PROSEDUR DIAGNOSIS

PENYAKIT MULUT DAN

SISTEM RUJUKAN
Sri Rezeki, drg., Sp.PM
TUJUAN UMUM

Pada akhir skills lab, mahasiswa

mampu melakukan prosedur
diagnosis penyakit mulut dengan
benar

Pada akhir skills lab, mahasiswa

mampu melakukan sistem rujukan
dengan tepat sesuai dengan
kondisi/kelainan pasien
TUJUAN KHUSUS
Pada akhir skills Lab, mahasiswa mampu untuk :
Menggali informasi (anamnesa) yang dibutuhkan
dalam penegakan diagnosis dari pasien
Mampu melakukan pemeriksaan klinis ekstra oral
dan intra oral yang tepat
Mampu menentukan dan merujuk untuk dilakukan
pemeriksaan penunjang yang dibutuhkan dan
dapat menginterpretasi hasil dari pemeriksaan
penunjang tersebut
Mampu menentukan diagnosis penyakit mulut
yang disebabkan oleh infeksi spesifik (jamur,
bakteri dan virus)
mampu menentukan penatalaksanaan penyakit
spesifik rongga mulut (jamur, bakteri dan virus)
KOMPETENSI YANG DIHARAPKAN
Mampu melakukan anamnesa
Mampu melakukan pemeriksaan klinis ekstra oral
dan intra oral
Mampu menentukan dan merujuk pasien untuk
pemeriksaan penunjang yang tepat
Mampu menentukan diagnosis penyakit mulut
karena infeksi spesifik
Mampu menentukan penatalaksanaan penyakit
infeksi spesifik rongga mulut secara komprehensif
Mampu merujuk pasien ke dokter spesialis sesuai
dengan kondisi/ kelainan pasien
Primary & Secondary
Lesions

Sri Rezeki, drg., Sp.PM

Primary Lesions of the Skin & Oral Mucosa
Macule
Circumscribed, flat lesion
Size < 1 cm
Varied in shape & color
May represent
hyperpigmented,
hypopigmented,
or vascular abnormalities

Multiple macules due to

physiologic pigmentation
Primary Lesions of the Skin & Oral Mucosa
Patch
Circumscribed, flat lesion
Size > 1 cm
Varied in shape & color
May represent
hyperpigmented,
hypopigmented,
or vascular abnormalities

Patch due to physiologic

pigmentation
Primary Lesions of the Skin & Oral Mucosa
Papule
Circumscribed, elevated,
superficial, solid lesion
Size < 1 cm
Varied in shape & color
May reflect hyperplasia of
cellular structure or
represent cellular
infiltrates
Dermal papule in a patient
with Lichen planus
Primary Lesions of the Skin & Oral Mucosa
Plaque
Circumscribed, elevated,
superficial, solid lesion
Size > 1 cm
Varied in shape & color
May reflect hyperplasia of
cellular structure,
represent cellular
infiltrates, or may be
formed by a confluence
of papules
Dermal plaque in a patien
with Lichen planus
Primary Lesions of the Skin & Oral Mucosa
Nodule
Solid palpable lesion
Size < 1 cm
Depth : above, level with,
or beneath the skin or
mucosal surface
May be result of
inflammatory, neoplastic,
or metabolic precesses

Pedunculate nodule
Primary Lesions of the Skin & Oral Mucosa
Nodule
Descriptor such as : soft,
firm, hard (bony), fixed,
movable, pedunculated
(has a stem-like
connecting part, a stalk
by which a nodule or a
tumor is attached to
normal tissue) or Sessile
(attached by a base; not
pedunculated or stalked)
Pedunculate nodule
Primary Lesions of the Skin & Oral Mucosa
Tumor
Solid palpable lesion
Size > 1 cm
Depth : above, level with,
or beneath the skin or
mucosal surface
May be result of
inflammatory, neoplastic,
or metabolic precesses

Tumor
Primary Lesions of the Skin & Oral Mucosa

Wheal
Edematous, rounded or
oval transitory papule
Variable size
Usually the result of an
allergic reaction

Wheal, allergy to latex

Primary Lesions of the Skin & Oral Mucosa

Vesicle
Circumscribed elevated
intraepithelial or
subepithelial lesion
Size < 1 cm
Contains : serous fluid

Vesicle
Primary Lesions of the Skin & Oral Mucosa
Bulla
Circumscribed elevated
intraepithelial or
subepithelial lesion
Size > 1 cm
Contains : serous fluid

Bulla in a patient with

Pemphigus vulgaris
Primary Lesions of the Skin & Oral Mucosa
Cyst
Encapsulated lesion
Variable size
Subcutaneous or
submucosal tissue filled
with liquid or semisolid
material

Dermoid cyst
Primary Lesions of the Skin & Oral Mucosa
Pustule
Circumscribed elevation
of variable size & shape
Containing a purulent
exudate
Depending on the color of
the purulent exudates, it
may appear white, yellow,
or greenish-yellow

pustule
Primary Lesions of the Skin & Oral Mucosa
Pustule
Circumscribed elevation
of variable size & shape
Containing a purulent
exudate
Depending on the color of
the purulent exudates, it
may appear white, yellow,
or greenish-yellow

pustule
Primary Lesions of the Skin & Oral Mucosa
Hemangioma
Red irregular macule or
patch of variable size &
shape
Caused by dilation of
dermal or mucosal
capillaries

Capillary hemangioma located

on the patients lower lip
Primary Lesions of the Skin & Oral Mucosa
Telangiectasia
Serpiginous lesions
caused by permanent
dilation of superficial
capillaries
Caused by dilation of
dermal or mucosal
capillaries

Multiple telangiectases on the

face of patient with alcoholic
cirrhosis of the liver
Secondary Lesions of the Skin & Oral Mucosa
Petechia
Circumscribed deposit of
extravasated blood or
blood pigment
Size < 2 mm

Multiple petechiae on the soft

palate in a patient taking
clopidogrel, an antithrombotic
agent
Secondary Lesions of the Skin & Oral Mucosa
Purpura
Circumscribed deposit of
extravasated blood or
blood pigments
Size 2 10 mm

Purpura secondary to trauma in a

patient taking warfarin (oral
anticoagulant)
Secondary Lesions of the Skin & Oral Mucosa
Ecchymosis
Circumscribed deposit of
extravasated blood or
blood pigments
Size > 1 mm

Large ecchymosis lesion secondary

to trauma associated with a minor
salivary gland biopsy
Secondary Lesions of the Skin & Oral Mucosa
Hematoma
Accumulated mass of
extravasated blood that
usually clots solid
swelling
Variable size & shape
within a tissue

Hematoma in a patient who was

taking heparin (parenteral
anticoagulant)
Secondary Lesions of the Skin & Oral Mucosa
Scale
Abnormal shedding
(desquamating)
Usually of dry & flaky,
dead epithelial cells

Scaly lesions occuring on the

forearm of a patient with psoriasis
Secondary Lesions of the Skin & Oral Mucosa
Atrophy
Diminution in the size of
cells, tissue, organs, or
body parts

Atrophy of the filiform papilae

occuring on the dorsum of the
tongue
Secondary Lesions of the Skin & Oral Mucosa
Erosion
Gradual breakdown
(denudation) of the
epithelium
Heals without scarring
Erosion as it relates to
oral hard tissues (enamel,
dentin, cementum)
gradual loss of tooth
substance by a chemical
process that does not
involve a known bacterial
action Erosion in a pt w/ erosive Lichen planus
Secondary Lesions of the Skin & Oral Mucosa

Excoriation
Superficial, sometimes
linear excavation of the
epidermis
Usually associated w/
scratching
Secondary Lesions of the Skin & Oral Mucosa

Ulcer
Irregularly shaped
excavation of the
epithelium that extends
below the basal cell layer
May heal with scar

RAU / SAR
Secondary Lesions of the Skin & Oral Mucosa

Fissure
Linear crack or cleavage
in epithelial lissue
Sharply defined abrupt
walls
Secondary Lesions of the Skin & Oral Mucosa

Crust
Hardness deposit of
variable thickness
consisting of dried blood,
serum, or purulent
exudate on skin and lip
vermilion
Secondary Lesions of the Skin & Oral Mucosa

Scar
Is a mark that remains
after the healing of a
wound, which may be
atrophic or hypertrophic
as a consequence of
variable degrees of
collagen proliferation
Secondary Lesions of the Skin & Oral Mucosa

Scar
Is a mark that remains
after the healing of a
wound, which may be
atrophic or hypertrophic
as a consequence of
variable degrees of
collagen proliferation
Secondary Lesions of the Skin & Oral Mucosa
Keloid
Sharply elevated,
irregularly shaped
hypertrophic scar due to
the formation of
excessive amount of
collagen
Tends to extend & grow
beyond the original site
of injury during
connective tissue repair
Secondary Lesions of the Skin & Oral Mucosa
Sinus
Abnormal channel that
leads from pathological
space to an anatomical
space permitting the
escape of pus
THANK YOU
 www.animationfactory.com

Backdrops: Title Backdrop Slide Backdrop Transitional Backdrop Print Backdrop

- These are full sized

backdrops, just scale them up!
- Can be Copy-Pasted out of
Templates for use anywhere!

Additional Graphics: Animated .GIFs

- Scale them up or down!
- .GIF clipart is animated.
- .JPG clipart can be scaled
up and take up little file
space.
- .PNG clipart can be scaled
unusually large without
distortion.
Still Frame .PNGs
 PERTANYAAN
1. Deskripsikan lesi yang tampak pada foto, termasuk
klasifikasi lesi, bentuk, ukuran, lokasi, warna dan
hal-hal lain yang dianggap perlu
2. Tentukan dan jelaskan anamnesa (spesifik) yang
harus ditanyakan pada pasien terkait lesi tersebut
3. Tentukan pemeriksaan penunjang disertai
alasannya
4. Tentukan diagnosis kerja dan alasannya
5. Tentukan diagnosis banding disertai alasannya
6. Tentukan penatalaksanaan secara menyeluruh
kepada pasien disertai alasannya (termasuk
instruksi khusus, dosis obat, rujukan)
Kasus 1
Kasus 2
Kasus 3
Kasus 4
Kasus 5
Kasus 6
Kasus 7
Kasus 8
Medical Referral (Consultation)
Procedure

Sri Rezeki, drg., Sp.PM

TEKNIK PENGISIAN FORMULIR RUJUKAN KE AHLI
BIDANG LAIN
Data rutin pasien (nomor rekam medik,
nama, jenis kelamin, usia)
Tanggal, bulan, tahun penulisan rujukan
Bagian yang dituju
Diagnosis kerja
Gambaran klinis yang ditemukan saat itu
Riwayat singkat penyakit
Riwayat obat-obatan yang telah diberikan
Jenis tindakan yang ingin dilakukan
(evaluasi/penatalaksanaan / evaluasi dan
penatalaksanaan)
Tanda tangan dokter pengirim
Nama dokter pengirim dan bagiannya
Quiz
1. Deskripsikan lesi yang tampak pada
foto !

2. Anamnesa (spesifik) apa yang harus

ditanyakan pada pasien terkait lesi
tersebut ?

3. Tentukan pemeriksaan penunjang !

4. Tentukan diagnosis kerja !

QUIZ Klp 1
Quiz Klp 2
QUIZ
Your subtopic goes here
 www.animationfactory.com

Backdrops: Title Backdrop Slide Backdrop Print Backdrop Transitional Backdrop

- These are full sized

backdrops, just scale them up!
- Can be Copy-Pasted out of
Templates for use anywhere!

Additional Graphics:
- Scale them up or down!
- .GIF clipart is animated.
- .JPG clipart can be scaled
up and take up little file
space.
- .PNG clipart can be scaled
unusually large without
distortion.