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Oral Hairy Leukoplakia: Clinical Indicator of an Immunosuppressive Condition and Challenges in Patient Management Agustina, Yohana Alfa; Wardhany, Indriasti Indah; Wimardhani, Yuniardini Septorini; Krisnuhoni, Ening; Iamaroon, Anak
Journal of Dentistry Indonesia Vol. 23, No. 2
Publisher : UI Scholars Hub

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Oral hairy leukoplakia (OHL) is defined as an asymptomatic white patch with vertical corrugation pattern the lateral borders of the tongue, that is associated with Epstein-Barr Virus (EBV) infection. Generally, it is related to immunosuppressive condition found in HIV-positive patients and patients undergoing immunosuppressive therapy. Sometimes, its clinical appearances could mimic other white lesions. Although most OHL cases are found in HIV seropositive individuals, finding in the immunocompetent individuals has also been reported. Appropriate clinical evaluations and laboratory investigations are important for patient’s comprehensive management. Objective: To report a finding of oral hairy leukoplakia as a clinical indicator of an immunosuppressive condition in otherwise a clinically healthy-looking individual and to discuss the challenges on patient management. Case Report: A 40 yearold man presented with asymptomatic, bilateral homogenous white hyperkeratotic plaques with a hairy appearance located on the dorsal of the tongue, extended to the lateral tongue mucosa. The patient failed to remember the lesion’s first appearance, until three weeks before a visit. Working diagnosis of OHL was made with differential diagnoses including white sponge nevus, leukoplakia and oral lichen planus. Histopathological assessment was consistent with OHL. Challenges on patient management include identifying possible risk factors and assuring patient for HIV testing. Conclusion: This case reported findings of OHL as the first clinical indicator of immunosuppressive condition that might be related to HIV-infection.

The Importance Of Oral Health Care Optimization In Bedridden Medicocompromised Patients: A Case Series Zahra, Faradina Siti; Parlindungan, Faisal; Aini, Muhammad Hafiz; Wardhany, Indriasti Indah
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.346-353

Background: Bedridden patients were highly susceptible to oral complications due to prolonged immobilization, impaired oromotor function, and limited capacity for self-care. The accumulation of debris and reduced salivary flow can become pathological, leading to infection in the oral cavity. This case report aims to describe two cases of medico-compromised bedridden inpatient highlighting the importance of optimizing oral health care. Case Report: Two bedridden inpatients were reffered to Oral Medicine Division, Universitas Indonesia hospital from internist. First case, was a 59-year-old female inpatient with stage IV breast carcinoma and bone metastasis. The second case, was a 68-year-old male inpatient with acute encephalopathy and multiple comorbidities. Both patients shows decreased consciousness, severe oral dryness with high Clinical Oral Dryness Scores (CODS), poor oral hygiene with a abundant plaque and debris, inflamed periodontal tissue and lip lesion. Oral health care maintenance by cleaning and wipping teeth and oral mucosa using sterile gauze moistened in 0.9% NaCl was done and demonstrated to caregiver to be done daily. Petroleum Jelly was perscribe for the lips lesions. Both patients showed improved mucosal hydration, debris reduction, and greater comfort. Discussion: Oral cavity infection is one of the factors that plays an important role in accomplishing the successful overall treatment while bedridden patients had increased risks of oral infection due to limited abilities. Cleaning and wipping with 0,9% NaCl was a safe choice for patient with high risk of aspiration, had a mild antiseptic properties and maintain mucosal hydration. Conclusion: Optimization of oral care in bedridden patients begin with the selection of oral health care maintenance methods by considering the patient's systemic condition.

Challenges in Managing Oral Manifestations of Anticonvulsant-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome Fajrin, Fildzah Nurul; Wardhany, Indriasti Indah; Rahmayanti, Febrina; Ikhsan, Muhammad; Pangeran, David
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.332-345

Background : Antiepileptic drugs were common causative agents for DRESS syndrome, which was a severe, idiosyncratic drug hypersensitivity reaction characterized by a prolonged latency period, fever, rash, and marked eosinophilia. The oral manifestations present a diagnostic challenge due its similarity to other hypersensitivity reactions as well as its comprehensive management. Objective: This case report aims to describe the challenges in comprehensive management of DRESS syndrome severe oral manifestations, highlighting the challenges from diagnosis to management for patient with complex comorbidities. Case: A 19-year-old female inpatient was referred to Oral Medicine division, Dental and Oro-maxillofacial unit of Universitas Indonesia Hospital (RSUI) for severe oral sores after treated with phenytoin and lamotrigine for her temporal lobe epilepsy and bipolar affective disorder. Patient shows general weakness and clinical examination revealed multiple intra oral erosions, lips erosions with exfoliation and haemorrhagic crust, generalized maculopapular rash, facial oedema, tender lymphadenopathy, and. Laboratory findings confirmed a severe hyper-eosinophilia (32%) and lymphopenia (13.5%), while liver function was normal. A diagnosis of DRESS syndrome was finally established. Case management were immediate withdrawal of phenytoin and lamotrigine, followed by multidisciplinary care including intra vena and topical corticosteroids. The patient's condition significantly improved after collaborative comprehensive treatment. Conclusion: Definitive diagnosis decisions requires careful consideration on the correlation of clinical findings, medication history, and hallmark laboratory results, especially in patients with complex comorbidities and intraoral clinical features with characteristics similar to other hypersensitivity reactions. Comprehensive collaborative management, including patient’s and other healthcare professionals collaboration, is crucial for successful treatment.

The Importance Of Oral Health Care Optimization In Bedridden Medicocompromised Patients: A Case Series Zahra, Faradina Siti; Parlindungan, Faisal; Aini, Muhammad Hafiz; Wardhany, Indriasti Indah
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.346-353

Background: Bedridden patients were highly susceptible to oral complications due to prolonged immobilization, impaired oromotor function, and limited capacity for self-care. The accumulation of debris and reduced salivary flow can become pathological, leading to infection in the oral cavity. This case report aims to describe two cases of medico-compromised bedridden inpatient highlighting the importance of optimizing oral health care. Case Report: Two bedridden inpatients were reffered to Oral Medicine Division, Universitas Indonesia hospital from internist. First case, was a 59-year-old female inpatient with stage IV breast carcinoma and bone metastasis. The second case, was a 68-year-old male inpatient with acute encephalopathy and multiple comorbidities. Both patients shows decreased consciousness, severe oral dryness with high Clinical Oral Dryness Scores (CODS), poor oral hygiene with a abundant plaque and debris, inflamed periodontal tissue and lip lesion. Oral health care maintenance by cleaning and wipping teeth and oral mucosa using sterile gauze moistened in 0.9% NaCl was done and demonstrated to caregiver to be done daily. Petroleum Jelly was perscribe for the lips lesions. Both patients showed improved mucosal hydration, debris reduction, and greater comfort. Discussion: Oral cavity infection is one of the factors that plays an important role in accomplishing the successful overall treatment while bedridden patients had increased risks of oral infection due to limited abilities. Cleaning and wipping with 0,9% NaCl was a safe choice for patient with high risk of aspiration, had a mild antiseptic properties and maintain mucosal hydration. Conclusion: Optimization of oral care in bedridden patients begin with the selection of oral health care maintenance methods by considering the patient's systemic condition.

Challenges in Managing Oral Manifestations of Anticonvulsant-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome Fajrin, Fildzah Nurul; Wardhany, Indriasti Indah; Rahmayanti, Febrina; Ikhsan, Muhammad; Pangeran, David
Odonto : Dental Journal Vol 12, No 3 (2025): December 2025
Publisher : Faculty of Dentistry, Universitas Islam Sultan Agung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/odj.12.3.332-345

Background : Antiepileptic drugs were common causative agents for DRESS syndrome, which was a severe, idiosyncratic drug hypersensitivity reaction characterized by a prolonged latency period, fever, rash, and marked eosinophilia. The oral manifestations present a diagnostic challenge due its similarity to other hypersensitivity reactions as well as its comprehensive management. Objective: This case report aims to describe the challenges in comprehensive management of DRESS syndrome severe oral manifestations, highlighting the challenges from diagnosis to management for patient with complex comorbidities. Case: A 19-year-old female inpatient was referred to Oral Medicine division, Dental and Oro-maxillofacial unit of Universitas Indonesia Hospital (RSUI) for severe oral sores after treated with phenytoin and lamotrigine for her temporal lobe epilepsy and bipolar affective disorder. Patient shows general weakness and clinical examination revealed multiple intra oral erosions, lips erosions with exfoliation and haemorrhagic crust, generalized maculopapular rash, facial oedema, tender lymphadenopathy, and. Laboratory findings confirmed a severe hyper-eosinophilia (32%) and lymphopenia (13.5%), while liver function was normal. A diagnosis of DRESS syndrome was finally established. Case management were immediate withdrawal of phenytoin and lamotrigine, followed by multidisciplinary care including intra vena and topical corticosteroids. The patient's condition significantly improved after collaborative comprehensive treatment. Conclusion: Definitive diagnosis decisions requires careful consideration on the correlation of clinical findings, medication history, and hallmark laboratory results, especially in patients with complex comorbidities and intraoral clinical features with characteristics similar to other hypersensitivity reactions. Comprehensive collaborative management, including patient’s and other healthcare professionals collaboration, is crucial for successful treatment.

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