Smiles for Life

1
Keganasan
Keganasan
Rongga Mulut
Rongga Mulut
goeno subagyo
Smiles for Life
2
Speaking
Chewing
Tasting
Swallowing
Laughing

Smilling

Kissing

Happiness

Socializing
C.Everett Koop:
You are not healthy without good oral health.
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Inte!Relationships "etween #al
an$ S%stemic Health an$ &isease
SIST'MI
K
#R(
L
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)
dokter gigi mempunyai tanggung jawab
profesional dan moral untuk mempelajari
kesehatan umum pasien sebelum
memberikan perawatan dental
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*
Wanita usia 65 tahun dengan
polimedikasi untuk penyakit
kardiovaskuler, dengan rampant aries
!karies yang "erkem"ang epat
meli"atkan "e"erapa gigi#
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+
Mani,estasi Keganasan $i Mulut
Signs
S%mptoms
Keganasan
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Mani,estasi Keganasan $i Mulut
Sistemik
Keganasan
Lokal
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Mani,estasi #al keganasan
$on%&odgkin lymphoma
!large uler on the so't
palate#
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Mani,estasi #al Keganasan
Chroni lymphoyti leukemia
!uler on the palate#
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Mani,estasi #al Keganasan
Chroni lymphoyti leukemia
!severe gingival enlargement and
ulerations#
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Mani,estasi #al Keganasan
(lkus Kronis )))))))))
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Mani,estasi #al Keganasan
Spontaneous gingi1al 2lee$ing o,
same patient with cihosis
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Mani,estasi #al Keganasan
Swollen3 shin%3 2lee$ing gingi1a o,
a patient with acute m%elogenous leukemia
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1)
Mani,estasi #al Keganasan
KE*+$+,+$
+$E-.+
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1*
Mani,estasi #al Keganasan
/aki%laki 60 tahun dengan
ulkus kronis pada sisi
lateral lidah kiri.
-empunyai ke"ia% saan
merokok dan minum
minuman keras.
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1+
/aki%laki perokok 51
th.
dg nonpain'ul lesion
pd dasar mulut
selama 1 "ln.

/eukoplakia

Candidiasis

/ihen
2lanus

3ral Caner
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1-
#R(L C(4C'R
Silent Kille
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1.
#al Cance
5
#R#!6H(R748'(L C(4C'R
IS TH' 'L'9'4TH
M#ST C#MM#4 C(4C'R :#RL&:I&'
; :ol$ Health #ganization 200*
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1/
#al Cance

303000 new cases $iagnose$ %eal%

.3000 $eaths each %ea

* %ea su1i1al ate< *0=

Oral cancer is the sixth most common cancer among
men
Inci$ence an$ Su1i1al o, #al
o 6ha%ngeal Cance
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#al Cance
4
5he overall survival rate 'or oral
aner in the general population is
506.
4
+ survival rate 7orse than prostate,
uterine, "reast, "ladder and olon
aners.
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#al Cance
5
( * !%ea su1i1al ate ,o (,ican (meican
men with oal cance is appo>imatel%
3)=?
5
:ith eal% $etection an$ teatment3 the *!
%ea %ea su1i1al ate can incease up to
.*=?
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#al Cance
'al% &etection Sa1es Li1es

5%year survival 'or loali8ed disease is

956

5%year survival 'or metastati disease is

:;6
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'al% Cance &etection
'al% #al Cance &etection is #,ten
6ossi2le
5issue hanges in the mouth that may
signal aner an o'ten "e seen and 'elt
easily
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Early detection Early detection
Chemoprevention Chemoprevention
High-risk:
P53; ploidy
BDJ
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( 6ecanceous Lesion
( mophologicall% altee$ tissue in which
cance is moe likel% to occu than in its
appaentl% nomal countepat
@:H# pu2lication31//-AA
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Clinial /esions
+ssoiated 7ith 2remalignany

Leukoplakia

'%thoplakia

Lichen planus
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( pe$ominantl% white lesion o, the oal
mucosa that cannot 2e chaacteize$ as an%
othe $e,ina2le lesion?
Leukoplakia
!W&3, :;;1#
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2.
:hite Lesions

/ihen planus

<ritional keratosis

5o"ao pouh keratosis

$iotine stomatitis

/inea al"a

/eukoedema

+tini heilitis

&ypertrophi andidiasis

&airy leukoplakia

White spongue nevus

,=uamous ell
arinoma

et
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Leukoplakia< Clinical Beatues
5
Leukoplakia usuall% a,,ects people o1e
the age o, )0 %eas @a1eage age is +0
%easA?
5
6e1alence inceases api$l% with age
paticulal% in males?
5
(ppo>imatel% . = o, the males o1e the
age o, -0 %eas ae epote$l% a,,ecte$?
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Leukoplakia< Clinical Beatues
Continue$
5
(ppo>imatel% -0 = o, the oal
leukoplakias ae ,oun$ on the lip 1emilion3
2uccal mucosa an$ gingi1a?
5
4ote< Lesions o, the tongue3 lip 1emilion
an$ ,loo o, the mouth account ,o moe
than /0 = o, those that show $%splasia o
cacinoma upon histologic e>amination?
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Leukoplakia< Clinical Beatues
Continue$
5
In$i1i$ual lesions 1a% in clinical appeaance
an$ ten$ to change o1e time?
5
'al%Cmil$ lesions usuall% appea as slightl%
ele1ate$ ga% o ga%!white plaDues3 which ma%
appea tanslucent3 ,issue$ o winkle$ an$ ae
t%picall% so,t an$ ,lat?
5
'al%Cmil$ lesions ae usuall% well $emacate$
2ut ma% 2len$ into the suoun$ing nomal
mucosa?
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Leukoplakia< Clinical Beatues
Continue$
5
'al%Cmil$ thin leukoplakia3 which sel$om shows
$%splasia on 2iops%3 ma% $isappea o continue
unchange$?
5
I, the cause @sA o, the lesion ae not emo1e$3
man% lesions will ga$uall% 2ecome thicke an$
lage?
5
The clinical appeaance @sA o, leukoplakia an$
the anticipate$ un$el%ing histopathologic
changes ae pesente$ in the ,ollowing $iagam?
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Homogeneous leukoplakia
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+ predominantly 7hite lesion 7ith
verruous,nodular, ulerated or erythematous
'eatures.
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4#4!H#M#8'4'#ES L'EK#6L(KI(
4o$ula @4A an$ 1eucous @9A leukoplakia
4
9
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+ predominantly 7hite lesion 7ith
verruous,nodular, ulerated or erythematous
'eatures?
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Leukoplakia
5 Tans,omation to $%splasia ates<
! Thin leukoplakia F sel$om @.0= h%pekeatosesA
! Thick leukoplakia F 1!-=
! 8anula leukoplakia F )!1*=
5 Tans,omation to SCC ates<
! Mo$eate $%splasia F )!11=
! Se1ee $%splasia F 20!3*=
! Esuall% 2!) %eas a,te onset o, leukoplakia
! Risk incease$ i, persistent lesion, female patient,
nonsmoker, FOM or ventral tongue site
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)+
Leukoplakia
5 Teatment<
&epen$s o, histologic $iagnosis
1A I, hyperkeratosis or mild dysplasia:
Clinical ,ollow!up e1e% + months
Complete emo1al @sugical3 lase3 etcA
2A I, moderate dysplasia or worse:
I, high!isk aea @floor of mouth, ventral or
lateral tongue):
Complete emo1al @sugical3 lase3 etcA
Try to preserve specimen for histological exam
GG Cae,ul long!tem ,ollow!up GG
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'%thoplakia
5 &e,inition<
H( red patch that cannot be clinically or
pathologicall% $iagnose$ as an% othe con$itionI
5 Most @J/0=A $o epesent epithelial dysplasia,
carcinoma in situ, or suamous cell carcinoma
5 Ma% 2e com2ine$ with leukoplakic aeas K
erythroleukoplakia, speckled leukoplakia
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'%thoplakia
%'%thoplakia
! histolog%< SCC
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*0
6ecanceous con$itions
Lichen planus
! Lichen planus is an in,lammoto% $isease
o, skin an$ mucosa o, unknown
aetiolog%3 though alteations in cell!
me$iate$ immunit% ma% 2e impotant?
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*1
Lichen planus
Re$ ,om<
5
Erythematous >atrophi
4
(lerated >erosive
4
?ullous
:hite ,om
5
@etuler
4
2apuler
4
2la=ue
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*2
+nnular 'orm o' lihen planus on the right "ual muosa.
$ote the pigmentation and the ring%like pattern o' Wikham
striae !yello7 arro7s#.
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+ retiular 'orm o' lihen planus. $ote
the "ilaterally symmetrial patterns,
7hih are harateristi o' lihen
planus.
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+nnular 'orm o' lihen planus on the right "ual
muosa. $ote the ring%like pattern o' 7hite
striae !yello7 arro7s#.
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*+
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*-
Tanda & Gejala Awal Oral Cancer

/esi putih atau merah yang menetap

(lkus yang tidak sem"uh

2em"engkakan yang progresi'

2eru"ahan iri permukaan yang tidak

7aAar

*igi goyah tanpa penye"a" Aelas

2erdarahan >mimisan yang tidak 7aAar

,uara serak yang "erkepanAangan

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*.

Baerah indurasi

2em"engkakan rahang

2aresthesia, dysesthesia lidah > "i"ir

5rismus Bysphagia

,um"atan Aalan na'as

Cervial lymphadenopathy

$yeri menetap atau menye"ar

*angguan pengelihatan
Late #al Cance
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*/
4
@olled "order
4
.ndurated margins
4
?leeding and 'ria"le
(lerated
,7ellin
g
3ral Caner
Clinial 'eatures:
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Cerruous
4
@olled "order
4
.ndurated margins
4
?leeding and 'ria"le
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& Suwas &a1eka
Caner o' 5ongue
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Bactos &ela%ing the &iagnosis o,
#al Cance

2asien lam"at "ero"at ke dokter

Dokter lambat mendiagnosis

5idak ada keluhan gangguan dalam

Aangka lama !asimptomatikA
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+/
:hat to look ,o $uing sceeningL
1? #al mucosal changes
2? "on% changes
3? Tooth mo1ements
Changes in the mouth:
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-0
Sceening '>amination
,o #al Cance
Sceening e>am eDuies<

8oo$ light

Ese o, a $ental o la%ngeal mio

Inspection o, Hhigh!iskI aeas

6alpation
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&engan melaksanakan tiga langkah pemeiksaan $ii
sen$ii $apat men%elamatkan hi$up an$a? &engan caa
$emikian $apat mem2antu menemukan kanke mulut
tahap $ini3 sehingga peawatan kanke $apat $ilakukan
se$ini mungkin?

"i2i

Li$ah

&asa mulut
Tiga langkah pemeiksaan $ii sen$ii
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-3

"i2i

amati 2i2i pa$a kea$aan te2uka $an

tetutup

&engan menggunakan telunMuk $an i2u

Mai peiksalah 2i2i untuk mengetahui
a$an%a pengeasanCkelainan $i 2i2i?
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-)
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-*
-+
--
LI&(H

Nulukan li$ah $an amati a$an%a

peu2ahan pa$a pemukaan li$ahO
wana3 luka3 pem2engkakan3

Taiklah uMung li$ah $engan

menggunakan kain kasa3 $an amati
pemukaan lateal li$ah
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&asa Mulut
5
&engan menggunakan uMung li$ah3
sentuhlah pemukaan $asa mulut3
asakan a$akah a2nomalitasL
5
"ukalah mulut le2a3 amati $asa mulut
$an pemukaan 1ental li$ah?
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.3
.)
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.*
petan%aan %ang pelu $ipahami

-engapa harus melakukan pemeriksaan mulut

sendiri)
(agar kanker dapat di deteksi dini)

Kapan 7aktu yang paling "aik untuk memeriksa

mulut)
(setiap 2 bulan sekali setelah membersihkan
mulut dan gigi)

/angkah apa yang harus dilakukan setelah

menemukan a"normalitas di mulut)
(memeriksakan diri ke dokter gigi )
Smiles for Life
.+
:aspa$ai Tan$a!tan$a #al Cance

luka %ang ti$ak sem2uh selama $ua

minggu

pem2engkakan atau 2enMolan $i mulut

lesi putih @leukoplakiaA atau meah

@e%thoplakiaA $i $alam mulut

pem2engkakan pen%e2a2 gigi tiuan ti$ak

$apat $ipakai

8igi menMa$i go%ah tanpa pen%e2a2 pasti

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.-
6'4ETE6
4
-ani'estasi oral keganasan "ervariasi karena
keganasan lokal di mulut atau mani'estasi
keganasan di tempat lain>sistemik.
4
-enermati dan me7asdai tanda D geAala
keganasan di mulut merupakan ara deteksi dini
oral aner.
4
Beteksi dini oral aner akan menyelamatkan
Ai7a penderitanya
4
2eme"elaAaran pemeriksaan diri sendiri dapat
menAadi salah satu sarana untuk deteksi dini
kanker mulut, sehingga pemeriksaan dan
pera7atan dapat segera dlakukan.
Smiles for Life
..
Thanks ,o
Thanks ,o
%ou paticipationP
%ou paticipationP
Smiles for Life
./