Diah Savitri Ernawati
Departement Of Oral Medicine, Faculty Of Dental Medicine, Universitas Airlangga

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The management of oral erythema multiforme in juvenile patient Diah Savitri Ernawati
Dental Journal (Majalah Kedokteran Gigi) Vol. 40 No. 4 (2007): December 2007
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (990.558 KB) | DOI: 10.20473/j.djmkg.v40.i4.p153-156

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Erythema multiforme is an acute inflammatory disease of the skin and mucous membranes that causes a variety of the skin lesionhence the name ‘multiforme’.The oral mucosa looks severely inflamed, but the feature are non specific and usually a biopsy is required in order to confirm the diagnosis. Cracked, bleeding, Crusted, swollen and ulcers of the lips is very characteristic of erythema multiforme, and lip involvement may cause significant morbidity. EM is assumed as an immune complex disorder which rises as a result of an immune response to an external agent such as herpes simplex virus or various drugs. We reported: 14-year girl, complained she suffered from painful oral ulceration for one week. One weeks advance the patient received a treatment of paracetamol and paramex for febris, headache and cough. Clinical examination of the skin showed no signs of cutaneous involvement. Other site such as the conjunctival, and genital were also free of lesions. The patients had several red-based superficial erosions on the upper and lower lips accompanied by crusting and bleeding. Intra oral findings showed multiple irregular erosions, ulcers and intense erythematous areas, mainly on the labial mucosa. The clinical diagnosis of EM was concluded by anamnesis and clinical appearance, with differential diagnosis of secondary herpes infection (herpes labialis) and pemphigus vulgaris. Systemic and topical corticosteroid therapy is frequently used to treat EM Although it may partially suppress the disease. Objective: This report explains and describes the management of patients with EM which may help dentists to determine an accurate diagnosis to avoid further complication and to give medical intervention to the disease. Conclusion: Early recognition of this disease may prevent delayed diagnosis and incorrect treatment.
RECURRENT APHTHOUS STOMATITIS RELATED TO PSYCHOLOGICAL STRESS, FOOD ALLERGY AND GERD Rina Kartika Sari; Diah Savitri Ernawati; Bagus Soebadi
ODONTO : Dental Journal Vol 6, No 1 (2019): July 2019
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.6.0.45-51

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Background: Recurrent Aphthous Stomatitis (RAS) is inflammation in oral mucosa characterized by recurrent single or multiple ulcers that usually affected in non keratinized mucosa. Etiology RAS is unknown but psychological stress, allergy, and gastrointestinal disease can be predisposing factors Case Management: A 23rd years old complained recurrent oral ulcer with free ulcer period for 3-5 days. The patient had a history of food allergy, GERD and psychological stress. Intraoral examination showed recurrent multiple ulcers in variation site of the mouth. DASS 42 screening showed high stress and high anxiety. Skin Prick Test showed positive allergy to kapok, beef, chicken, cow milk, white egg, duck egg, shrimp, cob fish, milkfish, chocolate, and peanut. Ulcers treated with nonsteroid antiinflammation Aloe Vera gel and stress management by reading assignment method.Discussion: Psychological stress altered the immune system so oral mucosa prone to inflammation, and make the history of GERD getting worse. Stress causes cortisol secretion that changes the imbalance of proinflammatory and antiinflammatory cytokines. Oral mucosa becomes more susceptible to hypersensitivity. In addition, stress decreased oral and esophageal mucosa resistance to GERDConclusion: RAS triggered by psychological stress, allergy, and GERD. Treatment of RAS is by elimination predisposing factors to prevent recurrence.
Human-leukocyte antigen typing in Javanese patients with recurrent aphthous stomatitis Diah Savitri Ernawati; Bagus Soebadi; Desiana Radithia
Dental Journal (Majalah Kedokteran Gigi) Vol. 43 No. 1 (2010): March 2010
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (392.658 KB) | DOI: 10.20473/j.djmkg.v43.i1.p26-30

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Background: Recurrent aphthous stomatitis (RAS) is a common oral disorder that despite extensive researches, the etiology of this phenomenon is still unknown. Because this phenomenon has been observed more often in families than in individual cases, genetic influence has been investigated in most researches. Purpose: The aim of study was to evaluate the association between human leukocyte antigen (HLA) and RAS in Javanese more precisely. Method: The analysis of HLA-A, and HLA-B in 85 Javanese RAS patients and 71 healthy control subjects, were performed by using the standard NIH microlymhocytotoxicity technique. Immunohistochemistry was performed for identification of HLA-DR and HLA- DQ antigen using monoclonal antibodies anti HLA-DR and DQ. Result: Our result revealed a close association between HLA-A9 and HLA-B35 RAS subject. A significant increase in the frequency of some antigens such as HLA-A9 (72,94%, p < 0,05;RR = 2,21), HLA-A24 (65,82%; RR = 1,24) and HLA-B35 in subjects with RAS was observed. Analysis with Immunohistochemistry HLA-DR, HLA-DQ is expressed on the surface of epithelial cells membrane of oral mucosa and macrophages in both major and minor RAS patients. Conclusion: HLA antigens are involved in susceptibility to RAS and the phenotypes were difference with other previous studies. HLA- linked genetic factors may play a role in the development of RAS.Latar belakang: Stomatitis aftosa rekuren (SAR) merupakan salah satu gangguan di rongga mulut yang paling sering terjadi. Fenomenapenyakit ini masih belum jelas dan masih membutuhkanpenelitian yang lebih lanjut. Faktor keturunan lebih sering daripada kasus individual. Pengaruh faktor genetik telah diteliti oleh beberapapeneliti. Tujuan: Tujuan penelitian ini untuk mengetahui adanya kaitan HLA dengan SARpada suku jawa secara lebih tepat. Metode: Analisis HLA-A, HLA-Bpada 85penderita RAS dan 71 penderita kontrol yang berasal dari suku Jawa dihitung dengan menggunakan teknik NIH Micro Lymphocytotoxicity. Teknik Imunohistokimia dilakukan untuk mengidentifikasi antigen HLA-DR, HLA DQ dengan menggunakan antibodi monoklonal HLA-DR & DQ. Hasil: Menununjukkan hubungan yang kuat antara HLA-A9 dan HLA-B-35 pada pasien SAR. Terdapat peningkatan yang signifikan dari beberapa antigen seperti HLA-A9 (72,94%, p < 0,05, RR = 2,21), HLA-A24 (65,82%, RR = 1,24) dan HLA-B35 pada pasien SAR yang di observasi. Analisis dengan Imunohistokimia tampak HLA-DR, DQ diekspresikan pada permukaan membran sel dan makrofag pada pasien SAR mayor maupun minor. Kesimpulan: Antigen HLA terlibat dengan kepekaan terjadinya RAS, dan fenotipnya berbeda dengan hasil penelitian sebelumnya HLA dan faktor genetik berperan penting pada terjadinya SAR.
The effect of musa acuminata stem in increasing macrophage and neovascular cells of healing process Apriasari, Maharani Laillyza; Puspitasari, Dewi; Rahayu, Retno Pudji; Ernawati, Diah Savitri
Padjadjaran Journal of Dentistry Vol 30, No 2 (2018): July
Publisher : Faculty of Dentistry Universitas Padjadjaran, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (838.226 KB) | DOI: 10.24198/pjd.vol30no2.18324

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Introduction: Musa acuminata stem has both of imunostimulatory and imunosuppressant effects that are influenced by their concentrations. The study aimed to analyze the effect of Mauli banana stem extract (EMBS) to increase the number of macrophage and neovascular cells in traumatic ulcer healing. Methods: Rattus norvegicus of male Wistar strain  were used  as model of traumatic ulcer. The left buccal mucous was biopsied, then used the histopathology method to find the number of macrophage and neovascular cells. Results: EMBS gel was effected when administered at a concentration of 37.5% because it significantly increased the number of macrophage and neovascular cells in traumatic ulcer healing on the 3rd day to 5th days. Conclusion:  It can be concluded that EMBS within concentration of 37.5% can accelerate ulcer healing through the increasing  number of macrophage and neovascular cells.
The correlation between exposure to cigarette smoke and the degree of mucosal epithelium-based dysplasia in Rattus norvegicus tongues Dorisna Prijaryanti; Diah Savitri Ernawati; Desiana Radithia; Hening Tuti Hendarti; Rosnah Binti Zain
Dental Journal (Majalah Kedokteran Gigi) Vol. 52 No. 4 (2019): December 2019
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v52.i4.p187-191

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Background: Cigarette smoke contains various carcinogenic substances such as polycyclic aromatic hydrocarbons and nitrosamines. These chemicals not only have the potential to damage DNA, but can also induce genetic mutations and activate genes that function during apoptosis. Thus, if the gene is dysregulated, it will cause cells to survive, proliferate and subsequently lead to the development of cancerous ones. Histologically, the carcinogenic process affecting the oral cavity starts with hyperplasia and dysplasia, followed by severe dysplasia then leading to invasive cancer and metastatic processes in other bodies. Purpose: This study aims to reveal the correlation between exposure to cigarette smoke and the degree of epithelial dysplasia evident in research subjects. Methods: This study used 27 samples of Rattus norvegicus tongue, divided into three groups, namely; a control group, a treatment group subjected to four weeks’ exposure to cigarette smoke, and a treatment group subjected to exposure lasting eight weeks. Each rat was placed in an individual chamber and exposed to smoke from 20 cigarettes introduced by a pump via a pipe for 7.5 minutes. The degree of epithelial dysplasia in each case was subsequently observed microscopically using HE staining technique. Results: Mild epithelial dysplasia increased by 0.82%, during the fourth week of exposure to cigarette smoke and by 2.99% during the eighth week. Similarly, moderate epithelial dysplasia rose by 5.29% during the fourth week of exposure and 5.99% during the eighth week. Severe epithelial dysplasia also increased by 2.2% during the fourth week of exposure and by 2.66% during the eighth week. Conclusion: The longer the exposure to cigarette smoke, the higher the degree of ensuing dysplasia.
Effects of sidestream tobacco smoke on P53 expressions in Rattus novergicus tongue epithelial mucosa Dian Angriany; Diah Savitri Ernawati; Adiastuti Endah Parmadiati; Hening Tuti Hendarti; Rosnah Binti Zain
Dental Journal (Majalah Kedokteran Gigi) Vol. 52 No. 3 (2019): September 2019
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v52.i3.p138-141

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Background: Smoking, both active and passive, has been widely recognised as toxic to the human body, since it induces several forms of cancer, including that affecting the oral cavity. Benzopyrene, the carcinogen contained in tobacco smoke, can even lead tocarcinogenesis which potentially affects the regulation of cell apoptosis in both active and passive smokers. Purpose: This study aims to investigate the carcinogenic effects of cigarette smoke on apoptosis of rat tongue mucosae through p53 expression. To determine the risk of malignant transformation through tumor suppressor genes in the apoptotic pathway. Methods: Rattus norvegicus subjects were divided into four groups, namely Treatment Group 1 exposed to sidestream cigarette smoke for four weeks (P1), Treatment Group 2 exposed to sidestream cigarette smoke for eight weeks (P2), Control Group not exposed to sidestream cigarette smoke for four weeks (K2), and Control Group (K) not exposed to sidestream cigarette smoke for eight weeks (K2). The exposure process was conducted using a smoking pump and alternating exposure. Four micron-thick sections of formalin were subsequently fixed together with paraffin embedded biopsy material from tongue mucosa of Rattus norvegicus. The tissue sections from the treatment groups were then analyzed immunohistochemically to compare the expressions of p53 and Bcl-2 proteins with those of the control groups. Results: The T-test results indicated statistically significant differences in the expressions of p53 between the 4-week control group (K1) and the 4-week treatment group (P1) (p=0.01, p<0.05) as well as between the 8-week control group (K2) and the 8-week treatment group (P2) (p=0.03, p<0.05). Conclusion: Exposure to cigarette smoke can induce changes in tumor suppressor genes and also affect the regulation of cell apoptosis, thus changing cell structure and leading to malignancy.
Expression Toll-like receptors in the oral mucosa of patients with recurrent aphthous stomatitis Diah Savitri Ernawati
Dental Journal (Majalah Kedokteran Gigi) Vol. 41 No. 1 (2008): March 2008
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (413.415 KB) | DOI: 10.20473/j.djmkg.v41.i1.p47-51

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Toll-like receptors (TLRs) have recently emerged as key receptors of the innate immune system. They recognize specific pathogenassociated molecular patterns initiating a host defence response. The oral mucosa epithelium encounters potential pathogens like bacteria and viruses in inspired air, and the discovery of TLRs on epithelial cells suggest that the epithelium has a role in the mucosal immune system. The aim of this study was to discover Recurrent Apthous Stomatitis (RAS) using etiopathogenetic molecular approach by observing the TLRs. Immunohistochemistry using monoclonal antibodies anti-TLR-2, TLR-3, TLR-4, TLR-5, TLR-7 and TLR-9 were used in this study. These antibodies are specific toward TLR on the surface of epithelial cells membrane and macrophages in patients with major and minor RAS. TLR was expressed on the surface of epithelial cells membrane of oral mucosa and macrophages in both major and minor RAS patients. TLRs was not expressed specifically in non-RAS patients. The results above showed indication, that functional TLRs expression by epithelial cells in oral mucosa had remarkable implication on natural immune response and disease pathogenesis. The expression of TLR was found in the oral mucous membrane on epithelial cells surface and macrophages patients with RAS.
The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis) Haryono Utomo; Indah Listiana Kriswandini; Diah Savitri Ernawati
Dental Journal (Majalah Kedokteran Gigi) Vol. 39 No. 4 (2006): December 2006
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (185.457 KB) | DOI: 10.20473/j.djmkg.v39.i4.p143-146

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In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox
Expression of CD133 in various premalignant and proliferative lesions Rahmi Amtha; Indrayadi Gunardi; Ferry Sandra; Diah Savitri Ernawati
Dental Journal (Majalah Kedokteran Gigi) Vol. 48 No. 2 (2015): June 2015
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (282.723 KB) | DOI: 10.20473/j.djmkg.v48.i2.p64-68

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Background: In Jakarta, oral squamous cell carcinoma (OSCC) usually detected in late stage with very low survival rate ofabout 1.1 years. OSCC may be preceded by premalignant lesion, so that early detection of the lesion may decrease the mortality rate due to oral malignancy. CD133 is a hematopoietic stem cell that play role in tissue regeneration, inflammation and tumor. Upregulated of CD133 was reported on tumor progression. Purpose: The aim of study is to determine circulating CD133 expression on premalignant (PML) and proliferative (PL) lesion. Method: Observational research was carried out on patients who seek treatment of PML and PL at Oral Medicine clinic. CD133 was taken from peripheral blood serum, examined using PCR. Data was analyzed by Chi square test. Result: 15 subjects (each of five subjects for PML, PL and control) consist of 40% male and 60% female. Age group of above 41 years old was most affected PML and PL (66.7%). Tongue is common site for oral lesion (40%). There is a significant different of circulating CD133 rate among all groups lesion (p=0.039). Conclusion: CD133 express differently in premalignant and proliferative lesions.
Fungal inhibitory effect of Citrus Limon peel essential oil on Candida albicans Iwan Hernawan; Desiana Radithia; Priyo Hadi; Diah Savitri Ernawati
Dental Journal (Majalah Kedokteran Gigi) Vol. 48 No. 2 (2015): June 2015
Publisher : Faculty of Dental Medicine, Universitas Airlangga https://fkg.unair.ac.id/en

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (180.332 KB) | DOI: 10.20473/j.djmkg.v48.i2.p84-88

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Background: Oral candidiasis is an opportunistic infections due to Candida albicans that often found in people with HIV/AIDS. Anti-fungi, polyne and azole, are used in the treatment of oral candidiasis, but often cause persistence and recurrence. Citrus Limon peel contains terpenoids capable of inhibiting the synthesis of ergosterol, a component of the fungal cell wall that helps to maintain cell membrane permeability. Essential oil derived from citrus limon peel, thus, is expected to inhibit the growth of Candida albicans. Purpose: This research was aimed to know how essential oil derived from citrus Limon peel can inhibit the growth of Candida albicans. Method: This research was a laboratory experimental research carried out in three phases. First, essential oil was made with cold pressing method, and then the concentration of 100% was diluted to 50%, 12.5%, 6.25%, 3.125%, 1.56% and 0.78%. A test was conducted on the culture of Candida albicans in Sabouraud broth, accompanied by control (+) and (-). Second, the dilution of essential oil was conducted to alter the concentration with inhibitory power, from the strongest one to the weakest one, and then it was tested on the culture of Candida albicans. Third, spreading was carried out from liquid culture to agar media in order to measure the number of colonies. Result: Candida albicans did not grow on media with 100% essential oil treatment, but it grew on media with 50% essential oil treatment. In the second phase, dilution of 100%, 90%, 80%, 70%, 60% and 50% was conducted. The growth of Candida albicans was found on the treatment media of 60% and 50%. On the agar media, the growth occurred in the cultured medium treated with 70%. Conclusion: The minimum inhibitory power of essential oil derived from citrus Limon peel against Candida albicans was in the concentration of 80%. Essential oil derived from citrus Limon peel has antifungal effect and potential as a therapeutic agent for oral candidiasis.