Kelompok 2

Modul 107 Pulpitis reversibel 2 topik 2

SkenarioSeorang pasien wanita berusia 39 tahun pekerjaaan penyiar, datang di rumah sakit gigi dan mulut dengan keluhan merasa sangat terganggu dan tidak nyaman karena gigi linu bila minum dingin dan pasien merasakan sering haus, bau mulut yang tidak enak,. Intra oral terdapat karies servikal pada gigi 21, karies proksimal pada gigi 43, white spot pada gigi 31,41,42.Tampak gingiva kemerahan. Pada tes vitalitas : gigi vital. Dari pemeriksaan saliva , pH strip berwarna kuning, pada pemeriksaan saliva dengan stimulasi, kecepatan aliran saliva 2 ml/5 menit, buffer saliva pH 6,8.

Anamnesa Nama : Asih

Alamat : SurabayaJenis kelamin / Usia : Perempuan / 39 tahunpekerjaan : penyiar

Riwayat penyakit menular : -Riwayat penyakit yang diidap : DM tidak terkontrol 2jam pp/puasa 340/120 mg/dlRiwayat alergi obat : -

Keluhan Utama : merasa sangat terganggu dan tidak nyaman karena gigi terasa nyeri (linu) bila minum dingin

Pemeriksaan IO◦ Karies servikal gigi 21

◦ Karies proksimal gigi 44

◦ White spot pada gigi 12

◦ Retraksi gingiva pada 31,41,42

Pemeriksaan gigi ◦ Tes Vitalitas : gigi vital

◦ Tes saliva pH test strip berwarna kuning Kecepatan aliran 2 ml / 5 mnt Buffer saliva pH 6,8

Pulpitis reversibel pada gigi 21 dan 44 White spot pada gigi 12

Diagnosa

• Px 39 tahun• Gigi linu dan tidak nyaman

• Pulpitis reversibel 21,

43• White spot

12

Rencana perawatan: • RM GIC pada 21,

44•CPP-APP pada gigi

12• Konsul perio

Sering haus Bau mulut tidak

enak Sering buang air kecil di malam hari

Diabetes melitus tak terkontrol

• Aliran saliva 2 ml / 5 menit• Buffer saliva

6,8

Diabetes Mellitus DM is a group of

metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both.

DM can have a significant impact on the delivery of dental care.

Type 1 DM:

5-10% of cases. Beta-cell (insulin

producing cell) destruction or defect in beta-cell function.

Absolute deficiency of insulin.

Two types: 1. Immune mediated:

Autoimmune destruction of insulin-producing beta cells of the pancreas.

2. Idiopathic: No evidence of autoimmunity.

Type 2 DM: 90-95% of cases. Results from impaired insulin function

(insulin resistance). Relative insulin deficiency. No destruction of beta-cells. Ketoacidosis is uncommon. The risk of developing type 2 DM

increases with age, obesity and lack of physical activity.

Type 2 DM is more prevalent in people with hypertension.

There often is a strong genetic predisposition.

DM Saliva flow rate

hyposalivation

Disturbance microflora

Ph saliva

Demineralization

Accumulation of plaque

caries

Role Caries in DM

kondisi inflamasi atau radang pulpa ringan sampai sedang yang disebabkan oleh jejas atau stimuli noksius namun pulpa mampu kembali pada keadaan semula setelah stimuli ditiadakan

Pulpitis Reversibel

Bila karies berlanjut

inflamasi

pulpitis

Detection of the patient with DM

Known diabetic person

1. Detection by history:

• Are you diabetic?• What medications are you taking?• Are you being treated by a physician?

2. Establishment of severity of disease and degree of control:

• When were you first diagnosed as diabetic?• What was the level of the last measurement

of your blood glucose?• What is the usual level of your blood glucose?• How are you being treated for your diabetes?• How often do you have insulin reactions?• How much insulin do you take with each

injection, and how often do you receive injections?

• Do you test your urine for glucose?• When did you last visit your physician?• Do you have any symptoms of diabetes at the

present time?

Undiagnosed diabetic person

1. History of signs and symptoms of diabetes or its complications.

2. High risk for developing diabetes

• Parents who are diabetic.

• Gave birth to one or more large babies.

• History of spontaneous abortions or stillbirths.

• Obese.• Over 40 years of age.

3. Referral or screening test for diabetes.

DM and The Mouth A number of oral conditions have been

associated with DM, particularly in patient with poor control of the disease. However, most patients are unaware of the oral health complications of their disease.

Therefore, it is important for dentists to educate patients about oral complications of DM and the need for proper preventive care.

Steps of dental management of diabetic patients

If patient is uncontrolled/poorly controlled:

Provide appropriate emergency care only. Request referral for medical evaluation,

management, and risk factor modification:

• If symptomatic, seek IMMEDIATE referral.• If asymptomatic, request routine referral.

RM GIC pada 21 dan 44Kelebihan :

-memiliki sensitivitas yang lebih rendah terhadap

kelembaban,- kekerasan permukaan yang lebih tinggi,- nilai estetik yang optimal,- stabilitas dimensional yang baik- ketahanan terhadap abrasi dan erosi asam yang lebih baik,- mampu melepaskan fluor lebih banyak

Rencana Perawatan

-Topikal aplikasi fluor-AplikasiCPP-ACP (casein-

phosphopeptideamorphous calciumphosphate)

Konsul pada bagian periodonsia, ortodonsia dan penyakit dalam

Remineralisasi non-cavitated lession of enamel and dentin

TERIMA KASIH