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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