Background: Autism spectrum disorders (ASD) are complex developmental disorders characterised by several levels of social interaction and communication difficulties. The prevalence of children with ASD worldwide is around 1:160, and the number of cases of autism has increased significantly. The oral microbiome is a diverse microbial biofilm with the second most complex microbiota in the human body after the gut. Several factors, such as lifestyle and health, can influence the oral microbiome’s composition and metabolism. Children with ASD generally have poorer oral hygiene and suffer from periodontal disease and dental caries more than typical children; this is associated with behavioural disturbances, such as communication limitations, motoric limitations, eating habits and the side effects of drugs. Continued oral microbiome dysbiosis can lead to gut microbiome dysbiosis. There are two hypotheses for the transmission of oral bacteria to the gut, via the hematogenous route or via the enteral route. Gut microbiome dysbiosis may regulate social behaviour, such as emotional dissonance and anxiety, through blood-brain-barrier and gut-brain-axis pathways. When there is inflammation of the periodontal tissue in ASD children, it can cause lipopolysaccharide (LPS) leakage to the blood-brain barrier (BBB) that can cause an inflammatory response and disrupt metabolic activity in the central nervous system. Oral dysbiosis, which continues into gut dysbiosis, can affect behaviour through the gut-brain axis. This review aims to determine the impact of oral microbiome dysbiosis on the behaviour of children with ASD.

<p><strong><em>ABSTRACT</em></strong></p><p><em> </em></p><p><strong><em>Background:</em></strong><em> </em><em>Candida albicans is normal flora of oral cavity that can be pathogenic due to predisposition influence so that trigger Oral candidiasis. Stichopus hermanii suspected as an Oral candidiasis therapy because it contain antioxidant compound, antitumor and antifungi. <strong>Objective:</strong> Analyzing the effectiveness of Stichopus hermanii supplementation as a </em><em>protective effect</em><em> of oral </em><em>candidiasis in Rats exposure to smoke. <strong>Materials and Methods:</strong> This experiment is post test only group control design using 35 male rats divided into 5 groups(X). X1 (negative control), X2 (positive control), X3 (Stichopus hermanii powder 0,0225mg/kgBB), X4 (Stichopus hermanii powder 0,045mg/kgBB), X5 (Stichopus hermanii powder 0,09mg/kgBB). Candida albicans induced into the mouth by an oral swab using cotton bud 3 times a week for 8 weeks. Smoke exposure as a predisposition factor be given 3 bars per day for 8 weeks. The rats being killed and tongue biopsies measure the thickness of tongue epithelium. The obtained data analyzation using One Way ANOVA and LSD test. <strong>Result: </strong>There is a significant difference (p&lt;0.05) between X1 and X2, X1 and X3, X1 and X4, X1 and X5, X2 and X3, X2 and X4, X2 and X5, X3 and X5</em>.<em> <strong>Conclusion:</strong> Adduction of Stichopus hermanii capable of reducing risk of Oral candidiasis. Supplementation of Stichopus hermanii powder 0,09mg/kgBB is the most effective reduce thickness of the tongue epithelium in the group that exposure to smoke and induced of Candida albicans.</em></p><p><strong><em>Keywords:</em></strong><em> Stichopus hermanii, Oral candidiasis, Tongue, Candida albicans, Thickness of Epithelium</em><em> </em></p><p><em><strong>Correspondence</strong>: Endah Wahjuningsih, Laboratorium Biologi Oral Fakultas Kedokteran Gigi Universitas Hang Tuah, Jl, Arif Rahman Hakim 150, Surabaya, Indonesia. Ph 031-5945864, fax: 031-5912191, e-mail address: endah1822@yahoo.com</em></p>