Latar belakang. Kandidiasis mulut disebabkan oleh infeksi Candida. Kondisi imunokompromais seperti DM merupakan salah satu faktor predisposisinya. Diabetes mellitus (DM) merupakan penyakit metabolik yang sering tidak disadari dan menjadikan penderitanya rentan infeksi. Tujuan. Penulisan ini bertujuan untuk melaporkan kandidiasis mulut polimorfik pada pasien yang sebelumnya tidak terdeteksi DM. Kasus dan penanganan. Seorang laki-laki 57 tahun datang ke Klinik Gigi dan Mulut, RSUP Dr. Sardjito mengeluhkan gangguan pengunyahan. Keluhan dirasakan sejak 1 bulan terakhir akibat gigi sebalah kiri atasnya goyah. Pasien menggunakan gigi tiruan sebagian lepasan (GTSL) sejak 5 tahun yang lalu. Sejak awal, GTSL susah dilepas sendiri oleh pasien. Akhir-akhir ini, terdapat keluhan mulutnya gatal dan nafas berbau. Dilaporkan adanya penurunan berat badan hingga 9 kg pada 3 bula terakhir. Ekstra-oral normal, intra-oral tampak plak putih pada dorsum lidah, area eritematus pada palatum berhadapan dengan plat GTSL, gigi avulsi, luksasi disertai resesi. Berdasar anamnesis dan pemeriksaan klinis, lesi mulut mengacu pada kandidiasis mulut dan pasien dicurigai menderita DM. Rencana perawatan meliputi Komunikasi, Informasi, dan Edukasi, terapi antifungal, ortopantomogram (OPG) dan konsultasi medis terkait kecurigaan DM. Penatalaksanaan lesi mulut meliputi debridasi dan Nystatin topikal. Dua minggu kemudian, lesi mulut menunjukkan perbaikan. Hasil OPG dan kadar glukosa darah (KGD) mengindikasikan latar belakang DM. Ekstraksi dilakukan setelah DM terkontrol diikuti pembuatan protesa. Fungsi mulut kembali normal dan diinstruksikan pengelolaan KGD. Kesimpulan. Temuan klinis kandidiasis mulut dapat digunakan sebagai indicator adanya gangguan sistemik, pada kasus ini adalah DM. Identifikasi dini lesi mulut terkait gangguan sistemik dapat membantu penderita untuk memperoleh perawatan sistemik lebih awal. Background. Oral candidiasis is caused bt Candida infection. Immunocompromise condition such as diabetes is one of its predisposition. Diabetes mellitus (DM) is metabolic disorder that is often not realized by the sufferer and makes the sufferer susceptible to infection. Purpose. This paper is intended to report the polymorphic type of oral candidiasis in patient with previously undetected DM. Case and management. A 57 years old man complained of impaired mastication due to teeth luxation since last month. Patient has wearing removable partial dentures since 5 years ago, which was hard to removed by himself. Lately the patient experienced prickly under dentures and halitosis. The patient reported about lost of weight as 9 kg in 3 months. No abnormality found extraorally, and intraorally it found some velvety white plaque on dorsum of the tongue, erythematous area on mucosal bearing dentures, avulsion and luxation of the teeth. Based on history taking and clinical examination, oral lesion regarded as oral candidiasis and the patient suspected to have DM. Treatment planning were oral health education, antifungal therapy, taking an OPG, medical consultation because of possibility of DM. Treatments comprises as oral debridement and topical nystatin. Two weeks later, oral lesion showed improvement. It revealed that OPG and Blood Glucosa Level (BGL) result were referred to DM. After his DM controlled, teeth extraction was done followed by construction of new denture. Normal oral function returned, and patient instructed to maintain BGL. Conclusion. Clinical findings as oral candidiasis can be used as an indicator of the existence of the systemic disease, in this case are DM. Early identification of oral lesion associated systemic disease could help the patient to obtain early treatment.

Latar belakang. Karsinoma sel skuamus oral (KSSO) merupakan salah satu kanker mulut yang paling sering terjadi. Deteksi dini kanker mulut menyulitkan oleh karena etiologi yang tidak pasti dan gambaran klinis yang tidak khas. Toluidine blue vital staining (TBVS) dilaporkan dapat membantu penegakan diagnosis KSSO. Tujuan. Penulisan ini bertujuan melaporkan kasus KSSO di lidah yang terdiagnosis melalui TBVS. Kasus dan penanganannya. Laki-laki 77 tahun dengan gigi tiruan lengkap mengeluhkan sakit pada lidah sejak 2 minggu lalu, yang tidak sembuh dengan terapi konvensional. Pasien adalah perokok berat selama 60 tahun. Temuan klinis menunujukkan ulkus soliter berdiameter 2,5 cm pada ventral lidah, tepi membulat, indurasi dan tertutup pseudomembran putih. Temuan lain berupa kandidas mulut pada mukosa palatal, kedua sudut mulut dan dorsum lidah. Berdasar anamnesis dan pemeriksaan klinis, dicurigai adanya keganasan pada lesi lidah. Perawatan awal ditujuan untuk pembersihan rongga mulut, terapi anti jamur dan perbaikan status nutrisi. Lima hari kemudian, dilaporkan adanya kaku lidah dan gangguan fungsi mulut. Klinis tampak ulkus pada lidah semakin dalam dan melebar, untuk memastikan kecurigaan keganasan dilaksanakan pemeriksaan TBVS. Hasil pemeriksaan positif sehingga ditegakkan diagnosis kerja KSSO. Pemeriksaan lebih lanjut, pasien dikirim ke Klinik Bedah Mulut Rumah Sakit Dr. Sarjito. Hasil biopsi positif menunjukkan KSSO, selanjutnya pasien dirujuk ke Klinik Onkologi. Kesimpulan. Karsinoma sel skuamus oral memiliki gambaran klinis tidak khas sehingga penyakit ini sulit terdeteksi secara dini. Diagnosis dan perawatan dini KSSO akan meningkatkan survival rate dan kualitas hidup penderitanya. Metode pemeriksaan diagnostic bantu dengan TBVS sangat membantu dalam penegakan diagnosis keganasan di rongga mulut. Background. Oral squamous cell carcinoma (OSCC) is one of the most oral cancers occurred. Early detection of oral cancer is difficult due to uncertain etiology and atypical clinical feature. Toluidine blue vital staining (TBVS) has been reported to assist the determination of OSCC. Purpose. This writing is intended to report the diagnosis of OSCC on the tongue through TBVS. Case and management. A 77 years old man with a full denture complained a painful tongue since 2 weeks ago, which no responseto conventional therapy. The patient is a heavy smoker for 60 years. Clinical findings showed a solitary ulcer with 2,5 cm in diameters on ventral of the tongue. It’s edges rounded, indurated and covered with white pseudomembranous. Other findings on palate mucosa, corner of the mouth and dorsum of the tongue regarded as oral candidiasis. Based on anamnesis and clinical examination, tongue ulcer is suspected as malignancy. Initial treatment comprises oral debridement, antifungal therapy and improvement of nutrition state. Five days later, tongue stiifness and oral dysfunction were reported. Clinically, the tongue ulcer is getting deeper and more extensive. For the determination of malignancy, TBVS was conducted with the results supported the impression of OSCC. For further examination, the patient was sent to the Oral Surgery Clinic, Dr Sarjito Hospital. Biopsy result is OSCC, then the patient was referred to Oncology Clinic. Conclusion. Oral squamous cell carninoma has an atypical feature so that the lesion is difficult to detect early. Early diagnosis and treatment is important as it increases the survival rate and quality of life of OSCC ptient. Methods of diagnostic to TBVS very helpful in establishing the diagnosis of malignancy in the oral cavity.

Latar Belakang: Ulkus aftosa kompleks mengacu pada ulkus mulut kronis berkaitan dengan gangguan sistemik. Kondisi tersebut, selain menimbulkan rasa sakit dan gangguan fungsi, dapat memperburuk kualitas hidup penderitanya. Tujuan: penulisan ini bertujuan untuk melaporkan keterkaitan antara ulkus aftosa kompleks dengan gangguan gastrointestinal, yaitu penyakit crohn. Kasus dan penanganannya: laki-laki 73 tahun mengeluhkan nyeri mulut sejak 3 bulan lalu, yang disertai dengan perut sebah, kembung dan terkadang nyeri ringan disertai dengan sakit kepala. Saat pemeriksaan, tampak adanya ulkus dengan dasar bergranuler, tepi sedikit meninggi dan tertutup lapisan putih pada mukosa lipatan mukobukal, pipi, dasar mulut dan palatum. Permukaan mukosa bibir dan pipi memberikan gambaran seperti batu bata (cobblestoning). Mengacu pada gejala dan temuan klinis, ditegakkan diagnosis kerja ulkus aftosa kompleks manifestasi gangguan gastrointestinal, susprk penyakit crohn. Terapi awal berupa kombinasi spiramycin-metronidazole, methyl-prednisolone, parasetamol dan larutan kumur perhidrol. Satu minggu kemudian, tampak adanya perbaikan lesi dan aktifitas fungsional. Berdasarkan pemerikasaan dari poli penyakit dalam Rumah Sakit Umum Sardjito (RSS), pasien mendapatkan medikasi lanzoprazole, ulsidex dan enzyplex. Terapi lanjutan berupa methyl-prednisolone dengan dosis tapering, anti jamur topical nistatin untuk mencegah infeksi ikutan dan larutan kumur yeng mengandung Benzydamine HCI untuk mengurangi nyeri. Kesimpulan: Ulkus mulut manifestasi penyakit Chohn mempunyai karakteristik unik dan dapat dibedakan dari ulkus mulut kronis lainnya. Dalam penegakan diagnosis ulkus aftosa kompleks, identifikasi etiologi gangguan sistemik yang tepat akan sangat membantu dalam menetapkan perawatan lesi mulut yang sesuai. Background: complex aphthous refers to chronic oral ulceration, which is related to systemic diseases. This condition can cause oral discomfort, alter the normal oral function anf eventually can decrease the quality of life. Purpose: this paper is intended to report the relationship between complex aphthous with gastrointestinal disorder, in particular crohn’s disease. Case and management: A73 year old man complaint a chronic sore mouth since 3 months ago. Abdominal discomfort, mild indigestion and headache occur accompanied by oral symptoms. Clinically, there were multiple ulcers with granular base, slightindurate border covered with white thick layers at mucobuccal fold, buccal, floor of the mouth and palate mucosa. Labial and buccal mucosa demonstrates a cobblestoning appearance. According to systemic symptoms and oral findings, complex aphthous as manifestation of gastrointestinal diseases, specifically suspected to Crohn’s diseases, is accepted as working diagnosis. Spiramycin combined with Metronidazole, Methyl-prednisolone, Paracetamol and perhidrol mouthwash were given as initial therapy. One week later, it seems some improvement on oral lesion and oral functional activity. From internal Medicine Clinic, Sardjito General Hospital, patient received Lanzoprazole, Ulsidex and Enzyplex. Tapering doses of methyl-prednisolone and oral fungal topical Nystatin for prevention from secondary infection were given as subsequent therapy. Benzydamine mouthwash was given for alleviate sore mouth. Conclusion: Complexs apthous ulcers as manifestation of crohn’s disease have a unique characteristic and quite discriminate to other chronic oral ulceration. In establishing the diagnosis of complex aphthous., the identification of proper etiology would help in determining the appropriate management of the oral lesion.