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    LAPORAN TUTORIAL

    SKENARIO 4

    LESI PRAGANAS RONGGA MULUT

    BLOK PENYAKIT DENTOMAKSILOFASIAL II

    Tutor : drg. Agustin u!"n S.D.# M.K$s

    Dr. drg. B"nun Kusu%"&"rd"ni# M.K$s

     K$tu" : Nu'si Egi P (NIM : )4)*)+)+)+,-

    S$/r$t"ris : K"!0in 1uni"&"n (M$2" (NIM : )4)*)+)+)+,,

      N"/3it" Lint"ng S (P""n (NIM : )4)*)+)+)+5-

    Anggot" : Aro'"3 Noor B (NIM : )4)*)+)+)+,6

      Ad$ A7u D&i R (NIM : )4)*)+)+)+58

      Ni9o N"t"n"$!  (NIM : )4)*)+)+)+,8

      Si!0it"ni" Putri (NIM : )4)*)+)+)+5-

      D"ni$! B$nn7 S (NIM : )))*)+)+)+,*

    FAKULTAS KEDOKTERAN GIGI

    UNIVERSITAS JEMBER 

    2015

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    DAFTAR ISI

    D"'t"r Isi;;;;;;;;;;;;;;;;;;;;;;;;;; )

    S/$n"rio;;;;;;;;;;;;;;;;;;;;;;;;;;. <

    St$ );;;;;;;;;;;;;;;;;;;;;;;;;;;. -

    St$

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    SKENARIO 4

    LESI PRAGANAS RONGGA MULUT

    Dr. Ati/ Kurni"&"ti# drg.#M.K$s

    S$or"ng !"/i!"/i =$rusi" 46 t"3un d"ting /$ do/t$r gigi d$ng"n /$!u3"n

    !id"3 t$r"s" tid"/ n7"%"n /$ti/" di"/"i %"/"n. P"d" "n"%n$sis di/$t"3ui "si$n

    t$!"3 %$n"%="!/"n gigi ="&"3 =$!"/"ng 7"ng d$/"t !id"3 /$ tu/"ng gigi# s$!"in

    itu "i$n %$%un7"i /$=i"s""n %$ro/o/ s$2"/ r"t" -+ ="t"ng

    s$ti" 3"ri. P"si$n s$ring %$r"s"/"n %u!ut n7" /$ring. P"d" $%$ri/s""n intr"

    or"! dit$%u/"n !"/ uti3 tid"/ d""t di/$ro/# tid"/ t$r"tur# $r%u/""n /"s"r#

     ="t"s tid"/ 2$!"s# dis$rt"i d"s"r /$%$r"3"n "d" !"t$r"! !id"3 "d" r$gion r$%o!"r 

    /"n"n# "!"si s"/it d"n tid"/ %ud"3 =$rd"r"3. Gigi g$!igi "d" ost$rior r"3"ng

     ="&"3 ="n7"/ t$rd""t /"ri$s d"n tu%"t"n !og"% d$ng"n $r%u/""n 7"ng /"s"r.

    "si! $%$ri/s""n PA "d" ="gi"n ost$rior !$si did""t/"n %od$r"t$ d7s!"si"

    d$ng"n 3i$/$r"tosis.

    2

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    STEP I

    ). Mod$r"t$ D7s!"si"

    D7s!"si" s$d"ng# $n$="!"n !"is"n Eit$! B"s"! /$ Str"tu% Sinosu%

    g$2"!" "to!ogis

    -. i$r/$r"tosis

    P$%=$ntu/"n !"is"n /$r"tin 7"ng A=nor%"! =$ru" $nu%u/"n /$r"tin

    7"ng =$r!$=i3"n

    4. P!"/ Puti3

    B$r9"/>=$r9"/ uti3 7"ng =i"s"n7" t$rd""t "d" !id"3 d"n %u/os" rongg"

    %u!ut6. L$si Pr"g"n"s

    L$si 7"ng s$9"r" /!inis tid"/ t$r!i3"t g"n"s n"%un s$9"r" "to!ogis "/"n

    g"n"s# %u!"i =$rsi'"t K"rsinog$ni/ (M$nu2u =$ntu/ K"rsino%"# d"n %u!"i

    %$rus"/ L"is"n B"s"!is.

    STEP II

    ). A"/"3 $n7$="= P!"/ Puti3 tid"/ d""t di/$ro/?

    2$nis L$si Pr"g"n"s rongg" %u!ut?

    8. K""n L$si Pr"g"n"s d""t =$ru="3 %$n2"di L$si G"n"s?

    )+. A"/"3 '"/tor>'"/tor $n7$="= t$r=$ntu/n7" L$si Pr"g"n"s? )). A"/"3 L$si Pr"g"n"s di"&"!i d$ng"n L$si 1in"/ "t"u s$9"r" !"ngsung?

    )

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    !"is"n /$r"tin t$rs$=ut t$!"3 %$n2"di s"tu /$s"tu"n d$ng"n !"is"n>!"is"n

    $it$!.

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    ,. G$2"!" 7"ng %$nun2u/"n !$si t$rs$=ut =$rsi'"t Pr"g"n"s "d"!"3:

    ". Ad"n7" D7s!"si" "d" !"is"n $it$! s$9"r" PA

     =. Inti d"ri S$! B"s"! t$r!i3"t !$=i3 =$s"r d"n g$!" s$9"r" PA

    di/"r$n"/"n "d"n7" $%=$!"3"n inti s$! n"%un sito!"s%" tid"/ 

    %$%=$!"3

    9. P"d" /"sus s/$n"rio "d"n7" P!"/ Puti3 7"ng tid"/ d""t di/$ro/.

    5. 1$nis>2$nis L$si Pr"g"n"s !"inn7" s$rt" 9irin7" "d" %u/os":

    ". L$u/o!"/i" : B$r9"/ uti3 "d" %u/os" RM

     =. Er7t3ro!"/i" : B$r9"/ %$r"3 "d" %u/os" RM

    9. Li93$n P!"nus : B$ntu/"n tid"/ r"t"# =$r&"rn" ungu# d"n /"s"r 

    d. Dis/$r"tosis : T$rd""t $ni%=un"n /$r"tin "d" !"is"n 7"ng

    Kong$nit"! tid"/ s$3"rusn7" $. Or"! Su=%u9ous: Ad"n7" =$ntu/"n s$$rti it" "d" RM

    Fi=rosis

    '. Pi$ S%o/$r : K$r"tosis "d" d"$r"3 %u/os" t$rt$ntu d"n !$=i3

    K$r"tosis t$="!

    g. @"r9ino%" In : Ad"n7" 9"%ur"n =$r9"/ %$r"3 uti3

    Situ

    8. Didug" L$si Pr"g"n"s d""t %$n2"di L$si G"n"s =i!" '"/tor>'"/tor d"ri

    $tio!ogin7" tid"/ di3i!"ng/"n d"!"% 2"ng/" &"/tu 7"ng !"%".

    )+. K$=i"s""n =uru/ s$$rti %$ro/o/# d"n %inu% %inu%"n /$r"s (A!/o3o!#

    D$'isi$nsi Nutrisi# Irit"si Kronis# Tr"u%"# Antio/sid"n D$'isi$nsi (R"di/"!

    B$="s# s$rt" g$n$ti9 /"r$n" ="3"n K"rsinog$ni/ d""t %$n2"di '"/tor>

    '"/tor $n7$="= t$r2"din7" L$si Pr"g"n"s.

    )). L$si Pr"g"n"s d""t tu%=u3 d"ri L$si 1in"/ /"r$n" $ng"ru3 d"ri '"/tor>

    '"/tor $tio!ogi. L$si Pr"g"n"s 2ug" d""t tu%=u3 s$9"r" !"ngsung =i!"

    "d"n7" '"/tor>'"/tor "d$/u"t untu/ %$n2"di Pr"g"n"s.)< !"is"n di"t"s !"is"n

      B"s"!is.

     =. Mod$r"t$ D7s!"si" : T$r2"di 3ingg" L"is"n Sinosu% d"n %$n7$="r 

      s"%"i /$ Pri9/!$ @$!! d"ri str"tu% t$rs$=ut

    9. S$0$r$ D7s!"si" : T$r2"di "d" L"is"n B"s"!is s"%"i d$ng"n

      L"is"n Korn$u%

    5

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    STEP I

    6

    ETIOLOGI

    Merokok Faktor

    PERUBAHAN SEL

    LESI

    KERATOSDYSPLAS

    Mild Dysplasia Md!"a#!

    Dysplasia

    S!$!"!

    Dysplasia

    HPA

    Pemeriksaan

    KLINIS

    PRAGAN   GANAS JINAK 

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    STEP  ). M"%u %$%"3"%i d"n %$n2$!"s/"n Etio!ogi L$si Pr"g"n"s RM 3ingg"

    %$n7$="=/"n D7s!"si"

    +#*, 

    "!/"!oid# s"!"3 s"tu 2$nis "!/"!oid "d"!"3 "r$9o!in 7"ng %$ng"ndung ->

    (%$ti!nitros"%ino roionitri!. Ar$9o!on 2$nis ini ""=i!" =$r9"%ur 

    d$ng"n /"ur (/"!siu% 3idro/sid" d"!"% ros$s %$ngin"ng "/"n

    %$ng3"si!/"n o/sig$n r$"/ti' (r"di/"! =$="s 7"ng %$ru"/"n $%i9u

     $rtu%=u3"n s$! 7"ng /"rsiog$ni/. Ar$9o!in$ "/"n %$n"i//"n %RNA

    d"n $/sr$si ro7$in 97st"tin @# nong!i9osi!"t$d rot$in d"s"r 7"ng

    %$ng"tur 0"ri"si $/sr$si 'i=ro=!"st d$ng"n 9"r" %$ng"tur r$gu!"sin7".

    S$!"in itu "r$9o!in$ 2ug" %$ning/"t/"n $/r$si d"ri /$r"tinosit gro&t3

    '"9tor>)# insu!in$ gro&t3 '"9tor>)# $/sr$si int$r!$u/in * 7"ng t$r!i="t

    d"!"% $%=$ntu/"n 2"ring"n 'i=rous s$3ingg" 2"ring" 'i=rous 7"ng

    t$r=$ntu/ s$%"/in ="n7"/. F!"0"noid# 9"t$93in# "nd t"nnin

    %$n7$="=/"n /o!"g$n %$ng"!"%i 9ross !in/ s$3ingg" s$!>s$!n7" "/"n

    su!it untu/ t$rd$gr"d"si.

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    d"!"% s"!i0"# 7"ng =$rgun" untu/ %$n$tr"!isir ="/t$ri d"!"% rongg"

    %u!ut d"n %$n7$="=/"n g"nggu"n 'ungsi s$!. P$nurun"n 'ungsi s$! ini

    dis$rt"i d$ng"n %$ning/"tn7" 2u%!"3 ="/t$ri "$ro= s$3ingg" rongg"

    %u!ut r$nt"n t$r/$n" in'$/si.

    Ro/o/ d""t %$n7$="=/"n 3i$r/$r"tosis di/"r$n"/"n "d"n7" $'$/ 

    "/i="t irit"si /ronis "s" ro/o/. Irit"si /ronis ini dis$="=/"n /"r$n"

    "d"n7" ="3"n /"rsinog$n 7"ng t$r/"ndung d"!"% ro/o/ 7"itu t"r#

    ni/otin d"n ="3"n /i%i" !"inn7" 7"ng d""t %$n7$="=/"n $ru="3"n

    "&"! stru/tur d"s"r $it$! %u/os" %u!ut s$$rti d$s/u"%"si $it$!#

    "troi ="3/"n d""t %$n7$="=/"n dis!"si" $it$! 7"ng %$ng"!"%i

    /$g"n"s"n. Ro/o/ %$nsti%u!"si %$!"nosit %u/os" %u!ut s$3ingg"

     rodu/si %$!"nosit %u/os" %u!ut =$r!$=i3"n d"n %$ng$nd" "d"

    !"is"n ="s"! %u/os" s$3ingg" t$r2"di ig%$nt"si "d" %u/os"

    t$rs$=ut.

    Pros$s $%="/"r"n ro/o/ %$ng3"si!/"n ="3"n>="3"n o/sid"n d"!"%

     2u%!"3 7"ng =$s"r# /ondisi ini %$n7$="=/"n /$tid"/s$i%="ng"n "nt"r"

    o/sid"n d"n "ntio/sid"n 7"ng dis$=ut str$s o/sid"ti'. Tinggin7" 2u%!"3

    /"ndung"n o/sid"n d"n r"di/"! =$="s 7"ng t$rd""t d"!"% ro/o/ d""t

     =$r$"/si d$ng"n gugus su!'idri! 7"ng %$n7$="=/"n $ru="3"n stru/tur 

    d"n 'ungsi %o!$/u!# t$r%"su/ s"!i0" 7"ng %$ru"/"n ="ri$r t$r3"d"

    s$r"ng"n s$n7"&">s$n7"&" o/sid"n d"n r"di/"! =$="s. P$nurun"n

    sist$% "ntio/sid"n d""t =$r"/i="t "d" /$rus"/"n /o%on$n>

    /o%on$n s$!u!$r 7"ng $nting s$$rti %$%=r"n !iid# rot$in d"n

    DNA.

    S$!"in %$ng"ndung ="3"n o/sid"n ro/o/ 2ug" %$ng"ndung ="3"n>

     ="3"n /"rsinog$n. B"3"n>="3"n /"rsinog$n "nt"r" !"in =$nCo7r$n$

    d"n "/ro!$in. B"3"n ="3"n /"rsinog$n d""t =$ri/"t"n d$ng"n ="s"

    DNA d"n %$n7$="=/"n /$s"!"3"n $%="9""n in'or%"si g$n$ti/ "d"

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    s""t DNA dir$!i/si s$3ingg" %$n7$="=/"n t$r2"din7" %ut"si DNA

    d"n d""t %$ni%=u!/"n /"n/$r# t$r%"su/ /"n/$r "d" rongg" %u!ut.

    d. Sin"r M"t"3"ri

    T$r!"!u ="n7"/ sin"r %"t"3"ri tid"/ ="i/ untu/ tu=u3. En$rgi d"ri

    %"t"3"ri s$=$n"rn7" r"di"si t"/ t$r!i3"t 7"ng s$3"t d"n =$r="3"7" "d"

    &"/tu 7"ng s"%". Ad" du" 2$nis ut"%" d"ri u!tr"0io!$t (U sin"r 7"ng

    %$n9""i =u%i# UA d"n UB. Sin"r UA %$ning/"t/"n $'$/ d"ri

    sin"r UB. M$r$/" %$n7$="=/"n n$o!"s%" /u!it# /"t"r"/# $nu""n#

    /$riut d"n 3i!"ngn7" $!"stisit"s /u!