The Response of the Indonesian Dental Community to the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to assess the response of dental health care workers in Indonesia to the COVID-19 pandemic through (1) a countrywide web-based, questionnaire survey of their knowledge, attitude, and infection control (IC) practices during the pandemic and (2) a focus group discussion (FGD) on the latter aspects with infected personnel, as well as (3) archival data collection on the epidemiology of COVID-19 amongst dentists in Indonesia. METHODS: A questionnaire survey using a web platform was conducted in May 2020 using a simple random sample of 3586 dentists working in different regions of Indonesia. The questionnaire attempted to elicit their knowledge and attitudes towards COVID-19, implementing IC measures, and providing dental care during the outbreak. The questionnaire comprised sections assessing participants' knowledge, awareness, and IC practice. In this study, the data were subjected to analysis through descriptive statistics and one-way analysis of variance (ANOVA) with a predetermined significance level of <.05. The study's second phase involved an FGD with dentists who had contracted the disease to discuss the impediments they faced during dental practice. We collected data on the number of dentists with COVID-19 from May 2020 to March 2022. RESULTS: The questionnaire survey revealed that the dentists had a satisfactory understanding of COVID-19 spread and the IC measures required to curb disease spread in the dental clinic. Of note, some dentists lacked knowledge of the incubation period of 5 days (21.19%). The vast majority of the respondents (>80%) were aware of the nature of the SARS-CoV-2 virus. Community health centres and the personnel who served there were the most exposed health care providers. CONCLUSIONS: Results suggest that the vast majority of the dental care professionals in Indonesia had adequate knowledge and awareness of COVID-19. However, some aspects of practice need to be improved in IC and related aspects.

The Antibacterial and Antibiofilm Effect of Amoxicillin and Mangifera indica L. Leaves Extract on Oral Pathogens.

Objective: This study aimed to determine the antibacterial and antibiofilm effects of amoxicillin combined with extract of Mangifera indica L. leaves against Staphylococcus aureus and Porphyromonas gingivalis. Materials and Methods: This was an experimental laboratory in vitro study with a posttest-only control group design. An antibacterial test using the plate count method and an antibiofilm test using the microtiter plate biofilm assay method were conducted. The research samples comprised extract of M. indica L. leaves with a concentration of 100%; amoxicillin and extract concentrations of 3.125%, 6.25%, 12.5%, 25%, 50%, and 100%; and amoxicillin. Dimethyl sulfoxide served as a negative control and co-amoxiclav served as a positive control. Results: The combination of amoxicillin and the extract exhibited an antibacterial effect against S. aureus at a concentration of 12.5% and higher and more effective than co-amoxiclac P. gingivalis at a concentration of 3.125% and higher. In the antibiofilm test, the combination of amoxicillin and the extract at a concentration of 25% after 1 h of incubation and a concentration of 6.25% after 3 h of incubation inhibited S. aureus. The inhibition of S. aureus biofilms at a concentration of 100% after 24 h of incubation was as effective as that of co-amoxiclav. The extract at a concentration of 25% over the entire incubation period showed more potent inhibition against the P. gingivalis biofilm than co-amoxiclav. Conclusions: The ethanolic extract of M. indica L. leaves and the combination of amoxicillin and the extract have the potential to inhibit the growth and formation of S. aureus and P. gingivalis biofilms.

Pre-dental treatment screening in Indonesia during the COVID-19 pandemic: a questionnaire survey of dental practitioners.

BACKGROUND: Dental practitioners have a high risk of contracting COVID-19 during the treatment of patients because of exposure to airborne droplets. However, the application of pre-procedure treatment screening in dental practices in Indonesia varied during the pandemic. The purpose of this study was to investigate the use of updated pre-procedure dental treatment protocols and procedures among dental practitioners in Indonesia. METHODS: This study consisted of dentists registered as members of the Indonesian Dental Association who attended the Indonesian Dental Association webinar series in 2021. All the participants completed a questionnaire survey. The participants, who were from various regions in Indonesia, were granted password-protected access to a URL hosting the questionnaire. The questionnaire collected demographic information and contained questions on adherence to updated protocols and patient screening procedures, to which the respondents answered "Yes" or "No". For the analysis, the participants were divided into three groups based on the type of facility where they were employed: public (government) hospitals, private hospitals, or university hospitals (dental schools). A chi-square test was used to investigate the association between professional background and the implementation of updated protocols, including pre-procedure dental treatment screening. A value of P < 0.05 was considered statistically significant. RESULTS: The age range of the participants was 20 - 60 years. The participants worked in facilities in 32 provinces in Indonesia. In total, there were 5,323 participants (males: n = 829; females: n = 4,494). In terms of professional backgrounds, 2,171, 2,867, and 285 participants were employed in government hospitals, private hospitals, and dental faculties, respectively. Among 5,232 participants who implemented updated COVID-19 prevention protocols, 5,053 (98%) participants performed pre-surgery procedures Among 151 participants who did not implement updated COVID-19 prevention protocols, 133 (88%) individuals carried out pre-rinse procedures. CONCLUSIONS: Almost all the dental practitioners employed in government hospitals, private hospitals, and dental faculties in Indonesia performed pre-surgery patient screening procedures. There was an agreement between the dental professionals in all three settings on the need for COVID-19 pre-treatment screening procedures in dental practices during the COVID-19 pandemic.

The potential of reuterin derived from Indonesian strain of Lactobacillus reuteri against endodontic pathogen biofilms in vitro and ex vivo.

Objectives: Despite the use of common irrigating solution with antimicrobial properties, failed root canal treatment remains a significant problem in endodontics. In the present study, we examined the efficacy of reuterin derived from probiotic bacteria, Lactobacillus reuteri on the biofilms of major endodontic pathogens using ex vivo model of root canal infections. Methods: Biofilms of major endodontic pathogens namely Enteoroccus faecalis, Fusobacterim nucleatum, Porphyromonas gingivalis, and Candida albicans were formed on root canals of 60 human premolar tooth samples accordingly a standard protocol. Thereafter, teeth were treated with either 2.5 % NaOCl (positive control), various concentrations of reuterin (test-group) or sterilized-distilled water (negative control) in a time-dependent assay. The efficacy of irrigation was evaluated by a time-dependent assay at 5 min and 30 min after irrigation by colony-forming units assay. The findings were further confirmed by species-specific real-time PCR. Data were statistically analysed using one way ANOVA with a significance level of P < 0.05. Results: Reuterin isolated from L. reuteri was effective against E. faecalis, C. albicans, F. nucleatum, and P. gingivalis biofilms, with a concentration of 100 µg/mL being the most effective compared to the negative control (P < 0.05) and also showed similar efficacy when compared with NaOCl. Conclusion: Reuterin isolated from L. reuteri has ability to inhibit in vitro and ex-vivo biofilms of endodontic pathogens, namely E. faecalis, F. nucleatum, P. gingivalis, and C. albicans. Reuterin has potential as a root canal irrigating solution due to its antibiofilm activity. Further research is warranted to determine the potential of probiotic bacteriotherapy in root canal systems.

Characterization of Oral Veillonella Species in Dental Biofilms in Healthy and Stunted Groups of Children Aged 6-7 Years in East Nusa Tenggara.

Impaired development that causes stunting is one of the most common health problems in Indonesia. In particular, the highest number of cases of stunting in Indonesia was reported in the East Nusa Tenggara (NTT) province. Previous studies have shown a tendency for deteriorating oral hygiene in children with a poor nutritional status. In addition, a higher proportion of oral Veillonella has been reported in children with poor oral hygiene. However, the relationship between populations of oral Veillonella and stunting has not been studied before. Therefore, this study aimed to analyze the oral Veillonella profile in the dental biofilms of healthy and stunted children aged 6-7 years. The participants were 60 elementary school students in the Nangapanda District, Ende, NTT, Indonesia. In this study, real-time polymerase chain reaction was used to examine dental biofilm samples from the healthy (n = 31) and stunted (n = 29) groups. The results revealed that seven oral Veillonella species were found in all groups. However, the number of four oral Veillonella species significantly differed between the healthy and stunted groups: V. denticariosi, V. infantium, V. rogosae, and V. tobetsuensis. This is the first study to demonstrate a potential association between oral Veillonella species and stunting in children.

Reuterin Isolated from Lactobacillus reuteri Indonesian Strain Affected Interleukin-8 and Human Beta Defensin-2 on Pathogens Induced-HaCat Cells.

Probiotic Lactobacillus reuteri has positive effects on health through inhibiting pathogenic bacteria and the ability to reduce inflammation. This study investigates the ability of reuterin isolated from L. reuteri Indonesian strain for increasing mRNA expression of interleukin (IL)-8 and human beta-defensin (hBD)-2 gene by epithelial cells, after exposure to oral bacteria. L. reuteri isolated from Indonesian's saliva, and species was confirmed by PCR, using 16S rRNA specific gene. To produce reuterin, the isolate was mixed in glycerol-containing MRS broth. Reuterin molecule's weight was counted by SDS-PAGE. Streptococcus mutans ATCC-25175 and Porphyromonas gingivalis ATCC-33277 were put in water (80°C) for 30 min, and each killed bacterial (107 CFU/mL) was inoculated into HaCat cell line (105 cell/mL). Reuterin was added in different concentrations (100%, 50%, 25%, 12,5%) and different incubation time at 37°C, 5% CO2. RNA was extracted, and a reverse transcription procedure was performed to obtain cDNA. Subsequently, a quantitative PCR method was performed to analyse the transcription level of IL-8 and HBD-2 mRNA expressed by inflamed HaCat cells. All results were statistically analysed by ANOVA test. PCR assays showed that clinical isolates were L. reuteri. Quantitative PCR results showed reuterin decreased the expression of IL-8 and increased the expression of hBD-2 in all concentrations and time periods set in this study (p < 0.05). Reuterin isolated from L. reuteri Indonesian strain increased expression of human beta defensin-2 as antimicrobial peptide and may be useful in combating inflammation.

Short- term effect of probiotic Lactobacillus reuteri consumption on the salivary microbiome profile of subjects undergoing orthodontic treatment with fixed appliances.

Objective: This prospective clinical study aim was to analyze the effect of the probiotic Lactobacillus reuteri Prodentis lozenges on salivary microbiome of subjects wearing fixed orthodontic appliances. Methods: Saliva samples were collected prior to consumption and 14th-day post probiotic lozenges consumption (n=40, age 18-23). Oral hygiene index-score (OHI-S) and papilla bleeding index (PBI) were recorded. The salivary microbiome was profiled by next-generation sequencing using the V3-V4 region of 16S-rRNA. Microbial composition, diversity and taxonomic biomarkers were analysed in comparison to probiotic intervention and the clinical characteristics of the cohort using standard bioinformatics tools. Results: The diversity and bacterial community structures did not change significantly in salivary microbiome of periodontally healthy subjects during short-term probiotic intervention. Probiotic consumption correlated with reduction of OHI and PBI scores (50% reduction of scores, P<0.001). The reduction of clinical indices was evident in conjunction with significantly reduced abundance of oral pathogens, such as Porphyromonas pasteri, Treponema sp., Fretibacterium fastidiosum, Kingella oralis and Propionibacterium acnes. Conclusion: Short-term probiotic intervention helped maintaining good oral health in patients undergoing fixed orthodontic therapy. Although overall oral microbiome structure remained largely unchanged, a significant alteration in the abundance of health and disease-associated species highlighted the beneficial effect of probiotic.

Antimicrobial and Antibiofilm Activity of Cinnamon (Cinnamomum burmanii) Extract on Periodontal Pathogens-An in vitro study.

OBJECTIVE: The aim of this study was to analyze the antibiofilm effectiveness of cinnamon (Cinnamomum burmanii) ethanol extract against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in vitro. MATERIAL AND: METHODS: Phytochemical tests were done to identify the cinnamon extract active substances. Furthermore, a crystal violet biofilm assay was used to analyze biofilm detachment after treatment with different concentrations (15, 10, 7.5, 5, and 2.5%) of cinnamon. Biofilm turbidity was measured at 595-nm wavelength using a microplate reader. Additionally, MTT assay was done to analyze the toxicity level of cinnamon extract on fibroblast cells. STATISTICAL ANALYSIS: The obtained data were analyzed for normality using the Kolmogorov-Smirnov test. The differences between each group were analyzed using a one-way analysis of variance statistical test, with a significance level of p <0.05. RESULTS: The results showed that the ethanol extract of cinnamon contains active compounds of flavonoids, alkaloids, saponins, tannins, quinones, and terpenoids. MTT result showed the cinnamon extract to be nontoxic. The biofilm assay results showed that all cinnamon concentrations exhibited an antibiofilm effect against P. gingivalis and A. actinomycetemcomitans in all incubation time compared with a negative control (p <0.05). CONCLUSIONS: Cinnamon extracts were effective in inhibiting biofilm of periodontal pathogens. Cinnamon extract might be useful as an alternative therapy for periodontal diseases. Future studies are still needed to confirm this result in vivo to analyze the efficacy of this extract as mouthwash.

The Efficacy of High-Volume Evacuators and Extraoral Vacuum Aspirators in Reducing Aerosol and Droplet in Ultrasonic Scaling Procedures during the COVID-19 Pandemic.

OBJECTIVE: SARS-CoV-2 can be carried by aerosols and droplets produced during dental procedures, particularly by the use of high-speed handpieces, air-water syringes, and ultrasonic scalers. High-volume evacuators (HVEs) and extraoral vacuum aspirators (EOVAs) reduce such particles. However, there is limited data on their efficacy. This study aimed to determine the efficacy of HVE and EOVA in reducing aerosols and droplets during ultrasonic scaling procedures. MATERIALS AND METHODS: Three ultrasonic scaling simulations were conducted on mannequins: 1. saliva ejector (SE) was used alone (control); 2. SE was used in combination with HVE; and 3. SE was used in combination with HVE and EOVA. Paper filters were placed on the operator's and assistant's face shields and bodies, and the contamination of aerosols and droplets was measured by counting blue spots on the paper filters. STATISTICAL ANALYSIS: All data were analyzed for normality using the Kolmogorov-Smirnov test. The differences between each method were analyzed using a two-way ANOVA, followed by a posthoc test. The differences were considered statistically significant when p < 0.05. RESULT: Using HVE and EOVA reduced aerosols and droplets better than using SE alone or SE and HVE: the posthoc test for contamination revealed a significant difference (p < 0.01). The assistant was subjected to greater contamination than the operator during all three ultrasonic scaling procedures. CONCLUSION: The usage of HVE and EOVA significantly reduced aerosols and droplets compared with using SE solely. Using these techniques together could prevent the transmission of airborne disease during dental cleanings, especially COVID-19. Further studies of aerosol-reducing devices are still needed to ensure the safety of dental workers and patients.

Novel Indigenous Probiotic Lactobacillus reuteri Strain Produces Anti-biofilm Reuterin against Pathogenic Periodontal Bacteria.

OBJECTIVE: The aim of this study was to evaluate the effect of reuterin produced by a novel probiotic strain of Lactobacillus reuteri against periodontal biofilms. MATERIALS AND METHODS: L. reuteri LC382415 (an indigenous Indonesian strain) was cultured in Man, Rogosa, and Sharpe (MRS) agar in anaerobic conditions for 24 hours. To isolate reuterin, L. reuteri was suspended in 300-mM glycerol in MRS broth and incubated under anaerobic conditions for 3 hours, and the supernatant fraction was filtered. The presence of reuterin was confirmed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and its concentration was determined. The effect of reuterin on Porphyromonas gingivalis ATCC 33277 and T. denticola ATCC 35405 biofilms was evaluated using biofilm assays. Biofilms were formed by incubating bacteria in 96-well microplates for 48 hours. A dose-dependent experiment was performed with reuterin concentrations of 12.5, 25, 50, and 100 µg/mL on biofilms. The inhibitory effect was measured at 1, 3, 6, and 24 hours. The biofilm masses were measured at 490 nm. Statistical analysis was using one-way ANOVA. RESULTS: The SDS-PAGE assay confirmed the presence of reuterin (52 kDa) in the culture supernatant of the L. reuteri strain. Reuterin in a concentration as low as 12.5 µg/mL significantly inhibited single- and mixed-species biofilms (p < 0.05). CONCLUSIONS: This is the first study to demonstrate the promising effect of reuterin isolated from L. reuteri LC382415 against periodontal bacteria. Further studies are warranted to explore the mechanism of this active component.

Efficacy of Bioceramic and Calcium Hydroxide-Based Root Canal Sealers against Pathogenic Endodontic Biofilms: An In vitro Study.

Background: Complete eradication of root canal pathogens cannot be predictably achieved by chemomechanical preparation and root canal disinfection. Therefore, an obturation material that has superior antimicrobial activity and sealing ability is required to inactivate residual microbes and prevent them from reentering the root canal system. Recently developed bioceramic root canal sealers are hydraulic cement which form calcium hydroxide during the hydration process. Like calcium hydroxide sealers, they exert an antimicrobial effect by releasing hydroxyl ions and increasing the pH. Objective: The objective of this study was to evaluate and compare the antimicrobial activity of a calcium hydroxide-based sealer and two bioceramic sealers against Porphyromonas gingivalis, Enterococcus faecalis, and Candida albicans biofilms. Materials and Methods: The sealers were dissolved in sterile saline to obtain supernatants. Biofilm formation assays, colony counting, and real-time polymerase chain reaction (PCR) were performed to evaluate the antimicrobial activity of each supernatant. The data were analyzed using one-way analysis of variance. Results: All sealers exerted effects against all three microbial biofilms. The biofilm formation assays showed that the bioceramic sealers were more effective against P. gingivalis and E. faecalis biofilms. In contrast, colony counting and real-time PCR showed that the calcium hydroxide sealer was significantly more effective than the bioceramic sealers. All tests showed that the calcium hydroxide sealer was more effective against C. albicans, with the colony count and real-time PCR results showing statistically significant differences. Conclusion: The calcium hydroxide-based sealer was more effective than the bioceramic sealers in eradicating pathogenic root canal biofilms.

Casein phosphopeptide-amorphous calcium phosphate fluoride treatment enriches the symbiotic dental plaque microbiome in children.

OBJECTIVES: The dysbiotic oral microbiome plays a key role in the pathogenesis of caries in children. Topical application of casein phosphopeptide-amorphous calcium phosphate containing fluoride (CPP-ACP/F) is an effective treatment modality for children with caries (CC). Hitherto the mechanism by which CPP-ACP/F modules the oral microbiome in CC has not been investigated. The study aimed to examine the CPP-ACP/F effect on the dental plaque microbiome of children group with caries. METHODS: This preliminary prospective clinical cohort included 10 children with caries. The children received topical fluoride CPP-ACP/F once-a-week for one month. Plaque samples were collected before and after treatment and subjected to 16S rDNA-based next-generation-sequencing. Microbial composition, diversity and functional roles were analyzed in comparison to the clinical characteristics of cohort using standard bioinformatics tools. RESULTS: CPP-ACP/F treatment modulated dysbiotic oral microbiome towards healthier community as the higher proportion of Proteobacteria and certain microbial protective species were enriched following CPP-ACP/F treatment. Despite overall uniformity of community structure in children with caries between the groups, some bacterial species were differentially represented in a statistically significant manner between pre- and post- treatments. Three bacterial species were found to be predictive of strongly sensitive to the CPP-ACP/F treatment, marked by decreased abundance of Lautropia mirabalis and increased abundance of Gemella haemolysans and Schwartzia succinivorans. CONCLUSION: Within the limits of the current study, it could be concluded that the CPP-ACP/F varnish treatment modulated the microbial composition of the dental plaque microbiome towards symbiosis. These symbiotic changes may demonstrate the potential clinical significance of CPP-ACP/F varnish treatment.

Diversity of Oral Microbiome of Women From Urban and Rural Areas of Indonesia: A Pilot Study.

Objective: The studies on the influence of geographical and socio-economic factors on the oral microbiome remain underrepresented. The Indonesia basic health research (RISKESDAS) 2018, showed an increasing trend in non-communicable diseases compared with the previous report in 2013. The prevalence of diabetes, heart disease, hypertension, and obesity are reported to be higher in urban areas than in rural areas. Interestingly, non-communicable diseases were found to be more prevalent in women than men. This pilot study aimed to examine the oral health and oral microbiome derived from tongue samples of healthy Indonesian women from urban and rural areas. Methods: Twenty women aged 21-47 years old from West Jakarta, residents of DKI Jakarta (n = 10) as representative of the urban area, and residents of Ende, Nangapanda, East Nusa Tenggara (n = 10) as representative of the rural area were recruited for this pilot study. The participants were evaluated by the Simplified Oral Hygiene Index (OHI-S) according to the criteria of Greene and Vermillion and divided into three groups. High-throughput DNA sequencing was performed on an Illumina iSeq 100 platform. Results: The principal component analysis displayed a marked difference in the bacterial community profiles between the urban and rural localities. The presence of manifest was associated with increased diversity and an altered oral bacterial community profile in the urban women. Two bacterial taxa were present at significantly higher levels (adjusted p < 0.01) in the urban oral microflora (Genus Prevotella and Leptotricia) could account for this difference irrespective of the individual oral hygiene status. The linear discriminant analysis effect size (LEfSe) analysis revealed several distinct urban biomarkers. At the species level, Leptotrichia wadei, Prevotella melaninogenica, Prevotella jejuni, and P. histicola, show an excellent discriminatory potential for distinguishing the oral microflora in women between urban and rural areas. Further, using SparCC co-occurrence network analysis, the co-occurrence pattern in the dominant core oral microbiome assembly was observed to be specific to its ecological niche between two populations. Conclusions: This is the first pilot study demonstrating the characterization of the oral microbiome in Indonesian women in urban and rural areas. We found that the oral microbiome in women displays distinct patterns consistent with geographic locality. The specific characterization of the microbiota of Indonesian women is likely linked to geographical specific dietary habits, cultural habits, and socio-economic status or the population studied.

COVID-19 Vaccines in Indonesia: Knowledge, Attitudes, and Acceptance Among Dental Professionals.

Background: At the time of writing, the number of Coronavirus Disease 2019 (COVID-19) cases in Indonesia has exceeded 2 million. The COVID-19 pandemic has caused severe disruptions in and unprecedented challenges to healthcare systems, including the one in Indonesia. Healthcare professionals, especially dentists, have an increased risk of contracting the virus. Many dental professionals in Indonesia have been exposed to the virus through close contact with aerosols and droplets from the oral cavities of their patients and have subsequently become infected. The Indonesian government commenced its COVID-19 vaccination program in January 2021. It is necessary to achieve high COVID-19 vaccination coverage rates among health workers. However, immunizations are voluntary, and some healthcare workers may be reluctant to receive them. The aim of this study was to evaluate the knowledge, attitudes, and acceptance of dental professionals of COVID-19 vaccines. Materials and Methods: A cross-sectional study was conducted among dentists taking part in the Indonesia Dental Association webinar in June 2021. Google Docs was used to create an online questionnaire, which was disseminated to the participants at the end of the webinar. The questionnaire consisted of 15 questions developed after being reviewed by experts. The questionnaire collected demographic data (age, gender, location, and affiliation/institution) and data on the dental professionals' knowledge and acceptance of COVID-19 vaccines in Indonesia as well as their attitudes toward COVID-19 vaccines. The respondents selected one option (agree/neutral/disagree) in response to each statement in the questionnaire. For data analysis, the respondents were divided into three groups according to their professional activity/employment category: national hospital (GOV), private hospital (PRIVATE), or academic faculty in a dental school (ACADEMIC). The data were analyzed using descriptive statistics and expressed as frequencies and percentages. A chi-square test was used to investigate the association between professional activity and acceptance of COVID-19 vaccines. Results: In total, 779 dentists from 34 provinces in Indonesia completed the questionnaire. There were 646 (83%) females and 133 (17%) males, with an age range of 24-73 years. In terms of the distribution of professional affiliations, the respondents included 23 (3%) academics, 285 (36.5%) private hospital/private practice practitioners, and 471 (60.5%) national hospital practitioners. In the statistical analysis, unadjusted odds ratios (ORs) were calculated with their 95% confidence intervals (CIs). Conclusions: Acceptance of COVID-19 vaccines is an essential determinant of vaccine uptake and the likelihood of controlling the COVID-19 pandemic. There is agreement between dental professionals in private hospitals and academic faculties (dental school) regarding the need for COVID-19 vaccination. Developing strategies to reduce public hesitation and increase trust is vital for implementing vaccination programs, and dentists can play a role in increasing the uptake of COVID-19 vaccines.

COVID-19 Awareness Among Dental Professionals in Indonesia.

Background: The COVID-19 pandemic caused by SARS-CoV-2 has claimed thousands of lives worldwide. To enhance knowledge and awareness of COVID-19, considerable online resources have been made available, including aspects related to the dental profession. The study aim was to examine the knowledge, perception, and attitude of dental professionals in Indonesia toward COVID-19. We conducted a survey via a questionnaire created using Google docs and distributed to 632 members of the Indonesian Dental Association in the context of a webinar hosted by the Indonesian Oral Biology Association on first June, 2020. Materials and Methods: The questionnaire consisted of 17 items pertaining to demographic data, knowledge and virus identification, awareness regarding drugs commonly used in dentistry during pandemic and research opportunities. Participants were asked to complete the questionnaire after the webinar by choosing one answer to each question. For the analysis, participants were divided into three groups according to their professional background i.e., employment at national hospital, private hospital, or academic faculty. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. The chi-square test was used to investigate the association between professional activity and the level of knowledge, perceptions, and attitudes about COVID-19. Results: Sixty percent of the participants correctly identified the pathogenesis of the disease. This knowledge was not associated with their professional affiliation (p = 0.95). Sixty-seven percentage had comprehensive knowledge about virus detection methods. This knowledge was not associated with their affiliation either (p = 0.54). Questions regarding drugs of choice, prevention, and the spread of COVID-19 were correctly answered by 89, 96, and 82% of the participants, respectively. Knowledge of these aspects were significantly associated with the professional affiliation (p < 0.05). All respondents were optimistic regarding research opportunities (p < 0.01). Respondents from academics were more interested in joining COVID-19-related research projects with governmental institutions (p < 0.01). Conclusion: Knowledge and awareness of COVID-19 among Indonesian dentists are reasonably good. However, further improvement would be beneficial to manage patients during this pandemic. As the number of COVID-19 cases continue to rise in Indonesia, it is important that dentists keep abreast of the updated knowledge on this moving field. Dentist knowledge on infection control should be strengthened through continuous educational programs.

Multi-omics tools for studying microbial biofilms: current perspectives and future directions.

The advent of omics technologies has greatly improved our understanding of microbial biology, particularly in the last two decades. The field of microbial biofilms is, however, relatively new, consolidated in the 1980s. The morphogenic switching by microbes from planktonic to biofilm phenotype confers numerous survival advantages such as resistance to desiccation, antibiotics, biocides, ultraviolet radiation, and host immune responses, thereby complicating treatment strategies for pathogenic microorganisms. Hence, understanding the mechanisms governing the biofilm phenotype can result in efficient treatment strategies directed specifically against molecular markers mediating this process. The application of omics technologies for studying microbial biofilms is relatively less explored and holds great promise in furthering our understanding of biofilm biology. In this review, we provide an overview of the application of omics tools such as transcriptomics, proteomics, and metabolomics as well as multi-omics approaches for studying microbial biofilms in the current literature. We also highlight how the use of omics tools directed at various stages of the biological information flow, from genes to metabolites, can be integrated via multi-omics platforms to provide a holistic view of biofilm biology. Following this, we propose a future artificial intelligence-based multi-omics platform that can predict the pathways associated with different biofilm phenotypes.

Caries Activity and Ph Level Changes after Fluoride Varnish and Casein Phosphopeptides-Amorphous Calcium Phosphate Application on Children's Saliva.

BACKGROUND: Caries is a disease affecting the hard tissue of the tooth wherein the demineralization process caused by Streptococcus mutans decreases saliva pH faster than the remineralization process can maintain it. Topical fluoridation, such as fluoride varnish and casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) is the most common preventive therapy for the disease. AIMS: The aim of this study is to assess the difference between fluoride varnish and CPP-ACP in reducing saliva pH and caries activity. MATERIALS AND METHODS: This is an experimental study with a sample population of 60 children (aged 8-9 years old), divided into two groups of 30. Group 1 was treated with fluoride varnish, Group 2 with CPP-ACP. A t-test was used to measure the effects of the different treatments. RESULTS: The result showed that the average difference in saliva pH before and after application was -0.12933 in Group 1 and -0.14033 in Group 2 (P = 0.256). The average difference in caries activity before and after application was 3.189 log colony-forming units (CFUs)/mL in Group 1 and 2.237 log CFUs/mL in Group 2 (P = 0.275). CONCLUSION: The most effective treatment for increasing saliva pH and reducing caries activity can be achieved by using the varnish for 1 month. However, there is no difference between fluoride varnish and CPP-ACP with regard to altering saliva pH and reducing caries activity statistically. Future study is needed to explore this result.

Indonesian Mangosteen Fruit (Garcinia mangostana L.) Peel Extract Inhibits Streptococcus mutans and Porphyromonas gingivalis in Biofilms In vitro.

BACKGROUND: Streptococcus mutans and Porphyromonas gingivalis are caries and periodontal disease-related bacteria. The mangosteen fruit (Garcinia mangostana L.) peel contains flavonoids, tannins, saponins, and xanthones that have antibacterial properties. AIMS: The aim of this study is to analyze mangosteen peel extracts' ability to inhibit S. mutans and P. gingivalis has biofilms growth in vitro. MATERIALS AND METHODS: Mangosteen peel extract effects on the S. mutans ATCC-3198 and P. gingivalis ATCC-3327 in biofilms growth were evaluated by a crystal violet biofilm assay. Each bacterium was inoculated into a brain-heart infusion broth for 24 h at 37°C anaerobic conditions. A volume of 200 µL (107 colony-forming unit/mL) of bacterial suspension were distributed in microplate wells and incubated for 24 h. Mangosteen peel extracts with different concentrations were added into biofilm wells. Biofilm without treatment was used as negative control. Biofilm mass was calculated by 0.5% crystal violet staining, and optical density was measured at 600 nm using microplate reader. All obtained data were statistically analyzed using one-way analysis of variance test with P < 0.05 set as the level of significance. RESULTS: The results showed that mangosteen peel extract could inhibit the growth of S. mutans and P. gingivalis in biofilms significantly compared to the negative control (P < 0.05). The most effective concentration and incubation time for inhibiting biofilm growth was 100% in 6 h for S. mutans and 100% in 24 h for P. gingivalis. CONCLUSION: Mangosteen peel extract is effective at inhibiting S. mutans and P. gingivalis biofilms, and this antibiofilm agent can be an alternative therapy in preventing caries and periodontal disease. Future studies are needed to explore this effect.

The Anti-inflammatory Effects of Glycerol-supplemented Probiotic Lactobacillus reuteri on Infected Epithelial cells In vitro.

BACKGROUND: One of the most interesting effects of probiotics is their ability to modulate the immune system through the induction of cytokines and to enhance the host immune response. AIMS: The purpose of this study was to evaluate the anti-inflammatory effect of glycerol-supplemented Lactobacillus reuteri on the transcription level of interleukin (IL)-8 and human-beta-defensin (hBD)-2 expressed by epithelial cells after exposure to bacteria. MATERIALS AND METHODS: The confluent-cultured HaCat cell line (105 cells/mL) was exposed to Streptococcus mutans ATCC-25175 and Porphyromonas gingivalis ATCC-33277 (107 colony-forming units [CFU]/mL) for 24 h and challenged with probiotic L. reuteri ATCC-55730 (107 CFU/mL) supplemented with glycerol. Subsequently, the transcription levels of IL-8 and hBD-2 in HaCat cells were analyzed using reverse-transcription polymerase chain reaction (RT-PCR). In addition, cell viability was analyzed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. All the obtained data were statistically analyzed using the one-way analysis of variance test, with P < 0.05 set as the level of significance. RESULTS: The MTT assays confirmed no cytotoxic effects of glycerol-supplemented L. reuteri on HaCat cells (viability >90%). mRNA expression of IL-8 and hBD-2 increased after exposure to both bacteria. The presence of glycerol-supplemented L. reuteri significantly reduced the expression of IL-8 and hBD-2 on HaCat cells (P < 0.05). CONCLUSION: Glycerol-supplemented L. reuteri reduced the expression of IL-8 and hBD-2, and the results may be proof of principle for a probiotic approach to combating inflammation. However, further studies are needed to validate this probiotic effect.