BAB VI PELAYANAN PENCEGAHAN A. RUANG LINGKUP PELAYANAN PENCEGAHAN Ruang lingkup pelayanan kedokteran gigi pencegahan dapat dilakukan menurut tahapan pencegahan karies gigi yang dapat dilakukan oleh individu, masyarakat dan tenaga profesional. Untuk hal ini, maka Jong (1993) telah membuat hubungan antara pelayanan kedokteran gigi pencegahan dari tahapan pencegahan karies gigi serta penyakit periodontal seperti terlihat pada tabel 5 dan 6. Dari tabel 6 terlihat, bahwa pada tahapan primary prevention, terthpat usaha keijasama pada hampir semua individu, masyarakat dan tenaga profesional. Pada tahapan ini, tenaga profesional memainkan peranan yang lebih banyak. Pada tahapan secondary prevention, individu dapat memakai jasa pelayanan kesehatan gigi yang ada, dan masyarakat dapat membantu menyediakan perlengkapan pelayanan kesehatan gigi. Tentu saja, penyakit-penyakit gigi dan kelainan-kelainan jarang terjadi hanya pada fase prepatogenesis saja, atau pada fase patogenesis. Maka, pelayanan pencegahan tahap pertama, tahap kedua dan tahap ketiga diperlukan, dan usaha kerjasama antara ketiga tahapan selalu diperlukan untuk kesehatan mulut yang optimal. Demikian juga, usaha-usaha pencegahan oleh tenaga profesional, individu maupun masyarakat secara sendiri-sendiri titik akan cukup untuk mencapai pemeliharaan kesehatan gigi secara optimal, karena kompleksnya etiologi penyakit gigi. Hal ini telah diuraikan pada bab terdahulu mengenai cost efectiveness fluor dalam pencegahan karies gigi.
Universitas Gadjah Mada
Tabel 5. Dental caries: individual, community and dental profession preventive dentistry services Levels of
Primary
Secondary
Tertiary
prevention Preventive
Health
Specific
Early
Disability
services
promotion
protection
diagnosis
limitation
Rehabilitation
and prompt treatment Services
Diet planning;
Appropriate use
Self-
Use of
Use of dental
provided
demand for
of fluoride;
examination
dental
services
the
preventive
Ingestion of
and referral;
services
individual
services;periodic sufficient
utilization of
visits to the
fluoridated
dental
dental office
water;
services
Appropriate use offluoride prescriptions; Use of a fluoride dentry’Ice; Oral hygiene practices. Services
Dental health
Community or
Periodic
Provision
Provision of
provided
education
school water
screening
of dental
dental services
by the
program;
fluoridation;
and referral;
services
schoolfluoride
provision of
research efforts;
mouth rinse
dental
lobby efforts
program; school
services
community promotion of
fluoride tablet program;school sealant program Services
Patient
Topical
Complete
provided
education;
application of
exam;prompt restorative
and fixed
by the
plaque control
fluoride ;fluoride
treatment of
prosthodontics;
dental
program; diet
supplement/rinse incipient
Universitas Gadjah Mada
Complex dentistiy;
Removable
Pulpotomy; minor tooth
Levels of
Primary
Secondary
Tertiary
prevention profession
counseling;
prescription; pit
lesions;
root canal
movement;
recall
and fissure
preventive
therapy;
implants
reinforcement;
sealant
resin
extraction
dental caries
restorations;
activity test
simple restorative dentistry; pulp capping..
Modified from Dunning IM; Principles of dental public health, ed. 4, Cambridge, MA, 1986, Harvard University Press; and Mandel, I., What is preventive dentistry? J Prev Dent 1:25, 1974.
Tabel 6. Periodontal diseases. individual, community and dental profession preventive dentistry services Levels of
Primary
Secondary
Tertiary
prevention Preventive
Health
Specific
Early
Disability
services
promotion
protection
diagnosis
limitation
Rehabilitation
and prompt treatment Services
Periodic visits to
Oral hygiene
Self-
Use of
Use of dental
provided
dental office;
practices
examination
dental
services
by the
Demand for
and referral;
services
individual
preventive
use of dental
services
services
Services
Dental health
Supervised
Periodic
Provision
Provision of
provide by
education
school brushing
screening
of dental
dental services
the
programs;
programs
and referral;
services
community promotion of
provision of
research efforts,
dental
provision of oral
services
Universitas Gadjah Mada
Levels of
Primary
Secondary
Tertiary
prevention hygiene aids; lobby efforts Services
Patient
Correection of
Complete
Deep
Removable
provided
education;
tooth
examination;
curretage;
fixed prost
by the
plaque control
malalig,nent;
scalling and
root
hodontics;
dental
program; recall
prophylaxis
curretage;
planing;
minor tooth
profession
reinforcement;
corrective;
splinting;
movement
restorative;
periodontal
and occlusal
surgery;
services
selective extraction
Modified from Dunning J.M.; Principles of Dental public health, ed. 2, Cambridge, MA, 1973, Harvard University Press and Mandel,I., What’s preventive dentistry? I Prey. Dent, 1:125, 1974. B. PELAYANAN KEDOKTERAN GIGI PENCEGAHAN PRIMER Pelayanan kedokteran gigi pencegahan primer dikelompokkan menjadi 3: I.
Pelayanan
kedokteran gigi
pencegahan
primer
diselenggarakan di
masyarakat 1. Fluoridasi air minum masyarakat 2. Fluoridasi air minum sekolah 3. Program suplemen fluor 4. Program kumur dengan fluor 5. Program sealant untuk anak sekolah II.
Pelayanan kedokteran gigi pencegahan primer diselenggarakan oleh profesi dental 1. Aplikasi topikal fluor oleh profesional 2. Pit dan fissure sealants 3. Konseling diet 4. Program kontrol plak 5. Test aktivitas karies
III.
Pelayanan kedokteran gigi pencegaban primer diselenggarakan oleh individu
Universitas Gadjah Mada
1. Pasta gigi mengandung fluor 2. Aplikasi produk fluor sençliri secara topikal 3. Praktek kebersihan mulut C. DOSIS SUPLEMEN FLUOR. 1. Bentuk peresepan fluor yang digunakan untuk individu umur >13 tahun R/ Tablet Sodium fluoride 2.2 mg (120 tablet) 1 tablet per hari, dikunyah clan dihisap-hisap sebelum ditelan 2. Dosis suplemen fluor yang diresepkan pada anak umur 0-13 tahun berdasarkan konsentrasi fluor dalam air minum dapat dilihat pada tabel 7 di bawah ini. Tabel 7. Dosage schedule for fluoride supplements recommended by the American Dental Association and the American Academy of Pediatric Age (years)
Concentration of fluoride in water(ppm) <0.3
0.3-0.7
>0.7
0-2*
0.25 mg F/day
0.0 mg F/day
0.0 mg F/day
2-3
0.50
0.25
0.0
3-13**
1.00
0.50
0.0
*WHO (1987), recommends age months – 2 years ** The American Academy of Pediatrics recommends 16, rather than 13, as the termination age Tabel 8. Topical fluoride agents for office use Vehicle
Application technique
Fluoride compound
Fluoride concentration
Aqueous solutions
Paints on
APF
13.200
SnF2
19.360
NaF
9.040
APF
12.300
NaF
9.040
APF
12.000
NaF
10.000
Gels Prophylaxis paste*
Trays Rotary polishes
20.000 *Other fluoride compounds and concentration available APF = acidulated phosphate fluoride ; the F ion is derived from NaF
Universitas Gadjah Mada
