Acrylic Denture that causes Cancer
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Transcript of Acrylic Denture that causes Cancer
CHAPTER I
INTRODUCTION
1.1 Background
There is a close relationship between a person's health condition with
environmental aspects. Social, cultural, political, economic, and
educational influence on morality that provides guidelines for individuals
in choosing actions in confronting and dealing with all things related to the
environment. Because of the lack of morals, people today tend to damage
and not keeping the environment again. Furthermore, the state of the
environment that is not balanced and polluted can influence human health.
Pollutants from the environment will be very dangerous for humans
because many chemical pollutants that are carcinogenic. When harmful
substances accumulate in the human body, it will damage the body's cells
and occurs the transmission of genes to the offspring.
Other aspects also affect the quality of each individual. Economic
conditions and low levels of education, for example, makes people more
ignorant and less concerned with the long-term effects of ignoring his
health. Awareness of oral health in developing countries such as Indonesia,
are very low. Oral health has not been given attention because most of the
people do not realize the importance of oral health. Attention to oral health
is very important, because with maintaining oral health will avoid systemic
disruption dental tissues such as digestive disorders, ongoing headaches,
inflammation in other parts of the body such as the heart muscle, kidneys,
joints, to oral cancer.
Lack of awareness of oral health also makes people prefer to check his
teeth to the dental handymen. It is driven by other factors such as the cost
and limitations of dentists in small towns. Dental handymen are not
equipped with sufficient medical science to handle patient’s illness and
handle the medical waste that could harm the patient itself.
1
1.2 Objective
1. Learning the nature of human relationships and the environment
2. Learning about the linkage of social, political, and economic to the
utilization of environment
3. Learning about the factors of environmental pollution based on a
systems approach (input, process, output, and outcome)
4. Learning genetic aspects and associated microorganisms of medical
activity
5. Learning about environmental pollution factors related medical
activities based on a systems approach (input, process, output, and
outcome)
6. Learning about the approaching to environmental management
consisting of planning, organizing, implementation, and evaluation
1.3 Problems
A Dental Hospital gets 45-year-old woman referral patient who were
diagnosed with oral cancer from the Puskesmas. On intra oral
examination, patients using dentures made of acrylic, never removed since
installed 3 years ago. The denture is attached very close to the gingiva and
teeth, and successfully removed by a dentist with difficulty, obtained the
rest of the roots of the teeth 45 and 46. Denture is not installed by a
dentist.
1.4 Benefit
1. Giving an overview of monitored and emerging health issues
2. Giving an explanation of social, political, and economical aspect that
influence to human health
3. Describing the pollutants and medical wastes to human health
4. Giving more information about the importance of holistic approach in
relationship between health and ecosystem (environment)
2
CHAPTER II
LITERATURE REVIEW
2.1. Oral Cancer
The term oral cancer includes cancers of the mouth and the
pharynx, part of the throat. About two-thirds of oral cancers occur in
the mouth and about one-third are found in the pharynx. Oral cancer
most often occurs in people over the age of 40 and affects more than
twice as many men as women. (Bethesda,2008)
Oral cancer is part of a group of cancers called head and neck
cancers. Oral cancer can develop in any part of the oral cavity or
oropharynx. Most oral cancers begin in the tongue and in the floor of
the mouth.
Almost all oral cancers begin in the flat cells (squamous cells)
that over the surfaces of the mouth, tongue, and lips. These cancers
are called squamous cell carcinomas.
When oral cancer spreads (metastasizes), it usually travels
through the lymphatic system. Cancer cells that enter the lymphatic
system are carried along by lymph, a clear, watery fluid. The cancer
cells often appear first in nearby lymph nodes in the neck.
Cancer cells can also spread to other parts of the neck, the
lungs, and other parts of the body. When this happens, the new tumor
has the same kind of abnormal cells as the primary tumor. For
example, if oral cancer spreads to the lungs, the cancer cells in the
lungs are actually oral cancer cells. (Bethesda,2003)
2.1.1. The following are risk factors for oral cancer3
1. Tobacco: Tobacco use accounts for most oral cancers.
Smoking cigarettes, cigars, or pipes; using chewing
tobacco; and dipping snuff are all linked to oral cancer.
The use of other tobacco products (such as bidis and
kreteks) may also increase the risk of oral cancer. Heavy
smokers who use tobacco for a long time are most at
risk. The risk is even higher for tobacco users who drink
alcohol heavily. In fact, three out of four oral cancers
occur in people who use alcohol, tobacco, or both
alcohol and tobacco.
2. Alcohol: People who drink alcohol are more likely to
develop oral cancer than people who don’t drink. The
risk increases with the amount of alcohol that a person
consumes. The risk increases even more if the person
both drinks alcohol and uses tobacco.
3. Sun: Cancer of the lip can be caused by exposure to the
sun. Using a lotion or lip balm that has a sunscreen can
reduce the risk. Wearing a hat with a brim can also block
the sun’s harmful rays. The risk of cancer of the lip
increases if the person also smokes.
4. Apersonal history of head and neck cancer: People who
have had head and neck cancer are at increased risk of
developing another primary head and neck cancer.
Smoking increases this risk.
5. Lifestyle. The lifestyle behaviors of a patient will play a
role in determinng his or her overhall risk of develophing
oral and pharingeal cancer.(Morse,2000)
Accordingly,clinicans should consider referring to
dietary and substance abuse treatment professionals any
patient who engages in high-risk behaviours in term of
both alcohol use and dietary practice. In addition, the
emerging contribution of ethnic and genetic
4
susceptibility also must be considered as a potentially
importent modifying factor.(Kahn,2000,
Bouchardy,2000)
Some studies suggest that not eating enough fruits
and vegetables may increase the chance of getting oral
cancer. Scientists also are studying whether infections
with certain viruses (such as the human papilloma virus)
are linked to oral cancer.
2.1.2.What are the risk factors for oral cancer?
Although heredity also plays a factor, certain lifestyle habits
and health conditions can increase a person's risk for
developing oral cancer. These include, but are not limited to:
Tobacco use The majority of patients with oral cancer use tobacco in
one form or another. Tobacco can damage cells in the
lining of the oral cavity and oropharynx, causing
abnormal cells to grow more rapidly to repair the damage.
Researchers believe that the DNA-damaging chemicals in
tobacco are linked to the increased risk of oral cancer,
according to the American Cancer Society.
Alcohol use The majority of patients with oral cancer use alcohol
frequently. Paired with tobacco use, patients who drink
and smoke increase their risk of developing oral cancer
even more. Researchers have found that alcohol increases
the penetration of DNA-damaging chemicals in the lining
of the oral cavity and oropharynx, according to the
American Cancer Society.
Sunlight Prolonged exposure to ultraviolet radiation from the sun
can cause skin cancer. People who are outdoors for an
extended period of time increase their risk of lip cancer,
5
as well.
Chronic irritation Chronic irritation to the lining of the mouth, due to poorly
fitting dentures or other reasons, may increase a person's
risk for oral cancer.
Lack of fruits and
vegetables in diet
Research has suggested that fruits and vegetables, which
contain antioxidants that can "trap" harmful molecules,
can decrease the risk for oral cancer (and other cancers).
Thus, it is speculated that persons with a low intake of
these types of foods are at an increased risk for (oral)
cancer.
Human
papillomavirus
(HPV) infection
HPV usually causes warts and has been linked to cervical,
vaginal, and penile cancers. HPV also increases the risk
for oral cancers.
Males Oral cancer is twice as common in men then in women,
partly because men are more likely to use tobacco and
alcohol.
2.1.3. Preventing oral cancer:
It is important to detect oral cancer as early as possible,
because treatment works best before the disease has
spread. The National Cancer Institute (NCI) and ACS
encourage people to take an active role in the early
detection of oral cancer by performing monthly self-
examinations. The Oral Health Education Foundation
recommends the following steps (below) when
examining your mouth. Take special note of any red or
white patches, lumps or thickening of skin, tissue, or
gums, a sore that either does not heal properly (after a 1-
6
to 2-week period), or a sore that tends to bleed easily or
excessively. In addition, be sure to take note of a
persistent sore throat, hoarseness, or difficulty
maneuvering the jaw during chewing or swallowing. Be
sure to consult your physician right away if any of these
symptoms are present.
Smoking, smokeless tobacco, and alcohol substantially
increase the risk of developing oral cancer. Quitting
tobacco and limiting alcohol use significantly lower the
risk of developing these cancers, even after many years
of use. Some oral cancers are linked to human papilloma
virus (HPV) infeions of the mouth and throat. Avoiding
HPV infection may help lower oral cancer risk. In
addition, eating a healthy, balanced diet with at least 2½
cups of vegetables and fruits every day may provide
some protection against oral cancer. Most oral cancer
could be prevented if people did not use tobacco or drink
heavily. Quitting tobacco and limiting alcohol use
sharply reduce the risk of developing oral cancer, even
after many years of use. Many oral cancers may be found
early by a combination of routine screening by a doctor
or dentist and by self-examination.
2.2. Self Cured Acrylic
Chemically cured PMMA
Chemically cured, or self cured, PMMA is auto
polymerised. This means that the polymerisation reaction starts as
soon as the powder and liquid components are mixed together.
These are therefore kept separately until required. The benzoyl
peroxide initiator present in the pre-polymerised poly
7
(methylmethacrylate) spheres may also be activated by chemicals.
In this case, no heat is required for the polymerisation reaction to
occur. Dimethyl-ptoluidine, a tertiary amine, is used to activate the
polymerisation reaction in chemically cured PMMA. After
polymerisation has commenced, the reaction is the same as for heat
cured materials (Young 2010, p. 27).
As mentioned by Telles et al (2009, p.137) Self-curing
acrylic resins have been widely used in orthodontics for making
plates for small tooth movements and space maintenance, palatal
disjunction appliances, retention plates, and fixed inclined planes1.
Either orthodontists or even general practitioners can make some of
these more simple appliances in order to prevent progression of
malocclusions, which can potentially require a more complex and
prolonged treatment in the future2. Therefore, despite being
inefficient in some orthodontic treatments, these appliances still
play an important role in correcting malocclusions during
deciduous and mixed dentition within each stage of the craniofacial
development3-4. Because of their limitations, these orthodontic
appliances are used only in the treatment of children and teenagers
as the practitioner can rely on both bone growth and eruptive tooth
movement.
As mentioned by Wrinkle et al (2006, p. 132) Cold-curing
(ie, autopolymerizing, self-curing, chemically activated) acrylic
resins contain a tertiary amine chemical accelerator, usually N,N-
dimethyl-ptoluidine, which is added to the monomer so
polymerization can be completed at room temperature in a short
period of time. In recent years, cold-curing acrylic resins have
found their way into the cosmetic industry for fingernail sculpting
and lengthening. This is accomplished at beauty salons, in shops
devoted exclusively to nail care, and by individuals from nail kits
purchased at beauty shops, drug stores, other retail outlets, and over
the Internet.
8
As mentioned by Kuroki et al (2010, p. 277) Self-cured
acrylic resins have routinely been used as materials for temporary
crowns or repairing fractured dentures in dentistry. Recently, the
relationship between periodontal diseases treatments or implant
treatments and occlusion has been examined closely, and so in
many cases, temporary crowns are worn for long-term follow-up
observations. In esthetic dental therapies, provisional restoration
may be used to discover the most appropriate shape and color tone
for the final prosthetic appliance, or follow-up observations of the
improved occluding relationship may be performed for a given
period of time. However, because self-cured acrylic resins have a
low degree of polymerization and a high water-absorbing property,
it has been empirically proven that the resins become contaminated
and release a strong odor when they are mounted in the oral cavity
for an extended period.
Chemically cured (or ‘Self’ cured) PMMA properties
Chemically cured materials rarely exhibit the same degree
of polymerisation as heat cured materials. For this reason, their
strength and hardness values are lower. It is possible to exhibit a
degree of control over the rate of material hardening by altering the
size of polymer particles and the volume of dimethyl-p-toluidine
added. As no heating is required, fewer stresses are introduced into
the chemically cured materials. Furthermore, there is less
polymerisation shrinkage so these materials may be considered
more dimensionally accurate than heat cured types. However,
aesthetics are somewhat compromised with chemically cured
acrylic resins. Yellowing of the materials tends to occur over time
owing to oxidation of the amine initiator. For these reasons, and
the incomplete polymerisation of the material, a higher level of
excess monomer tends to bepresent in the finished denture base.
Chemically cured acrylic resins are most commonly used only for
9
denture repairs or additions, onstruction of custom trays or the
production of orthodontic removable appliances (Young 2010, p.
27).
Contents of chemically cured PMMA powder and liquid (Young
2010, p. 27).
Powder Liquid
Pre-polymerised PMMA spheres
Benzoyl peroxide (initiator) (1-2%)
Pi
Pi Pigment (1%)
Methylmethacrylate monomer
Hydroquinone (inhibitor) (<1%)
Glycol dimethacrylate (crosslinking
agent) (1-2%)
D
D Dimethyl-p-toluidine (activator)
2.2.1 The Technique of Self Cured Acrylic Denture
The denture was fabricated using the conventional
technique for the patient. For the fabrication of the surgical
stent, an irreversible hydrocolloid impression was made.
The impression was poured in the dental stone.
Before fabricating the base, a die pin was inserted in
the center of the anterior mandible region and then the base
was fabricated. The die pin was inserted to separate the
anterioir section of the cast from the base. The canine
region was marked on the cast according to the denture.
A self curing acrylic resin stent was prepared for the
bone mapping, and seven holes were prepared in the
marked canine region, 2 mm apart from each other. Three
holes were prepared on the buccal slope of the ridge, and
one on the crest of the ridge. The cast was sectioned in the
canine region using a saw before bone mapping.
10
The fit of the clear acrylic resin stent was checked in
the patient's mouth. The stent was checked for stability.
Before starting the bone mapping procedure, buccal and
lingual local anesthetic infiltration was given to the patient.
Bone mapping was done according to the holes prepared on
the stent using the No.20, Sterile, endodontic file. The
endodontic file was introduced perpendicular to the soft
tissue until it was stopped by the resistance of the
underlying bone. The rubber stop was placed near the
external surface of the stent.
The reading were calculated on a scale and
transferred on the sectioned part of the cast using the resin
stent and the same endodontic file. The markings on the cast
were connectd to get the morphology of the bone. Accoring
to the bone morphology, the implant diameter was decided
and osteotomy od the cast was done at the implant site.
Guiding rods were placed in the osteotomy site end
the parallelism of the rods was checked. Metal sleeves of 2
mm diameter site. The osteotomy sites must correlate with
the stent when the patient has his mouth wide open during
the surgical procedure. It's important to stabilize the stent
during maximum mouth opnening. The maxillary, self-cure,
clear, acrylic record base and the lower surgical guide stent
were stabilized with acrylic stops in the maximum mouth
opnening position.
According to the bone mapping, a 2 mm crestotomy
was required to get the adequate bone width in the canine
region. At the surgical appointment, tha patient was
prepared for surgery and local anesthesia was given at the
implan site. The flap was raised from the right premolar to
the left premolar area and crestotomy was done at the
11
implant site. Then the pilot drill was inserted through the
metal sleeve and the osteotomy site was prepared to the
required length.
Osteotomy sites were prepared with the squence of
the drill and then checked for parallelism using paralleling
rods in the oesteotomy sites. Implant(3,8 mm diameter and
10 mm length) were placed at the osteotomy site and the
flap was closed. Antibiotic and anti-inflammatory agents
were given to the patient and patientwas called next day for
a check up. After a week, nylon caps were placed on the
implants and were picked up from the lower dentures using
autopolymerizing resin. The implant-retained mandibular
complete denture was inserted (Bhosale et al 2010, p. 30-
33).
2.2.2.The Care and Maintenance of Acrylic Denture
Dentures, like natural teeth,must be cleaned to keep mouth
healthy and odor free.
a. Brush the surfaces of the denture inside and outmorning and
night. Brushwith the solution fromdenture cleanser soaking
solutions, liquid soaps or special toothpaste designed for
dentures.
b. After the first night, store the denture in water or denture
cleanser soaking solution when we are notwearing them.
This helps keep the shape and prevents drying out.
c. Don't adjust or repair a denture ourselves. We can
permanently damage the
denture and cause harm to the tissue in our mouth.
d. Don’t use hotwater on the denture. It willwarp.
e. Don't use scouring powders on the denture, as they can
remove the denture materials or roughen the surface
12
f. Don't use abrasive cleaners or bleach to remove stains. They
can change the color of gum-colored acrylic.
Patient instruction in the care of the dentures should include
the following topics:
1. Denture insertion
First-time denture wearers may want to know if it
matters which prosthesis is inserted first. A patient
asking about this should be reassured that the order of
insertion does not matter—unless there is virtually no
retention to the upper denture. In this case the lower
plate should be inserted first. If the patient has
significant undercuts in the retromylohyoid space,
instruction should clarify the mandibular denture needs
to be positioned posterior to its ultimate position; the
posterior segment seated; and then the prosthesis
brought anteriorly and then fully seated. If the patient
suffers from cognitive dysfunction due to stroke or
Alzheimer’s Disease (or other dementia), it may be
impossible for him or her to initially distinguish upper
and lower denture or to correctly position a prosthesis
over the ridge. In such an event, the dentist needs to
work with both the patient and the caregiver who will
be able to reinforce the information away from the
office. Parenthetically, it should be stressed that for
some patients, use of a mirror will actually make the
process MORE difficult, whereas it may ease matters
for others.
2. Cleaning dentures
13
Patients should be taught to remove their prostheses
after each meal for a rinsing and to clean thoroughly at
least once daily. Thorough cleaning involves brushing
and soaking. Brushes specifically designed for denture
cleaning should be recommended. These feature a wide
handle for easy gripping; stiff bristles of one length on
one side of the head (for use against broader, flatter
denture surfaces such as facial, palatal, and lingual
surfaces); and bristles set in a pyramidal arrangement
on the other side (for cleaning the tissue surface of the
denture). Patients should be cautioned not to use
toothpaste (other than toothpaste specifically designed
for use on dentures) as the high abrasivity of non-
denture toothpaste will scratch acrylic, thereby, dulling
and removing anatomic and esthetic details from the
denture surface. Daily soaking in cleanser specifically
designed for dentures is recommended for assuring
cleanliness and eliminating odors. Patients should be
cautioned to always rinse the denture thoroughly after
soaking in order to avoid ingesting traces of caustic
cleaning agents.
3. Diet
Patients should be cautioned that chewing and
swallowing with the new dentures is a learned behavior
and lip- and tongue-biting are very common risks at
first. To ensure comfortable eating while fostering
confidence in the prostheses, patients should be urged
to continue to consume the quality and variety of foods
they did prior to receiving the new dentures until those
foods can be easily consumed without discomfort from
the dentures. As a patient gains skill with the
14
prostheses, the range of foods can gradually expanded
to include crisp fruits cut in small
pieces, nuts, and sandwiches.
4. Night use
Patients, whether first-time users or those receiving a
new set, should always be instructed to leave their
dentures out of the mouth for at least 6 hours per day in
order to allow the bearing tissues to rest. For most
individuals, this is most conveniently and acceptably
accomplished during sleep. Whenever dentures are
removed for an hour or more, they should be
thoroughly cleaned and then placed in water or a
cleansing agent.
a. Remove denture for 6 hours/day
b. Store in water or cleansing agent after cleaning
c. Important to fit and function
d. Examination of mucosal tissues
5. Recall
Patients with complete dentures likely have lower
awareness of preventive dental behaviors than the
average American consumer. As such, adeliberate,
proactive effort must be made to bring them back to the
practice annually for a recall. This is important to re-
evaluate and revise, as necessary, the prostheses and to
assess the health of the oral cavity. Over 90% of the
30,000 new cases of oral cancer diagnosed in America
annually are found in persons over age 50 years.
Denture use is correlated with advanced age, use of
tobacco, and lower socioeconomic status—the three
strongest risk factors for development of oral cancer.
As such, it is essential for dental professionals to
15
establish and stress a program of recall examinations
for their edentulous patients just as they do for their
patients who maintain their natural teeth (Shay 2010, p.
3-4)
2.2.3 Effects of residual monomer
a. In the oral cavity
Burning and erythema reaction under the denture
base is often termed the denture sore mouth. The causes
vary among trauma, poor oral hygiene, bacterial infections
and allergic reactions. Most denture sore mouth caused by
trauma from denture base adaptation is not good.(Umriani,
2008)
Denturesore mouth has 3 levels of severity of the
first pin point hyperemia, a little inflammation around the
mucosal glands in the posterior and palate, both diffuse
hyperemia a wider area of inflammation, erythema, and on
almost all areas cover. When you get to this point, it looks
like the color of the mucosa of allergic reactions in the form
of red spots. The third granular papillary hyperemia, which
is covered by a mucosal surface nodules are inflamed and
often the area is smaller than the second stage. (Umriani,
2008)
Actual allergic reaction to acrylic resin denture base
can develop immediately after the installation of dentures or
patients become sensitive to the denture base in pairs, but
this is rare.(Umriani, 2008)
To determine whether the patient is hypersensitive
to denture base materials necessary to test paste on the skin
16
and mucosa where both testing methods are equally
beneficial. Oral mucosa can clear response to allergic
reactions such as skin reactions but also reactions arising in
the oral mucosa heal faster and more easily. (Umriani,
2008)
Description of the reaction is a burning feeling,
edema, and erythema at the contact area with the denture
and the denture supporting tissues. These changes often
appear more clearly in the upper jaw area because closer
denture base and constantly in contact with soft tissue.
Since the introduction of polymethyl methacrylate
or acrylic resin which is often referred to in the field of
dentistry, there has been reported about the reaction to the
material for denture base. Is described as allergic reactions
and irritation of local chemical reactions that picture looks
oralnya heat symptoms such as mouth and tongue, erythema
and oral mucosal erosions. These symptoms can be
attributed to several factors therefore it is important to pay
attention to all the existing kemungkinaan including trauma
from denture wearers, chemical irritation caused by acrylic
resin, acrylic resin allergic or hypersensitive to systemic
disease that is not associated with acrylic resin. (Umriani,
2008)
There are two distinguishing marks or allergic
response requirements of the responses due to other causes,
namely: (Umriani, 2008)
a. The response will be lost if the allergen is removed
b. Reaction will recur if the network of contacts back to the
allergen at the same location or in the paste test shows
positive results. Tissue response to allergens varies from
17
one patient to another patient and can also vary in the same
patient at different times.
Initial reaction to the allergen will affect the next
attack such a person on first contact with the components
contained in the jewelry, perfume or household chores.
Networks involved generally showed erythema with edema
waxy and cause a burning sensation aatau itching. (Umriani,
2008)
Sensitization can also be caused by repeated contact
with the allergen material for denture care. Virtually all
cases reported in clinical irritation that occurs under the
denture after months or even years ahun known as allergic
to the acrylic resin monomer methyl methacrylate.
(Umriani, 2008)
Many authors suspect that the monomer remaining
from incomplete polymerization of acrylic resin are
allergens on contact allergy. Allergy to acrylic resin is a
possibility but it is not common or rare. although rare,
allergic reactions more frequently caused by
swapolimerisasi acrylic resin and acrylic resin
swapolimerisasi is due to residual monomers containing
more than 5%.(Umriani, 2008)
2.2.4 At the dentist and tekhniker
Testing is the only paste that can be used to distinguish
between contact allergy. Hochman (1997), to test the paste
on 3 subjects first patient had an allergic reaction to
monomer, the second patient dentist who has experience an
allergic reaction on his arm after holding the acrylic resin
and the third patient dentist who did not show an allergic
18
reaction to acrylic resin. Testing is done by clearing the
ventral surface of the arm and the patch is placed
approximately 10mm square. Patients were instructed not to
wet the area and let the attached for 48 hours. After 48
hours shows that the liquid monomer, the first patient there
is a great positive reaction, both patients are a great positive
reaction, all three patients there was a positive reaction with
multiple papules and third patients are negative reactions
and there is no response at all. These results are consistent
with delayed type hypersensitivity reaction.
Residual monomers methyl methacrylate from
acrylic resin is an irritant that brings prier rapid
inflammatory response by direct action on the network
when a direct contact with the irritant. Due to entrainment
of methyl methacrylate monomer in acrylic resin, a
miraculous researchers have proved that the residual methyl
methacrylate monomer may cause hypersensitivity or
allergic reactions, as well as local irritation if not undergo
polymerisation reactions perfectly. Whereas when methyl
methacrylate polymerizes completely then it will not cause
hypersensitivity reactions(Umriani, 2008)
On acrylic resin base material generally allergic
reaction that occurs is a slow reaction and is known as
allergic contact stomatitis or venetata. (Umriani, 2008)
2.3. The rest of the root of a tooth
The revocation of the imperfect that which is characterized by
remaining partly roots, even the crown often happen if when the revocation of
the crown of a tooth is very fragile. Is marked by to form holes in the teeth
that have been very large or existence of deformities the root of which cause
19
difficulties for the revoking. No need to worry because jempatan the
revocation of the back at the rest of the root of the problem. To ease the
repeal, usually need to the awaited a few months that the remaining the root
of a tooth closer to the upper surface of the gums. Needs to be supporting
checks as roentgen of a photograph order to clarify the position of the root of
the left. But, if has caused complaints, should be revoked as soon as possible
to reprint.
The rest of the root ( stump ) in the science of dentistry called
“gangrene radiks”. Of his name just “gangrene”which means something
already “dead”. Of course it ' s not salutary again, because also a place of
being fertile for bacteria reproduce. Moreover, there yet interferes with the
onset of pain and swelling, of course are deeply disturbing. Pain and swelling
show reaction of the body against infection teeth. And this is heightened
going on the formation of a collection of pus also as a result of the process of
infection that occurs around the root of a tooth that is left the root of this.
Need to know, the rest of the teeth or root is infected was a focus of infection
or origin infection that can happen in other organs of the body, as in the skin
the eye, tht, nerves and others. The teeth or to the rest of the roots like this
should immediately lifted, but of course the patient suggested to drink
antibiotika a few days before. This to reduce infections has happened so that
the revocation of the running smoothly without hindrance. The revocation of
the cannot be done in a state of teeth was ill because local anesthesia ( a local
anesthetic ) are often not optimal. , would inflict pain upon the revocation. In
other words the teeth can ' t dianestesi well. Need not be afraid to undergo the
revocation of the teeth moreover, their condition had are deeply disturbing.
Surely you bored drink drug anchoring pain if pain is often arises. That needs
to be observed for prudence revocation comorbidities such, is the presence of
such as blood high ( hypertension ), piddle sweet ( diabetesmelitus ), the ills
of a blood disorder.
20
2.3.1. About the rest of the root of a tooth
The teeth seen from a glance of eye has two its greatest part,
namely crown of a tooth and the root of a tooth. Under normal
condition crown of a tooth is a passage that seems in the cavity of
the mouth and the root of a tooth situated in the gums. On certain
conditions the teeth of man not whole again and remain only the
rest of the root of a tooth.
The rest of the root of a tooth caused by some respects between
other :
Tooth decay of dental caries
As a result of trauma
The act of revoking the teeth are not perfect
2.3.1.1. The rest of the root of a tooth that caused by dental
caries
Dental caries happened because there are bacteria
in the mouth and carbohydrates that attaches in the
teeth that within a specified time had not been cleaned.
Bacteria in the mouth will issue a toxin that will change
carbohydrates into a substance acidic resulting in
demineralisasi e-mail. If there is any finished eating
habits gargling and rubbing a carious tooth teeth not
going to happen because the process demineralisasi can
be balanced with the process of remineralisasi by saliva
provided the condition of the mouth clean. Cleanliness
the mouth that is either not going to give it a chance on
bacteria to has made a hole in the teeth of us. Caries
who in the process of originally visible only white
patches on email increasingly going to be changed so
brown and perforated. If not domesticated cleanliness
the mouth of a hole can become widely and in
21
penetrating a layer of dentine. At this stage if no dental
treatment hole grow broad and in up the dental pulp
much contain blood vessels, lymph and neurons.
Ultimately teeth will die his teeth kropos, gripis
piecemeal until the corolla expired and is left roots
teeth.
2.3.1.2. The roots of the teeth caused by trauma
The Crown of the teeth can be broken because
teeth banged something due to accidents, falls, fights or
other reasons. Often crowns broke all the teeth roots
and leaves. This makes the pulpa dental Trauma to be
dead. Broken front teeth can make the reduced
aesthetics and sometimes caused a crisis of confidence
in a person.
2.3.1.3. Remaining roots teeth caused by revocation being
imperfect
On the act of revoking teeth sometimes not
successfully depriving of teeth a whole. Crown flourish
broken and roots in gums are still left behind. It is
caused by some respects between other structure a
broken tooth, roots teeth bent, roots teeth spread,
calcified teeth, application of forceps less proper and
excessive pressure when the act of revoking.
Remaining roots teeth left vary from its size of less than
1 / 3 roots teeth until roots teeth for gums. Remaining
roots teeth only ignored it will emerging out gums after
some time, lost alone because teresorbsi by the body
can even grow to a cyst.
22
2.3.2. The influence
People are still didn ' t notice health the teeth and his mouth.
The rest of the root of a tooth left behind in the oral cavity left
alone. Whereas due to inflicted the rest of the root of a tooth a lot.
The rest of the root of a tooth could cause pain the head prolonged,
fetor not enak and trigger the growth of a cyst even a neoplasm.
The rest of the root of a tooth usually has not been vital again,
pulpanya dead. The teeth suffered serious damage and any
remnants of the root of a tooth potentially to happen infection the
root of the teeth and infection network supporting teeth. The
infection is inflicting pain from mild until purty, subjected to
enlargement, the gums occurring pernanahan, swollen in the face
up to difficult to open the mouth ( trismus ). Patient sometimes
become limp because difficult to eat. A swelling that is happening
on the bottom of the jaw, of reddened skin, palpable hard like
wood, the tongue raised up and pain that spread highly dangerous
and if late handling can be casualties (Ludwig' s Angina )
Infection in the root of a tooth or teeth can result in
supporting tissue migrasinya bacteria to the organs other through
the blood vessels. The theory is known with focal plane infection.
A bacterium that is derived from infection teeth into other vital
organs, and increases the risk of heart disease kidney the stomach,
the joints, and others. So the teeth are infected into the entrance of
for bacteria to spread throughout the body. A tooth that is left the
root of cannot be used for a process of mastication is perfect. A
disorder of mastication be the reason masyararakat to make
artificial tooth. The problem, until now, many still make artificial
tooth above the rest of the root of a tooth. This situation can trigger
an infection of the teeth and network supporting the teeth
23
2.3.3. Handling.
The rest of the root of a tooth left behind in the oral cavity
cannot be allowed course, except on certain conditions.
Penatalaksanaan the rest of the root of a tooth is dependent of
clinical examination of the root of a tooth and tissues
penyangganya. The root of a tooth that is intact with a network of a
buffer that remained good and is could still cure. Tissue pulpanya
eliminated, replaced by pulpa an imitation, then their crown of a
tooth. The root of a tooth that has been teeter and not possible
treated tissue penyangganya need to be revoked. The rest of the
root of a tooth of small size less than 1 / 3 the root of a tooth that
occurs due to the revocation of the teeth that is not perfect left
alone. For the rest of the root of a tooth the size more than 1 / 3 the
root of a tooth that occurs due to the revocation of the teeth want to
stay taken. It is the possibility of a photograph teeth ronsen need to
do first. The lifting of the rest of the root of a tooth generally easy.
The teeth already are facing serious damage so that the tissue strut
his teeth are not strong again. For a case difficult needed the act of
surgical rin.
2.4. Environment factor human treatment to tekhniker
Community factors, lack of awareness of the importance of seeing a
competent health care and the long distances that must be taken and the
high cost of seeking health care that is licensed as a dentist, causing the
tooth pick comes to builders because it is considered more efficient in
terms of making dental practice still be alive. Also for people who works
as a tooth, this is their livelihood, so it is not possible given the limitations
of a handyman dental expertise.
24
Cultural factors are culture of the community itself. The desire to get
a result similar to that done in the practice treatment teeth with a
competent health care professional with a much cheaper cost that the
community chose handyman gear and formed the mindset that comes to
builders teeth faster and cheaper than a dental hygienist to the other so it
became a culture in the community, especially for people who are still
very low level of awareness of the dangers that can be posed to treatment
is not carried out by experts.
Factor means or inadequate facilities to implement the provisions
contained in the Permenkes also an obstacle and infrastructure that must be
met by the head of the provincial or district health department and agency
heads to establish a health center dental handyman who had done
handyman work gear based Permenkes 339/1989. (Wayan,Gusti , 2013)
2.5. Political, Economic and Social Factors influence on Human Health
Views from the political aspect, the development of a country also affects
to a society health. According to Emil Salim 1990, the continued development
aims to improve the society prosperous, to meet a public needs and aspirations.
Naurally, the continued development aims to the equitable development between
two generations, it’s in the present and in the future generations. The continued
development can be measured by three criteria: no wasteful use of natural
resources, no pollution and the other environmental impacts. It’s activities should
be increased useable resources or replaceable resource. The continued
development also has a positively impact in the socio-economic change that does
not ignore the ecological and social systems in which people are dependent on
him.
For example, the government's political efforts also affect to the security
of the preservation of natural resources and the environment of existing and
prevention of ecosystem disruption. This effort is in order to guarantee a good
25
quality of life and keep it good until there were the next generations. With the
preservation of environmental balance, the quality of public health will also be
increased.
Political factors will greatly affect for the being of other factors. It’s such
as economic, ecological, social and cultural. Which give indirectly affect to the
human health.
WHO public health made in understanding the holistic approach to create
a framework and find things related in. The concept of population health and
determinants of health, such as social, economic and environmental dimensions
the same as in sustainable development (Public Health Agency of Canada, 2010):
the physical factors, social factors and economic factors.
Physical factors in the natural environment (eg air of where we breathe,
the water we drink and the food we eat) is a major influence on health. For
example is in Canada, they has identified eight significant health problems
associated with climate change, including the health effects of smoke rising,
illnesses and deaths from heat waves and cold, water and food contamination,
diseases transmitted by insects, the health effects of depletion stratospheric ozone,
and extreme weather events.
Social factors, such as the education and social support, which enable and
support healthy choices and lifestyles, as well as people who are knowledgeable,
intentions, behaviors and skills to deal with life in a healthy way, is a major
influence on health. Where the people are leve is give much influence here.
Economic factors, such as income level and employment status, are
important determinants of healts. The groups that have a high income will got the
better of health care. Person who has control over the work situation and a little
stress associated with living longer than those who work more stressful or riskier.
Among the factors of political, social and economic are highly sustainable
and relate one to another in determining the quality of a person's health.
26
CHAPTER IV
DISCUSSION
A 45-year-old woman was diagnosed with cancer of the oral cavity. The
patient uses the dentures are made from acrylic and never took off for 3 years.
Artificial tooth is attached closely upon gingiva and a tooth. It brings the rest of
the root. No dentures fitted by a dentist.
Of those cases, the women use the dentures of acrylic. Acrylic polymer
and monomer consists of Polymer called poli methyl methacrylat and the methyl
metachrilat monomer. These monomers are carcinogenic in case of imperfect
polymerization such as in engineering self cured. If the polymerization of acrylic
resin running short, will cause the monomer content have yet to react to the
polymer remains high. Residual monomer content in acrylic resin high needs to
get attention. When the material is used in the oral cavity can lead to irritation of
the mucosa occurring oral cavity its manifestation in the form of redness, pain and
swelling.
Residual Monomer in the bonding between the denture and the rest of the
root of the potential to irritate. Residual Monomer will enter into the rest of the
roots that lead to the onset of irritation.
Irritation resulting in the presence of inflammation. The existence of
factors that effect long enough that the wearing of dentures is never released for 3
years cause irritation became a chronic irritation. As a result the occurred
hiperplasia. Hiperplasia is the increased number of cells in a tissue/organ. The
number of cells increases included in the system development/organ. The cells
develop into much by way of splitting. The cleavage of their cells in excess of its
normal speed. Well, the development of cell division was gradually able to
suppress the innervation around the network. Reactive hyperplasia that can
develop into cancer. If the polymerization of acrylic resin running short, will
cause the monomer content have yet to react to the polymer remains high.
27
Residual monomer content in acrylic resin high needs to get attention. When the
material is used in the oral cavity can lead to irritation of the mucosa occurring
oral cavity its manifestation in the form of redness, pain and swelling.
So who played an important role in cancer this is irritation chronic which
is due to the use of artificial tooth that never detachable for 3 years and adheres
closely at gingival and teeth where stimulates growth of cancer cells. The second
is the monomer that is carcinogenic who is also resulting in an irritant. The
monomer obtained from artificial tooth acrylic resulting from the process of
polymerization of being imperfect
“Why the people prefer to dental handyman than a dentist ?”
Dental problems cause many people are looking for dental health care both
for treatment and for dental care. Dental health services in the community not
only in the practice of a dentist or clinic only, but there are other practices that
builders teeth. Historically, handyman gear has existed since the Dutch colonial
era. Even the construction workers, dental encourage the Dutch colonial
authorities established dental education institutions STOVIT (school tot opleiding
van indische tandartsen) at Surabaya in 1928. (Anonim, 2012) Since the number
of teeth handyman who has set up practice, the government through the Minister
of Health issued a health minister rules Numbers 53/DPK/I/K/1969 on the
Registration and Work Permit Running Plumbers Gear (hereinafter referred
Permenkes 53/1969).
To limit the license to practice dental craftsman, the government issued
Permenkes No.. 339/Menkes/Per/V/1989 About Plumbers Dental Work
(hereinafter referred to Minister Regulation 339/1989) which regulates dental
license renewal handyman who has have permission. With the enactment of this
Permenkes then no new licenses issued by the government for the handyman gear,
so the only handyman teeth already have a license to practice before this applies
Permenkes can extend permission. In 2011 the Ministry of Health issued new
regulations that Permenkes No. 1871/MENKES/PER/IX/2011 on Revocation of
Regulation of the Minister of Health No. 339/MENKES/PER/V/1989 About
28
Plumbers Dental Work (hereinafter referred to Permenkes 1871/2011). Given this
and all handyman Permenkes teeth operations in Indonesia revoked license and
can not open the practice again, but in fact the builders still remain open dental
practice activities. From this background it can be argued that the formulation of
the problem how Permenkes implementation of 1871/2011 and the factors that
influence whether The implementation Permenkes.
The existence of many dental handyman assessed unsettling, this is
because the Permenkes 339/1989 gear only limited competence artisan making
denture of acrylic removable partial or full removable denture and install, but the
in fact a lot of rogue builders who perform dental practice beyond the competence
and beyond that permitted such things do fillings or tooth extraction, installation
of braces and other competencies that they should not be doing. By Therefore the
government issued Permenkes 1871/2011. With the enactment of this rule then it
should have teeth builders should never open practice again.
According to Rini Zaura Anggraini, chairman of the Indonesian Dentists
Association (Recognizes) there are currently at least 75,000 artisans across
Indonesia teeth (Lusia Kusuma Anna, 2012) . They operates freely without regard
to the provisions of Minister Regulation 1871/2011, as well as the lack of sanction
of the government in the form of a reprimand, closure practices or criminal
sanctions given to the builders teeth still open practice. Many builders are still in
operation and dental practice outside actions are allowed while the government
does not regulate or provide sanctions to the teeth indicates that the artisan
Permenkes 1871/2011 has not been can be effectively implemented.
Several factors influence the effectiveness of a rule such as factor of its
own law, the law enforcement apparatus, means or facility factors, factors public
and legal factors alone kebudayaan. Factor in this case is Minister Regulation
1871/2011 does not have strict sanctions so that the builders teeth still dare to
open a practice and serve patients to date. Factor Law enforcement in this case has
not been enforcing the Minister of Health, it can be seen that the lack of action
taken by the government to cover the activities practices carried out by a tooth.
Factor means or facility that is not adequate to implement the provisions
29
contained in the Minister of Health also is a constraint faced in its application, for
example the lack of facilities and infrastructure that must be met by the head of
the provincial health department or district and agency heads to develop artisan
dental clinic that has been doing handyman work gear based Permenkes 339/1989.
Community factors, lack of public awareness of the importance of
medication to competent health care and the long distances that must be taken and
the high cost of seeking health care that is licensed as a dentist, cause the tooth
pick comes to builders because it feels more efficient than terms of cost and time.
This causes there are always people who went to a craftsman teeth so dental
practice handyman can still be alive. In addition to the community who works as a
tooth, this is their livelihood, so not likely to be abandoned given the limitations
of their expertise.
Cultural factors is the culture of the community itself. The desire to obtain
a result similar to that done in the treatment of teeth with builders competent
health professionals at a cost much cheaper cause people choose handyman gear
and formed the mindset that comes to handyman gear faster and cheaper than a
dental hygienist to the other so that the become a culture in society, especially for
the people who rate still very low awareness of the dangers that can be posed to
treatment is not carried out by experts. (Soerjono Soekanto, 2011)
30
CHAPTER V
CONCEPT OF MAPPING
31
CHAPTER VI
CLOSING
5.1 Conclusion
A 45-year-old woman referral patient who were diagnosed with
oral cancer, the problem begins due to the use of denture acrylic resin and
there is self cured or chemically acrylic that contains Pre-polymerised
Polymethyl Methylmethacrylate (PMMA) spheres as polymer and
Methylmethacrylate as monomer. If there are large amounts of residual
monomer, it can Burning and erythema reaction under the denture base is
often termed the denture sore mouth. The causes vary among trauma, poor
oral hygiene, bacterial infections and allergic reactions. There are because
the residual monomers methyl methacrylate from acrylic resin is an irritant
that brings prier rapid inflammatory response by direct action on the
network when a direct contact with the irritant. Most denture sore mouth
caused by trauma from denture base adaptation is not good. This oral
cancer is compounded by the Denture is not installed by a dentist. It may be
due to several factors why patients prefer handyman teeth than dentist:
Community factors, Cultural factors, Political factors, Physical factors,
Social factors and Economic factors. With minimal experience and
knowledge, the handyman dental practice as a dentist without an official
license. Obviously this can cause some problems, especially in patients who
are treated. Because the quality of dental care by handyman it is not
necessarily good and true. And as in the case, if the installation and
maintenance of acrylic denture less true or not true, it can cause oral cancer.
5.2 Suggestions
We should learn about oral cancer, so that we can maintain our oral
health effectively. If we do so, an oral cancer on oral cavity just like in
the case would not happen.
32
Apply what we have learned in studying oral cancer, so what we learn is
not wasted by doing the application and we can be spared from this oral
cancer.
We have to know the care and use of dentures in a good and right way.
Then always maintain the cleanliness of dentures, for example by
cleaning it after eating.
Choose a dentist than handyman gear for installation good and true
denture, with attention to culture, physical, politics and economics
factors.
Consult to dentist regularly about your dentures, so your dentures will
not very close to the gingiva and can removed easily. And then any
disease can be detected as soon as possible and oral health care can take
place better.
33
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