11/10/2016

CONCEPT OF DISEASE - ILLNESS Learning Objectives:

• Understand the basic concepts of disease,
etiology, pathogenesis, clinical manifestation
of disease and appearance of disease.
1. Define and discuss the concepts of health,
wellness, illness, disease, and sickness;
2. Discuss the concepts of natural history of
disease.
3. Define the terms etiology, physiology, pathology,
pathophysiology and pathogenesis.

1 2

Learning Objectives: Definition

4. Define clinical manifestations, signs, symptoms, Health
syndrome.
5. Describe the clinical course and appearance of Wellness ORAL
disease, defining the terms acute and chronic
diseases, preclinical, clinical, subclinical and
carrier.
Wellbeing HEALTH
Illness
Disease
3 4

What is Health? Health is multidimensional.

• People with a narrow perspective consider health as
the absence of disease or disability or biological • The following are the
dysfunction.
dimensions of health:
• The most widely used of the broader definitions of
health is that within the constitution of the World
Health Organization (1948), which defines health as:
‘A state of complete physical, mental, and social
well-being, and not merely the absence of disease
or infirmity.’

5 6

1
 11/10/2016

Definition : Wellness - Wellbeing DISEASE, ILLNESS, SICKNESS

Wellness
• The positive component
of good health which
reflects how one feels
as well as one’s ability
to function effectively.
Wellbeing
• Subjective perception of
balance, harmony and
vitality
• The objective component
known as standard of
living.
• The subjective component
is refered to as quality of
life.
Sickness
• A pathological/physiological/
Disease psychological dysfunction defined
professionally
• The individual’s perceptions and
behavior in response to the disease,
Illness as well as the impact of that disease
on the psychosocial environment
• A state of social dysfunction based
on professional and social
agreement

7 8

You cannot be healthy without oral

Relation between illness & disease
health

Feels unwell Feel well  Oral health means

much more than
healthy teeth
Abnormality
Illness Healthy
absent  Oral health and general
health should not be
Abnormality Disease and interpreted as separate
Disease
present illness entities

Functions of the mouth

• Speaking ●o Smiling
• Chewing ●o Kissing
• Tasting ●o Happiness
• Swallowing ●o Socializing
• Laughing ●o Mimic

11 12

2
 11/10/2016

What is Oral Health ? GLOSSITIS ATROPHIC

• A standard of health of the oral and related

tissues which enables an individual to eat,
speak and socialise without active disease, NUTRITIONAL
DEFICIENCIES MALIGNANCY
discomfort or embarrassment and which
contributes to general well-being
(Department of Health, 1994).
• http://www.dh.gov.uk/en/Publicationsandstatisti
cs/Publications/PublicationsPolicyAndGuidance/
Browsable/DH_5554779 ANEMIA

14

BASIC CONCEPT OF DISEASE

Oral Diseases
• A condition of the body or some part or organ
manifestasi penyakit di mulut, of the body in which its functions are
baik subyektif dan/atau deranged.
obyektif, – It is a mal-adjustment of human organism to the
yang dapat disebabkan oleh environment.
– I t is deviation from normal function
faktor lokal di dalam mulut,
atau faktor sistemik, atau  Disease can be described as an alteration in body
kombinasi keduanya. functions resulting in a reduction of capacities or
shortening of the normal life span.

16

Adaptations to Homeostatic Imbalance in Adaptations to Homeostatic Imbalance in

Health and Disease Health and Disease
Healthy Adaptation is Homeostatic, restoring
normal equilibrium and health. ....Individual's ability to be able
to maintain the body's homeostasis
Disturbance to
Homeostasis or dynamic equilibrium ...

• In general ... (illness) did not involve new

Adaptation forms of life, but rather an extension or
Healthy disease distortion of normal life processes ..............
Normal abnormal

17

3
 11/10/2016

HSV infection .. disease  a number of physiological

process that has changed, so it is
HSV-1 virus necessary to identify and examine on:
itself is not a
disease, but it
can cause –changes in normal physiological
changes in processes
subjects with –properties of the disturbances
end result is –the impact of the disruption of vital
disease. processes.

Disturbance to Homeostasis ..... some criteria that allow a disease to be

identified, grouped and understood, so as
Abnormal
Normal
Adaptation diagnosed are:
Health Disease • Etiology
• Risk factor
• Pathogenesis
Physiology Pathology • Manifestasi
• Komplikasi
• Prognosis
Pathophysiology • Epidemiology

21

Etiology is the the study of the causes

of disease
Classification of Disease
Etiological factors are factors that cause disease • According to Etiologic Factors
Etiological factors may be Environmental or Genetic
1. Hereditary. Due to defect in the genes of one or
• Microorganisms, viruses, • Inherited gene or other parent which is transmitted to the offspring.
bacteria & other parasites chromosomal mutations
• Physical factors, physical (alterations to DNA) 2. Congenital. Due to a defect in the development,
trauma, radiation, etc hereditary factors, or prenatal infection; present at
• Chemical agents, drugs,
Diseases may be birth. (e.g. cleft lip, cleft palate)
toxins genetic,
• Nutritional excess or deficit
3. Metabolic. Due to disturbances or abnormality in
environmental or the intricate processes of metabolism.
• Psychological stressors
multifactorial
24

4
 11/10/2016

Classification of Disease Classification of Disease

According to Etiologic Factors
4. Deficiency. Results from inadequate intake of
absorption of essential dietary factors.
5. Traumatic. Due to injury.
6. Allergic. Due to abnormal response of the body to
chemical or protein substances or to physical stimuli.
7. Neoplastic. Due to abnormal or uncontrolled growth
of cells.
According to Etiologic Factors
8. Degenerative. Results from the degenerative
changes that occur in tissue and organs
9. Infective. Due to infection
10. Iatrogenic. Results from the treatment of a disease.
11. Idiopathic. Cause is unknown; Self-originated; of
spontaneous origin.

25 26

Hand foot mouth disease Caries dentis

• Enterovirus

27 28

To cite disease with uncertain etiology, a risk factor is a variable associated with
frequently used additional terms such as: an increased risk of disease or infection.
• Risk factor • Age
● Primary • An aspect of personal • Gender or Sex
• Ethnicity
● Idiopathic behavior or life style, an
environmental exposure, or • Occupation
● Essential an inborn or inherited
characteristic, that, in the
• Habit
• Social
basis of epidemiologic status/income
For examples: evidence, is known to be • Geographic
associated with health- location
• Essential / primary hypertension, related condition (s) • Genetic
considered important to predisposition
• Idiopathic facial pain prevent. • Diet

29 30

5
 11/10/2016

RISK FACTOR  likely only provide direction to

the unidentified cause, or may simply facilitate
Pathogenesis
the development of the disease in the certain
• The pathogenesis of a disease is the
individuals...
mechanism that causes the disease.

Malnutrition Oral infection • The term can also describe the origin and
development of the disease, and whether
Aging Oral cancer it is acute, chronic, or recurrent.

Carbohydrate microbial infection, inflammation,

consumption  Caries dentis malignancy and tissue breakdown.

31 32

Etiology Pathophysiological
Pathophysiology Adapted physiological reactions process

eradication Defense mechanisms adaptation

a convergence of pathology with physiology.

• Pathology is the medical discipline that Humoral Autoimmune reaction Allergy

immune Acquired
describes conditions typically observed during reaction immune
Organ alteration reaction
a disease state. Anergy
Primary subjective clinical sign
• Physiology is the biological discipline that
Compensated physiological reaction
describes processes or mechanisms operating
Pathological
within an organism. Secondary subjective clinical sign process

33 34

Primary HSV-1 Infection is the presence and multiplication of a

infection living organism, virus or protein in or on a host
•HOSPES
(Seronegative) organism.

Herpes labialis/
Appearance of Infectious Diseases:
RIH
Acute Gingivostomatitis 1. Preclinical: not evident but destined to progress
to clinical status
Reaktivation 2. Clinical: shows signs and symptoms
remision 3. Sub-clinical: If a disease is inactive (dormant).
• HOSPES Resolution 4. A Carrier is an individual who harbours the
(Seropositive) pathogen and can infect others but may not
Secondary
Latent Virus infection show signs of the disease

36

6
 11/10/2016

Natural history of disease The natural history of disease

Investigate:
Investigate:
Investigate: Identification
• The natural history of disease refers to a LabLabLab Dx/TxDx/Tx
Dx/TxIntervention
Dx/Tx
Dx/Tx
RoRoRo Dx/Tx
description of the uninterrupted
progression of a disease in an individual
from the moment of exposure to causal Healthy PRE-CLINICAL PHASE CLINICAL
agents until recovery or death. zone PHASE

Biological
SymptomSymptom
Symptom
Symptom Sign
SignSign
Sign
onset of appears
appears
appears appears
appears
appears
disease appears appears

According to Duration or Onset Clinical Manifestation of disease

Acute Illness. Usually has a short duration and severe.
• The signs and symptoms appear abruptly, are intense
and often subside after a relatively short period.
• Following an acute illness a person may return to
normal level of wellness

Chronic Illness. Slow onset. Persists, usually longer than 6 Laboratory

months and can also affect functioning in any dimension. analysis
• Chronically ill person have long term disease process
 Remission - Period during which the disease is controlled
symptoms are not obvious Subclinical
 Exacerbation - The disease becomes more active again at a
future time, recurrence of pronounced symptoms. stadium

39

Various clinical manifestation of

disease
Iceberg phenomenon of disease
What the Symptomatic
DISEASE X ILLNESS A physician sees disease

DISEASE Y ILLNESS B
What the Pre-
symptomatic
physician
disease
DISEASE Z ILLNESS C doesn’t see

41 42

7
 11/10/2016

Biological
alteration
Organs have a reserve
ability to function
beyond the usual needs

………. changes detected

after a severe condition Kaposi Sarkoma

The course of a disease from onset

to resolution.
• Clinical manifestation of disease
• Complication. A condition that occurs during
or after the course of an illness. symptom

• Prognosis. Prediction of the course and of a

disease, medical opinion as to the outcome of DISEASE ILLNESS
a disease process. Good prognosis means that
there is great possibility to recover from the
disease and poor prognosis means that there sign
is great risk for morbidity or mortality.
45

CARDINAL MANIFESTATION OF
SIGN
SIGN SYMPTOM
SYMPTOM DISEASE
SIGN
SIGN SYMPTOM
SYMPTOM • Pain • Weight changes
• Fever • Bleeding
• Fatigue • Lymphadenopati
• Dyspnea • Xerostomia
• Oligouri • Oral burning
• Poliuri sensation
• Anemia • Bad breath/
CARDINAL MANIFESTATION OF • Edema Halitosis
DISEASE • etc

8
 11/10/2016

 INFECTION
PAIN • exogenous

Clinical
FEVER • endogenous

DISEASE ( tumor )  INFLAMMATION

FUO

 MALIGNANCY

● pericoronal
DENTISTRY STUDENTS
pulpal ● ● periodontal
BASIC MEDICAL BASIC CLINICAL –
SCIENCES MEDICAL SCIENCE
dental origin
● PHYSIOLOGY ● NEUROLOGY
TOOTHACHE ? ● ANATOMY ● INTERNAL
COMPREHENSION TO MEDICINE
● PATHOLOGY
Heterotopic manifestation ORGAN/
FUNCTIONAL
● myogenous, vascular, neuropathic DISORDER/DISEASE CANDIDATES
conditions DENTIST

Dentist is no longer
treating teeth in
patients, but rather
patients who have teeth.

9
 11/10/2016

KLINIK
Dokter gigi mempunyai tanggung jawab
profesional dan moral untuk
mempelajari keadaan kesehatan umum
pasien sebelum memberikan perawatan TANDA ILLNESS
DISEASE GEJALA
dental.

56

CONCEPT OF ILLNESS PATIENT

• People may view illness and disease as the
same entity, health professionals view them as
completely separate
• Illness is a personal state in which the person feels Gejala/Symptom Tanda/Sign
unhealthy or ill.
• Illness may or may not be related to disease
• Illness is a state in which a person’s physical,
emotional, intellectual, social, developmental or
spiritual functioning is diminished or impairment
compared with previous experience.

57

HEALTH
Problems Case report ..........................
Disorders
S • Seorang perempuan 21 tahun mengeluhkan
Y functional Structural S tidak dapat membuka mulut lebar sejak 3 hari
M I yang lalu, sakit kepala, meriang, tidak enak
P G badan, demam, pipi bengkak, untuk makan
T Morpho- Bio-
O logically
Cellular
chemically N dan menelan juga terasa sakit.
M Pathophysiology - pathoanatomically
pathogenesis
aetiology

10
 11/10/2016

Setelah dilakukan pemeriksaan dengan cermat: Case report ..........................

KESADARAN Compos mentis
TANDA VITAL Tekanan darah : 110/70 Hg
Nadi : 100/menit Wisdom tooth
impaction
Suhu : 37,8o C
Respirasi : 30 x/menit
Asymmetrical
EKSTRAORAL Pipi kanan bengkak, merah, Trismus face
Trismus
OPG 48 impaksi mesioanguler klas 2

62

GEJALA : TANDA: Data Klinik subyektif : Data Klinik obyektif :

sakit kepala ● ● 0C
Suhu : 37.8 Diperoleh dari hasil Hasil pemeriksaan fisik /
meriang ● ● Nadi : 100 X/menit wawancara dua arah yaitu klinik
antara dokter-pasien +
badan tidak enak ● ● Resp : 20 X/menit
demam ● ● Pipi kanan bengkak pemeriksaan penunjang
Autoanamnese
atau pemeriksaan
sakit membuka mulut ● ● Trismus : maks. 25 mm. atau laboratoris.
menelan sakit ● ● Gigi 48 impacted alloanamnese
DATA KLINIK sering terjadi kesenjangan “makna”
antara keluhan pasien dengan yang
Subyektif & Obyektif
ditangkap oleh dokter
64

ODONTOGENIC  Bleeding
 sinus
pulpal ● ◙ Gingivitis,
 psychogenic
● periodontal
 neuropathic ◙ Periodontal disease
● Gingival
 cardial ◙ Traumatic incidents
● pericoronal
 vascular
◙ Post surgery
 myofacial
NON ◙ Blood dyscrasia
ODONTOGENIC
66

11
 11/10/2016

Halitosis - bad breath Halitosis - bad breath

● Periodontal disease
● Third molar opercula
● Decayed teeth
● Oral cancer
● Nasal infection
● Tonsilitis, pharyngitis
● Gastric problems
● Diabetes, Uremia
● Oral disease

Bad taste/ dysgeusia Paraesthesia & anaesthesia

• Elderly • Psychosis • Neurological injuries Medication
• Heavy smoker • Neurological • Anaesthetic Sedatives
disorders needle Tranquilizers
• Bad oral hygiene • Jaw fracture
• Periodontal disease • Xerostomia Hypnotics
• Surgey
• ANUG • Uremia ● Malignancy ● Psychosis
• Diabetes • Malignancy ● Diabetes
• Medication • Others ● Pernicious anemia
● Multiple sclerosis

Xerostomia
Local inflammation Autoimmune diseases:
● Infection ● Mikulicz”s disease
● Salivary gland fibrosis ● Sjogren’s syndrome
● Dehydrasi ORAL SIGN
● Drug in use
● Chemotherapy
● Alcoholism

71

12
 11/10/2016

 sakit kepala
 meriang Primary Clinical Secondary Clinical
 badan tidak enak Data Data
 demam
 sakit membuka mulut
 menelan sakit • HEADACHE
● Gejala diatas jarang terjadi secara bersamaan, tetapi • FEBRILE
sering muncul berurutan secara kronologis sesuai • FEVER • SICKNESS
dengan perubahan yang ada di dalam tubuh. • FATIGUE
• DIZZINESS
● Gejala yang satu dapat menimbulkan berbagai gejala
ikutan

PATIENT DIAGNOSTIC
THERAPY
PROBLEM/S DECISION

DIAGNOSTIC
METHOD
Oral Diagnostic Method

● To determine the appropriate diagnostic

decisions which required a systematic and
effective approach to the various issues that
arise in patients……….

DIAGNOSTIC METHODS

13
 11/10/2016

ASSIGNMENT
• Jelaskan berbagai kemungkinan
penyebab manifestasi kardinal
penyakit !

79

14