The use of natural ingredients in the medical field is starting to be in great demand by the

pharmaceutical industry. Natural materials sourced from biodiversity have been developed
and widely used as medicines. These natural materials are referred to as biomaterials because
they have biocompatible properties that do not cause harmful side effects to tissues and
organs. Natural resourses are predictited to be likely used in the future replace the syntetical
medicines because its advantages and the side effects of the medicine that commonly used.
Some of the synthetical drugs side effects are anxiety, constipation, diarrhaea and gestinal
disorder.

One of the natural ingredients that are often used in the medical field is chitosan. Chitosan is
a biopolymer resulting from the deacetylation of chitin derived from the exoskeleton of
animals from crustacean groups such as squid, shrimp and crabs. Chitosan can also be
obtained from the Mollusca group such as clams shells. In crustacean animals, especially crab
shells, shrimp shells and squid bones contain chitin which is produce chitosan through a
certain degree of deacetylation and molecular weight. Chitosan obtained by consisting four
steps which are demineralization, deproteination, depigmentation and deasetilation. Every
step is aim to remove minerals and proteins molecules also to hydrolize the acetyl groups to
amine groups. This amine groups are the indicators of deacetylation degree. As many acetyl
groups were hydrolyzed to amine groups increase, the higher degree of deacetylation could
be achieve. This biopolymer has anti-inflammatory agent, antibacterial agent, antitumor,
analgesic properties and has potential for wound healing. Khanna et al (2019) stated that the
higher the degree of deacetylation, the higher the rate of wound healing. Chitosan can be
varied into modified forms as gels, sponges, membranes, fibers, films and pastes to be used
as needed, as it used to stop bleeding, heal wounds and an antibacterial agent.

Some treatments in dentistry have the potential to cause tissue injury in the mouth. Since
mouth and mucosa are soft tissues, the wound generally occured in ulcer form. Ulcers may
form because of trauma and it has a high recurrency. When an injury trauma occurs, the body
will respond to inflammation so that it will activates cells that will play a role in the wound
healing process. Wound healing consists of three stages, the stage of inflammation,
proliferation and remodeling. As a polymer that plays a role in wound healing, Chitosan has a
role in regenerating cells at the proliferative stage. Chitosan may boosting the proliferative
stage by increasing the growth of keratin cells, helps to form new blood vessels and increase
fibroblast cells. Wound healing is characterized by an increase in the extracellular matrix of
fibroblast cells, activation of polymorphonuclear cells, cytokine production and stimulation
of type IV collagen.

The gold standard of ulcers treatment that applied in dentistry are Triamcinolone acetonide
and Chlorhexidine mouth wash. These two are synthetical material that commonly used.
Although these two medicine has an effective effect to cure ulcers, Triamcinolone acetonide
is one of corticosteroid that can not be used widely and long term appliance. Corticosteroid
has several effect that may lead to irritation and organ disfunctions. As well as the
Chlorhexidine, it can not be used more than 14 days as it has side effects to irritate the soft
tissue and potentially forming stains to teeth.

As described above, chitosan are harmless and can be tolerate by human body as it has
excellent biocompability and biodegradable. Chitosan are one of the best alternative to
replace the synthetical medicines that widely used in medication. Chitosan could be sourced
from shellfish, one of shellfish which is green mussel (Perna viridis). In Aceh, Perna viridis
commonly consumed by the local citizens but the shells has not been used optimally so that it
leaves organic waste that accumulates undegradable shells left. Perna viridis shell waste is
usually used as handicrafts by the local community. Utilization of Perna viridis shell can also
be processed into chitosan which has advantages in absorbing harmful substances and healing
wounds. According to research by Nur Arif et al (2013), chitosan from Perna viridis has a
degree of deacetylation of 77.80% which allows it to help the wound healing process.

One of the a stable form of topical chitosan is gel form. The advantages of gel form chitosan
are able to maintain molecular weight and could be store to 15 days without pasteurisation.
The gel form also easy to apply as the mucosa is soft tissue, it could be penetrate well to the
ulcers. Gel form are made from the combination of acetic acid and chitosan. The
concentration of chitosan may varied to 5% to 10% which has the best consistency and flows
of viscosity.

Perna viridis must be concern to be one source of chitosan. Until now there has been no
study related to effectivity the use of gel form chitosan from the shell of Perna viridis as a
wound healing agent. Therefore, it need future research related to chitosan based on Perna
viridis shell before it could commercially produce by industry for topical wound healing
agent.