Peran Plak Gigi pada

Patogenesis Penyakit
Periodontal & Karies Gigi

Fakultas Kedokteran
Universitas Diponegoro
2018
Plak Gigi

Deposit lunak berupa lapisan tipis

yang melekat erat pada
permukaan gigi atau permukaan
struktur keras lain dalam rongga
mulut dan mengandung bakteri
beraneka ragam.
1. Plak Gigi & Penyakit
Periodontal
• Inflamasi pada jaringan
penyangga gigi
• Penyebab : Plak, infeksi
bakterial, viral, hormonal dll
• Jaringan periodontal : gingiva,
membran periodontal, tulang
alveolus, sementum
Keluhan
• Gusi bengkak
• Sakit
• Berdarah (ringan sd spontan)
• Bau mulut
• Gigi goyang
Kelanjutan penyakit
periodontal
• Gingivitis jika tidak dirawat
berlanjut menjadi periodontitis
marginalis 
Pocket periodontal, resesi
gingiva, resorbsi tulang, migrasi
gigi
• Abses periodontal, IO & EO
Penatalaksanaan
• Kontrol plak (initial)
• Tergantung keparahan.
• Medikamen
• Operatif : Curretage,
Gingivectomy, gingival graft,
bone graft, fiksasi, systemic
control
• Scalling – Polisihing – edukasi :
habit
2. Plak & Penyakit
Karies
Clinical finding:

Initially, it may appear as a small chalky area

(as indicating an area of demineralization)
but eventually develop into a large and
brown/ blueblack cavitation.
• Commonlly started in fissure, pit occlusal,
and interdental surface, because food
remain to be happen in these areas.
Classification:
Numerous ways to classify caries
is by :
q  Location : m, d, o, b, l, or combined
q Etiology : baby bottle, early
childhood, rampant caries, etc.
q Rate of Progression : Acute, chronic,
recurent.
q  Affected hard tissue : enamel,
dentinal, root caries
Diagnosis & examination
• Primary diagnosis involves :
• Inspect to all visible tooth surface,
using : good light source, mirror,
sonde and explorer.
• Explore cavity, eliminate food debris,
dried with cotton or airflow  to
know cavity expantion & pulpal
response.
• Routine examination : Sondation,
percussion, pressure & palpation.

• X-rays, transillumination
fibreoptic : when the naked eye
couldn’t detect the lesion, at
interproximal, cervical, or apical.
Caries Risk :
Symtoms:

q    No pain to severe pain

q Pain : by heat, cold, sweet foods
/drinks, spontaneous.
q Also cause : bad breath, bad
sensation /foul taste, infection &
spread to surrounding soft tissue.
Penjalaran karies Gigi
menjadi Penyakit pulpa
• pulp irritation,
• pulp inflamation
• death of pulp.
Progression of pulp diseases:

1.   Pulp Irritation (Iritasi pulpa)

• -  Lesion on enamel or cementum,
but no pathologic changes on to pulp
tissue.
• - Subjective : sensitive when acidic/
sweet feed/drinking
 Objective :
-  EO : t.a.k
- IO :
Ins : caries (+), may on multiple
surfaces.
Son : superficial, pain (-)
Per : (-), Pres : (-), Pal : (-)
Pulp inflammation :
Hiperemi pulpa
• -Multiple injuries : acidic substance/
toxic metabolite rise on deep cavities,
when we don’t treat it & cause pulp
tissue inflammation.
• -1-st step is hyperemia/ vascular
vasodilatation
• Subj : Pain present until injuries
(food/drinks) were eliminated from
cavity. No history of spontaneus pain.
   Obj :
• - EO : t.a.k
• - IO : I : Caries +
• S : Medium, severe sensitive (+++)
but decrease fastly
• P/P/P : -/-/-
Partial Acute Pulpitis
• Pulp tissue inflammation on to pulp chamber
area only.
• Subj : pulsation, spontaneous & long
duration pain without stimulation.
      Obj : - EO : -
- IO : I : Caries +
S : medioprofunda/profunda, pain (+++)
P/P/P : +/-/-
Total acute Pulpitis

• - Pulp tissue inflamation on to all

area of pulp chamber + apical
canal & spread to periapical
tissue.
• -Subj : Severe pain, spontaneuos,
spread in to temporal, cervical &
auricular area.
• Obj :
- EO : t.a.k.
- IO : I : Caries +
S : profunda, pain (+++)
P/P/P : +/-/+
Chronic pulpitis
• - Chronical inflammation of pulp
tissue
• - Can turn to acute phase
• - Subj : History exam : presenting
complain, but pain may be absence
now.
• - EO : t.ak.
• - IO : I : caries +, calculus
might accumulated on the
same area
S : profunda, pain (++)
P/P/P : -/-/-
Pulp death
• Pulpitis yg tidak mendapat perawatan akan
mengalami kematian (nekrosis). Karena
kematiannya di sertai dengan invasi
mikroflora oral, maka disebut sebagai
Gangren Pulpa.

• Mikroba gangren pulpa dan metabolit

toksiknya menyebar ke jar. periodontal
apikal menyebabkan periodontitis apikalis.
• Nekrosis pulpa juga dapat
menyebabkan periodontitis apikalis,
akibat dari jaringan nekrotik pulpa
yang lisis bersifat toksik.
• - Subj : Pada kondisi akut, muncul
keluhan sakit. Pada kondisi kronis
tidak ada keluhan.
• Obj : EO : t.a.k.
• IO :
• Inspection : profunda, pulp
perforate, colour change.
• S : profunda, pain (-)
• Percussion : +/-, Pressure : +/-
• Palpation : luxation (+)
Management:

q Preventif : 1) Personal oral hygiene -->

brushing & flossing daily, to minimize
etiologic agent, remove & prevent
formation of plaque. 2). Dietary
modification 3). Others
q  Curatif :
• Basic treatment : conservative to
maximize the function of
masticatory, phonetic and aesthetic.
Extract when : excesive caries,
posterior.
PENJALARAN

• Penyakit karies yang tidak mendapat

perawatan, menyebabkan kematian
pulpa. Penjalaran infeksi odontogen
dapat menjalar secara lokal (IO dan
EO) menjadi periapical diseases. Gigi
gangren dan periapical diseases juga
dapat menjadi sumber infeksi (focal
of infection) yg menyebar ke organ
lain melalui foramen apikal.
 Dental Plaque

Cariogenic Periodontopathy Immunosupressif

agent :
S mutans, A Actinobacilus, Endotoksin LPS
viscosus, L baccilus Spirochaetas, (lipopolisakarida) di
Bacteriodes, Vaillonella jaringan periodontal

Dental Periodontal Sistemic

Caries Diseases Diseases
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