k9_fkg_manifestation systemic disease.ppt
TRANSCRIPT
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Manifestation systemic
disease
In oral cavity
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Clinical signs & symtoms of oral disease
due to :
• Renal disease
• Anemia• Leukemia
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MANIFE!AI "EN#A$I! %INAL
di rongga mulut
'ilda (afny Lu)is
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Penyakit Ginjal
*ero)a+an di rongga mulut
aki)at *enanggulangan
medik
dise)a)kan %%$
"enting , "enanggulangan dental *asien dengan %%$
*erlu modifikasi untuk mencega+ kom*likasi
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Gagal Ginjal Kronik
$erusakan yang ce*at *ada fungsi gin-al menye)a)kan
%e-ala klinik uremia se-umla+ *eru)a+an
fisiologik yang da*at
menye)a)kan
%e-ala .ral
/ uremic stomatitis : sakit & ulser
/ ulserative uraemic stomatitis : *lak *uti+ yang da*at
meli*uti mukosa mulut
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Gangguan Gastrointestinal
Gangguan Saraf
Hematologik
Sistem Kardiovaskular
Osteodistro
U r e m i a
Simtom Khusus
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>20 mg/dl
>50 mg/dl
>100 mg/dl
GG!
Simtom
dialisis
Kom"romis #ungsi
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> 5 mg/dl
> 10 mg/dl
simtom
dialisis
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Manifestasi di rongga mulut karena
Gagal ginjal kronik :
/ 0ry mout+/ Mucosal ulceration
/ 1acterial and fungal *la2ues
/ "allor of t+e mucosa
3 anaemia 4
/ .ral *ur*ura
/ '+ite *la2ue 3 uraemic
stomatitis 4/ %iant cell lessions 5
osteolytic lession in -a6s
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!rom)osito*enia
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Cont777
• Rasa metalik
• 1au amoniak 3tingginya kandungan urea4
evere %%$ :• 8remic stomatitis9 mera+ dan esudat
a)u/a)u
• 8remic frost 9 di mukosa selain di kulit karena de*osit kristal urea
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. . . Stomatitis Uremik
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Cont777
• 1leeding di la)ial9 )uccal9 *alatum lunak
margin lida+ 9 gingiva 3 *etec+iae dan
ecc+ymosis4
• Enamel +y*o*lasia )ila *enderita usia anak
• Specific osseus changes *ada ra+ang :
• !riad; tiga serangkai : +ilang lamina dura9
demineralisasi tulang 9 )ro6n tumor;central
giant cell tumor;radiolucent terlokalisir
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• %iant cell lesions *ada
ra+ang da*at ter-adi sama
se*erti yang dise)a)kan
+y*er*arat+yroidism
+y*er*arat+yroidism
secondary karena %%$
atau karena lamanya
dialysis dan akanmeningkatkan lesi oral5
osteolytic lession *ada
tulang
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Pasien yang mengalami dialisis
Akses ke sirkulasi *asien terutama melalui
arteriovenous s+unt
)iasanya *ada lengan )a6a+
Muda+ terinfeksi
)akteraemia
"enderita memerlukan
A1 *ro*+ylais
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• "asien yang mengalami +aemodialisa
+e*arinisasi9 *enca)utan gigi se)aiknya ditunda
sam*ai le)i+ kurang
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RENAL trans*lant *atients :
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=7 Cyclos*orin : gingival
overgro6t+
>7 Nifedi*ine : may)e
*rescri)ed for conco/ mitant +y*ertension in
renal *atient
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"redis*osition factor :
• Lo6ered resistance
• Meta)olik c+ange
• Imun deficiency:
*rimer rare
secondary
muc+ more common
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DIABETES MELLITUS
common endocrine disorder
a result of a deficiency of insulin
or resistance to insulin
(as no s*ecific oral signs or symtoms
(o6ever9 *ossi)ly )ecause of general
lack of resistance to infeksi
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!Periodontal disease
"roses # gingi$itis
)ecome eaggerated
undiagnosed dia)etic
advanced *eriodontal
disease
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• Prin%i"les of treatment :
sim*ly t+ose of *eriodontal treatment in
non dia)etic *atient
&ut al'ays remem&er
t+e dia)etic *atient is more t+an normally
susce*ti)le to infection
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(! )ral *andidiasis
Candida s** are fungi
/ 6ide distri)ution
/ fre2uently form *art of t+e commensal flora of t+e
+uman )ody
s6a) taken from skin9gut9 vagina or mout+
*! Al&i%ans9 C7 !ro*iclis9 C7 "seudotro*icalis9 C %la)rata
C7 Crusei9 C 7 "ara*silosis
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Condition se*ticaemic candidaemia mayinvolve t+e lungs9 myocardium and ot+er vital
organs very *oor *rognosis
0enture stomatitis
eryt+ematous
"seudomem)rane
candidiasis ; !+rus+ Acute
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+! Stomatitis
due to : / de+ydration
/ candida infection
tomatitis *atient : undiagnosed
inade2uately treated dia)etes
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,! Sore tongue
due to Anemia
early in t+e disease *roces
)efore su)stantial amount of glucose are
*assed into t+e urine
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-! Im"ared 'ound
•
luka *enca)utan yang tidak sem)u+
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.! /erostomia
• 8ndiagnosed or *oorly controlled dia)etes
• 0ue to : de+ydration
secondary *olyuria
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0! )ral 1y"ogli%aemi% drugs
• May %ause :
7 %lossodynia 5 1M
1urning mout+ syndrome
Early manifestation of
undiagnosed dia)etes
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$lassifikasi
/ !y*e I 3 I00M 4 //////////// uvenile onset
/ !y*e II 3 NI00M 4 ////////// Adult onset 3 ?@ 4
/ %estational 0ia)etes Mellitus 3 $e+amilan 4
imtom
/ "olidi*sia
/ "oliuria
/ "olifagia/ $e+ilangan )erat )adan
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0iagnosis 3 Evaluasi La)oratorium 4
/ Level gula dara+ *uasa meningkat secara konsisten diatas
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0ia)etic %ingivitis
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"enanggulangan *asien 0M
/ Mengurangi stres
$un-ungan 6aktu *endek ///// teknik sedasi
/ Instruksi diet
!eruskan *emasukan diet normal
/ Mem*erkecil risiko infeksi
"emeriksaan dan *rofilaksis ulangan
/ $onsultasi medis
0okter +arus dili)atkan dalam *enentuan *em)erian insulin selama *era6atan gigi
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ANEMIA
!+e c+aracteristic features of Anemia is reduction in t+e
level of +aemoglo)in 6+ic+ is usually accom*aneid )y adecreased num)er of eryt+rocytes
Red cell trans*ort of oygen
t+e formation of eryt+rocytes 6it+in t+e )one marro6 is
stimulated )y a num)er of nutritional factors :
B( 2 Iron and foli% a%id
A)sor*tion de*ends on normal mucosa in small intestine7
Lack of eit+er vit 1
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• "ernicious anemia failure to a)sor) vit 1
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• !+e c+anges )y nomeans restricted to t+etongue and ulceration orsoreness may occure t+e
6+ole of oral mucosa
• !+e *atient 6it+ anemiaor latent iron deficiency is*articularly susce*ti)le to
infection )y Candida Al)icans and angularc+eilitis or !+rus+ mayoccure
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!+e *atient may
com*lain of
distur)ances of taste
sensation
1ut some *atient 6it+
advanced megalo)lastic
anemia t+e result of folate def
may +ave no oral com*licationand mucosa may a**ear to )e
6it+in normal clinical limits
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LEUKEMIA
A malignant *roliferation of 6+ite cells re*lacing t+eirnormal develo*ment in )one marro6
/ lym*+ocytic
/ monocytic
/ myeloid/.ral signs & sym*toms to
)e t+e first indication of t+e
*resent of Leukemia
/"articularly of one of t+e
acute ty*e
gingiva are fre2uently
involve
+y*er*lastic gingivitis
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Fragile red s*ongy gingivae In more advanced cases t+at )leed s*ontaneosly or of Leukemia oral ulser
follo6ing slig+t in-ury very common large9
*ainful and dificult to
treat
A%ut mono&lastik
Leukemia
!+e maintenance of oral +ygiene may )e of great +el* in
reducing t+e distressing oral sym*t+om :
*o$ering agents and antise"ti% 'as1es
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Manifestasi di mulut karena defisiensi
nutrisi7
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Gangguan 3utrisi
$eutu+an oral mucosa mem)ranedi*engaru+i kom*le faktor9 termasuktergantung *ada nutrition yang %uku" 4
memadai!
0efisiensi Nutrisi ter-adi karena tiga +al:
7 ekskresi meningkat
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Amyloidosis / Amiloidosis
• "enyakit kronik yang -arang
ter-adi
• "rotein yang )er akumulasi di
dalam organ/organ atau
-aringan amyloid meng+asilkan
*rotein fi)rous
• Amiloidosis *rimer da*at
mengenai -antung9 lida+9syaraf
dan saluran cerna se+ingga
mem)entuk tumor terlokalisi
tdd dari amyloid
Macroglosia
"ur*ura
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0efisiensi Folic acid9 1
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(y*o*+os*+ataemia & Gitamin 0 defisiensi
• 0ental +y*o*lasia
*em)entukan enamel tidak
sem*urna ; mineralisasi tidak
sem*urna
• "em)esaran "ul*a c+am)er
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S%ur$y 5 ascor)ic acid deficiency 3single $itamin def 4
• 1iasanya ter-adi *ada :
/ *asien tua
/ *asien muda yang menga)aikan makan ; diet yang ketat
1y"er"lasti% gingi$itis
/ gingiva mem)engkak/ ra*u+/ 1er6arna ungu/ "a*ila ra*u+/ "endara+an s*ontyan
!reatment : +ig+ dose vit C
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Hink di-um*ai *ada *enderita dengan 1M
Anoreia nervosa
geografic tongue