K9_FKG_Manifestation Systemic Disease.ppt

8/18/2019 K9_FKG_Manifestation Systemic Disease.ppt

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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

Documents

K9_FKG_Manifestation Systemic Disease.ppt