Haryono Utomo
Klinik Spesialis Terpadu Rumas Sakit Gigi dan Mulut Fakultas Kedokteran Gigi Universitas Airlangga, Surabaya, Jawa Timur, Indonesia

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Rapid Relief Mechanism of Allergic Rhinosinositis after “Assisted Drainage” Therapy Utomo, Haryono
Journal of Dentistry Indonesia Vol 19, No 3 (2012): December
Publisher : Faculty of Dentistry, University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (986.342 KB) | DOI: 10.14693/jdi.v19i3.135

Abstract

Rhinosinusitis is mostly affected by viral infections and allergy and resolves without antibiotics usage. However, antibiotics are still frequently used as drug of choice for rhinosinusitis. If conservative treatments failed, surgical procedures had to be done. Neurogenic inflammation is involved in rhinosinusitis. Possibly because rhinosinusitis-induced chronic gingivitis successfully relieved by the “assisted drainage therapy” (ADT). This new periodontal therapy consists of scaling and root planing followed by subgingival massage. However, the mechanism had not been clearly verified. Objective: To verify the mechanism of allergic rhinosinusitis symptoms relief by ADT. Methods: Randomized control time series design experimental study was conducted in two groups of Wistar rats. Allergic sensitization was performed by injections and inhalation of ovalbumin (OVA). Gingivitis was induced by synthetic Porphyromonas gingivalis lipopolysaccharide (PgLPS1435/1450). One group was subjected to ADT before inhalation and another groups without ADT. Immunohistochemistry for biomarkers of allergic reaction (LTC4 and ECP) and neurogenic inflammation (CGRP and VIP) performed. Results: After OVA inhalation, allergic reaction and neurogenic inflammation biomarkers had significantly lower in rats subjected to ADT before inhalation than without ADT (p=0.001). Conclusion: ADT significantly decreased nasal allergic reaction and neurogenic inflammation biomarkers, therefore could be proposed as an adjunct therapy of allergic rhinosinusitis.DOI: 10.14693/jdi.v19i3.135
Neurogenic Inflammation Involves in Systemic Spread of Oral Infection Utomo, Haryono
Journal of Dentistry Indonesia Vol 21, No 1 (2014): April
Publisher : Faculty of Dentistry, University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (797.975 KB) | DOI: 10.14693/jdi.v0i0.215

Abstract

Focal infection theory proposed in early 1900’s stated that dental infection caused systemic disorders. Nevertheless, the theory was abandoned since large number of teeth were extracted with no satisfying result. Recent reports revealed that oral infections were able to spread systemically. However, there is no rationalization available to explain how assisted drainage therapy (ADT), a periodontal therapy that could relief migraine and asthma within minutes. Oral neurogenic and immunogenic inflammation interaction involving pro-inflammatory markers such as calcitonin gene-related peptide (CGRP), TNF-α; and antiinflammatory vasoactive intestinal peptide (VIP) was still under investigation. Objective: To verify the spread of oral inflammation to distant organ after performing ADT by analysing CGRP, VIP and TNF-α expressions. Methods: Two different concentration of Porphyromonas gingivalis lipopolysaccharide (PgLPS1435/1450) was injected intragingivally into two groups of 12 Wistar rats. After four days, 12 rats were given ADT and all samples were subsequently sacrificed 40 mins after ADT. Immunohistochemistry analysis using CGRP, VIP and TNF-α on the nasal and bronchus tissue was performed. ANOVA was used for statistical analyisis of the difference between CGRP, VIP and TNF-α expression between experimental groups. Results: PgLPS injections slightly increased CGRP, VIP and TNF-α expressions in the control group. Rats undergone ADT had lower CGRP and TNF-α but higher VIP expressions. Conclusion: Neurogenic inflammation involved in systemic spread of oral infection. ADT was able to downregulate inflammation in distant organ posibly by stimulating VIP.
Chronic periodontitis as an etiology of sleep disturbances and premenstrual syndrome (PMS) Utomo, Haryono
Dental Journal (Majalah Kedokteran Gigi) Vol 40, No 1 (2007): (March 2007)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v40.i1.p27-32

Abstract

It is obvious that sleep disturbances may induced by acute pulpal or periodontal pain. Other causes of sleep disturbances which also termed as sleep dysfunction, or insomnia, according to the patient has to be treated by physician. Nevertheless, in a case report, surprisingly, periodontal treatment relieved sleep disturbances and premenstrual syndrome (PMS). Coincidentally, women also more vulnerable to sleep disturbances and periodontal disease. It is also interesting that the exact etiology of PMS is still unknown, and 80% women who suffered from PMS also experience sleep disturbances. Recently, there has been increasing numbers of literatures and evidence-based cases linking periodontal disease to systemic diseases. However, systemic effects of periodontal disease that lead to PMS which associated with sleep disturbances are rarely discussed. Several mechanisms had been proposed to involve in these symptoms: female sexual hormonal imbalance, stimulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) and neurogenic switching mechanism. In addition, as estrogen makes women more susceptible to stress, it worsen the symptoms. The glucocorticoid hormones synthesized upon stimulation of the HPA-axis, either by stress or pro-inflammatory cytokines, may disrupt the sleep-wake cycle; and also create estrogen dominance. The aim of this study is to propose the etiopathogenesis of PMS which associated with sleep disturbances that may be related to chronic periodontitis. Since in this case report scaling and curettage resulted in the disappearing of PMS and sleep disturbances; the conclusion is that chronic periodontal disease may act as one of the etiologies of PMS and sleep disturbance.
A new concept in orthodontics: faster and healthier tooth movement by regularly consuming xyilitol chewing gum Utomo, Haryono
Dental Journal (Majalah Kedokteran Gigi) Vol 40, No 4 (2007): (December 2007)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v40.i4.p176-180

Abstract

Xylitol was first discovered in the 19th century, it wasn’t until the 1960’s that commercial production was first implemented. Recent studies showed that xylitol chewing gum is beneficial for preventing caries and periodontal disease. Therefore, it is also advantageous for orthodontic treatment, especially the fixed orthodontics patients who have difficulties in acquiring optimal oral health, particularly periodontal health which important in remodeling. However, how consuming xylitol chewing gum may stimulate tooth movement and preventing root resorption is still unclear. It is suggested that chewing activities may stimulate tooth movement, since jaw hypofunction leads to lower mineral apposition and bone function; and narrow periodontal ligament (PDL). These conditions may lead to impaired remodeling process, and increases the susceptibility of root resorption during orthodontic tooth movement. Moreover, since stimulation of the PDL could be mechanoreceptive (i.e. chewing action) or nociceptive (i.e. painful stimulation), periodontal nerve fibers are supposed to play an important role in bone remodeling. It is supported by a study which revealed that during tooth movement, the galanin-containing immunoreactive nerve fibers, a part of primary sensory neurons in the PDL is increasing. Galanin is able to induce osteoclast differentiation that needed for bone resorption in orthodontic treatment. The objective of this study is to elucidate a new concept in using xylitol chewing gum as an excellent media to have a faster and healthier orthodontic movement. Since continuous chewing stimulates the PDL which enhances tooth movement, improves oral health, and prevents root resorption; it is concluded that this concept is possible.
Integrated orofacial therapy in chronic rhinosinusitis management for children with sleep bruxism Utomo, Haryono
Dental Journal (Majalah Kedokteran Gigi) Vol 43, No 2 (2010): (June 2010)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v43.i2.p97-101

Abstract

Background: The prevalence of rhinosinusitis was 20% in ambulatory patients and was mostly affected by viral infections and allergy. If conservative treatments of rhinosinusitis failed, surgical procedure is an alternative choice. Previous case report revealed that the rhinosinusitis symptoms were successfully relieved by the "assisted drainage" therapy only. Nevertheless, this therapy was less successful in children with sleep bruxism (SB). Purpose: To report an integrated orofacial therapy for management of rhinosinusitis children with sleep bruxism (SB) which consisted of the assisted drainage, night-guard and masseter muscle massage therapies. Case: Two boys who suffered from rhinosinusitis with bruxism were unsuccessfully treated with conventional treatment. Case management: Patients was subjected to the assisted drainage therapy that was scaling and root planning combined with gingival massage, and masseter muscle massage; night guard was worn in night sleep. They successfully relieved the rhinosinusitis symptoms. Conclusion: Based on the successful result, this integrated therapy could be suggested as an adjuvant in rhinosinusitis management.Latar belakang: Prevalensi rinosinusitis adalah 20% pasien rawat jalan dan umumnya disebabkan oleh infeksi virus dan alergi. Apabila terapi konservatif rinosinusitis mengalami kegagalan maka pilihan terakhir adalah operasi. Pada laporan kasus yang ada telah terjadi perbaikan gejala rinosinusitis setelah dilakukan terapi “assisted drainage” saja. Akan tetapi, terapi ini kurang berhasil pada anak dengan sleep bruxism (SB). Tujuan: Melaporkan suatu terapi orofasial terintegrasi untuk tatalaksana rinosinusitis pada anak dengan sleep bruxism (SB) yang terdiri dari terapi assisted drainage, night guard dan masase otot masseter. Kasus: Dua anak laki-laki yang menderita rinosinusitis dengan bruxism telah mengalami kegagalan pada perawatan konsvensional. Tatalaksana kasus: Pasien dilakukan terapi assisted drainage yang adalah scaling dan root planning yang dikombinasikan dengan masase gingiva dan masase otot masseter; sedangkan nightguard dipakai saat tidur malam. Terapi ini berhasil mengurangi gejala rinosinusitis. Kesimpulan: Berdasarkan keberhasilan terapi, terapi terintegrasi ini dapat digunakan sebagai ajuvan dalam tatalaksana sinusitis.
Relieving idiopathic dental pain without drugs Utomo, Haryono; Rulianto, M.
Dental Journal (Majalah Kedokteran Gigi) Vol 44, No 2 (2011): (June 2011)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v44.i2.p82-87

Abstract

Background: Teeth are commonly obvious source of orofacial pain. Sometimes the pain source is undetectable, thus called as idiopathic dental pain. Since dentist wants to alleviate or eliminate the pains with every effort in their mind, a lot of drugs could be prescribed. Moreover, it is make sense that endodontic treatment or even tooth extraction will be done. Unfortunately, endodontic treatment may also initiate neuropathic tooth pain that is caused by nerve extirpation, thus worsen the pain. Therefore, another cause of dental pain such as referred pain, periodontal disease, or stress which related to psychoneuroimmunology should be considered. In order to prevent from unnecessary drugs or invasive treatment such as root canal treatment and extraction, correct diagnosis and preliminary non-invasive therapies should be done. Purpose: This review elucidates several therapies that could be done by dentists for relieving idiopathic dental pain which includes massage, the “assisted drainage” therapy, modulation of psychoneuroimmunologic status and dietary omega-3. Reviews: Understanding the basic pathogenesis of pain may help in elucidating the effects of non-drug pain therapy such as muscle massage, the “assisted drainage” therapy, omega-3 and psychological stress relieving. These measures are accounted for eliminating referred pain, reducing proinflammatory mediators and relieving unwanted stress reactions consecutively. Psychological stress increases proinflammatory cytokines and thus lowered pain threshold. Conclusion: As an individual treatment, this non-drug therapy is useful in relieving idiopathic dental pain; nevertheless, if they work together the result could be more superior.Latar belakang: Gigi adalah suatu penyebab umum dari nyeri orofasial. Kadang kala penyebab nyeri tidak dapat ditemukan, sehingga disebut sebagai nyeri gigi idiopatik. Karena dokter gigi berupaya untuk mengurangi atau menghilangkan nyeri dengan segala cara maka banyak obat akan diresepkan ke pasien. Bila gagal maka sangat mungkin dilakukan perawatan saraf gigi bahkan pencabutan gigi. Akan tetapi, perawatan endodontik juga dapat menimbulkan nyeri neuropatik yang disebabkan oleh ekstirpasi saraf gigi, sehingga nyeri makin parah. Sebab itu, penyebab lain nyeri gigi seperti nyeri yang dialihkan (referred pain), penyakit periodontal atau stres yang berhubungan dengan psikoneuroimunologi perlu dipertimbangkan.Untuk mencegah kejadian konsumsi obat yang tidak perlu ataupun perawatan endodontik dan pencabutan gigi maka diagnosis yang tepat dan terapi non-invasif harus dilakukan terlebih dahulu. Tujuan: Studi pustaka ini menerangkan beberapa terapi yang dapat dilakukan dokter gigi untuk mengurangi nyeri gigi idiopatik yaitu masase, terapi assisted drainage,modulasi status psikoneuroimunologi dan diet omega-3. Tinjauan Pustaka: Pengetahuan mengenai patogenesa nyeri dapat menerangkan efek terapi nyeri non-medikamentosa seperti masase otot, terapi assisted drainage, diet omega-3 dan mengurangi stres psikologis. Berbagai terapi ini dapat mengurangi nyeri alihan, mediator proinflamasi dan mengurangi stres. Stres psikologis akan mengingkatkan sitokin proinflamasi yang menurunkan ambang nyeri. Kesimpulan: Sebagai terapi individual, terapi non-medikamentosa ini berguna untuk mengurangi nyeri gigi idioaptik, akan tetapi bila bekerja sama dapat lebih baik lagi.
Sensitization of the sphenopalatine ganglion (SPG) by periodontal inflammation: A possible etiology of sinusitis and headache in children Utomo, Haryono
Dental Journal (Majalah Kedokteran Gigi) Vol 39, No 2 (2006): (June 2006)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v39.i2.p63-67

Abstract

Sinusitis is a frequent complication of allergic rhinitis. Theoretically, sinusitis could be found in human since infancy. The prevalence of diagnosed sinusitis is 20% of ambulatory patients in daily practice. Unfortunately, a lot of sinusitis cases must be treated by surgical operation. Other cases are treated conservatively with decongestants, corticosteroids, antibiotics and diathermy. However, dental treatment approach for sinusitis management is rarely discussed. Headache, especially migraine is also a common problem in children. Sinusitis and migraine, are closely related; sinusitis sufferers often accompanied by migraine and vice versa. This phenomenon resulting in misdiagnosis of the main etiology of sinusitis and migraine; if this case happens in young children, the diagnosis should be more complicated. Dental procedures which may directly reduce the periodontal inflammation were done to children diagnosed as sinusitis by otolaryngologist and pediatrician. In a short period of time, the sinusitis and headache symptoms subsided. The objective of this case reports is to propose the possible explanation of the neurogenic switching mechanism cut off, that resulting in the instant relief of sinusitis and headache symptoms. Regarding the immediate relief of the symptoms, the role of autonomic nervous system should also be considered. Since parasympathetic innervations of nasal, sinus mucosa and maxillary periodontal tissues originated from the sphenopalatine ganglion; the conclusion is that the periodontal inflammation may sensitize the sphenopalatine ganglion which may trigger sinusitis and headache in children.
Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment Nugraeni, Yuli; Kamadjaja, David Buntoro; Utomo, Haryono
Dental Journal (Majalah Kedokteran Gigi) Vol 42, No 1 (2009): (March 2009)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v42.i1.p25-30

Abstract

Background: Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose: The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews: Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL) becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA); the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion: Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.
Management of oral focal infection in patients with asthmatic symptoms Utomo, Haryono
Dental Journal (Majalah Kedokteran Gigi) Vol 39, No 3 (2006): (September 2006)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v39.i3.p120-125

Abstract

Asthma is commonly related to allergic diseases, nevertheless only 40% of asthma patients are related to allergy or atopy. There are some unknown etiologies of asthma that are still in researches. One of the possible causes of asthma is the multiple chemical sensitivity syndrome (MCS) which related to the “neurogenic switching hypothesis”. Since rhinitis, sinusitis and asthma are closely related, treatments which are successfully reduce or eliminate the rhinitis and sinusitis symptoms should also be advantageous to asthma management. There were a lot of sinusitis treatments which reduced asthma symptoms such as nasal corticosteroid, diathermy and surgery. It was also been reported that oral focal infection might cause sinusitis. However, the involvement of oral focal infection in the etiopathogenesis of asthma was seldom discussed. The objective of this study is to propose a mechanism of the relationship between oral focal infection and asthma which is explained by the “neurogenic switching hypothesis”. Two asthmatic patients who also had periodontal disease, pulpal and periapical infection were treated with conventional and/or surgical dental treatments. After the dental and periodontal treatments were completed, the usual triggers of severe asthma attacks such as cold and house dust did not elicit the asthma symptoms. It concluded that regarding to the disappearing of asthma symptoms, the elimination of oral focal infection had a beneficial effect in reducing asthma symptoms.
Reducing allergic symptoms through eliminating subgingival plaque Utomo, Haryono; Prahasanti, Chiquita; Ruhadi, Iwan
Dental Journal (Majalah Kedokteran Gigi) Vol 41, No 4 (2008): (December 2008)
Publisher : Faculty of Dental Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/j.djmkg.v41.i4.p155-159

Abstract

Background: Elimination of subgingival plaque for prevention and treatment of periodontal diseases through scaling is a routine procedure. It is also well-known that periodontal disease is related to systemic diseases. Nevertheless, the idea how scaling procedures also able to reduce allergic symptoms i.e. eczema and asthma, is not easily accepted, because it is contradictory to the “hygiene hypothesis”. However, since allergic symptoms also depend on variable factors such as genetic, environmental and infection factors; every possible effort to eliminate or avoid from these factors had to be considered. Subgingival plaque is a source of infection, especially the Gram-negative bacteria that produced endotoxin (lipopolysaccharides, LPS), a potential stimulator of immunocompetent cells, which may also related to allergy, such as mast cells and basophils. In addition, it also triggers the “neurogenic switching” mechanism which may be initiated from chronic gingivitis. Objective: This case report may explain the possible connection between subgingival plaque and allergy based on evidence-based cases. Case: Two adult siblings who suffered from chronic gingivitis also showed different manifestations of allergy that were allergic dermatitis and asthma for years. They were also undergone unsuccessful medical treatment for years. Oral and topical corticosteroids were taken for dermatitis and inhalation for asthma. Case Management: Patients were conducted deep scaling procedures, allergic symptoms gradually diminished in days even though without usual medications. Conclusion: Concerning to the effectiveness of scaling procedures which concomitantly eliminate subgingival plaque in allergic patients, it concluded that this concept is logical. Nevertheless, further verification and collaborated study with allergic expert should be done.