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 patients illness and handle the medical waste that could harm the patient itself.

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 Describing the pollutants and medical wastes to human health Giving more information about the importance of holistic approach in relationship between health and ecosystem (environment)

3. 4.

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
3

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 cancer 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 dont 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 suns 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 importent 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. contribution of ethnic and genetic susceptibility also must be considered as a potentially modifying factor.(Kahn,2000,

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, 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 Males HPV usually causes warts and has been linked to cervical, vaginal, and penile cancers. HPV also increases the risk for oral cancers. 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
6

encourage people to take an active role in the early detection of oral cancer by performing monthly selfexaminations. 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 1to 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 2 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

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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 (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,Ndimethyl-ptoluidine, which is added to the monomer so polymerization can be completed at room temperature in a short
8

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. 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,
9

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 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 Pre-polymerised PMMA spheres Benzoyl peroxide (initiator) (1-2%) Pi Pi Pigment (1%) Glycol dimethacrylate (crosslinking agent) (1-2%) D D Dimethyl-p-toluidine (activator) Liquid Methylmethacrylate monomer Hydroquinone (inhibitor) (<1%)

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.

10

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. 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.
11

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 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. 3033). 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.

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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. Dont 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 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 matterunless 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 Alzheimers 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
13

process MORE difficult, whereas it may ease matters for others.

2. Cleaning dentures 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 nondenture 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
14

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 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 reevaluate 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.
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Denture use is correlated with advanced age, use of tobacco, and lower socioeconomic statusthe three strongest risk factors for development of oral cancer. As such, it is essential for dental professionals to 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

16

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 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)
17

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 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 resin and caused acrylic by resin swapolimerisasi acrylic

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
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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 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

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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 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 gangrenewhich 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

20

such as blood high ( hypertension ), piddle sweet ( diabetesmelitus ), the ills of a blood disorder.

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 : 2.3.1.1. 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
21

Tooth decay of dental caries As a result of trauma The act of revoking the teeth are not perfect The rest of the root of a tooth that caused by dental

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 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. 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.
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Remaining roots teeth caused by revocation being

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.

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
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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

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

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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. 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, its 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. Its activities should be increased useable resources or replaceable resource. The continued
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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 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. Its 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.

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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.

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
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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. 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
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(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 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.

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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 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)

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CHAPTER V CONCEPT OF MAPPING

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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

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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. 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.

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