMMA immersed in mouthwash containing alcohol 21.6%, (A3) PMMA immersed in mouthwash containing alcohol 9%, (B1) thermoplastic nylon immersed in aquades, (B2) thermoplastic nylon immersed in mouthwash containing alcohol 21.6%, (B3) thermoplastic nylon immersed in mouthwash containing alcohol 9%. Flexural strength of two materials was tested using universal testing machine (Shimadzu AGS - 5KNX, Japan). All of the data obtained were analyzed using two way Anova test. Result: The mean of flexural strength for group A1 (104.275 ± 15.469 MPa), A2 (103.298 ± 10.387 MPa), A3 (111.626 ± 14.957 MPa), B1 (42.707 ± 4.857 MPa), B2 (38.258 ± 3.246 MPa), and B3 (40.218 ± 1.542 MPa). Result of analysis showed that there was a significant differences between flexural strength of polymethylmethacrylate and thermoplastic nylon (p<0,05), but immersion in mouthwash containing alcohol showed no significant difference (p>0,05). Conclusion: This research found that flexural strength of polymethylmethacrylate higher than flexural strength of thermoplastic nylon and mouthwash containing alcohol can be an alternative for cleaning a denture because it does not affect the flexural strength of both material significantly.

The Effect Ant-Nest Plant (Myrmecodia pendans) Extract on Streptococcus sanguinis and Treponema denticola Biofilms

Introduction: Ant-nest plant (Myrmecodia pendans) contains triterpenoid, flavonoid, saponin and tannin that acts as antibacterial substance. Objectives: This study’s aim was to analyze the effect of Myrmecodia pendans extract effect towards biofilm of Streptococcus sanguinis and Treponema denticola. Methods: Ant-nest plant was extracted using maceration technique. The obtained extract was diluted into five different concentrations using phosphate buffer saline (PBS). S. sanguinis and T. denticola ATCC 35405 were cultured in Brain Heart Infusion (BHI) broth, 48h, 37°C, anaerobic atmosphere and distributed into four 96 well-plate for 24h to form biofilm. Subsequently, the extract was distributed into the well that contained the mono-species and multispecies biofilm and then incubated for 1h, 3h, 6h and 24h. Chlorhexidine (0.2%) was used as positive control and BHI broth was used as negative control. The biofilm was stained using crystal-violet and measured by microplate reader with a wavelength of 490 nm. Data were statistically analyze using one-way ANOVA test and Post Hoc LSD test which p < 0,05 was set as significant difference. Result: The most effective concentrations to reduce mono-species biofilm were 100% in 1h incubation period for S. sanguinis (OD = 1,403 ± 0,019) and 24h for T. denticola (OD = 1,012 ± 0,037) and multispecies biofilm (OD = 0,984 ± 0,001) compared to negative control. Statistical analysis showed that ant-nest plant extract significantly reduced S. sanguinis, T. denticola and multispecies biofilm mass compared to negative control (p < 0,05). Conclusion: The ant-nest plant extract has inhibitory effects against S. sanguinis and T. denticola biofilm and it may be used as alternative for dental therapy. Future studies are needed to evaluate the potential of ant-nest plant extract in multispecies composed of other oral bacteria.

Differences in Taste Sensitivity between Vegans and Non-Vegetarians in Palembang, Indonesia

Introduction: Many studies have shown that nutritional deficiencies can affect taste sensitivity. One group at high risk of nutritional deficiencies is vegans. Objective: The aim of the present study was to investigate the differences in taste sensitivity between vegans and non-vegetarians in Palembang, Indonesia. Methods: This was an observational analytic study with a quasi-experimental approach. A total of 60 subjects aged 21–45 years were included in this study. The subjects were divided into two groups: vegans (n = 30) and non-vegetarians (n = 30). Taste sensitivity was measured using the filter paper disc method. Five taste qualities (sweet, salt, sour, bitter, and umami) were tested using four different concentrations for each taste quality. The lowest concentrations identified correctly by the subjects were recorded as the taste sensitivity scores. The taste sensitivity scores were subsequently summed to form the taste scores. The data were analyzed using the Mann–Whitney U test. Results: The mean values of the sweet, bitter, and umami taste sensitivity scores and the taste score in the vegan group were lower than those in the non-vegetarian group. The mean value of the salt taste sensitivity score in the vegan group was higher than that of the non-vegetarian group, while the mean value in the sour taste sensitivity score was the same for both groups. There were no significant differences in the sweet, salt, sour, bitter, and umami taste sensitivity scores and taste scores of the vegan and non-vegetarian groups (p>0.05). Conclusion: The vegans and non-vegetarians in Palembang in this study have differences in taste sensitivity, but these results are not significant.

Functional Crown Lengthening: Biological Width Correction

Introduction: Functional crown lengthening is one of the most common surgical procedures that facilitating restorative treatment. It was done on teeth with inadequate clinical crowns in the presence of deep and subgingival pathologies. Inadequate clinical crowns defined as tooth with less than 2 mm cervico-incisal of sound. Case Report: The 32 years old female patient complained on broken restoration on upper left anterior tooth since one week ago. He also complained about upper right anterior tooth that turned brown. The tooth had received root canal treatment with direct composite restoration since 3 years ago, but the restoration on tooth 11 and 21 was broken. The remaining crown on tooth 11 and 21 was less than 2 mm. The periapical radiograph examination showed tooth 11 and 21 was non-hermetic obturation. Functional crown lengthening and root canal treatment was performed on teeth 11 and 21, with porcelain crown restoration and fiber post. Conclusion: Functional crown lengthening result affects the quality of post retreatment restoration. The success of functional crown lengthening is marked by no recurrent gingival hyperplasia after functional crown lengthening.

Degree of Acidity, Salivary Flow Rate and Caries Index in Electronic Cigarette Users in Sleman Regency, Indonesia

Introduction: The Yogyakarta Special Region ranks sixth for highest number of smokers of the 33 provinces in Indonesia. Smokers account for 31.6% of the total population. Sleman Regency ranks fourth in daily consumption of cigarettes of the five regencies or cities in Yogyakarta. The body part most exposed to direct cigarette smoke is the oral cavity. Saliva is a liquid secreted inside the oral cavity to act as a buffer. Nicotine content in conventional cigarettes is known to diminish the salivary flow rate and the acidity (pH) of the saliva. A continual decrease in saliva pH over time may cause dental caries. The use of electronic cigarettes is a nicotine replacement therapy (NRT) method to help people quit smoking; they emit a lower nicotine level than conventional cigarettes. Objective: The aim of this study was to evaluate the saliva pH, salivary flow rates, and caries index of electronic cigarette smokers. Methods: This study used a cross-sectional method to compare the saliva pH, salivary flow rate, and caries index of 30 smokers of electronic cigarettes and 30 non-smokers as a control group. Data were analyzed using SPSS version 22.0 software and considered statistically significant at p < 0.05. Results: The Mann-Whitney analysis showed a significant difference in the saliva pH between electronic cigarette smokers and non-smokers. Independent T-Test analysis showed no significant difference in the salivary flow rates of the two groups. The Mann-Whitney analysis also showed no significant difference in the caries index of the groups. Conclusion: Results indicated that there is a significant difference in the saliva pH of electronic cigarette smokers, while the salivary flow rates and caries indices of electronic cigarette smokers and non-smokers were similar.

The Effectivity of Tamarillo (Cyphomandra betacea Sendtn.) Decoction Against The Growth of Candida albicans

Introduction: Candida albicans is an opportunistic fungus that can become a pathogen which causes candidiasis when the condition of the oral cavity is imbalanced. Tamarillo (Cyphomandra betacea Sendtn.) is a low-fat and low-calorie fruit that has high nutritional value and provides a number of micronutrients, including vitamins, minerals, and chemical compounds, such as flavonoids, terpenoids, steroids, saponins, alkaloids, and tannins. The pharmacological effects of flavonoids, tannins, and saponins are antimicrobial and anti-fungal. Objective: This study was conducted to determine the effectiveness of a tamarillo (Cyphomandra betacea Sendtn.) decoction against the growth of Candida albicans. Method: The concentrations of tamarillo decoction used in this study were 6.25, 12.5, 25, 50, and 100%. This experimental laboratory study used the well diffusion method by measuring the diameter of the inhibitory zone. Nystatin and distilled water were used as the positive and negative controls, respectively. Results: Result showed that Tamarillo has antibacterial effect against Candida albicans. The decoction of 50% tamarillo was found to be the minimum inhibitory concentration on Candida albicans. Conclusion: Starting at a 50% concentration, tamarillo decoction is an effective growth inhibitor of Candida albicans. Hence, this natural product might be applied as an adjunctive therapy for oral candidiasis. However, further studied are still needed to confirm this result.

Overview of the Total Bacteria and Number of Streptococcus mutans in the Saliva of Children with High Caries Activity

Introduction: Microorganisms play a crucial role in the early stage of caries. Streptococcus mutans produces lactic acid, which enhances the risk of caries. Polymerase chain reaction (PCR) is a molecular biology technique used in the amplification and replication of DNA. PCR exhibits high specificity and a rapid detection time, as well as differentiation between microorganisms. Based on a previous study, there is a significant correlation between S. mutans in saliva and the prevalence of caries. Objectives: To provide an overview of the total bacteria and number of S. mutans in the saliva of children aged between 5 and 10 years at the Department of Pediatric, Faculty of Dentistry, Trisakti University, Jakarta, Indonesia. Methods: Saliva sample from children (n = 28, aged 5-10 years old) was collected from healthy children. 2-3 mL of a saliva samples were collected and cultured by using TYS media for total bacterial count. The number of S. mutans in the saliva of these children was counted by real-time PCR methods by using a fluorescence chemical compound green SYBR using 16S rRNA gene specific primers for S. mutans. Results: The average number of total bacterial colony count in saliva was 9.965 ± 2.078 log10 CFU/mL, and the average number of S. mutans in the saliva of children was 8.303 ± 2.351 log10 CFU/mL. Conclusion: The number of S. mutans in the saliva of children in Department of Pediatric, Faculty of Dentistry, Trisakti University was categorized is in the high-risk.

Mahkota Dewa (God’s Crown) Fruit Extract Inhibits the Formation of Periodontal Pathogen Biofilms in vitro

Introduction: Mahkota dewa (Phaleria macrocarpa) is an Indonesian fruit that contains antibacterial compounds, such as flavonoids, saponins, and tannins; it has been used as an alternative treatment for controlling infection. Objectives: This study aimed to examine the effect of mahkota dewa fruit extract on the formation of Porphyromonas gingivalis (P. gingivalis), Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), and Treponema denticola (T. denticola) biofilms in vitro. Methods: God’s crown fruit was extracted using the maceration technique, and then diluted into different concentrations (25%, 12.5%, 6.25%, 3.125%, and 1.56%) using phosphate buffered saline (PBS). P. gingivalis ATCC-33277, A. actinomycetemcomitans ATCC-29522, or T. denticola ATCC-35405 were cultured in brain heart infusion (BHI) broth, 24h (anaerobic-condition), and then each type of bacteria (108CFU/mL) was distributed into a 96-well microplate to form a biofilm. Subsequently, the fruit extracts were distributed into the biofilm-containing well plates and incubated for 1h, 6h, and 24h. A biofilm without the fruit extract and chlorhexidine-gluconate (0.2%) was used as the negative and positive control, respectively. Crystal violet (0.5%w/v) was used to determine the density of the remaining biofilm using a microplate spectrophotometer (600 nm). Data were statistically analyzed using one-way ANOVA, and p <0.05 was set as the level of significance. Results: The mahkota dewa fruit extracts significantly inhibited the formation of a biofilm for all three bacterial strains at all concentrations and for each incubation time (p <0.05) based on optical density (OD)±SD. The best concentration of fruit extract to inhibit biofilm formation was 25% for P. gingivalis (OD=0.19±0.06), 12.5% for A. actinomycetemcomitans (OD=0.14 ± 0.16), and 25% for T. denticola (OD=1.17±0.19) in comparison to the biofilm mass of the negative control, which was 1.67±0.06, 1.17±0.34, 2.66±0.38 for P. gingivalis, A. actinomycetemcomitans, and T. denticola, respectively. Conclusion: Based on these results, mahkota dewa fruit extract can inhibit the formation of biofilm on P. gingivalis, A. actinomycetemcomitans, and T. denticola, and it may potentially be used to prevent the infection associated with periodontal disease.