ipd ginjal ht

36
Oral Manifestation of Renal Disease & Hypertension Arny Erawaty Muryah, drg PPDGS ILMU PENYAKIT MULUT (April 10 2015)

Upload: ummipratiwi

Post on 13-Sep-2015

46 views

Category:

Documents


7 download

DESCRIPTION

Ipd Ginjal

TRANSCRIPT

  • Oral Manifestation of Renal Disease & HypertensionArny Erawaty Muryah, drgPPDGS ILMU PENYAKIT MULUT(April 10 2015)

  • Renal Disease

    Meliputi gangguan keseimbangan asam-basa, kelainan elektrolit, nefrolitiasis, hipertensi, penyakit ginjal akut, penyakit ginjal tahap akhir (end-stage renal disease / ESRD) tipe diabetik dan non diabetik.

    Gagal ginjal, dapat terjadi secara akut Acute renal failure ; ARF (setelah pembedahan atau trauma parah), atau adanya obtruksi pembuluh darah ginjal menyebabkan gagal ginjal kronis (chronic renal failure ; CRF).

    Gagal ginjal akan menimbulkan retensi cairan, asidosis, akumulasi metabolik dan bahan obat, kerusakan platelet ( memicu pendarahan), hipertensi, anemia dan efek endokrin.

    (Burket : 2008)

  • Major function of Renal

  • Type of Renal Failure(Haider et al : 2013)

  • Burket : 2008

  • Burket : 2008

  • Oral Manifestations of Renal DiseasesGhom : 2013, Haider 2011, Scully : 2010, Ongole :2013)

  • Oral Manifestations of Uremia

    Oral mucosa pale mucosa

    Salivary gland decreased salivary flow resulting in erostomia.

    Odor & taste odor of urea on breath and metallic taste.

    Candidiasis candidal infection can occur on tongue.

    Gingiva increase in calculus formation, gingival inflammation, bleeding.

    Teeth enamel hypoplasia, dark brown stain on crowns, dental malocclusion

    Other petechiae, ecchymosis, erosive mucous, burning and tenderness with dryness of mucosa.(Ghom et al : 2014)

  • Uremic Stomatitis

  • Tipe 1. Erytemopultakeus

  • Tipe 2. Ulseratif

  • more extensive area of erosion verlying a delicate atrophicmucosa. The typical striae are seen anterior to the erosion.

  • Hiperplasia gingiva oleh karena drug induced pada CRF (Sunil et al : 2012)

  • Hipoplasia email pada gagal ginjal (Sunil et al : 2012)

  • Oral candidiasis on dorsal of tongue

  • (Scully : 2010)

  • Hypertension

  • . (Ongole et al : 2013) Hipertensi

  • Blood pressure determined (Scully : 2010)

  • Types of Hypertension

    (Ghom : 2010)

  • Blood Pressure Measurement (Scully : 2010)

  • Klasifikasi tekanan darah. (Ongole et al : 2013)

  • Antihypertension Medicine(Popescu et al : 2013)

  • Oral side effects of antihypertension medicines(Ongole : 2014)

  • Orofacial manifestationsNone specific to hypertension, The development of facial palsy has been described in the occasional patient with very severe hypertension.

    Side-effects of anti-hypertensive medications include: chronic cough (e.g., angiotensin converting enzyme inhibitors ACEIs); taste changes (e.g., ACEIs, beta blockers, alpha-adrenergic blockers); angioedema of lips, face, tongue (ACEIs, angiotensin II receptor blockers-ARBs); upper respiratory tract infections (e.g., ARBs); gingival hyperplasia (e.g., calcium channel blockers CCBs); dry mouth (e.g., thiazide diuretics and alpha-adrenergic blockers); lichenoid reactions (e.g., thiazide diuretics and beta blockers); and lupus-like oral and skin lesions (e.g., direct vasodilators). (Scully : 2010)

  • Xerostomia karena diuretik, calsium channel bloker

  • Lichenoid drug eruption oleh karena beta bloker

  • Hiperplasia oleh karena calsium channel bloker

  • Kandidiasis pada mukosa bukal

  • General Management

    (Ongole et al : 2013)

  • Dental ConsiderationInteraksi anastesi lokal - non selective beta-blockers toksisitas

    Penurunan dosis epinefrin dan diperpanjang jarak pemberiannya

    Teknik injeksi dengan perlahan menghindari reaksi yg tidak diinginkan

    NSAIDs menurunkan efek diuretik antihipertensi parasetamol

    Kontrol kecemasan, stres dan rasa sakit antianxietas

    Xerostomia agen parasimpatomimetik (pilocarpine atau cevimeline)

    Disarankan cukup minum dan berkumur, mengunyah permen tanpa gula, mengurangi konsumsi kafein, tidak menggunakan obat kumur yg mengandung alkohol

    Karies aplikasi topikal fluorida. (Popescu et al : 2013, Ongole et al : 2013)

  • Penutup

  • DAFTAR PUSTAKA

    Ongole, Praveen : Textbook of Oral Medicine, Oral Diagnosis and Oral Radiology, second edition, Elsivier, 2013Proctor R, Kumar N, Stein A, Moles D, Porter S : Oral and Dental Aspects of Chronic Renal Failure Journal of Dental Research; Mar 2005; 84, 3; Health & Medical Complete page. 199Scully C : Medical Problems in Dentistry, 6th Edition, Elsevier, 2010 page 111-115 and 296-303Scully C, Almeida P.de Oslei, Bagan Jose,Dios PD, Taylor AM : Oral Medicine and Pathology at a Glance, edition first published, Blackwell Publishing Ltd, 2010Field, Anne; Longman, Lesley : Tyldesley's Oral Medicine, 5th Edition , Oxford University Press, 2003 Page : 254-259Bailoor ND, Nagesh KS: Fundamentals of Oral Medicine and Radiology, Jaypee Brothers Medical Publishers (P) Ltd New Delhi, 2005Ghom A.Govindrao : Textbook of Oral Medicine, Jaypee, 2010Haider S.Raza, Tanwir F, Momin I.Abdul : Oral aspects of chronic renal failure, Pakistan Oral & Dental Journal Vol 33, No. 1 April 2013

  • DAFTAR PUSTAKA

    Mozaffari P. Mosannen, Amirchaghmaghi M, Mortazavi H : Oral Manifestations of Renal Patients Before and After Transplantation: A Review of Literature DJH Vol.1, No.1 : 2009

    DeLong, Leslie. : General and oral pathology for the dental hygienist. 2nd ed, 2013 Wolters Health, 2013Scully, C. : Oral And Maxillofacial Medicine. 2nd ed. Edinburgh: Churchill Livingstone. 2008 Ghom AG, Lodam,: textbook of Oral Medicine, third edition, Jaypee, 2014Greenberg SM, Glick M, Ship AJ : Burkets Oral Medicine, Hamilton, 2008Hamid MJ, Dummer CD, Pinto LS : Systemic Conditions, Oral Findings and Dental Management of Chronic Renal Failure Patients: General Considerations and Case Report, Brazilian Dental Journal : 17(2) 2006Garca E. de la Rosa, Padilla AM, Romo SA, Ramirez MA : Oral Mucosa symptoms, signs and lesions, in end stage renal disease and non-end stage renal disease diabetic patients, Oral Medicine and Pathology, Med Oral Patol Oral Cir Bucal;11:E467-73. 2006Patil S, Khandelwal S, Doni B, Rahman F, Kaswan S.: Oral Manifestations in Chronic Renal Failure Patients Attending Two Hospitals in North Karnataka, India, OHDM - Vol. 11 - No. 3 - September, 2012

  • Sunil, Kumar, Sawheney, Gaur B, Rastogi T : Spectrum of orofacial manifestations in renal diseases, Journal of orofacial research 2(4) oct-dec 2012 page 216-220 Popescu SM, Mercuu Veronica, Mihaelatuculina, Dascslu Ionela : Hypertensive Patients and Their Management in Dentistry ; Review Article, ISRN Hypertension Volume 2013, Hindawi Publishing Corporation Article ID 410740,8pages

    Vesterinen Maarit : Oral Health And Kidney Disease With Emphasis On Diabetic Nephropathy, Academic Dissertationuniversity Of Helsinki, Unioninkatu 34, Helsinki, November , 2011Pinto A, Roldan R, Sollecito, TP. : Hypertension in Children: An Overview Journal of Dental Education , Volume 70, Number 4, November 2005

    Kessler CS, Joudeh Y, Evaluation and Treatment of Severe Asymptomatic Hypertension, University Of Illinois At Chicago College Of Medicine, Chicago, Illinois, American Family Physician, Volume 81, Number 4, 2010 www.aafp.org/afp

    DAFTAR PUSTAKA

  • Syukron...

    smellpatients complain of ammonic taste and smell, particularly in the morning. It is causedthe patients may complain of xerostomiawhich is caused by direct involvement of salivary gland,chemical inflammation, dehydration and mouthbreathing. he acute rise in BUN level may result in uremic stomatitis, which appears as erythemopultaceous form, characterized by red mucosa covered with a thick exudate and a pseudomembrane

    by the high concentration of urea in saliva and its breakdown to ammonia.

    *