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

MANIFESTASI KEMOTERAPI DI

RONGGA MULUT

Wilda Hafny Lubis drg MSi

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