kbk fk hormonal-1.ppt [read-only] -...
Post on 06-Apr-2019
219 Views
Preview:
TRANSCRIPT
Endocrine abnormalities
• In general changes in the oral mucosa dictated
by endocrine abnormalities are not common
• The most frequently cited changes are those • The most frequently cited changes are those
due to the endocrine disturbances found in
normal life especially:
during preqnancy
and
at the menoupouse
PREGNANCY
The hormonal changes that occure
chronic gingivitis
proliferation of capillaries
fragilefragile
papillae may bleed at the least injury
secondary infection may occure
may lead to halitosis
Pregnancy gingivitis
Ocasionally a single papilla
may become considerably
Enlarged
Present as an epulis = Pregnancy epulis
and RAS= Recurent Apthous Stomatitis
Treatment :
Oral hygiene
Kehamilan
Tanda dimulut
Pregnancy ginggivitis
- Pembesaran
- Merah
- Perdarahan- Perdarahan
Pregnancy epulis atau tumor
- Menonjol
- Hemorrhagic
- Pada akhir kehamilan
Evaluasi dan penanggulangan dental
- Sesudah trimester pertama -------- dental prophylaxis
- Selama trimester kedua -----perawatan gigi tertentu tidak
dianjurkan ----- bacteremia
- Selama akhir trimester kedua ------ perawatan yang tidak
dapat ditunda ----- kontrol karies
- Permulaan trimester ketiga ----- profilaksis ulangan - Permulaan trimester ketiga ----- profilaksis ulangan
- Bulan terakhir kehamilan ------ tidak dianjurkan
- Radiography : hindari selama kehamilan
- Dokter gigi harus konsultasi ke dokter sebelum pemberian
obat
- Obat-obatan yang harus dihindari : aspirin, lidocaine,
penicillin, antianxiety ( diazepam ), nitrous oxide, tetracycline
Menoupose
The hormonal changes occuring during and after the
menoupose directly affect the oral mucosa
Patient commonly report :
- a sour metallic or bitter taste- a sour metallic or bitter taste
- Have halitosis a bad taste
- Dry mouth
- BMS
Melakukan Identifikasi & eksploitasi
Kanker
sering
dijumpai
saat ini
Ahli- ahli scince+kemoterapi
Perbedaan biologi sel kanker
Mengembangkan obat dan
kombinasinyakombinasinya
Menghancurkan tumor>dari pada sel normal
Beberapa respons pnk kanker
Terhadap kemoterapi:
1. Untuk penyembuhan kanker
2. Mungkin dapat
menyembuhkan kanker
3. Memperpanjang hidup
4. Tidak respon terhadap kanker
Manifestasi
kemoterapi dapat
dijumpai di rongga
mulut
Kemoterapi
• Perawatan kanker dengan menggunakan obat- obatan yang
dapat menghancurkan sel kanker, menghentikan berlipat ganda
Disebut obat anti kanker
• Sel normal tumbuh dan mati secara terkontrol• Sel normal tumbuh dan mati secara terkontrol
• Sel kanker→ sel tidak normal
•
• Kerusakan sel= efek samping, merusakkan sel normal juga
membelah
membentuk>tidak terkontrol
Efek samping berpengaruh pada:
• Pembentukan sel darah dalam sumsum tulang
• Sel dalam saluran cerna (mouth, stomach, intestines)intestines)
• Sistem reproduksi
• Folikel rambut
• Organ vital juga dapat terpengaruh eq. heart, lung, kidneys, nervous system
Kemoterapi dapat mempengaruhi
pada :…Cont.
• Efek samping tergantung pada tipe dan dosis kemoterapi.
• Recovery time tergantung pada kesehatan
secara umum dan tipe kemoterapi yang diberikan
Beberapa efek samping kemoterapi
Anemia
mengurangi
kemampuan sel
darah merah
Sedikit sel
darah merah
Nausea
Vomiting
Obat baru
Pain
Obat KH dapat
merusak syaraf
Rasa terbakar
Kehilangan
rambut
Dapat
mengenai darah merah
yang membawa
Oksigen
Nafas pendek
Lemah
capek
Reduce
thisMati rasa
Sakit mencucuk
Pada kaki dan
tangan
mengenai
semua jenis
rambut
Akan tumbuh
kembali setelah
perawatan
Manifestations in Oral Cavity :
Mukositis and ulceration :
mucosa gastrointestinal rentan
terhadap efek toksik
Infeksi oral: Leucopenia
meningkatnya risiko infeksi ,
pengobatan setelah dilakukan
kultur, mencegah infeksi sistemik kultur, mencegah infeksi sistemik
atau septicaemia.
Neurotosik, sakit yang dalam, terus
menerus, bilateral dan seperti
sakit gigi
Xerostomia
Perubahan pengecapan
Manifestation.. Cont..
Perdarahan, pengurangan platelet
( thrombocytopenia )
Perkembangan gigi yang abnormal
Pemeriksaan jaringan lunak, keras dan jaringan periodontal
Pasien dengan kelainan haematologi ,mungkin menderita immunosuppression atau thrombocytopenia harus di konsul ke onkologi
Tindakan pre kemoterapi:
konsul ke onkologi
Hilangkan daerah infeksi dan iritasi seperti akar gigi , gigi tajam dll.
Jadwal kemoterapi selanjutnya sebaiknya 7-10 hari setelah penyembuhan
Informasi penting :
Faktor pembekuan Kateter vena central
darah
Tempat kolonisasi bakteri
Komplikasi
haemaragikhaemaragik
terjadi Perlu antibiotic prophylactic
Platelet Neutrophil <
< 50 ribu/mm High risk of infection
and septicaemia
Perawatan Dental / Oral yang harus diperhatikan
• Teknik menyikat gigi
• Makanan yang tajam
• Berkumur dengan alkohol• Berkumur dengan alkohol
• Penggunaan propilaksis
• Pencegahan demineralisasi
• Pasien sering muntah
• Tidak boleh pakai gigi palsu
• Pertahankan oral hygiene
• Sebelum memulai kemoterapi kanker , pada penderita dilakukan evaluasi untuk
mengenali dan menyingkirkan sumber-sumber infeksi oral yang dapat memperburuk rangkaian perawatan memperburuk rangkaian perawatan kemoterapi
EFFECT OF RADIOTHERAPY
Oral complications of head and neck
radiation 1. Mucositis
- Generalized mucosal erythema ( after initiation of
treatment)
-Desquamation and ulceration-Desquamation and ulceration
- Extreamly pain, eating nearly impossible
- Sites : buccal, labial and lingual mucosae
- Healing rapidly follows the cessation of radiation
- Mucosal atrophy permanent
- Candidiasis
2.Xerostomia
- Bacterial colonization of the teeth
- Difficulty of swallowing and managing food
- Plaque formation and debris accumulation
3. Caries radiation
- Rampant caries
Caused by : xerostomia, accelerated
decalcification of irrradiated teeth, reduced
oral hygiene
The three major risk factors in the development of osteoradionecrosis* Anatomic site of the trauma ------
mandible develop necrosis 5 times more
frequently
* Dose of radiation
* Dental status of patient ----- patients with
teeth are
more likely than edentulous patients
Osteoradionecrosis and extraction
Risk of development of osteoradionecrosis to
timing of extraction :
- High risk : extractions during radiation therapy
- Elevated risk : extractions just prior to radiation
therapy
- Lowest risk : !2 mo or more after radiation therapy
Extraction strategy
Pre radiation extraction of actively infected teeth
Extraction done 12 mo or more after radiation
therapy are lesser risk
Oral complications of cancer
cemotheraphy
Factors affecting frequency of development of oral
problems
1. Patient related variables
- The younger patient ------ more likely affect
- The type of malignancy----- lymphoma, leukemia :
higest
frequency
- Patient with poor oral hygiene and pre existing
odontogenic and periodontal infection -------high risk
Dentist should be work with oncologist to optimize the
2. Therapy related variables
* Type of drug
- Antimetabolite ( methotrexate ) ------ mucositis
- Alkylating agent ( 5 fluorouracil------ mucositis
- Adriamycin ----- minor salivary gland
* Dose of drug administration* Dose of drug administration
* The timing of drug administration
Oral Complications
Direct Stomatotoxicity1. Mucositis
- Diffuse ulcerative condition
- Generally on nonkeratinized oral mucosa
- Extrem pain
- Erythema and ulceration of some or all mucosal - Erythema and ulceration of some or all mucosal
surfaces : typically ginggiva, dorsal surface of
the
tongue
- Ulcerative area may appears grayish white with
central areas of necrosis
- Self limiting and tends to heal spontaneously in
about 14 days
2. Xerostomia
Adriamycin ---- xerostomia
3. Neurotoxicity
Alkaloid ----- neurotoxicity ----- odontogenic pain
Symptoms usually disappear with
discontinueance
drugs
Indirect Stomatotoxicity
Infection
1. Bacterial infection
- Tooth pain, deep caries, sensitivity to percussion
2. Soft tissue infection
* Ginggiva
- Marginal, papillary and attached ginggiva
in patients pre existing periodontal diseases
- Infectious lesions : localized necrotic area
of ginggiva ( similar to ANUG)of ginggiva ( similar to ANUG)
- Tends to spread laterally, apically,
large area of ginggiva and mucosa
- Pain, bad taste
- Underlying bone may be exposed
- Bleeding
Mucosa
- Ulceration secondary infection
- The center is deeply punched out and contain
grayish white necrotic center
- The border of the ulcer may be raised
- In leucopenic patients shoul be admitted to the
hospital and treated with intravenous Antibiotic
Salivary gland infection- Parotid gland --- most frequently affected
- Complain of pain of sudden onset
- Unilateral
- The parotid gland may be enlarged and
erythemtous
- Pus may be milked from the parotid duct
- Fever- Fever
- Dry mouth
Myelosuppressed patients with salivary gland
infection require hospitalization
Management : cooperation of the dentist,
oncologist and infectious disease specialist
2. Fungal infection
In the myelosuppressed host
Oral Candidiasis
- Raised, white, curdy looking areas
- White necrotic areas may be scraped off, revealing
a raw, bleeding base
- Oral candida infectious may spread to the oesophagus
or lungs ------ dysphagia, febrile
3. Viral infection
- Herpes simplex virus infections---- commissura of the
lips
- Herpes zoster infection
- Recurrent herpes infection
Oral bleeding cause by thrombocytopenia
top related