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Periodontitis Kronis

Periodontitis kronis adalah suatu peradangan kronik yang terjadi pada jaringan periodontium yang disebabkan oleh penumpukan plak pada gigi yang nantinya akan menyebabkan kerusakan jaringan periodontal dan tulang alveolar. Periodontitis kronis ini biasanya menyerang usia 30 tahun keatas sehingga disebut juga adult periodontitis. Karakteristik Umum Periodontitis Kronis: Karakteristik umum dari periodontitis kronis ini meliputi: a.Adanya penumpukan plak didaerah supragingival dan subgingival. b.Adanya inflamasi gingiva. c.Terbentuknya poket periodontal. d.Menghilangnya tulang alveolar dan adanya nanah. Gejala Periodontitis kronik adalah: a.Adanya perdarahan waktu menyikat gigi. b.Halitosis. c.Gingiva yang membengkak. d.Adanya resesi gingiva sehingga gigi tampak panjang. e.Poket periodontal menjadi dalam. Faktor resiko periodontitis kronik adalah: a.Faktor Lokal Penumpukan plak pada gigi dan permukaan gingiva pada bagian dentogingiva junction merupakan faktor lokal penyebab periodontitis kronik.Pada penumpukan plak tersebut terdapat mikroba patogen dan virulen,seperti, Porphyromonas gingivalis, Bacteroides forsythus, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Eubacterium.Akan tetapi,bakteri Actinomyces actinomycetemcomitans, Campylobacter rectus, dan Eikenella corrodens juga menyebabkan periodontitis kronik. b.Faktor sistemik Perkembangan plak untuk bisa menjadi periodontitis kronis umumnya berjalan dengan lambat.Akan tetapi,ketika periodontitis kronik terjadi pada orang yang mengalami diabetes melitus maka akan menyebabkan kerusakan periodontal menjadi cepat. c.Faktor lingkungan dan kebiasaan Merokok dapat meningkatkat seseorang terkena periodontitis kronik karena pada seorang perokok terbentuknya plak dan calculus lebih cepat daripada orang yang tidak merokok.

Pemeriksaan periodontitis kronis

Pemeriksaan klinis dilakukan pada jaringan gusi dan melihat apakah ada gigi-gigi yang mengalami kegoyangan. Hubungan antara gigi-gigi rahang atas dan bawah saat menggigit juga akan diperiksa.

Gambar Pemeriksaan kedalaman poket Kemudian akan dilakukan pemeriksaan yang disebut periodontal probing, yaitu teknik yang digunakan untuk mengukur kedalaman poket (kantong yang terbentuk di antara gusi dan gigi).

Kedalaman poket ini dapat menjadi salah satu petunjuk seberapa jauh kerusakan yang terjadi. Sebagai tambahan, pemeriksaan radiografik (x-rays) juga perlu dilakukan untuk melihat tingkat keparahan kerusakan tulang. Perawatan periodontitis kronik

Pada kasus-kasus periodontitis yang belum begitu parah, biasanya perawatan yang diberikan adalah root planing dan kuretase, yaitu pengangkatan plak dan jaringan yang rusak dan mengalami peradangan di dalam poket dengan menggunakan kuret. Tujuan utamanya adalah menghilangkan semua bakteri dan kotoran yang dapat menyebabkan peradangan. Setelah tindakan ini, diharapkan gusi akan mengalami penyembuhan dan perlekatannya dengan gigi dapat kembali dengan baik.

Pada kasus-kasus yang lebih parah, tentunya perawatan yang diberikan akan jauh lebih kompleks. Bila dengan kuretase tidak berhasil dan kedalaman poket tidak berkurang, maka perlu dilakukan tindakan operasi kecil yang disebut gingivectomy. Tindakan operasi ini dapat dilakukan di bawah bius lokal.

Pada beberapa kasus tertentu yang sudah tidak bisa diatasi dengan perawatan di atas, dapat dilakukan operasi dengan teknik flap, yaitu prosedur yang meliputi pembukaan jaringan gusi, kemudian menghilangkan kotoran dan jaringan yang meradang di bawahnya.

Antibiotik biasanya diberikan untuk menghentikan infeksi pada gusi dan jaringan di bawahnya.Antibiotik yang biasanya digunakan adalah amoxicillin dan metronidazole. Pencegahan Periodontitis kronis

Sikat gigi dua kali sehari, pada pagi hari setelah sarapan dan malam hari sebelum tidur. Melakukan flossing sekali dalam sehari untuk mengangkat plak dan sisa makanan yang tersangkut di antara celah gigi-geligi. Memakaian obat kumur anti bakteri untuk mengurangi pertumbuhan bakteri dalam mulut, misalnya obat kumur yang mengandung chlorhexidine. Berhenti merokok Melakukan kunjungan secara teratur ke dokter gigi setiap 6 bulan sekali untuk kontrol rutin dan pembersihan calculus dan plak.

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f38679252ee3d8b316a316a2d6a3149292829492d6a31492d492d282 949292829282907250725e620e620c620e724e620e624c520e624c520 e6200725292d492d6a314a2d6a316a2d8b356a316a31492d492d0829 282908290829e624292d292d282d072507250725292d29296a314a31 292de624c5208318831883188318a41cc524c624e628a520c520e7282 82d28312831082d2831c624c6240729282d282d493107290729e6242 82d072908290729492d49318b356a356a354a316b356b358c396b354 a3149314a316b356b35292d0829c624c620a41c841c4214631842146 3182110211021104110200c210c0008000c000c2110000c200c201020 0c000c200c201041146214a41cc52007290829282de624c51c8310631 08c35734ef75ef75e9452b456f75a5a6b9c73de77df7bff7fff7fff7fff7ff f7fff7fff7fff7fff7fff7fff7fff7fff7ffe7fff7fde7bff7ffe7fff7fff7fff7fff7fff 7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7ff f7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7bff7fbd77de7b fe7bff7ffe7fff7fde7bfe7bde7bde7b9c739b731667cb41c324e328052 d893d052961146114831462106310621062144110411442106214621 062146210621441106210421062104110421041104210410c4110596 73967596739675a6b596b5a6b596b7a6f5a6b7a6f5a6b7b6f7a6f7b6f 7a6f9b737b6f9b737b6f9c739b739c739b73bc739b739c739b73bc779 c73bc779c73bc779c73bc779c73bd77bc73bc77bc73bd77bc73bc77b

c73bd77bc73bc77bc73bd77bc73bd779c73bc779c739c779b739c779 b739c779b739c739b6f7b6f7a6f9b733867d55a3046ed3d8b318b316 a318b3Periodontitis agresif adalah suatu penyakit periodontal yang terjadi pada anak-anak, khususnya pada masa remaja (pubertas) yang ditandai dengan hilangnya perlekatan dan tulang alveolar yang cepat, pada satu atau lebih gigi permanen yang terlibat. Patogenesis periodontitis agresif pada dasarnya sama dengan penyakit periodontitis lainnya. Penyebabnya bersifat heterogen dan merupakan interaksi berbagai faktor, baik bakteri, imunologis maupun genetik. Akan tetapi, Actinobacillus actinomycetemcomitans mempunyai sifat khusus dalam meningkatan kerusakan pada periodontitis agresif, yaitu dengan memproduksi faktor virulensi dan memiliki kemampuan dalam merusak jaringan penghubung. Periodontitis agresif merupakan penyakit yang sangat sulit untuk diatasi, dikarenakan penyakit ini dapat mengakibatkan perusakan jaringan lunak dan tulang yang dapat menyebabkan peningkatan mobiliti gigi dan kehilangan gigi. Klasifikasi periodontitis agresif ada 2,yaitu: 1.Localized aggressive periodontitis 2.Generalized aggressive periodontitis

1.Localized aggresive periodontitis

Definisi : merupakan penyakit destruktif pada kavitas oral yang biasa terjadi pada gigi Molar pertama dan gigi Incisivus pada anak-anak dan dewasa muda, yang menyebabkan kerusakan tulang dalam jangka waktu yang sangat cepat dan menyebabkan kehilangan gigi geligi.

Karakteristik klinik : a.Penyakit dijumpai pada gigi Molar pertama dan Incisivus dengan hilangnya perlekatan pada daerah interproksimal paling sedikit 2 gigi. b.Berkurangnya inflamasi secara klinis disamping ditemukan poket periodontal yang dalam. c.Pada kebanyakan kasus jumlah plak yang mempengaruhi gigi minimal, sehingga cenderung tidak konsisten dengan jumlah kerusakan periodontal yang ditemukan. d.Penyakit Localized Aggresive Periodontitis berkembang dengan cepat. e.Migrasi distolabial gigi Incisivus maksilaris. f.Pembentukan diastem secara berkala. g.Peningkatan mobilitas gigi Molar pertama. h.Sensitif dari permukaan akar yang terbuka terhadap suhu dan stimulasi taktil. i.Rasa sakit tajam dan rasa sakit yang menyebar sewaktu mastikasi. j.Dapat terbentuk abses periodontal pada tahap ini dan terjadi pembesaran pada kelenjar limfe. Gambaran radiologi : a.Kehilangan tulang alveolar disekitar Molar pertama dan Incisivus pada usia pubertas

b.Suatu bentuk kerusakan tulang alveolar yang meluas dari permukaan distal gigi P2 hingga permk. mesial dari gigi M2 c.Kerusakan tulang dalam arah vertikal lebih sering dijumpai pada daerah gigi Molar sebab tulang interdental didaerah ini lebih luas dibanding didaerah Incisivus

2.Generalized Aggresive Periodontitis Definisi : merupakan suatu penyakit yang umumnya terjadi pada orang dewasa pada usia dibawah 30 thn / lebih. Penyakit ini ditandai dengan hilangnya attachment interproksimal secara keseluruhan yang mempengaruhi 3 gigi permanen lainnya selain Molar pertama dan Incivus.

Karakteristik klinik : a.Umumnya memiliki jumlah plak bakterial yang lebih sedikit yang berhubungan dengan gigi yang terlibat. Secara kuantitatif, jumlah plak cenderung tidak seimbang dengan kerusakan periodontal yang terjadi secara kualitatif. A. actinomycetemcomitans dan Bacteroides tonsythus ditemukan pada plak gigi penderita.

b.Pada kasus Generalized Aggresive Periodontitis dijumpai 2 bentuk respon jaringan gingival: *.Pada jaringan inflamasi akut: Terjadi proliferasi, ulser & berwarna merah terang Perdarahan dapat terjadi secara spontan/melalui stimulasi ringan *.Pada kasus lainnya : Jaringan gingiva cenderung berwarna merah muda Bebas inflamasi Terkadang terjadi stipling walaupun akhirnya tdk ditemukan lagi Poket yang dalam dapat ditemukan melalui probing

c.Beberapa pasien Generalized Aggresive Periodontitis mengalami kondisi sistemik seperti pada kekurangan berat badan, depresi mental dan malaise

Gambaran Radiologis : a.Terdapat bentuk kerusakan tulang yang parah dengan jumlah plak gigi yang minimal. b.Terlihat kehilangan tulang alveolar yang mendukung lebih dari tiga gigi kecuali molar pertama dan incisivus.

Terapi / penanganan agresif periodontitis:

1.Instruksi oral hygiene 2.Evaluasi kontrol plak 3.Skeling supra gingival dan sub gingival kalkulus 4.Root planing 5.Kuretase 6.Bedah periodontal jika dibutuhkan dan seharusnya diberikan juga prophylactic antibiotik selama pembedahan periodontal dan pasien dianjurkan memakai chlorhexidine sebagai antiseptiknya. 7.pemeliharaan periodontal