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Purpose To establish an oral lesion image database that could accelerate the development of artificial intelligence systems for lesion recognition and referral decision. Materials and Methods We describe the establishment of a multi-sourced image dataset through the development of a platform for the collection and annotation of images. Further, we developed a used-friendly tool (MeMoSA® ANNOTATE) for systematic annotation to collect a rich dataset associated with the images. We evaluated the sensitivities comparing referral decisions through the annotation process with the clinical diagnosis of the lesions to identify lesions that are challenging to identify through images alone. Results The image repository hosts 2474 images of oral lesions consisting of oral cancer, oral potentially malignant disorders, benign lesions, normal anatomical variants and normal mucosa that were collected through our platform, MeMoSA® UPLOAD. Over 800 images were annotated by seven oral medicine specialists on MeMoSA®ANNOTATE, to mark the lesion and to collect clinical labels. The sensitivity in referral decision for all lesions that required a referral for cancer management/surveillance was moderate to high depending on the type of lesion (64.3–100%). Conclusion This is the first description of a database with well-annotated oral lesions. This database has already been used for the development of AI algorithm for classifying oral lesions. Further expansion of this database could accelerate the improvement in AI algorithms that can facilitate the early detection of oral potentially malignant disorders and oral cancer.

Oral cancer is a major health issue among low- and middle-income countries due to the late diagnosis. Automated algorithms and tools have the potential to identify oral lesions for early detection of oral cancer. In this paper, we aim to develop a novel deep learning framework named D’OraCa to classify oral lesions using photographic images. We are the first to develop a mouth landmark detection model for the oral images and incorporate it into the oral lesion classification model as a guidance to improve the classification accuracy. We evaluate the performance of five different deep convolutional neural networks and MobileNetV2 was chosen as the feature extractor for our proposed mouth landmark detection model. Quantitative and qualitative results demonstrate the effectiveness of the mouth landmark detection model in guiding the classification model to classify the oral lesions into four different referral decision classes. We train our proposed mouth landmark model on a combination of five datasets, containing 221,565 images. Then, we train and evaluate our proposed classification model with mouth landmark guidance using 2,455 oral images. The results are consistent with clinicians and the \(F_1\) score of the classification model is improved to 61.68%.

Oral cancer disproportionately affects low- and middle-income countries, where a lack of access to appropriate medical care contributes towards late disease presentation. Using artificial intelligence to facilitate the automated identification of high-risk oral lesions can improve patient survival rates. With image classification using oral cavity images and other forms of medical images, the information to be classified can often be extremely localized. To address this problem, we propose the use of convolutional neural networks with trainable soft attention. Further to this, we incorporate the use of localization loss to penalize the difference between attention maps and clinically annotated mask. This effectively allows clinicians to help guide soft attention. Improvements to the baseline were made, with an accuracy of 0.8333 and a ROC AUC of 0.8632, which equates to increases of 0.0245 and 0.0394, respectively. This accuracy corresponds to a sensitivity of 0.8469 and a specificity of 0.8208. Perhaps of more importance, is a model that demonstrates better capability at paying attention to the lesions in its decision making. Furthermore, visualizing resulting attention maps can help to strengthen clinical confidence in AI decision making.

Oral cancer is a major global health issue accounting for 177,384 deaths in 2018 and it is most prevalent in low- and middle-income countries. Enabling automation in the identification of potentially malignant and malignant lesions in the oral cavity would potentially lead to low-cost and early diagnosis of the disease. Building a large library of well-annotated oral lesions is key. As part of the MeMoSA®(Mobile Mouth Screening Anywhere) project, images are currently in the process of being gathered from clinical experts from across the world, who have been provided with an annotation tool to produce rich labels. A novel strategy to combine bounding box annotations from multiple clinicians is provided in this paper. Further to this, deep neural networks were used to build automated systems, in which complex patterns were derived for tackling this difficult task. Using the initial data gathered in this study, two deep learning based computer vision approaches were assessed for the automated detection and classification of oral lesions for the early detection of oral cancer, these were image classification with ResNet-101 and object detection with the Faster R-CNN. Image classification achieved an F1 score of 87.07% for identification of images that contained lesions and 78.30% for the identification of images that required referral. Object detection achieved an F1 score of 41.18% for the detection of lesions that required referral. Further performances are reported with respect to classifying according to the type of referral decision. Our initial results demonstrate deep learning has the potential to tackle this challenging task.

Background: Indonesia has the third largest population of smokers in the world, however, little is known about the use of chewing tobacco/betel quid in Indonesia. This paper describes the characteristics of chewing tobacco/betel quid users in Indonesia, to understand the user population and inform future research. Methods: The 2011 Indonesia GATS included 8,176 adults ages 15 and older. These data are weighted to be nationally representative. Weighted descriptive statistics and multivariate logistic regression were run using SAS 9.4. Results: Estimated national prevalence for exclusive chewing tobacco/betel quid use was 0.9%, for exclusive smoked tobacco use was 33.9% and for dual use was 0.8%. Multivariate logistic regression analyses showed that exclusive chewing tobacco/betel quid users were significantly more likely to be female, and to be older adults (45-64); while smokers are more likely to be male and younger (25-44). Conclusions/Importance: These results provide information on the different characteristics of users by product type, and show that users' demographics vary by their product of choice. This study helps to inform researchers and practitioners of the burden of chewing tobacco/betel quid use in Indonesia. These data, especially specific data on chewing tobacco/betel quid use patterns, are limited in this context, and this knowledge can help to identify populations who need quit tobacco interventions.

Background: The COVID-19 pandemic has affected health care systems around the world. Dentistry is one of the most closely related to the production of aerosols or droplets. Minimal visits to a dental clinic or hospital are highly recommended except in emergency cases. The government's recommendation is the use of teledentistry to conduct diagnosis, treatment, and monitoring of diseases. The oral medicine field is fully in charge of this activity and until now it has never been studied how the characteristics of oral medicine patients who use teledentistry services including their level of satisfaction. Method: To describe the characteristic including the level of satisfaction of Oral Medicine patients using teledentistry in Dental Hospital Usakti during pandemic COVID-19. An observational cross-sectional study was conducted in the Oral Medicine Clinic in 31 patients who used teledentistry services at the beginning of the COVID-19 pandemic under informed consent. Validated modified questionnaire and sociodemographic data were collected and satisfaction scores were categorized. Results: The validity of the questionnaire showed Cronbach-alpha 0.83 with a reliability of 0.95 and a separation of 4.49. Most of the subject used teledentistry was female (54.83%), 31-60 years old (51.61%), no history of contact with COVID-19 patient, and prior history of teledentistry (100%, 77.41%, respectively). 93.6% of subjects showed a high satisfaction level in using teledentistry services. Conclusion: The characteristic of oral medicine patients using teledentistry described a high satisfaction level, thus the teledentistry method could be a solution in/after the pandemic era.

Aim: Proper oral care is an important contributor to overall health, and various antiseptic options are available for the prevention and treatment of oral diseases. Povidone-iodine (PVP-I) oral formulations remain popular for their broad spectrum of effect and favorable tolerability profile. Our aim was to provide a narrative review looking at the past and current studies evaluating PVP-I usage for the maintenance of oral health. Materials and Methods: Querying the PubMed and Web of Science databases using the terms “PVP-I,” “Oral Health,” and “Dental Care,” we identified and systematically reviewed articles for a literature review of PVP-I applications in the area. In addition to potent antimicrobial action against common viruses, fungi, and bacteria, the absence of reported resistance to PVP-I makes it an increasingly attractive option in today’s settings. Results: The applications for PVP-I range from routine oral care and gingivitis through to the management of oral mucositis and surgical site disinfection following dental surgeries. Evidence also suggests that PVP-I confers additional benefits that complement its antiseptic properties. These include anti-inflammatory, anti-edematous, and hemostyptic effects, which can improve clinical outcomes. Conclusion: The clinical benefits of PVP-I warrant its ongoing consideration as a reliable antiseptic for broad oral care needs.

Purpose: This study aimed to determine the association between tobacco consumption (kretek) and betel quid chewing with oral cancer risk. Materials and Methods: A total of 81 cases of oral cancers were matched with 162 controls in this hospital-based study. Information on sociodemographic characteristics and details of risk habits (duration, frequency and type of tobacco consumption and betel quid chewing) were collected. Association between smoking and betel quid chewing with oral cancer were analysed using conditional logistic regression. Results: Slightly more than half of the cases (55.6%) were smokers where 88.9% of them smoked kretek. After adjusting for confounders, smokers have two fold increased risk, while the risk for kretek consumers and those smoking for more than 10 years was increased to almost three-fold. Prevalence of betel quid chewing among cases and controls was low (7.4% and 1.9% respectively). Chewing of at least one quid per day, and quid combination of betel leaf, areca nut, lime and tobacco conferred a 5-6 fold increased risk. Conclusions: Smoking is positively associated with oral cancer risk. A similar direct association was also seen among betel quid chewers.

Background: Oral cancer is one of the sixth most common cancers in human, and oral squamous cell carcinoma (OSCC) is the most common type of oral cancer. The clinical appearance of OSCC may resemble other types of oral cancer such as rhabdomyosarcoma (RMS). The definitive diagnosis is crucial as the management and prognosis of both lesions are quite different. Case Report: A 42-year-old male presented with a unhealed painful ulcer of the posterior right lateral border of the tongue for about 4 months. Restricted mobility of the tongue and positive submandibular lymph nodes were detected. Wide excision with regional neck dissection was performed. Discussion: Pleomorphic RMS (PRMS) was identifed by immunohistochemistry of positive desmin and smooth muscle actin. The clinical presentation of the lesion is exactly similar to OSCC. PRMS is a rare type of high-grade sarcoma of the oral cavity. It usually occurs in the deep of lower extremities of adult on the six decade. Conclusion: Although the management of OSCC and RMS is almost alike, the ability of metastasis is salient compared to OSCC. Therefore, the definitive diagnosis should be careful due to its characteristic.

Shisha is a water pipe that tobacco extract and fruit scented burnt using coal. It produces the smoke through the vessel and inhaled using a hose with good taste. The culture of shisha smoking is popular in Midle East country that curently has been also entering Indonesia. The side effect of shisha smoking habit is still very rare reported. The aim of this study is to describe the oral mucosa condition of shisha user. A preliminary observasional study was conducted at several sisha cafe at South of Jakarta. Under informed consent, subject with habit of tobacco and shisha smoker were included. Sociodemographic data (age, gender, duration, frequency of smoking), salivary flow rate and oral mucosa changes were documented. Eighteen subjects were recruited into this study. Most of shisha smoker was also tobacco smoker. Shisha was more practiced by maleat age (15-24 year old). The oral mucosa changes such as keratosis, melanosis, leukoedema, coated tongue, gingivitis and xerostomia were found on subject with habit of tobacco smoking habit only or both shisha and tobacco smoking. The oral mucosa changes were mainly because of the tobacco content in shisha. However, singly shisha smoking habit seems making a lesser efect to the oral mucosa rather than if the subject also practice tobacco smoking habit. It may be trigered by the temperature of smoke and carcinogenic effect of tobacco. Apparently the shisha smoking habit may caused oral mucosa changes almost the same with tobacco smoking habit.

Mouth ulcer plaster is effective in accelerating the healing of recurrent aphthous stomatitis and traumatic ulcers. Recurrent aphthous stomatitis (RAS) is one of the most commonly occurring oral diseases. The prevalence of oral ulceration worldwide is 4%, with RAS having the largest proportion (25%). Recurrent aphthous stomatitis is oral ulceration which has a self-limiting disease, but the specific medication to reduce pain caused by lesion is still less varied nowadays. This study aimed to examine the differences in the effectiveness between topical application of hyaluronic acid (HA), mouth ulcer plaster (MUP) and 0.1% triamcinolone acetonide (TA) as a positive control in the healing of RAS and traumatic ulcers (TU). This was a quasi-experimental study by measuring the lesion diameter as well as visual analogue scale (VAS) pre- and post-administration of three types of medication. Kruskal-walis test results show that there are differences in effectiveness (p=0.000) of the three types of medication to cure RAS and TU. There are signicant differences in the reduction of RAS and TU lesion diameter (p = 0.015) and VAS (p = 0.038) with the use of HA and MUP on the 4th day. There is no signicant difference in effectiveness (diameter and VAS) of MUP and TA medication on the fourth day (p = 0.880 and p = 1.000 respectively). There is no signicant difference among HA, MUP and TA on the healing of the lesions on the seventh day (p>0.05). It can be concluded that the effectiveness of MUP is similar to that of topical medications containing corticosteroids in the healing of RAS and traumatic ulcers.ABSTRAKStomatitis aftosa rekuren (SAR) merupakan salah satu penyakit mulut yang paling umum terjadi. Prevalensi ulserasi mulut di seluruh dunia adalah 4%, dengan SAR menempati urutan terbesar yaitu 25%. Stomatitis aftosa rekuren merupakan ulserasi mulut yang memiliki self-limiting disease, namun sediaan obat yang spesifik untuk mengurangi rasa sakit yang ditimbulkan lesi sampai saat ini masih kurang bervariasi. Penelitian ini bertujuan untuk mengetahui perbedaan efektivitas antara aplikasi topikal asam hialuronat (AH), plester sariawan (PS) serta triamcinolone acetonide 0,1% (TA) sebagai kontrol positif dalam menyembuhkan SAR dan ulkus traumatikus (UT). Jenis penelitian eksperimental klinis kuasi dengan mengukur diameter lesi serta skala visual analog (VAS) pra dan paska pemberian tiga jenis obat. Hasil uji Kruskal-walis menunjukkan bahwa terdapat perbedaan efektivitas (p=0,000) ketiga jenis obat terhadap penyembuhan SA dan UT. Terdapat perbedaan bermakna penurunan diameter lesi (p = 0,015) dan VAS (p = 0,038) SAR dan UT dengan penggunaan AH dan PS pada hari ke-4. Tidak ada perbedaan bermakna efektivitas (diameter dan VAS) obat PS dan TA pada hari ke-4 (p = 0,880 dan p = 1,000 secara berurutan). Tidak ada perbedaan bermakna antara masing-masing obat AH, PS dan TA terhadap penyembuhan lesi pada hari ke-7 (p >0,05). Kesimpulan efektivitas PS sama dengan obat topikal yang mengandung kortikosteroid dalam menyembuhkan stomatitis aftosa dan ulkus traumatikus.

Background: In Jakarta, oral squamous cell carcinoma (OSCC) usually detected in late stage with very low survival rate ofabout 1.1 years. OSCC may be preceded by premalignant lesion, so that early detection of the lesion may decrease the mortality rate due to oral malignancy. CD133 is a hematopoietic stem cell that play role in tissue regeneration, inflammation and tumor. Upregulated of CD133 was reported on tumor progression. Purpose: The aim of study is to determine circulating CD133 expression on premalignant (PML) and proliferative (PL) lesion. Method: Observational research was carried out on patients who seek treatment of PML and PL at Oral Medicine clinic. CD133 was taken from peripheral blood serum, examined using PCR. Data was analyzed by Chi square test. Result: 15 subjects (each of five subjects for PML, PL and control) consist of 40% male and 60% female. Age group of above 41 years old was most affected PML and PL (66.7%). Tongue is common site for oral lesion (40%). There is a significant different of circulating CD133 rate among all groups lesion (p=0.039). Conclusion: CD133 express differently in premalignant and proliferative lesions.

Background: Estrogens are sex hormon that play an important role in bone metabolism, including in bone remodeling during orthodontic treatment. Women has a monthly cycle which is affected by fluctuations of estrogen that is menstruation and ovulation. Purpose: The study was aimed to determine the differences of orthodontic tooth movement during menstrual an ovulation cycle. Methods: Five women were given ± 100 g orthodontic force using fixed orthodontic appliance with straight wire technique at the time of menstruation and ovulation with an interval of 1.5 months. Orthodontic tooth movement and levels of estrogen were measured during menstruation and ovulation. Results: Statistical results showed a significant differences between estrogen levels and orthodontic tooth movement (p < 0.05). When estrogen levels decline as in menstruation, tooth movement as results of orthodontic force would increase, whereas when estrogen levels increase as the time of ovulation, tooth movement would decrease. Conclusion: The estrogen level in menstruation and ovulation cycle may affect the tooth movement on ortodontic treatment.Latar belakang: Estrogen merupakan hormon seks yang mempunyai peran penting dalam metabolisme tulang termasuk dalam remodeling tulang selama perawatan ortodonti. Wanita memiliki siklus bulanan yang dipengaruhi oleh fluktuasi estrogen yaitu menstruasi dan ovulasi. Tujuan: Penelitian ini bertujuan untuk mengetahui perbedaan pergerakan gigi akibat gaya ortodonti pada siklus menstruasi dan ovulasi. Metode: Lima orang wanita diberikan gaya ortodonti ±100 gr menggunakan alat orthodontik cekat dengan teknik straight wire pada saat menstruasi dan ovulasi dengan selang waktu 1,5 bulan. Selain itu subyek juga diukur kadar estrogennya saat menstruasi dan ovulasi. Hasil: Hasil statistik menunjukan kadar estrogen berbanding terbalik dengan pergerakan gigi ortodonti (p < 0,05). Saat kadar estrogen menurun seperti pada menstruasi, maka pergerakan gigi akan meningkat, sedangkan pada saat kadar estrogen meningkat seperti saat ovulasi, maka pergerakan gigi akan menurun. Simpulan: Kadar estrogen pada siklus menstruasi dan ovulasi dapat mempengaruhi pergerakan gigi pada perawatan ortodonti.

Background: There are many instances in oral cancer cases in which a lack of patient cooperation was found to be a hampering factor in the overall case management. A good relationship between dentists and patients should therefore be built in conjunction with other treatment modalities. Case Report: Three complete oral cancer cases with dentist–patient relationship problems are presented. One of the common basic ways to build a good relationship is through communication and empathy. A relationship is also influenced by psychological distress, experience from previous treatments, socioeconomic factors, the healthcare system, time constraints, and belief. Conclusion: No single intervention strategy can improve the compliance of an oral cancer patient. An assessment of patient knowledge and understanding of the regimen along with clear and effective communication and trust in the therapeutic relationship are important in the overall patient management.

Radiotherapy has impact in oral health especially on the secretion capacity of the salivary glands. Another impact is the increase of Candida albicans colony. Objectives: To evaluate salivary flow in relation with Candida albicans colony in head and neck cancer patients during and after radiotherapy. Methods: Twenty-four head and neck cancer patients in Dharmais Cancer Hospital, Jakarta who were undergoing radiotherapy or had undergone radiotherapy and 24 match healthy volunteers were included in the study. Clinical observation carried out by collecting unstimulated salivary flow rate and followed by culture of Candida in Saboraud agar medium. Data were analyzed statistically by Chi-square. Results: Nasopharynx cancer was the most frequent type of head and neck cancers (87.5%) followed by tongue cancer (12.5%) and and found in 41-50 years old patients and 51-60 years old patients respectively, with male predilection compare to female (17:7). Approxiamtely 87.5% of subjects showed decreased salivary flow rate (1.01-1.50mL/10min) during and after radiotherapy. However, 91.7% of cancer patients had increased C.albicans colony during and after radiotherapy compared to control (p=0.00). Conclusion: This study showed that radiotherapy induced hyposalivation and might increase the C.albicans colony.

Background: Recurrent ulcer on angular area is usually called stomatitis angularis. It is caused by many factors such as vertical dimension reduce, vitamin B12, and immune system deficiency, C. albicans and staphylococcus involvement. Clinically is characterized by painful fissure with erythematous base without fever. Purpose: to describe an unidentified angular ulcer proceeded by recurrent ulcers with no response of topical therapy. Case: An 18-years old male came to Oral Medicine clinic in RSCM who complained of angular recurrent ulcers since 3 years ago which developed on skin and bleed easily on mouth opening. Patient had fever before the onset of ulcers. Large, painful, irregular ulcers covered by red crustae on angular area bilaterally. Patient has been treated with various drugs without improvement and lead to mouth opening limitation. Intra oral shows herpetiformtype of ulcer and swollen of gingival. Case management: Provisional diagnosis was established as viral infection thus acyclovir 200 mg five times daily for two weeks and topical anti inflammation gel were administered. Blood test for IgG/IgM of HSV1 and HSV2 were non reactive, however ulceration showed a remarkable improvement. The ulcers healed completely after next 2 weeks with acyclovir. Conclusion: The angular ulceration on above patient failed to fulfill the criteria of stomatitis angularis or herpes labialis lesion. However it showed a good response to antiviral. Therefore, unidentified angular ulceration was appointed, as the lesion might be triggered by other type of human herpes virus or types of virus that response to acyclovir.Latar belakang: ulser rekuren pada sudut mulut biasanya disebut stomatitis angularis. Kelainan ini disebabkan oleh banyak faktor seperti berkurangnya dimensi vertikal, defisiensi vitamin B12 dan sistem kekebalan tubuh, infeksi C. albicans serta staphylococcus. Secara klinis kelainan ini ditandai dengan fisur sakit pada sudut mulut dengan dasar eritematus tanpa disertai demam. Tujuan: Melaporkan kasus ulser sudut mulut rekuren yang tidak biasa, tanpa respon terhadap terapi topikal yang biasa diberikan. Kasus: Seorang lakilaki berusia 18 tahun datang ke klinik Penyakit Mulut RSCM dengan keluhan ulser rekuren pada sudut mulut yang meluas ke kulit sekitarnya sejak 3 tahun yang lalu. Ulser mudah berdarah saat pasien membuka mulut dan demam sebelum lesi timbul. Ulser membesar, bilateral, sakit, tepi tidak teratur, ditutupi oleh krusta merah. Pasien telah diobati dengan berbagai obat, namun tidak menunjukkan perbaikan. Intra oral tampak ulser jenis herpetiformis pada gingiva disertai dengan pembengkakan. Tatalaksana kasus: Diagnosis awal ditegakkan sebagai infeksi virus, oleh karena itu pasien diberikan acyclovir 200 mg lima kali sehari selama dua minggu dan gel anti radang topikal. Walaupun hasil darah IgG/IgM HSV1 dan HSV2 non reaktif, namun ulserasi menunjukkan penyembuhan yang luar biasa dengan anti virus yang diberikan. Ulser sembuh sempurna setelah pemakaian acyclovir 2 minggu berikutnya. Kesimpulan: ulserasi sudut mulut pada pasien di atas gagal memenuhi kriteria stomatitis angularis atau herpes labialis. Namun ulser menunjukkan respon yang amat baik terhadap antivirus. Diagnosis ditetapkan sebagai ulserasi sudut mulut yang tidak teridentifikasi. Kemungkinan lesi dipicu oleh virus herpes manusia jenis lain atau jenis virus yang memberikan respon terhadap asiklovir.

Shisha is a water pipe that tobacco extract and fruit scented burnt using coal. It produces the smoke through the vessel and inhaled using a hose with good taste. The culture of shisha smoking is popular in Midle East country that curently has been also entering Indonesia. The side effect of shisha smoking habit is still very rare reported. Aim of this study is to describe the oral mucosa condition of shisha user. A preliminary observasional study was conducted at several sisha cafe at South Jakarta. Under informed consent, subject with habit of tobacco and shisha smoker were included. Sociodemographic data (age, gender, duration, frequency of smoking), salivary flow rate and oral mucosa changes were documented. Eighteen subjects were recruited into this study. Most of shisha smoker was also tobacco smoker. Shisha was more practiced by male at age (15-24 years old). The oral mucosa changes such as keratosis, melanosis, leukoedema, coated tongue, gingivitis and xerostomia were found on subject with habit of tobacco smoking habit only or both shisha and tobacco smoking. In conclusion apparently the shisha smoking habit may casue oral mucosa changes almost the same with tobacco smoking habit

Background: Crohn’s disease is an uncommon condition characterized by granulomatous lesions. It is a rare disease and affects mainly in the terminal ileum. It may also manifest in the oral cavity as an unhealed, painful chronic apthous-like ulcer and may be undiganosed, so that it leads to the mismanagement of the disease. Purpose: To overview the establisment and managment of a retarded child with chronic painfull ulcers and gastrointestinal problems. Case: An 11-year-old retarded child who complained of ulcers since 6 months ago on the both side of the cheek and the lateral border of the tongue. Large irregular lesions were found accompanied by lips swelling, gingival hyperplasia, mucosal tags, hypersalivation. The blood test showed that the patient was suffering from anemia and haematinic (Fe, Folat and vitamin B12) deficiencies. Weight loss occurred for last 6 months, abdominal pain and constipation were also identified. Daily food pattern showed imbalance food intake. Histopathology features showed granolumatous lesions and was confirmed as a Crohn’s disease. Case management: Reassurance and team work with gastroenterologist were performed. Systemic sulfasalazin combined with corticosteroid and multivitamin were administered. Oral hygiene was maintained with hyaluronic acid mouthwash. Reduced in size of ulcer, pain and swelling were shown gradually. Oral ulcers and gastrointestinal symptoms disappeared after 2 months treatment. Conclusion: Diagnosis of Crohn’s disease needs a comprehensive clinical examination and histopathological test are mandatory to be able to manage the disease thoroughly.