Introduction Down syndrome is a congenital genetic disorder caused by an error in cell division, resulting in the presence of an additional third chromosome 21. Down syndrome is one of the leading causes of intellectual disability. Millions of these patients face various health issues. This study aimed to provide information about the challenges in the management of chronic ulcer mimicking OSCC in Down Syndrome child with motoric disorders. Case A 12-year-old boy with Down Syndrome and motoric disorders was referred to Oral Medicine Department. In the extraoral examination, the patient had a dysmorphic face and dry lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. The 55 teeth were sharp and caused an occlusion trauma to the right lateral border of the tongue. The patient was diagnosed with a chronic traumatic ulcer mimicking OSCC based on clinical examination. The medication given to the patient were sodium chloride 0.9%, povidone-iodine mouthwash 1%, and petroleum jelly. Conclusion Children with Down syndrome often suffer from orofacial abnormalities which can affect their oral health and their family’s quality of life. Dental and oral care for Down Syndrome children with motoric disorders required some challenges and collaboration with their parents, families, and caregivers.

Xerostomia merupakan keluhan subjektif mulut kering yang dapat disebabkan oleh penurunan sekresi saliva. Sekresi saliva dipengaruhi oleh beberapa faktor seperti faktor usia, terapi radiasi kanker, medikasi, faktor psikologis, serta beberapa faktor lainnya. Laporan kasus ini bertujuan untuk mengetahui tatalaksana komprehensif terhadap unstimulated salivary flow rate pada pasien severe xerostomia. Laporan kasus: Pasien lakilaki berusia 68 tahun dirujuk dari Departemen Bedah Digestif ke Departemen Ilmu Penyakit Mulut Rumah Sakit Hasan Sadikin. Pasien datang dengan keluhan mulutnya terasa kering, sering merasa haus, dan memiliki kesulitan dalam menelan serta berbicara. Pemeriksaan intraoral menunjukkan frothy saliva pada dasar mulut, depapilasi pada dorsum lidah, food debris pada palatum, serta kaca mulut melekat pada dorsum lidah dan mukosa bukal. Laju alir saliva dievaluasi menggunakan pemeriksaan sialometri (unstimulated salivary flow rate <0,1 ml/menit). Pemeriksaan kondisi psikologis dievaluasi menggunakan kuesioner DASS-21 dan menunjukkan tingkat depresi moderate, tingkat kecemasan severe, dan tingkat stres normal. Derajat keparahan xerostomia dievaluasi menggunakan kuesioner VAS (Visual Analogue Scale) Xerostomia. Diagnosis kerja ditegakkan sebagai severe xerostomia berdasarkan skala Challacombe. Penatalaksanaan dari bagian Ilmu Penyakit Mulut antara lain aplikasi petroleum jelly pada bibir dan berkumur menggunakan obat kumur chlorine dioxide patented zinc sebagai stimulator sekresi saliva. Simpulan:Tatalaksana komprehensif pasien severe xerostomia yang dipicu oleh faktor depresi dan kecemasan antara lain berkumur buang dengan larutan chlorine dioxide patented zinc, menjaga kebersihan mulut, rutin minum air putih, mengelola pikiran dengan baik agar terhindar dari gangguan cemas berlebih serta berkonsultasi ke psikiater atau psikolog untuk mengevaluasi kondisi psikologis.

Introduction: Dermatitis herpetiformis (DH) is an autoimmune vesiculobullous disease associated with celiac enteropathy. The clinical manifestation of DH is the occurrence of a papulovesicular rash on the skin. Oral mucosal involvement in DH is very rare. This study aimed to describe the impact of COVID-19 on the acute exacerbation of oral dermatitis herpetiformis. Case Report: A 74-year-old woman was referred to the Oral Medicine Department with a chief complaint of the blisters on the skin for a week and ulcers in the oral cavity appeared two days ago. Extraoral examination revealed crusts on the neck and extremities. The lips appeared dry and desquamative. Intraoral examination revealed erosive lesions covered with a white-yellowish plaques on the right and left sides of the buccal mucosa, an ulcer with a diameter of 0.5 cm, and purpura hemorrhagic on left buccal mucosa and right lateral border of the tongue. Histopathological examination of the skin lesion revealed a subepithelial blister with eosinophils and neutrophil cells. The definitive diagnosis of dermatitis herpetiformis was made. She was given 5 mg intravenous dexamethasone, cetirizine 10 mg, and clindamycin 300 mg by the dermatologist. We gave hyaluronic acid 0.025% mouthwash for oral ulcers and petroleum jelly for the lips. The oral lesions had significant improvement after 4 weeks of treatment. Two months later, the patient experienced acute exacerbation after being infected with COVID-19 (anti-SARS-CoV-2 IgG S-RBD >40,000 AU/mL). The oral lesions healed after a month of treatment. Conclusion: COVID-19 can trigger the acute exacerbation of dermatitis herpetiformis. SARS-CoV-2 causes an immune dysregulation and hypersensitivity reaction.