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All Journal Sriwijaya Journal of Forensic and Medicolegal Crown: Journal of Dentistry and Health Research
Priscilla Kapoor
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Public Health

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The Epidemiology of Oral Carcinogenesis in the Indonesian Archipelago: A Cross-Sectional, Population-Based Analysis of Oral Cancer and Potentially Malignant Disorders Driven by Kretek Smoking and Betel Quid Chewing Mariana Alifah; Sudarto Sudarto; Khalil Jibran; Theresia Putri Sinaga; Lisye Tiur Simanjuntak; Priscilla Kapoor
Crown: Journal of Dentistry and Health Research Vol. 2 No. 2 (2024): Crown: Journal of Dentistry and Health Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/crown.v2i2.240

Abstract

Introduction: Indonesia faces a severe but poorly quantified epidemic of oral cancer (OC) and oral potentially malignant disorders (OPMDs), driven by culturally endemic habits of kretek (clove cigarette) smoking and betel quid chewing. The absence of robust, large-scale epidemiological data has critically hampered the development of targeted public health interventions. This study aimed to determine the prevalence of OC and OPMDs and to quantify their association with these specific cultural practices in a large, geographically diverse Indonesian population. Methods: A multi-center, cross-sectional study was conducted across the Indonesian archipelago, enrolling 17,850 adults aged ≥30 years through a stratified, multi-stage cluster sampling design at community primary health centers (Puskesmas). Participants completed a structured questionnaire and underwent a standardized oral examination by calibrated dental professionals. All statistical analyses, including bivariate tests and multivariable logistic regression, were performed using survey-specific methods to account for the complex sampling design (stratification, clustering, and weighting) to produce nationally representative estimates. Results: The overall, nationally-weighted prevalence of the combined OC/OPMD outcome was 5.7% (95% CI: 5.2% - 6.2%). The prevalence was 4.9% for OPMDs and 0.8% for OC. After adjusting for confounders in a survey-weighted multivariable logistic regression model, current kretek smoking (Adjusted Odds Ratio [AOR]: 6.15; 95% CI: 4.98 - 7.59) and current betel quid chewing (AOR: 9.22; 95% CI: 7.31 - 11.63) were the most powerful factors associated with the presence of OC/OPMDs. A significant, non-linear dose-response relationship was observed for both habits. Conclusion: The burden of oral cancer and its precursors in Indonesia is substantial and is overwhelmingly associated with the culturally embedded habits of kretek smoking and betel quid chewing. These findings provide definitive, population-level evidence underscoring the urgent necessity for culturally-tailored public health strategies focused on cessation, regulation, and systematic early detection to mitigate this preventable cancer epidemic.
Procedural Failures as Independent Predictors of Delayed Intracranial Foreign Body Diagnosis in Mild Traumatic Brain Injury: A Multivariable Logistic Regression Analysis from North Sumatra, Indonesia Aisyah Andina Rasyid; Priscilla Kapoor; Febria Suryani
Sriwijaya Journal of Forensic and Medicolegal Vol. 3 No. 2 (2025): Sriwijaya Journal of Forensic and Medicolegal
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjfm.v3i2.247

Abstract

Introduction: Retained intracranial foreign bodies in patients presenting with a Glasgow Coma Scale (GCS) score of 15 represent a rare but potentially fatal diagnostic pitfall in emergency trauma management, carrying profound medicolegal consequences under Indonesian health legislation. This retrospective multi-centre cohort study identified independent procedural risk factors predicting delayed diagnosis (>24 hours) of intracranial foreign bodies among mild traumatic brain injury (mTBI) patients in North Sumatra, Indonesia. Methods: Medical records from 1,240 mTBI patients (GCS 13–15) presenting to three tertiary trauma centres were reviewed; 45 cases with confirmed intracranial foreign bodies were identified, of whom 14 (31.1%) experienced delayed diagnosis. Results: Bivariate analyses demonstrated that failure to perform digital wound palpation (78.6% vs. 9.7%, p<0.001) and non-adherence to neuroimaging guidelines (71.4% vs. 9.7%, p<0.001) were significantly overrepresented in the delayed group. Multivariable logistic regression, adjusted for age, sex, mechanism of injury, and centre, identified non-adherence to computed tomography guidelines (adjusted odds ratio [aOR] 8.71, 95% CI 3.80–21.45, p<0.001), failure to palpate the wound bed (aOR 6.42, 95% CI 2.15–18.50, p<0.001), and an initial GCS of 15 (aOR 3.15, 95% CI 1.42–7.21, p=0.012) as significant independent predictors. Model calibration was excellent (Hosmer–Lemeshow p=0.711; accuracy 88.4%). Conclusion: A sentinel autopsy case demonstrated the fatal sequence: an undetected stone caused subarachnoid haemorrhage, brainstem compression, and asphyxial death. Strict protocol enforcement for secondary physical survey completion and CT guideline adherence is imperative to prevent fatal outcomes and mitigate medicolegal liability in Indonesian emergency departments.
Co-Authors Aisyah Andina Rasyid Febria Suryani Khalil Jibran Lisye Tiur Simanjuntak Mariana Alifah Sudarto Sudarto Theresia Putri Sinaga