BLOK 13 SWELLING

SCENARIO 3

my teeth are not

growing
 GROUP 6
DOSEN FASILITATOR: drg. Ricky Amran, MARS

Soundra Liany 2010070110006

Fadila Reza Putri 2010070110008
Alvi Yusra 2010070110009
Frisca Maharani 2010070110026
Molarica Alveonita 2010070110033
Rahmah Hidayati 2010070110034
Indriana Zusuan 2010070110035
Salsabila Aurefcia 2010070110042
Indah Vandriani 2010070110048
Ghea Augesta Amanda 2010070110070
Aufa Galuh Chikalika 2010070110077
Siti Nuraliza 2010070110095
FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS BAITURRAHMAH2020/2021
 my teeth are not growing

A 15-year-old girl came with her mother to the RSGM with a

complaint of a lump on the right back gum since 1 month ago.
Intraoral examination revealed a lump in the distal 45 gingival
region, and an unerupted tooth 46. Radiographic examination
revealed impacted tooth 46, with a radiolucent lesion with a
corticated radiopaque border (clear, firm) over its crown as in the
attached radiograph.
STEP I (CLARIFICATION OF TERM)
1 Calculus 2 Lingual prenulum

Salivary gland It is a fold of

stones are mucous
salivary gland membrane that
calculus that is connects the
formed due to tongue to the
the deposition of floor of the oral
calcium salts cavity and the
with organic. mandible.
 STEP 2 DEFINE THE PROBLEMS
1.Why does the pain increase when eating spicy food in this case?
2.What is the case diagnosis in the scenario
3. Does the scenario case have a differential diagnosis, if so, explain what?!
4. Can the case recur after treatment in the scenario?
5. If not treated immediately what will happen to the patient?
6.How are other signs and symptoms related to the case in the scenario
7. Can the lymph nodes spread to other areas or to other people?
8. How is the interpretation of the radiographic image in the case in the
scenario?
9. What is the cause of the scenario case
10.What kind of treatment for the case in the scenario
11. What is the meaning of the floor of the mouth in the calculi around the
erythematous area?
 STEP 3
BRAINSTORM
 1 2
Why does the pain increase
when eating spicy food in this
case?
- In this case, the pain can get
worse when eating where saliva
production increases, but the
salivary glands experience
obstruction / blockage so that
saliva production is forced to
come out. This is what causes
pain when chewing.
What is the case diagnosis in
the scenario
- The diagnosis
sialolithiasis or salivary gland
stones that are formed from
the deposition and hardening
of chemicals in the salivary
glands, which are shaped like
stones. These stones can
block the flow of saliva into
the mouth so that the
salivary glands become
swollen and painful.
3
Does the scenario case have a
differential diagnosis, if so, explain
what?!
is
- A). Sialodenitis is inflammation
of the parotid gland such as
acute bacterial caused
- B). Lymphoepithelial cysts are
non-cancerous
- C). Sjorgen's syndrome is an
immune system disorder
characterized by dry eyes and
dry mouth.
 4 5 6
Can the case recur after treatment in If not treated immediately what How are other signs and symptoms
the scenario? will happen to the patient? related to the case in the scenario

- It is recurrent if after surgery but the
salivary glands are still blocked,
especially after simple surgical
excision.
- Some complications can occur
such as: swelling, infection of
the salivary glands, which is
characterized by fever, redness
in the infected area, abscess
(pus) appears, xerostomia and
more serious chronic
sialodenitis.
- Sialothiasis sometimes causes no
symptoms, especially when new
stones form. salivary gland stones
only cause symptoms if they are
large enough. Symptoms include
pain and swelling in the salivary
glands, pain and swelling in the
mouth, face and neck, dry mouth
and inability to open the mouth.
 7 8
Can the lymph nodes spread to
other areas or to other people?
- It cannot be transmitted to other
people because this disease is not
a contagious disease and it is
impossible to move from one duct
to another because it is a blockage
by calculi where the stone in the
duct will only increase in
size/enlarge if not treated.
9
How is the interpretation of What is the cause of the scenario
the radiographic image in the case
case in the scenario?
- The etiology of sialolithiasis is
- Radiopaque or white not known with certainty, but it is
appearance under the thought to be a series of
tongue, due to calcified processes initiated by
obstruction in the salivary abnormalities of calcium
ducts/ducts. Which shows metabolism and salt precipitation.
the occurrence of then followed by layering of
petrification in the organic and inorganic materials to
submandibular salivary gland form a stone.
(Warthon ductus), not only in
the submandibular gland but
also in the parotid gland.
 10
What kind of treatment for the case
in the scenario
• non-surgical treatment: if the
sialolith is small, moist heat therapy
should be applied, the occasional
NSAID (non-steroidal anti-
inflammatory drug) and education
for the consumption of bitter and
sour foods and drinks.
• surgery: sialectomy (cannulate
the ducts to remove stones)
• minimally invasive: lithotripsy
( treatment without anesthesia with
the aim of reducing the size of the
calculi into small fragments so as
not to interfere with salivary flow.
11
What is the meaning of the floor of
the mouth in the calculi around the
erythematous area?
surgery.
- In the lingual region there is a
stone that is formed due to organic
and inorganic deposits and can
block the flow of saliva from the
glands into the oral cavity and in
that area there is an inflammatory
reaction in the form of swelling and
redness in the area.
STEP 4 PROBLEM ANALYSIS
lower tongue swelling

subjective, objective and supporting

examination

diagnosis differential diagnosis

Clinical patoghenesis
Etiology
symtomps

Patofisiologi
 STEP 5
LEARNIN
G 1. Students are able to understand and explain the
examination of cases
OBJEKTIF 2. Students are able to understand and
explain.Regarding diagnosis and differential
diagnosis in cases
3. Students are able to understand and explain the
pathophysiology of the case
4. Students are able to understand and explain the
etiology and clinical symptoms
5. Students are able to understand and explain
management
 STEP 6
LEARN TO BE INDEPENDENT

At this step, we conduct self-

study, namely by looking for
various literatures related to
learning objectives, either from
books, medical journals, or from
experts.
 STEP 7
Self-
study
results
1. Students are able to understand and explain the examination of cases

• Subjective Examination
a. Extraoral examination
b. Intraoral examination.
• Supporting investigation
• Standard X-ray films (occlusal and panoramic• Computed tomographic scan
• Ultrasonography
• Sialography
• Sialo MRI
• Sialendoscopy
2. Students are able to understand and
explain.Regarding diagnosis and
differential diagnosis in cases
-Diagnosis Sialolithiasis due to blockage of
saliva secretion because there are small
stones resulting from condensation of organic
substances, and the patient feels pain when
swallowing because the stone area where
swelling occurs is surrounded by an
erythematous area.
- Differential diagnosis
- • Sialodenitis
- • Lymphoepithelial cysts are noncancerous
cysts that grow slowly and develop in the
salivary glands.
- • Sjorgen's syndrome
3. Students are able to understand and explain the
pathophysiology of the case
The process of sialolite formation consists of 2 phases,
namely the phase of formation of the core and the phase
of formation of the outer layer. -In the initial phase the
core is formed by salt deposits associated with organic
substances which will then coat on the - the next phase
by organic and inorganic materials such as bacterial
components, desquamation of epithelial cells, electrolyte
changes and decreased glycoprotein synthesis, this
occurs due to the decay of cell membranes due to the
aging process.
4. Students are able to understand and explain the etiology and clinical symptoms

• may be asymptomatic. The most common clinical symptoms found in patients with
sialolithiasis are pain and swelling in the sumandibular area, especially during and after
eating.

• There are 2 factors that are the reason for the high incidence of submandibular gland
sialolithiasis. First, because the nature of the saliva produced contains a lot of mucin, organic
matter, phosphatase enzymes, calcium phosphate, alkaline pH and low carbon dioxide.
Second, because of the anatomical shape of Warthon's duct, which is long and winding with
the orifice position higher than the duct and the size of the duct being smaller than its lumen.
5.Students are able to understand and explain management

A). Non-surgical treatment: if the sialolith is still small, moist heat therapy is carried out,
occasional NSAID (non-steroidal anti-inflammatory drugs) administration and education for
the consumption of bitter and sour foods and drinks.
B) surgery: Marsupialization The removal is done by means of an incision, with a semilunar
incision, then the sialolite stone is removed with clamps. After spending, sewing or suturing
is done. The main goal of dental suturing is to place and close the surgical flap, in order to
promote optimal healing. Next, a topical ointment is applied to the sutured area.
• Transoral approach, by performing surgery on the anterior floor of the mouth. by extending
the excision of the papilla until the stone is visible and marsupializing the hilum of the duct
after the stone has been removed. Interventional sialography. In this technique, blind
extraction of stones in the canaliculus with Dormia basket is performed and combined with
sialography. Therapeutic sialoendoscopy, using a small endoscope with a diameter of 1.2-
1.3mm. flow).
 Conclusion
Sialolithiasis is a disease commonly found in the salivary glands. This disease is the main cause
of blockage in the salivary glands. As the cause of the occurrence and the mechanism of
formation of salivary gland stones is not known with certainty. Clinical symptoms include swelling
in the salivary gland area accompanied by pain that comes and goes, especially when eating.
Physical examination with bimanual palpation is expected to be able to feel the enlargement of
the ducts and salivary glands in evaluating stones, in addition to supporting examinations that
CREDITS:
can be carried This presentation
out, namely templatemethods
through radiological was created by Slidesgo,
to diagnose sialolithiasis. The occlusal
including
and panoramic icons by Flaticon,
radiological and infographics
examinations, & images by Freepik
sialography, ultrasonography, xeroradiography,
scintigraphy and computer tomography can indirectly provide information about the presence of
sialoliths and the condition of the salivary glands. Treatment of salivary gland sialolithiasis is
carried out starting from conservative therapy and operative therapy with intraoral sialolith
removal or sialithectomy.
 References
Elvia, Muhtarum Yusuf. 2011. DIAGNOSIS DAN TERAPI SIALOLITIASIS
KELENJAR LIUR. Fakultas Kedokteran Universitas Airlangga-RSUD Dr. Soetomo
Surabaya.
(Hammett JT, Walker C. Sialolithiasis. 2022 Apr 30. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 31751035.)
Managing Sialolithiasis. Ferneini, Elie M. Journal of Oral and Maxillofacial
Surgery, Volume 79, Issue 7, 1581 - 1582
Nyoman Ayu Anggayanti, Endang Sjamsudin, Melita Sylvyana -Jurnal Kedokteran
Gigi Universitas Padjadjaran 32 (3), 136-142, 2021)
Steffano Aditya Handoko, MPH, SALIVARY GLAND STONE (SIALOLITHIASIS),
PENDIDIKAN KEDOKTERAN
CREDITS: GIGItemplate
This presentation FAKULTAS KEDOKTERAN
was created UNIVERSITAS
by Slidesgo,
UDAYANAincluding
2018) icons by Flaticon, and infographics & images by Freepik
Thanks!
..