A female patient aged 40 years (secretary in a private company) came to

RSGM-P FKG UNAIR for making fixed partial denture on the upper right teeth. At
this time the module case patients showed clinical symptoms, intra oral and
radhiographic as follows. Clinical symptoms : patient complained theres a cavities
and throbbing pain in head spontaneously since 1 week ago on the right side. Patient
also complained of bad breath and mouth sore inside of the cheek (near the cavities).
Intra oral : extraction of teeth 14, 15. Theres a dental caries profunda on 16.
On the right buccal mucosa theres white ulcer, eritematous irregular edges with size
5 x 3 mm, and the patient suffered from pain. Patient had poor oral hygiene, there are
a lot of dental calculus on all regions. Radiographic views: theres widening of
periodontal ligament in apical caries tooth (16).
Then of clinical symptoms and examination of intra oral, this case need
integration across various fields of dentistry include Periodontia, Oral Medicine,
Conservation and Prosthodontia. Before making a fixed partial denture, step to do is
disease control. After disease control is comlpeted, then we continue to restorative
treatment.
There were three diagnoses of patient complaints. The important etiology is
come from poor oral hygiene. First, poor Oral Hygiene cause the accumulation of
plaque in all regions. Plaque then mineralized to form dental calculus. Plaque and
calculus that contains a variety of bacteria (Streptococcus sanguis Streptococcus
milleri Actinomyces israelii Actinomyces naeslundii, Prevotella intermedia,
Capnocytophaga spp., Fusobacterium nucleatum Veillonella spp.) irritate the gums
and cause damage to epithelial cells - connective tissue cells (conective tissue) as
well as the elements - the basic elements of intercellular namely: collagen, growth
factors and glikolis which later became marginal gingivitis.
Various products of bacterial metabolism in calculus will cause halitosis.
Halitosis is the result of the metabolism of the bacteria in the oral cavity and the
leftovers as well as the activity of anaerobic gram-negative bacteria, which is a
product of protein breakdown of sulfur-containing gases such as volatile sulfur
compound (VSC). Halitosis or bad breath is classified according to the causes
because of local and systemic factors. Local factors derived from the bacteria in the
oral cavity. The patient was referred for treatment periodontia to eliminate the causes
such as scaling, root planing, flossing, mouthwash administration, Dental Health
Education by dentist, as well as instructions to control in order to keep good Oral
Hygiene.
Systemic factors that cause halitosis is diabetes, patients with uremia and
trimethylaminuria and the others. For the patient should be referred to a specialist in
internal medicine to overcome the disease that cause halitosis.
The second, sores caused by mechanical trauma / physical of sharp teeth due
to caries, local irritation cause erosion. Erosion into the dermis layer form ulcer called
traumatic ulcers. Poor oral hygiene will increase the severity of the traumatic ulcer
itself. The patient should be referred to the UPF Oral Medicine for treatment such as
topical drug delivery applications (kenalog cream), giving mouthwash and instruction
to improved nutrition.
The third, poor oral hygiene can cause dental caries. Caries is caused by
demineralization of enamel by bacterial fermentation of carbohydrates. If not treated
immediately, the material of bacterial toxins will continue to demineralize enamel
until to the roof of the pulp even perforation. Toxin from the bacteria can enter dentin
tubules irritate the pulp. In terms of subjective and radiographic examination, it can
be concluded the patient suffered from irreversible pulpitis. Irreversible pulpitis is a
condition of persistent inflammation of the pulp, which is caused by a stimulus or
injury. Circumstances will lead to continued inflammation necrotic tissue, then the
tooth becomes non-vital. The patient was referred to the conservation UPF to get root
canal treatment (pulpectomi, drainage of the cavity, then filled).
After disease control is completed, the patient is ready for restorative
treatment. the patient was referred to the UPF Prostodontia to make fixed partial
denture. Due to loss of teeth (14, 15), consideration pontic on canines and molar
teeth, denture bridges In making should be based on the law of Ante. Law of Ante
states that "The surface area of the periodontal tissue abutment must be equal to or
greater than the surface area of the missing tooth or anodontia area. then the proper
restorative treatment is fixed-fixed partial denture. Finally the patient is given
instructions to maintain oral health and control to the dentist for maintanance and
post evaluation treatment.