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  The term aphthae is derived from the Greek word aphthi , which means “  burning   “, “to set on fire” or “to inflame,” and is thought to have been first used by the philosopher Hippocrates to describe the pain associated with a common disorder of the mouth during his time (likely, aphthous stomatitis).  Recurrent aphthous stomatitis.  RAS, the most common ailment affecting the oral cavity, is characterized by recurrent disruption of the oral mucosa in the form of painful ulcers.1 It is a diagnosis of exclusion, and other causes of ulcerative stomatitis should be explored before a diagnosis of RAS is made. RAS accounts for 25 percent of recurrent ulcers in adults and 40  percent in children.4 The severity of the stomatitis is represented by one of three subtypes. SAR diklasifikasikan menjadi bentuk mayor, minor dan herpetifomis. SAR mayor adalah bentuk yang paling parah yang ditandai dengan ulser oval, besar, dan dalam  berdiameter 1-3 cm, sering memiliki tepi meninggi dan tidak beraturan. Pada bentuk ini dapat terjadi 1-10 ulser secara bersamaan dan dapat berlangsung selama beberapa minggu sampai beberapa bulan. Penyembuhan ulser ini dapat menyebabkan sikatriks. 1-3 SARminor umumnya berlangsung selama 1-2 minggu. Minor RAS.  Minor RAS is the most prevalent form and typically occurs in patients who are 5 to 19 years old. Outbreaks are characterized by a few, superficial, round ulcerations that are <10mm and accompanied by a gray pseudomembrane and erythematous halo.5  Lesions can involve every nonkeratinized mucosa of oral cavity 20 especially in  buccal and labial mucosa, floor of mouth and on the ventral or  border of tongue 21 and is un common in the keratinized gingiva,  palate or dorsum of tongue  last for 10-14 days and heal without scarring.  Major RAS.  Major RAS has a wider distribution (commonly extending to the gingiva and  pharyngeal mucosa), is larger in size, (>10mm), and has a longer duration of outbreak. Minor aphthae typically resolve within 14 days of presentation, whereas major aphthae may persist for over six weeks. Further, major aphthae pose a significant scarring risk as well.5  is a rare, severe form of RAS, also known as periadenitis   mucosa necrotica recurrens. They may  be round or oval with clearly defined margins,  but  prodromal symptoms more intense, the ulcers lasting significantly longer, are usually deeper, with raised irr egular  border, are more  painful, have a  predilection for lips, soft  palate and fauces 24 where they may cause some dysphagia.   Herpetiform RAS.  Herpetiform RAS presents with dozens of small, measuring less than 5mm, deep ulcers that often coalesce and therefore present as large ulcers with an irregular contour. Outbreaks are nonscarring and typically resolve within one month. Regardless of the subtype,  RAS lesions can impair one’s ability to effectively speak, swallow, and maintain dental hygiene.5  KARAKTERISTIK    Rekuren      Tidak menular      Self limiting disease   memiliki periode waktu tertentu untuk penyembuhannya tapi bukan berart RAS nya ga perlu diobatin      Tanpa gejala penyakit lain      Terjadi pada anak2, dewasa muda dan perempuan      Lesi bulat atau oval dikelilingi halo eritem      Mukosa non keratin      Memiliki 3 tipe ulser      Stages of Recurrent Apthtous Stomatitis    premonitory,  pr e-ulcerative, ulcerative and healing.    The premonitory stage lasts for upto fir st 24 hour s of development of RAS. Patients suff ering from lesion may have burning or tingling sensation at the site of development of RAS. Epithelium of the affected site is infiltrated with mononuclear cells, and edema  begins to develop.     The pre-ulcerative stage occur s during the first 18 to 72 hour s (3 days) in the development of a lesion of RAS. Painful sensations vary in intensity during this stage,  but-are usually moderately severe. Clinically, the aphthae begin as erythematous macules or papules with slight indurated erythematous halo. On the cheek s or lips, lesions are circular, whereas in the buccal or labial sulci or vestibule, oval lesions occur . Lesions overlying fibro muscular  bands such as the frenum are exceptionally painful.    The ulcerative stage lasts from 1 to 16 days. Clinically, the  papule or macule, which had begun to erode in the second stage, enlarges and ulcerates  but remains a discrete lesion. The maximum size is usually attained 4 to 6 days after the onset. Two or  three days later, there is cessation of  pain, leaving  residual discomfort that correlates clinically with the ap pearance of the covering fibrino membranous  slough. 28 The ulcerative bed is infiltrated mainly  by neutrophils, lymphocytes and  plasma cells. This  stage may last from a few days to 2 or several week s.     Healing stage occur s during 4 to 35 days. The lesions usually heal without scarring in 10 to 21 days. The ulcer is covered by epithelium, and wound healing occurs, often leaving no scar or trace of the lesion of RAS, 11 with significant lessening of pain.  Peningkatan level progesteron, terutama saat  progesteron dalam keadaan memuncak berhubungan dengan maturasi dan keratinisasi mukosa rongga mulut. Pada level tertinggi progesteron, akan terjadi keterlambatan maturasi sel  –   sel epitel di mukosa rongga mulut. Keterlambatan maturasi sel sel epitel terutama  pada proses keratinisasi menyebabkan mukosa rongga mulut mudah terkena invasi, hal tersebut dikarenakan barier pertahanan mukosa belum terbentuk sempurna. Invasi pada  mukosa rongga mulut dapat menyebabkan ulserasi, salah satunya adalah SAR. Peningkatan level progesterone berpengaruh pada penekanan respon imun, hal ini berdampak apabila terjadi perlukaan pada mukosa rongga mulut atau terjadi infeksi, maka proses  penyembuhan atau proses  self    limiting yang terjadi akan lebih lama 1.   Faktor Genetik    Prevalensi lebih tinggi pada pasien dengan riwayat keluarga positif, khususnya jika kedua orangtuanya juga terkena. Faktor genetik memberikan pengaruh onset penyakit menyerang lebih awal dan lebih sering daripada kasus tanpa faktor genetik. Faktor genetik diperkuat adanya identifikasi tipe histocompatibility antigen  (HLA) (ex: HLA B12, B51, Cw7) tertentu pada  beberapa kelompok pasien aftosa. 2.   Faktor Imunologis   Perubahan reaksi imun mempengaruhi penurunan pertahanan mukosa. Penelitian serologis yang membandingkan pasien RAS dan kontrol tidak terkena menunjukkan pengurangan rasio sirkulasi sel helper CD4+ terhadap sel suppressor CD8+. RAS dipengaruhi beberapa antigen non spesifik dan sel T- mediated   respon imun yang terlibat dalam jalur lokal limfositik. Penelitian menunjukkan bahwa seluruh proses ulserasi aftosa, dari inisiasi sampai progresi, yang dilihat melalui sel epitel oral ditemukan tidak hanya antigen HLA kelas I tetapi juga antigen HLA kelas II. Hal ini membuat sel-sel secara antigen dianggap benda asing dan menjadi target cell-mediated   respon imun oleh limfosit dan sel Langerhans. Hal ini dapat terlihat pada pasien stomatitis aftosa, terdapat tingginya efek limfositotoksik melawan sel epitel oral dibandingkan dengan kontrol tidak terkena.   Pengamatan pada jaringan biopsi bahwa ulser aftosa yang baru erupsi menunjukkan  pengelompokkan limfosit T pada perifer lesi, sedangkan aftosa yang sudah matur yang awalnya didominasi CD4+ helper/ sel supresor dan digantikan oleh sitotoksik limfosit CD8+. 4. Faktor Nutrisi RAS disebabkan defisiensi beberapa faktor nutrisi diantaranya zat besi, folat, dan vitamin B12. Pasien RAS yang menunjukkan tanda fisik dan gejala defisiensi nutrisi atau diskrasia darah, diperlukan pemeriksaan untuk mendapatkan hitung darah lengkap dan serum folat, vitamin B12, dan ferritin. 5. Faktor Lingkungan 1) Stres 2) Trauma lokal 3) Merokok 4) Hipersensitivitas makanan Beberapa makanan yang berhubungan dengan onset ulser diantaranya susu sapi, gluten, cokelat, kacang, keju, pewarna azo, agen perasa dan pengawet. 5) Obat-obatan Beberapa obat seperti anti inflamasi non steroid seperti asam propionat, asam fenilasetik, dan diklofenak dapat memicu terjadinya ulser oral. Beberapa ulser biasanya terjadi sebagai efek samping dan menghilang dengan penghentian obat. Frekuensi RAS meningkat pada penggunaan  sodium lauryl sulfate  yang terkandung pada pasta gigi.

Amigos coloridos

Mar 24, 2018

Quero agradecer

Mar 24, 2018
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