MODUL 1

PROBLEM BASED LEARNING : Smoking as Risk Factors of

Oral Disorders

Group B:
1. Rr. Dwi Listyorini 021311133016
2. Nurnya Aini Dewi 021311133017
3. Rahmad Rifqi Fahreza 021311133018
4. Frida Fardanila Asmoro 021311133019
5. Mellisa Soliman 021311133020
6. Pramadita Suryaningastuti 021311133021
7. Achmad Gigih Andy Putra 021311133022
8. Wiwin Saputri 021311133023
9. Intan Vallentien Dwi H 021311133024
10. Anisa Nindya Wirastuti 021311133025
11. Ni Made Titia Prabandari I 021311133027
12. Diva Amelia Ruslianda 021311133028
13. Adina Risdayanti 021311133029
14. Sigit Ahmad Indarto 021311133030

FACULTY OF DENTAL MEDICINE

AIRLANGGA UNIVERSITY
Semester I – 2013 / 2014
 PREFACE

We praised the God because of His blessings, we were able to complete this scientific
writing,”Smoking as Risk Factors of Oral Disorders”
We give thanks to the people who are mentioned below because they have been
helping us until we finished this scientific writing:
1. Dr. Retno Pudji Rahayu, drg., M.Kes

2. And all the people who have been helping us to finish this paper.

We realized that this scientific writing is still far away from perfect, so, we hope that
we could receive any supporting and developing comments from the reader. In addition we
hope that this paper is able to give some benefits to all of the reader to better understand
about dental health.

November 2013

Author
 Table of Contents
Preface…………………………………………………………………………………… i
Table of contents………………………………………………………………………… ii
List of pictures…………………………………………………………………………… iii
Abstract……………………………………………………………………………….…. iv
Chapter 1
1.1 Background………………………………………………………………………….. 1
1.2 Problem………………………………………………………………………………. 1
1.3 Purpose………………………………………………………………………………. 1
1.4 Benefit………………………………………………………………………………... 1
Chapter 2
2.1 Cigarettes…………………………………………………………………………. 2
2.1.1 Nicotine
2.1.2 Tar
2.2 The Effects of Smoking in Oral
2.2.1 Discoloration
2.2.1.1 Teeth
2.2.1.2 Gums/Gingiva
2.2.1.3 Lips
2.2.2 Periodontal Disease
2.2.2.1 Gingivitis
2.2.2.2 Periodontitis
2.2.3 Calculus
2.2.3.1 Plaque
2.2.4 Caries
2.2.5 Xerostomia
2.3 Preventive Actions for Oral disorders due to Smoking
Chapter 3
Conceptual mapping…………………………………………………………………………29
Chapter 4
Discussion and Analysis………………………………………………………………..……30
Chapter 5
5.1 Conclusion……………………………………………………………………….………36
5.2 Suggestion……………………………………………………………………………….36
References review……………………………………………………………………

\
List of Picture
 ABSTRACT

Cigarette is one addictive substance that when used can harm our health. Many substance in
cigarette that harmful for body, such as nicotine and tar. With respect to oral health, it is had
an important role of increasing risk for oral disease such as teeth, gum, and lip discoloration,
caries, calculus, mouth odor, gingivitis, and periodontitis. Studies have shown that tobacco
use may be one of the most significant factors in the development and progression of oral
disease. Educating and advising people of representative and repressive actions for oral
disorders due to smoking may be one of the solution that can help people to improve their
health.
 CHAPTER 1
INTRODUCTION
1.1 Background
Indonesia ranks third after China and India (WHO, 2008) and ranked as fifth
largest cigarette consumer after China, the United States, Russia and Japan in 2007.
Survey in Indonesia, such as RISKESDAS, GYTS, and GATS show the amount of
cigarette problem consumption for public health. RISKERDAS is national health
survey conducted a population-based regularly every three years in
Indonesia.Prevalence (GATS 2011) show 67% smoker are man 2.7% smoker are
woman, and 80.4% current smoking population smoked cigarettes only. (tcsc-
indonesia.org/Masalah-Rokok-di-Indonesia.pdf accessed on 25 November 2013)
Tobacco use is linked with many serious illness such as cancer, lung disease,
and heart disease as well as numerous other health problem. Tobacco users also at
increased risk for oral disease. Studies have shown that tobacco use may be one of the
most significant risk factors in the development and progression of oral disease.
Smoking is one of the most significant risk factor associated with the development of
gum disease. Cigarette contains many chemical subtances, such as nicotine and tar
that can make plaque. Bad behaviour of the smoker that rarely brushing and flossing
exacerbate plaque growth. (www.clinicaltrials.gov NIH publication No.12-1142
August 2012 accessed on 25 November 2013)

1.2 Problems
1. What is Cigarette ?
2. What are the effect of smoking in oral?
3. How the preventive actions for oral disorders due to smoking?
1.3 Purpose
1. To know about cigarette
2. To know about the effect of smoking in oral
3. To know about preventive and repressive actions for oral disorders due to
smoking?
1.4 Benefits
1. Readers can explation about cigarette
2. Readers can know and explain the effect of smokin in oral
3. Readers can know about the preventive actions for oral disorders due to smoking.
 CHAPTER II
Review of Literature

2.1 Cigarette
A cigarette is a small cylinder of finely cut tobacco leaves rolled in thin paper
for smoking. The cigarette is ignited at one end and allowed to smolder; its smoke
is inhaled from the other end, which is held in or to the mouth and in some cases
a cigarette holder may be used as well. Most modern manufactured cigarettes
are filtered and include reconstituted tobacco and other additives. (Wigand, 2006)
Cigarette is one addictive substance that when used result in harm to the health
of individuals and communities. Then There is also mention that tobacco is processed
including cigars wrapped or other material produced from plants Nicotiana tabacum,
Nicotiana Rustica and other species or synthesis containing nicotine and tar with or
without additives. (Hans Tendra, 2003).

2.1.1 Nicotine
When we think of drug abuse, we may not think about cigarettes. But
cigarettes are adictive because they contain a drug – Nicotine. Nicotine is a
stimulant, and just like a cocaine, amphetamines, or methamphetamines,
ncotine works by speeding up the processing rate of the central nervous
system. Nicotine is highly addictive, and smokers can quickly become
dependent on cigarettes and suffer serious symptoms of withdrawal when they
try to quit. (David 2003, Pp. 9-10).
Nicotine is a really a poisonous alkaloid (a compound that contains
carbon and nitrogen and is found in some plats, some are poisonous, others
can be used for medicinal puroses). Nicotine is the ingredients of cigarettes. In
the United states, Tobacco Products such as cigarettes are made from a blend
different types of tobacco leaves, and then sugar and the flavorings are added.
Most American cigarettes are made from ”lighter” blend of tobacco which
products, such as those used in pipes and cigars, burn a fdrker tobacco, which
gives off an alkaline smoke. Why does it matter? The pH content
(acid/alkaline balance) of smoke determines how much nicotine absorbed
through mouth when you smoke. In general, the darker and more alkaline the
tobacco, the more nicotine is absorbed in mouth. (11-12)
Nicotine, the main determinat of tobacco use and addiction, is now
available as a medication to assist smoking cessation and is being evaluted as
a medication for a variety of other medical disorders. Nicotine acts on
nicotinic cholinergic receptors, which demonstrate divesity in subunit
structure, function, and distribution within the nervous system, mediating the
complex action of nicotine described in tobacco smokers. Nicotine affects
most organ system in the body. The nature and intensity of effects of nicotine
are nfuened by the rate and route of dosing and by the developtent of
tolerance. Effects of nicotine are most intense, nd addiction is most likely
occur, with rapid dosing, as occurs with cigarette smoking. Addiction to
nicotine ccurs as a cosuquence of both positive reinforcement and seeking to
relieve withdrawal symtomps that occur in the context of physical
dependence. The most important toxicity of nicotine is the maintenance of
addiction to tobacco use, which result in many millions of premature deaths
and other severe illnesses yearly. Whether nicotine has direct toxicity
independent of causing addiction is the subject of the remaider of this volume
(Nicotine Safety and Toxicity, 12, oxford university press, 1998 )
2.1.2 Tar
Cigarettes look deceptively simple, consisting of paper tubes
containing chopped up tobacco leaf, usually with a filter at the mouth end. In
fact, they are highly engineered products, designed to deliver a steady dose of
chemical contents.
One of the chemical contents is tar. Tar is inhaled when the smoker
draws on a lighted cigarette. In its condensate form, tar is the sticky brown
substance which can stain smokers’ fingers and teeth yellow-brown. All
cigarettes produce tar but the brands differ in amounts.[1]
Each particle in tar consists of a large variety of organic and inorganic
chemicals, including the majority of mutagenic and carcinogenic agents in
tobacco smoke (IARC, 1986). Tar probably contributes to the taste and aroma
of cigarette smoke and, as such, probably has some influence on smokers’
behavior. (Blakely, 1998)
2.2 The effects of Smoking in Oral
2.2.1 Discoloration
The most visible and immedate dental manifestation seen by the public
is tooth discoloration. Smoker’s teeth tend to develop tobacco stains; these
may be yellow, brown, dark brown or even black stains, the severity
depending partly on duration and frequency of the habit. Tooth discoloration
may therefore have a deleterious effect on individual’s apperance which in
turn may result in social disvantage for smokers (Alkhatib, 2005)

2.2.1.1 Teeth
Smoke habit cause brown line until black line on a third crown
servical. Colour change on dentine which exposed and darken calculus
also seen on smokers. Chewing tobacco produce tar which cause stain
on pit, fissure, and other soft surface which direct connect with
tobacco. Under the microscope, email cuticule, email, and dentine
which exposed also discoloration occur.

2.2.1.2 Gums / Gingiva

Discoloration also occur in gum. Its cause in many factors, such
as smoke. Smoke can heat on the gum and make the gum become
darken. The normal gum colour has pink colour. But, smoker gum has
darken gum and maybe become dark.

2.2.1.3 Lips
The main cause of darken lip of smoking is nicotine. Nicotine is
substace which can destroy the skin and darken the lip. Nicotine also
cause decreasing of iron absorbing which can disturb forming process
of blood haemoglobin which cause lip turn into the dark.

2.2.2 Periodontal Disease

Dental Plaque is the primary etiological in periodontal disease. However,
there are many other factors that can modify how an individual’s periodontal
tissues will respond to the accumulation of dental plaque. Among such risk
factors, there is increasingevidence that smoking tobacco products alters the
expression and rate of progession of periodontal disease.

2.2.2.1 Gingivitis
Gingivitis is an inflammation of the tissues in the periodontium
are limited to the gingiva, which is caused by microorganisms in the
underlying form a colony and form dental plaque attached to the edge
of the gingival.
Dental plaque as a trigger og gingivitis is a condition that
occurs. According to research muller et al i 2002 after six-mouth
observed in the group of smokers found more supragingiva plaques
that non-smokers. Meanwhile, according to research from calsina et al
2002 gingival recession is more severe in the group of smokers than
non-smokers to quit smoking and even in heavy smokers there is an
increase in gingival recession as much 2.3%. Recession in smokers
due to vasoconstriction and reduced inflammatory response caused by
nicotine from cigarettes that enter the bloodstream. It also led to the
group of smokers was found bleeding on probing compared to non-
smokers group or stop smoking. (Amith 2007, Pp. 12-18)
Heavy smokers often present with a thickened, fibrotic
appearance their gingival tissues. Studis following the protocol of the
experimental gingivitis in man studies (Theilade et al, 1965), in which
all oral hygiene is withdrawn over a period of up to four weeks and the
development of gingivitis is observed, have found that the
development of gingivitis is delayed among smokers. The rate of
plaque accumulation is similar in smokers and non smokers, however,
smokers show less ginggival inflammatory change, with less gingival
bleeding, gingival redness, and gingival fluid flow. (Bergstrom and
preber, 1986). Hence, it appears that smoking may suppress the normal
immune response to the accumulation of plaque. The major clinical
implication of these findings is that the masking of gingival bleeding in
smokers may lead to failure to recognize the presence of periodontal
disease.
 Acute necrotizing ulcrerative gingivits occurs more frequently
in smokers. Possible mechanism for this increased susceptibility
include vasoconstriction og gingival blood vessel, reduced activity of
leukocytes, and proliferation of anaerobic, fuso-spirochaetal micro-
organism, these factors interact with the other factors, namley oral
hygiene and mental stress.

2.2.2.2 Periodontitis
Periodontitis means "inflammation around the tooth" - it is a
serious gum infection that damages the soft tissue and bone that
supports the tooth. All periodontal diseases, including periodontitis, are
infections which affect the periodontium. The periodontium are the
tissues around a tooth, tissues that support the tooth. With
periodontitis, the alveolar bone around the teeth is slowly and
progressively lost. Microorganisms, such as bacteria, stick to the
surface of the tooth and multiply - an overactive immune system reacts
with inflammation.Untreated periodontitis will eventually result in
tooth loss, and may increase the risk of stroke, heart attack and other
health problems. Bacterial plaque, a sticky, colorless membrane that
develops over the surface of teeth, is the most common cause of
periodontal disease. (Darwadi, R P, 2013)

It is difference between periodontitis and gingivitis. Gingivitis

occurs before periodontitis. Gingivitis usually refers to gum
inflammation while periodontitis refers to gum disease and the
destruction of tissue and/or bone. Initially, with gingivitis, bacteria
plaque accumulates on the surface of the tooth, causing the gums to go
red and inflamed; teeth may bleed when brushing them. Even though
the gums are irritated and bothersome, the teeth are not loose. There is
no irreversible damage to bone or surrounding tissue.
Untreated gingivitis can progress to periodontitis. With
periodontitis, the gum and bone pulls away from the teeth, forming
large pockets. Debris collects in the spaces between the gums and
teeth, and infect the area. The patient's immune system attacks bacteria
 as the plaque spreads below the gum line. Bone and connective tissue
that hold the tooth start to break down - this is caused by toxins
produced by the bacteria. Teeth become loose and can fall out.Put
simply, Periodontitis involves irreversible changes to the supporting
structures of the teeth, while gingivitis does not. (Ana Pejčić 2007, Pp.
53-59)
Recent studies have revealed an association between smokinh
and more severe periodontitis. After allowing for the effects of oral
hygiene and the patient’s age, smoking has been shown to be
associated with eeper periodontal pockets and mre alveolar bone loss.
There is also evidence that the rate of progression of periodontitis is
more rapid among smokers.

2.2.3 Calculus
Reports that calculus formation is more abundant in smokers may be
due to the increased salivary flow rates. There is an increased calcium
concentration in fresh saliva in smokers following smoking. Nicotine
affects the exocrine glands by an initial increase in salivary and bronchial
secretions that are followed by inhibition of the secretions. The organic
components may also arise from this source, the proteins and polypeptides
constituting the major fraction. The increased amount of calculus found in
smokers might therefore be due to an effect of tobacco smoke upon
properties of saliva. This too is impacted by poor oral hygiene which,
together with smoking (independent of the level of oral hygiene), are both
associated with halitosis.
(Mana dapus nya?)
2.2.3.1 Plaque
Plaque is an essential prerequisite for dental caries to occur,
since it is plaque bacteria that produce the acid which dissolves the
enamel. However, plaques are of varying cariogenicity, which depends
to a large extent on their bacterial composition. In addition, plaque
thickness shoud affect cariogenicity because thickness determines the
extent of any acid challenge to the teeth. Increasing plaque thickness
 would also be expected to minimise the potentially protective influence
of dissolution inhibitors in saliva. In addition to shielding the tooth
surface from fresh supplies of dissolution inhibitors, plaque bacteria
are also a source of enzymes that can cause their degradation; for
example, alkaine phosphatase and protease. The fact that plaque is a
region in the mouth relatively free from salivary inhibitors is probably
one reason why calcification, leading to calculus formation, is
associated with plaque. A second reason is the presence of certain
bacteria that calcify e.g. Corynebacterium (formerly Bacterionorma)
matruchotii and S. sangui I/II (more recently S. gordonii). The former
bacterium contains cell wall components that can nucleate crystal
growth, whilst the latter bacterium can metabolize basic amino acids,
and thereby, locally raise pH, which favors calcium phosphate
precipitation.

2.2.4 Caries
The initial caries lesion is chalky white because the increased pore
volume reduces the translucency of the enamel. On drying the lesion, the
fluid in the pores is replaced by air, which reduces the refractive index. The
white spot then becomes brown, as chromogenic dietary pigments penetrate
into the pores. Discoloured carious dentine, if not directly visible, may be
visible (white/grey/brown) through the enamel, for instance approximal
caries may be observed from the occlusal or buccal aspect. a brown zone
occurs ahead of bacterial progress within demineralised dentine. The colour
of exposed carious dentine depends on the state of activity in the lesion, the
more active the lesion, the lighter (white, yellow) is the colour; arrested
lesions appear dark brown. The brown colour of dentine is attributed to
Maillard pigmentation or melanin or, alternatively, pigments such as
lipofuchsin and bile acids. (Schuurs, Albert, et al(ed), 2013)
2.2.5 Xerostemia
Xerostomia is derived from Greek: Xeros means dry, stoma means
mouth. Dry mouth is a condition which the secretion rate of salivary
stimulation is decreasing. (Amelia 2012, p. 6) This condition is controlled
 by the sympathetic and parasympathetic nervous system, in patients
suffering from psychologic problems. (Goldman 1980, p. 170)
The reduction in salivary buffering and flushing action leads to
greater plaque accumulation and an attenndant increase in caries incidence,
in addition to excerbation of plaque-associated gingival inflammation and
mucosal disturbances. (Wilson 1996, p. 175)
Over 400 different drugs have been implicated as causing
hyposalivation or xerostomia, with the majority possessing some degree of
anticholinergic (antiparasympathetic) activity. (Wilson 1996, p, 266-267).
Drug-induced xerostomia is most commonly associated with
anticholinergics (atropine, diphenoxylate), antihypertensives,
Tar on cigarette is easyly attached on enamel. Smoking habit also
able to cause xerostomia. Dry mouth (Xerostomia) is one of the most
common contributors to bad breath. Bad breath associated with a dry mouth
(Xerostomia) is caused by a reduction in the cleansing mechanism of the
mouth as a result of reduced flow of saliva (Dr. Tim Kenny, 2011). Without
enough saliva to wash away food particles and dead cells, bacteria can
colonize your tongue, gums, and cheeks, where they promote tooth decay
and produce foul-smelling sulfur compounds.
2.1 The Preventive and Repressive Actions for oral Disorders due to Smoking
1. Teeth should be brushed twice daily,brush your teeth for at least two minutes in the
morning before breakfast and last thing at night before you go to bed. Because
smoking habits, will make your teeth become yellow and the color is not good due
to the nicotine. Therefore it is advisable to regularly clean the teeth.This removes
plaque, which can lead to damaged teeth, gums, and surrounding bone.After
brushing your teeth, clean your tongue too. You can use a tongue cleaner or a soft-
bristle toothbrush, stroking in a back-to-front direction. Tongue cleaning is
particularly important for people who smoke.
How to brush your teeth:
 Place the head of your toothbrush against your teeth, then tilt the bristle
tips to a 45 degree angle against the gum line. Move the brush in small
circular movements, several times, on all the surfaces of every tooth.
  Brush the outer surfaces of each tooth, upper and lower, keeping the
bristles angled against the gum line.
 Use the same method on the inside surfaces of all your teeth.
 Brush the chewing surfaces of the teeth.
 To clean the inside surfaces of the front teeth, tilt the brush vertically and
make several small circular strokes with the toe (the front part) of the
brush.
 Brushing your tongue will freshen your breath and clean your mouth by
removing bacteria.
In addition to brushing, in removing dental plaque can also use dental floss. Regular
flossing may also reduce gum disease and bad breath by removing plaque that forms
along the gum line. Dental floss is a thread that you can use to clean between your
teeth. The basic technique is:
 Take a length of the floss (about 45cm) and wrap it round the middle
finger of each hand
 Keep about 5cm of floss between your fingers and gently rock it down
between your teeth
 Pull the floss tight, slide it up and down against your tooth surface and
under your gum line
 Repeat this action for both sides of all your teeth making sure that you use
a clean length of floss for each one
2. Brushing teeth is recommended to use a toothbrush that has the characteristic such as
soft and horizontal bristles of same size and small brush head. Use a soft bristled
toothbrush, this will reduce the abrasion to the tooth surface and reduces irritation of
the gums.Or you can also use an electric toothbrush with an oscillating or rotating
head. Because a lot of evidence that shows the use of an electric toothbrush is more
effective in removing plaque and preventing gum inflammation.
3. Brushing teeth is recommended to use toothpaste containing fluoride. Toothbrushing
(especially with fluoridated dentifrices) is effective in the reduction of
caries.Toothbrushing is effective in reduction of gingivitis,but not of aggressive
periodontitis.There are many different types of toothpaste on offer such as:
  Standard toothpastes usually contain between 1,000 and 1,500 ppm
fluoride. They contain mild abrasives such as calcium carbonate, which
gives the toothpaste its cleaning power.
 Whitening toothpastes contain added ingredients that may remove
superficial stains from the enamel covering your teeth. However, the
colour of your teeth is determined by the layer underneath (dentine) and
they don’t appear to change the colour of this. Whitening toothpastes can
be abrasive and so some dentists advise you to use them only with manual
toothbrushes and not electric ones. Always follow the instructions on the
toothpaste packet.
 Sensitive toothpastes block tiny channels that may have opened up on your
teeth making them sensitive to hot and cold. As well as the ingredients
found in standard toothpastes, these contain active desensitising elements
such as strontium chloride, potassium chloride or potassium citrate.
4. Preventive measures that should be considered for people who have sensitive teeth
than by using a special toothpaste for sensitive teeth such as watch what you
eat,frequent consumption of highly acid foods can gradually dissolve tooth enamel
and lead to dentin exposure.The foods may also aggravate the sensitivity and start the
painful reaction. Use fluoridated dental products and fluoridated mouth rinse can
decrease sensitivity,and also can help prevent tooth decay and help get rid of any last
bits of bacteria or leftover food that you might have missed with your toothbrush.
However, don't use mouthwash straight after brushing your teeth. Choose a separate
time, such as after lunch. And don't eat or drink for 30 minutes after using a fluoride
mouthwash.
5. Routine use of antiseptic mouthwash after brushing and if you have a gum or mouth
infection. Many of these mouthrinses products with antimicrobial properties can
reduce oral malodor by reducing the number of microorganisms chemically. Often
used active ingredients in these products are chlorhexidine (CHX), essential oils
(EOs), triclosan and cetylpyridinium chloride (CPC). Mouthrinses can also reduce
halitosis by neutralizing odor, and these active ingredients can prevent the growth of
bacteria in the mouth. Suggest drinking plenty of water to moisten a dry mouth and, to
avoid dehydration, sucking sugar free sweets/mints or chew sugar free gum to
stimulate saliva flow.
6. Avoid using tobacco products, tobacco reduces your ability to fight infection and
delays healing. Tobacco users are much more likely to develop gum disease. Promote
smoking cessation in those who smoke and drink alcohol. The best thing for yourself
that is by stop smoking. It is difficult to quit smoking, but many people find success
through a combination of medicine, a stop-smoking program, and counseling.
Schedule regular trips to the dentist based on how often you need exams and cleaning
recommended for 6 months.
 CHAPTER III
Conceptual Mapping
 CHAPTER IV
Discussion and Analysis

From the study case, it is already known that

We can conclude that the man get oral disorders such as teeth, gum, and lips
discoloration, caries, periodontal disease, mouth odor that caused by dry mouth (xerostomia),
calculus and gingivitis.
The man feels painful on his teeth when he eats hot and cold foods. Probably, this
painfulful sensation caused by caries or getting periodontal disease namely periodontitis.
One of the biggest constituent inside the cigarette is tar. Tar is composed by
thousands of chemicals and it is carcinogenic. When the cigarette is smoked, tar enters the
oral cavity as dense vapor and it will become solid and form a brown deposition on the
surface of the teeth, respiratory tract and lungs after cold.
The oral cavity is very easily exposed to harmful effects of smoking. The mouth is the
beginning of the absorption of the burning cigarette substances, cigarette temperature in
mouth was 30oC, while the temperature of the tip of a burning cigarette was 900 oC. Hot
smoke that continually blowing into the oral cavity is the stimulus that causes the changes in
blood flow and reduce the secretion of saliva. Consequently, mouth becomes dry and more
anaerobic, thus providing a suitable environment for the growth of anaerobic bacteria in
plaque.
Plaque which interact with cariogenic bacteria will cause caries. Caries can cause
painful sensation when the man eat hot or cold food. Selwitz stated that Dental Caries results
from an ecological imbalance in the physiological equilibrium between tooth minerals and
oral microbial biofilms. Streptococcus mutans will lead carbohydrate and glucose
fermentation to acid condition. The condition is called Demineralization that become pH
drops to below 5.5, demineralization process is faster than remineralization. This causes more
tooth mineral melt and make a hole in the tooth. Minerals are necessary gear available in
saliva and fluoride toothpaste and liquid dessert. Caries information can be retained at this
level. If demineralization continuous, there will cause perforation. Sugar serves as a
sweetener and preservative, providing a fragrant odor, this will cause the attraction best taste,
smell and form of the food itself, so that there is a tendency people will choose sugary foods.
Cavities are painfulless until the hole bigger and attach the nervous of teeth. Deep caries will
cause painful especially when exposed to stimuli of gear hot, cold or sweet. Caries will
increase the size and reach the pulp room which the teeth that contains nervous systems and
blood vessels. When the room reached the pulp, the inflammatory process will occur and over
time a bacterial infection can lead to death pulp tissue. This process will lead caries in further
condition.
Selain karies, periodontal disease atau lebih tepatnya periodontitis yang disebabkan
karena merokok juga dapat menyebabkan nyeri ketika makan makanan panas atau dingin.
With periodontitis, destruction of the alveolar bone and periodontal ligament, apical
migration of the epithelial attachment resulting in the formation of periodontal pockets,
Debris collects in the spaces between the gums and teeth, and infect the area. The patient's
immune system attacks bacteria as the plaque spreads below the gum line. Bone and
connective tissue that hold the tooth start to break down - this is caused by toxins produced
by the bacteria. Teeth become loose and can fall out away from the teeth. The large pocket
caused by destruction of the alveolar bone will expose cementum (the surface layer of the
tooth root ) and root dentine, which may cause sensitivity. This inflammation will cause the
tooth to become sensitive to hot and cold stimulus.
Selain permasalahan nyeri ketikan makan makanan panas dan dingin, pria ini juga di
jauhi teman-temannya. Efek merokok ini secara fisiologis yaitu bau mulut dan terjadinya
perubahan warna pada gigi, gusi dan bibir. Hal ini lah yang menyebabkan dia dijauhi oleh
teman-temannya. Bau mulut sebagian besar disebabkan oleh mulut kering (xerostomia),
calculus, dan gingivitis. Hal tersebut merupakan efek dari merokok. Tar on cigarette is easily
attached on enamel. Smoking habit also able to cause xerostomia. Dry mouth is one of the
most common contributors to mouth odor. Mouth odor associated with a dry mouth
(xerostomia) is caused by a reduction in the cleansing mechanism of the mouth as a result of
reduced flow of saliva. Without enough saliva to wash away food particles and dead cells,
bacteria can colonize your tongue, gums, and cheeks, where they promote tooth decay and
produce foul-smelling sulfur compounds.
Reports that calculus formation is more abundant in smokers may be due to the
increased salivary flow rates. There is an increased calcium concentration in fresh saliva in
smokers following smoking. Nicotine affects the exocrine glands by an initial increase in
salivary and bronchial secretions that are followed by inhibition of the secretions. The
organic components may also arise from this source, the proteins and polypeptides
constituting the major fraction. The increased amount of calculus found in smokers might
therefore be due to an effect of tobacco smoke upon properties of saliva. This too is impacted
by poor oral hygiene which, together with smoking (independent of the level of oral hygiene),
are both associated with halitosis.
Gingivitis is an inflammatory disease that most commonly occur and lead to halitosis
caused by gram-negative bacteria such as veilonella, Fusobacterium nucleatum and
Porphyromonas gingivalis hidden in the diseased periodontal tissues and cause gas odor. In
addition to the decaying food debris trapped in the pocket, on the condition of saliva can also
decompose so quickly exacerbate mouth odor individuals. In addition, the necrotic tissue is
formed and reduced blood supply caused oxygen levels in the area of infection is also
reduced. Thus the bacteria will continue to grow and release substances that function as
virulence and can cause purulent exudate coming out through the gingival sulcus. Metabolic
reactions arising produce H2S gas and NH2 (Amino) resulting in elevated concentrations of
volatile sulfur in the air in the oral cavity.
So, the man feels painful when he ate hot and cold food because of caries and
periodontitis. And why his friends avoid him when he talked because of the gum, teeth, and
lips look different from the other. And another possibility is mouth odor.
 CHAPTER 5

5.1 Conclusion
5.2 Suggestion
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