1.1. BACKGROUND
1.2. PURPOSE
1st CHAPTER
INTRODUCTION
Ecosystem is a science that study about connection delivers mortal, where
found interaction between environments biotic with environment abiotic. In
ecosystem there is relation between human and environment, so that both of
them were so needed each other. In this condition, human is most dominant
influence than environment. Although environment can influence the human
behavior, but human can adapted this condition as they want. Human should
wise when they want to exchange the environment. So that, there is a balance
condition between human and the environment. So, it can create healthy
environment and healthy people, too. In this case, In this PBL-Dentistry
Faculty of Airlangga University, we give an example about the human and
environment relationship holistically.
To explain about the relation between human and environment holistically.
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2.1. SCENARIO
2nd CHAPTER
BRAIN STORMING
Tutorial 1 : case story
There is a case that was given to us, to be discussed and decide what the
main problem is.
The case: A professional dentist that lives on rural (purlieus) area, forced
to loose his career after 15 years working because of his sickness. He often
feels stiff and pain on the muscle of the neck and upper arm, often has a
long recover cough (chronic) and also often has narrow breath.
We also decided the learning issue, and we had to look for articles and
literatures that relevant with the learning issues.
Tutorial 2 : learning issues presentation
We presented the articles and literatures that we got. Then, we discussed
them together to find the temporary hypothesis. And the hypothesis is
“Environment and Life style are the main factor that cause stiff and pain
on the muscle of the neck and upper arm, long recover cough (chronic) and
also narrow breath.
Then, we were given the other keywords. Then, we had to look for them to
be discussed in the next tutorial.
Tutorial 3 : made the concept mapping
We presented the results of our searching of the keywords, we discussed
them, and then we discover the new hypothesis. Then we made the
concept mapping.
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2.2. MAIN PROBLEM
Tutorial 4: decided the main problem.
We discussed further more about the concept mapping and in the end of
this meeting, we decided what the main problem is.
1. Why he has a kind of symptom like feels stiff and pain on the muscle of
the neck and upper arm, often have a long recover cough, and also often
have narrow breath ?
2. What is the suitable diagnose for him that we can get based on his
symptom ?
3. How and what should he do to recover his health and keep working as a
dentist ?
A professional dentist 36 years old (man).
live on rural (purilieus) place
after 15 years working, often feels stiff and pain on the muscle of the neck
and upper arm, often have a long recover cough, and also often have
narrow breath
Hard Smoker
Hard worker
Dislike exercise
Careless about environment
3th CHAPTER
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2.3. KEY WORDS
CONCEPT MAPPING
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4th CHAPTER
LITERATURE REVIEW
Environment is the combination of various physically condition
surrounding the creature that influence the growth, and the ability of the creature
to survive. Environment consist of biotic factors and a biotic factors. The biotic
factors consist of the entire creature surrounding the individual biologically (for
example: human, virus, etc) and psychosocially (for example: culture, belief, etc).
Environment can be classified based on its condition. they are healthy
environment and unhealthy environment. Healthy environment is condition of the
optimally environment so that can give any good influence for the realization of
optimally healthy status. Whereas, the unhealthy environment is condition that
disturb the human being that exist on that environment.
The healthy environment criteria are
Courtyard
Wastes disposal
Prosperity / housing
Sewage disposal
Road
Health facility
Public facility
Organization
Environment health rate is influenced by water and air condition, wastes
managing, diseases vector controlling, etc. if the Environment health rate was not
better, so the condition is the unhealthy environment indication. The unhealthy
environment can be caused of the pollution on the environment. The environment
pollution consists of air pollution, water pollution and land pollution.
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4.1. ENVIRONMENT
First kind of environment pollution is air pollution. The air pollution is
caused by the existence of the certain substance in the air in certain number, for a
long time, so it can caused the air composition change from the normal condition.
It may occur because of natural factors and man-made factors. Several example of
natural factors are dust of windblast, organic wastes decaying process, and etc.
while the examples of man-made factors are dust of industrial activity, chemical
substance consumptions, cigarette smoke, and etc. the effects of air pollution are
sight decrease, health problem, respiration system decrease, and etc.
The second one is water pollution. The water pollution is caused by the
existence of the certain substance in the water that caused the composition change
in it, so the water is not suitable for all the function and the purpose of the water
benefit. It may occur because of industrial activity, and any agricultural chemical
substances, and etc. the effects of water pollution are unbalance water ecosystems,
caused some skin diseases, pollute drinking water source, any other diseases, and
etc.
The last one is land pollution. The land pollution is caused by the
existence of the certain substance (organic and inorganic) in land that caused
damage in it, so it can give the support power for human living. It may occur
because of natural events, and several man-made factors. The effects of land
pollution are disturbance of organism ecosystems that exist inside the land.
Air pollution is a mixture of solid particles and gases in the air. Car
emissions, chemicals from factories, dust, pollen and mold spores may be
suspended as particles. Some air pollutants are poisonous. Inhaling them can
increase the chance you'll have health problems. People with heart or lung disease,
older adults and children are at greater risk from air pollution.
There are many substances in the air which may impair the health or
reduce visibility. These arise both from natural processes and human activity.
Substances not naturally found in the air or at greater concentrations or in
different locations from usual are referred to as pollutants.
there are some pollutant in air pollution :
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1. Nitrogen oxides
Nitrogen oxides is the generic term for a group of highly reactive gases, all of
which contain nitrogen and oxygen in varying amounts. Many of the nitrogen
oxides are colorless and odorless. However, one common pollutant, nitrogen
dioxide (NO2) along with particles in the air can often be seen as a reddish-
brown layer over many urban areas. Nitrogen oxides form when fuel is
burned at high temperatures, as in a combustion process. The primary
manmade sources of NOx are motor vehicles, electric utilities, and other
industrial, commercial, and residential sources that burn fuels. NOx can also
be formed naturally.
2. sulfur dioxide
Several human studies have shown that repeated exposure to low levels of
SO2 (below 5 ppm) has caused permanent pulmonary impairment. This effect
is probably due to repeated episodes of bronchoconstriction. One study has
found a decrease in lung function in smelter workers exposed for over 1 year
to 1-2.5 ppm SO2. No effect was seen in the same study in workers exposed
to less than 1 ppm. In another study, a high incidence of respiratory
symptoms was reported in workers exposed to 20-30 ppm for an average of 4
years. Workers exposed to daily average values of 5 ppm SO2 (with
occasional peaks of 53 ppm) had a much higher incidence of chronic
bronchitis than controls.
There are numerous studies on the potential effects of SO2 as a component of
air pollution. These studies are difficult to interpret because of confounding
factors and uncertainty about exposure concentrations.
3. Carbon monoxide
Carbon monoxide is colorless, odorless, non-irritating but very poisonous
gas. It is a product by incomplete combustion of fuel such as natural gas, coal
or wood. Vehicular exhaust is a major source of carbon monoxide.
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Carbon monoxide inhibits the blood's ability to carry oxygen to body tissues
including vital organs such as the heart and brain. When CO is inhaled, it
combines with the oxygen carrying hemoglobin of the blood to form
carboxyhemoglobin (COHb). Once combined with the hemoglobin, that
hemoglobin is no longer available for transporting oxygen.
When inhaled, CO quickly binds with hemoglobin in red blood cells in the
lungs, creating COHb. This can affect the amount of hemoglobin available
for the transport of oxygen throughout the body, which may in turn lead to
symptoms of CO poisoning.
Breathing low levels of CO can cause:
a. fatigue
b. increased chest pain in people with chronic heart disease
In otherwise healthy people, inhaling higher levels of carbon monoxide may
cause flu-like symptoms (with no fever) such as: headaches, dizziness,
weakness, sleepiness, nausea, vomiting, confusion, disorientation.
Headaches, dizziness, weakness, sleepiness, nausea, vomiting, confusion,
disorientation, and At very high levels, exposure to carbon monoxide will
cause loss of consciousness and death
4. Carbon dioxide (CO2),
Several studies have monitored workers repeatedly exposed to elevated levels
of CO2 gas. Exposure to 1-1.5% for 42-44 days caused a reversible acid-base
imbalance in the blood and an increased volume of air inhaled/minute
(minute volume). In another study, harmful effects were not observed in 19
brewery cellar workers repeatedly exposed to average concentrations of 1.1%
CO2, with levels occasionally up to 8% for a few moments. Submarine
occupants exposed to 3% CO2, 16 hours/day for several weeks experienced
flushing of the skin, an impaired response of the circulatory system to
exercise, a fall in blood pressure, decreased oxygen consumption, and
impaired attentiveness. Adaptation to some of the effects of long-term
exposure to CO2 has been reported.
Sources of air pollution refer to the various locations, activities or factors
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which are responsible for the releasing of pollutants in the atmosphere. These
sources can be classified into two major categories which are:
Anthropogenic sources (human activity) mostly related to burning different
kinds of fuel
a. "Stationary Sources" as smoke stacks of power plants, manufacturing
facilities, municipal waste incinerators.
b. "Mobile Sources" as motor vehicles, aircraft etc.
c. Marine vessels, such as container ships or cruise ships, and related port air
pollution.
d. Burning wood, fireplaces, stoves, furnaces and incinerators .
e. Oil refining, and industrial activity in general.
f. Chemicals, dust and controlled burn practices in agriculture and forestry
management, (see Dust Bowl).
g. Fumes from paint, hair spray, varnish, aerosol sprays and other solvents.
h. Waste deposition in landfills, which generate methane.
Natural sources
Dust from natural sources, usually large areas of land with little or no
vegetation.
Methane, emitted by the digestion of food by animals, for example cattle.
Radon gas from radioactive decay within the Earth's crust.
Smoke and carbon monoxide from wildfires.
Volcanic activity, which produce sulfur, chlorine, and ash particulates.
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4.3. STIFF AND PAIN ON THE MUSCLE
Dental restorations can be classified into two types. Direct restorations are
done by inserting filling material directly into the tooth. Indirect restorations are
fabricated outside of the mouth.
In recent years, there has been a marked increase in the development of
esthetic materials made of ceramic and plastic. These mimic the appearance of
natural teeth and are more esthetically pleasing where they will be visible. But the
strength and durability of traditional materials still make them useful, particularly
in the back of the mouth where they must withstand the extreme forces that result
from chewing. The traditional materials include gold, base metal alloys, and
dental amalgam.
Amalgam, produced by mixing mercury and other metals, is still the most
commonly used filling material. Some people have expressed concern about
amalgam because of its alleged mercury content. In fact, amalgam is composed
mostly of complex compounds where the mercury is bound chemically to the
other ingredients. Although mercury by itself is classified as a toxic material, the
mercury in amalgam is chemically bound to other metals to make it stable and
therefore safe for use in dental applications. In fact, amalgam is the most
thoroughly studied and tested restorative material now used. Compared to the rest,
it is durable, easy to use, and inexpensive. The supposed dangers of dental
amalgam have been much in the news recently - amalgam has been blamed for
mercury poisoning and other systemic disease. Dental materials contain several
toxic components, including carcinogenic and teratogenic components and
allergens, and, although they are manufactured to be inert and biologically
inactive, clearly they may release some elements into the mouth. Despite these
potential problems decades of worldwide clinical experience and research show
that side effects to dental material are rare.
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4.2. DENTAL MATERIAL
The Purpose of Pain
Pain is a protective mechanism for the body, it occurs whenever any tissues are
being damaged and causes the individual to react reflex to remove the pain
stimulus. Even such simple activities as sitting for long time on the Ischia can
cause tissue destruction because of lack of blood flow to the skin where the skin is
compressed by the weight of the body. When the skin become painful as a result
of the ischemia, the person shifts his weight unconciously.A person who has lost
his pain sense, such as after spinal cord injury, fails to feel the pain and therefore
fails to shift his weight.
Muscular pain mechanism
Pain can has its main origin in skeletal muscle as well, that can take place through
3 mechanisms.
First, due to the motoneutron activity a muscle is strongly contracted.
Through the motorist collateral fiber that is delivered also to proprius nucleus. In
turn, the propius nucleus activity cause the pain felt on that contracted muscle.
This muscle pain is known as reflectorical muscular pain.
Second, muscle pain can come from the muscular ischemia. The
prolonged contraction can cause the accumulated of metabolic trash in the muscle,
while at the time is also occurring the vasoconstriction. That metabolic trash
accumulation is acting as the irritation generating painful sense generally
encountered on the tight muscle.
Third, muscle pain can appear when the muscle contracted strongly and
prolonged. This condition tightly streches the connection of myofacial to
periosteum, generating pain with the exact localization. This pain more known as
the entesialgia.
The muscular pain due to ischemia and the reflectorical muscular pain
are diffusive in their distributions. Moreover, the muscular pain could speard or
subjected to its distal part. It is often too that the muscular pain did not felt in its
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origin place. Nevertheless, the pains come from the bone and the periosteum felt
exactly on the sources.
The phenomenon of the pain spreading to the distal place encountered
more obviously on the censorical stimulated. Stimulation on the motorical fiber
could also generate the pain. Clearly, the neurogenical pain is due to the existence
of spreading based on the stimulation place to the distal along its spread to the
side.
If radix having stimulation, thus the pain felt is based on as high as the
radix location spread in the censorical area it cares. A censorical area of a radix
dorsalis is known as the dermatome. And the pain absolutely spread in a
dermatomal area is known as the radicular pain. ( attachment 1)
Peripherical nerves in the arm and legs are formed by a numbers of
censorical fibers based on several radix dorsalis. When the peripherical nerves
have irritation, thus the spreading pain is felt as well. Nevertheless, the areas that
pain passed consist of parts of several dermatomes. The area is known as the
peripherical nerves area. The pain sreading in the peripherical nerves area should
not to be called the radicular pain. But rather the pain like that is named the
pseudoradicular.
The pain source located far from the place felt painful, usually in the
deep organ, such as the pain come from heart, oesophagus, diaphragm, urethra,
postat, etc. Those pains are known as the referred pain.
Rate of tissue dammage as the cause of pain.
Bradykinin and Histamine as possible Stimulators of pain Endings.
The precise mechanism by which tissue damage stimulates pain endings is not
known.However, many research workers have shown that extracts from damaged
tissues cause intense pain when injected beneath the normal skin. Therefore, it is
all most certain that some chemical substance release d from the cells or formed in
damages tissue excite the pain nerve endings.
There are many reasons to believe that the substance bradykinin or some
similar product might be the principal substance that stimulatates pain endings.
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For instance, When this substance is injected in extremely minute quantities
underneath the skin ,severe pain is felt. Futhermore, cell damage releases
proteolytic enzymes that almost immediately split bradykinin and other similar
substance from the globulins in the interstitial fluid.And, finally ,bradykinin and
similar substances can be found in the skin when painful stimuli are applied.Thus,
the postulated mechanism for eleciting pain : damage to cells releases proteolytic
enzymes that then split bradykinin and associated substances from globulin and
these in turn stimulate the nerve endings .
Another substances possibly involved in at least some types of pain is
histamine , because damaged cells also release this substances and because almost
infinitesimal amounts of it, too, can cause very severe pain upon its injection
beneath the skin.
Tissue Ischemia and Muscle Spasm as Causes of Pain. When blood
flow to a tissue
Becomes very painfull within a few minutes. And the greater the rate of
metabolism of the tissue,the more rapidly the pain appears. For instance, if a
blood pressure cuff is placed around the upper arm and inflated until the arterial
blood flew ceases, exercise of the forearm muscles can cause severe muscle pain
within 15 to 20 seconds. In the abstence of muscle exercise, the pain will not
appear for three to four minutes. Cessation of blood flow to the skin, in which the
metabolic rate is very low , usually does not cause pain for about 20 to 30
minutes.
Muscle spasm is a frequent cause of pain , also. The reason for this is a
probably two-fold. First, the contracting muscle compresses the intramuscular
blood vessels and either reduces or cuts of the blood flow. Second, muscle
contraction increases the rate of metabolism of the muscle. Therefore, muscle
spasm probably cause relative muscle ischemia so that typical ischemic pain
results.
The cause of pain in ischemia is yet unknown however, it is relieved by
supplying oxygen to the ischemic tissue. Flow of unoxygenated blood to the tissue
will not relieve the pain.
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One of the suggested causes of pain in ischemia is accumulation of large
amounts of lactic and acid in the tissues, formed as a consequence of the
anaerobic metabolism that occurs during ischemia. However, it is also possible
that other chemical agents, such as bradykinin and histamine, are formed in the
tissues because of the muscle cell damage and that these, rather than lactic acid,
stimulate the pain nerve endings.
‘Referred pain’
The interscapular region as the ‘referred pain’ area , all of pains impuls
come from the organs within thoracic cavity of T.2 to T.5 could be shown in the
interscapular region thereby the pains come from the lungs (carcinoma), heart
(ischemical heart disease), aorta arches (aneurism), pancreas (pancreatitis), and
from stomach along with duodenum ( ulcus peptical) and oesophagus (oesophagus
carcinoma) may be referred to the interscapular region. In the lower right part of
interscapular region could be felt the referred pain from the gall bladder
(cholesicitis or cholelitiasis).
Mechanism or referred pain
Branches of visceral pain fibers are shown to synapse in the spinal cord
with some of the same second order neurons that receive pain fibers frm the skin.
When the visceral pain fibers are stimulated intensely pain sensations from the
viscera spread into some of the neurons that normally conduct pain sensations
only from the skin, and the person has the feeling that the sensations actually
originate in the skin it self. It is also possible that some referred pain results from
convergence of visceral and skin impulses at the level of the thalamus rather than
in the spinal cord.
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Visceral pain
In clinical diagnosis, pain from the different viscera of the abdomen and
chest is one of the few criteria that can be used for diagnosing visceral
inflammation, disease, and other ailments. In general, the viscera have sensory
receptors for no other modalities of sensation besides, and visceral pain differs
from surface pain in many important aspects.
One of the most important differences between surface pain and visceral
pain is that highly localized types of damage to the viscera rarely cause severe
pain. For instance, a surgeon cut the gut entirely in two in a patient who is awake
without causing significant pain. On the other hand, any stimulus that causes
diffuse stimulation of pain nerve endings through out a viscus cause pain that can
be extremely severe. For instance, occluding the blood supply to a large area of
gut stimulates many diffuse pain fibers at the same time and can result in extreme
pain.
Localization of visceral pain-Referred Visceral Pain
Pain from the different viscera is frequently difficult to localize for a
number reasons. First, the brain does not from firsthand experience that the
different organs exist, and therefore, any pain that is localized internally can be
localized only generally. Second, sensations from the abdomen and thorax are
transmitted by two separate pathways to the central nervous system-the true
visceral pathway and the parietal pathway. The true visceral pain is transmitted
via sensory fibers of the autonomic nervous system ,and the sensations are
conducted directly from the parietal peritoneum,pleura, or pericardium, and the
sensations are usually localized directly over the painfull area.
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Poncoast syndrome
To know about pancoast syndrome in comparing with thoracic outlet
syndrome, it have some important things, that is:
a) Pain and that felt spreding from shoulder to all along arm, pancoast
syndrome is continue. But in thoracic outlet syndrome only felt position of
body (head and neck)..........
b) Rotgenologic checkup of thoracic outlet syndrome not often produce
abnormality. That clearly and relevant, but on torax rontgen photo of
pancoast syndrome always show a tumor in lung’s apex.
Pancoast syndrome is a symtomps combination effect ofpressing at faskuli
pleksus brakhialis intercostal, ganglion stelatum and system sympatetic nerve.
Manifestation cause that pressing is pain felt continues. Starting from load region.
And then spreading at all along arm. Censoric nerve ulnaris area. Then develop
horner syndrome and anhidrolisisn (psilateral in face and upper arm).on the next
continue step will happen mucles atrofi intrinsik arm.
It is founded a tumor in lung’s area on rontgent photo. Although it was
often occured that tumor always constant asymptomatic for a while, but finally
pancoast syndrome is developing. At first, it is felt uncomfortable only on area of
load.
Under neck’s area often included in that uncomfortable area. Although
position of neck is not influence censoric’s manifestation.actually, that burned
down pain and asleep is felt in the nerves ulnaria distribution area.
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Tubercolusis Pain
Pain from tubercolusis or other pulmonary disease is by no means always
typically pleuritic. It may often be dull and aching and may be localized over any
portion of the thoracic wall, most often the area of underlying disease. With
chronic adhesive pleuritis, especially that due to tubercolusis, fibrosis may extend
out from the pleura to involve all the structures of the torachic wall and may
sometimes produce a severe persistent ,aching pain that may last for months. In
the apex fibrosis may involve the brachial plexus and produce severe pain in the
arm. Such pain is more often due to carcinoma than to tubercolusis and the
distinction may be difficult. The pain of carcinoma is likely to be more severe and
to be associated with evidence of venous obstruction.
Chest pain of the pleural origin must be distinguished from thoracic pain
due to other causes, The pain of pericarditis is usually constant and less severe. It
does not vary with respiration unless is also present, and is usually most severe
over the precordium, sometimes radiating to the base of the neck both anteriorly
and posteriorly,and the shoulder of arm.
Cough
A cough, also known as tussis is a sudden, often repetitive, spasmodic
contraction of the thoracic cavity, resulting in violent release of air from the
lungs, and usually accompanied by a distinctive sound.
Coughing is an action the body takes to get rid of substances that are
irritating the breathing passages. A cough is usually initiated to clear a buildup of
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4.4 COUGH AND NARROW BREATH
phlegm in the trachea. Coughing can also be triggered by a bolus of food entering
the trachea rather than the esophagus due to a failure of the epiglottis. Frequent or
chronic coughing usually indicates the presence of a disease. Provided the patient
is a non-smoker and has a normal chest X-ray, the cause of chronic cough in 93%
of all patients is due to asthma, heartburn or post-nasal drip. Other causes of
chronic cough include chronic bronchitis and medications such as ACE inhibitors.
Coughing can happen voluntarily as well as involuntarily.
Cough that often happened is called common cold, is the lightest acute
cough, generally followed with light fever and cold
Types of cough
coughing can be classified as either acute or chronic. Acute complications
include cough syncope (fainting spells due to decreased blood flow to the brain
when coughs are prolonged and forceful), insomnia, cough-induced vomiting,
rupture of blebs causing spontaneous pneumothorax (although this still remains to
be proven), subconjunctival hemorrhage or "red eye", coughing defecation and in
women with a prolapsed uterus, cough urination. It usually happens for less than
14 days. Chronic complications are common and include abdominal or pelvic
hernias, fatigue fractures of lower ribs and costochondritis. It usually happens for
more than 14 days.
There are four factors that caused cough:
1. infection factor: cough that is caused by inflammation in respiratory canal
which produce a lot of mucus so that it need to get rid by coughing. Such
as disease that related with viruses like selesma, influenza.
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2. mechanic factor: cough that is caused by dust and phlegm inside the
respiratory canal, pressure change in respiratory canal (because of
disturbance in vessels and lungs), vicious process of strange thing inside
the respiratory canal. those things can stimulate our body to get cough. For
example, postnasal drip syndrome.
3. chemical factors: cough that is caused by irritation on respiratory canal
caused by cigarette smoke or chemical essence, so that mucus on the
respiratory system has to be coughed
4. temperature factor: cough that is caused by very cold or very hot air. It can
distract moist in the respiratory canal.
SYMPTOMS DIAGNOSIS SELF-CARE
1. Has your cough begun
recently?Go to Question 12.**
2. Are you very short of
breath, and are you
coughing up pink, frothy
mucus?
Your symptoms may be
from a serious condition
called PULMONARY
EDEMA (fluid in the
lungs).
EMERGENCY
GO TO THE
NEAREST
EMERGENCY
ROOM RIGHT
AWAY.
3. Does your cough produce
clear or pale yellow mucus?
You may have a viral
illness such as a COLD or
the FLU.
Get plenty of rest,
and drink lots of
fluids. Try over-
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the-counter
medicines to treat
your symptoms.
4. Does your cough produce
yellow, tan or green mucus?
You may have an
infection of the airways
such as CHRONIC
BRONCHITIS. If you
have a fever with shaking
chills and are very ill, you
may have a more serious
infection such as
PNEUMONIA.
See your doctor. He
or she can prescribe
medicine to relieve
your symptoms.
Get plenty of rest,
and drink lots of
fluids. If you
smoke, stop
smoking.
5. Does the cough come
with shortness of breath and
wheezing?
These symptoms may be a
sign of ASTHMA, a
constriction of the
airways.
Asthma can be
dangerous and
should be
diagnosed and
treated by your
doctor.
6. Do you have swelling in
your legs and/or shortness
of breath when you are
active or after you have
been lying down?
Go to Question 10.*
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7. Do you have heart
problems?
Persistent coughing can
be caused by
CONGESTIVE HEART
FAILURE, especially
when there is a buildup of
fluid in the lungs.
See your doctor.
8. Have you recently started
coughing up blood or
bloody sputum?
Go to Question 12.**
9. Have you recently started
having sharp chest pain,
rapid heartbeat, swelling of
the legs and sudden
shortness of breath?
Bloody mucus with these
symptoms may mean that
a blood clot has moved
from your leg to your
lungs. This is called
PULMONARY
EMBOLISM.
EMERGENCY
SEE YOUR
DOCTOR RIGHT
AWAY.
*10. Do you have a fever,
chills and night sweats
along with chest pain when
you cough or take a deep
breath?
These symptoms may be
caused by
TUBERCULOSIS or
another type of infection.
See your doctor.
11. Have you
unintentionally lost weight?
This may be a sign of a
serious illness, such as
LUNG CANCER. Other
See your doctor
right away.
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signs of lung cancer may
include a cough that
produces bloody sputum,
shortness of breath and
wheezing.
**12. Did you inhale dust,
particles or an object?
IRRITATION OF THE
AIRWAYS will cause
coughing to attempt to
clear the object or
irritation out of the
airway.
If the coughing is
severe or if you
don't believe the
irritant has been
cleared from your
airway, see your
doctor or go to the
emergency room
right away.
For more information,
please talk to your doctor. If
you think your problem is
serious, call your doctor
right away.
Narrow Breath
Narrow breath or dyspnea is the effect of the fluid that enter the congest
pulmonary or edema pulmonary. When the we breath, the air is free to enter and
out into the pulmonary. However, when the narrow breath attach happen, the
respiration become hard because the muscle around the respiratory pipe become
small. At the same time, the respiratory tissue will be sore where these both
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unsure make the object shortness of breath. Narrow breath can be chronic or
acute. It depends on the caused and the level of sickness.
Acute Dyspnea
Acute dyspnea with the suddenly start is the main caused of the emergency room
visiting. Acute dyspnea is caused by respiratory sickness, pulmonary sickness or
traumatic breast.
Chronic Dyspnea
Chronic dyspnea is caused by asthma, Chronic Obstructive Pulmonary Disease,
emphysema, pulmonary inflammation, and tumor. Chronic dyspnea is signed by
chronic cough. This cough will be happened three times in a year and it called
chronic bronchitis.
There are two main factors that caused shortness of breath:
A. Internal factor
Internal factor is the factor that happened from the patient’s aspect. There are 5
internal factors that caused shortness of breath:
1. Genetic aspect
This genetic aspect happens between the subjects in one family. The example: if
the father has shortness of breath, his son will have a probability to be narrow
breathe. But this isn’t always happening automatically to his children. Or the
parents don’t have shortness of breath, but have a nose resistance problem that
signed by dizzy in the morning, nose can’t work well if the weather is cold, or
having another resistance problem, so their children have a probability to be
narrow breath.
2. Resistance problem aspect
Resistance problem aspect can be caused by food or material in the air.
3. Respiratory canal aspect
Some people have a unique respiratory canal. They have a sensitive respiratory
canal that caused they is easy to become shortness of breath.
4. Sex
Sex or gender can become the factor of shortness of breath, although the
presentation is small.
5. Race
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B. External factor
The external factor is the factor that happened because of the environment. There
are 13 external factors that caused shortness of breath:
1. Dust
Dust can cause narrow breath because dust contains many materials that make our
respiratory pipe become smaller.
2. Animal, such as cockroach
If somebody has a resistance problem with animal, they’ll have the bigger
probability to become shortness of breath.
3. Fungi
Fungi can cause shortness of breath. Moist environment is the main factor that
causes the growth of fungi. So, people who live in moist environment usually
have bigger threat than people who live in normal environment.
4. Food
Some food can make people allergy. And one of the effects of allergy is shortness
of breath.
5. Medicine
Some people can’t receive all medicine. There’s some medicine can make people
allergy.
6. Perfume
Some people have a problem with perfume or the smell of that perfume.
7. High emotional expression
People with high emotional expression have a bigger probability to become
shortness of breath.
8. Smoking
Smoking is the most important thing that cause shortness of breath. In Indonesia
at least 80 percent narrow breath is caused by the increasing of smoker. Although
in cigarette is found 4000 death toxic materials. That chemical material is
carcinogenic which can sediment on the pulmonary pipe and will make the
pulmonary pipe swallow. So the smoker will be narrow breath.
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9. Air pollution
Today no area where is no pollution. And the most worried thing is that pollution
will be impact on human life. Air pollution is the biggest pollution in the earth.
Air pollution will contaminate the air that human breath.
10. Infection
Infection can also make people narrow breath. The infected material will enter
human respiratory system and will irritated pulmonary canal.
11. Exercise induced narrow breath
People who have narrow breath must induce their exercise with their endurance.
12. Weather
Weather can make people narrow breath, people who can’t adapt with the weather
where they live.
13. Human habit
Bad habit such as smoking and never exercise will make people have probability
of narrow breath.
If the narrow breath doesn’t treat well, it will make the pulmonary hard
and can’t develop well. If this situation is happened in long time, the pulmonary
function will be lost. If the patient doesn’t care about this condition, the structure
of the respiratory pipe, which become small for temporary at the first, will be
changed permanently. The muscle that circle respiratory canal will be bigger. It
called remodeling respiratory canal. If the remodeling happened, it will be hard to
change respiratory pipe into normal because this structure changed is irreversible.
Exercise is important for the subject of shortness of breath. If they do the exercise,
their respiratory muscle will be better and stronger. They can breath better than
other who doesn’t do exercise. Not all exercise can did by the subject of shortness
of breath. The example of the exercise for the subject of narrow breath is asthma
exercise. With asthma exercise their respiratory canal will be function well and
they can breathe more freely, because their respiratory muscle is practiced to work
like normal people. And it will make the subject can breath well because their
respiratory pipe will be bigger.
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4.5 LIFE STYLEErgonomic
Definition of Life Style
Life style actually is a combination from what somebody influx into the
body and what somebody does into the body. Both of them, that we known as a
life style. It appears cause of somebody’s habit factor, not cause of a genetic
factor. So, every body can change their life style better than before. Our life style
can prevent the breeder of disease that we have cause of genetic factor. As that
said by dr. Lamont Murdoch from university faculty of medicine, Loma, India : "
wrong genetics fills rifle and our life style that interesting the woodpecker. "
Relation between Life Style and Somebody’s Helathy
Our life style is very influence our healthy today, tomorrow, and at the
future. Therefore, it’s important for every body to pay attention their life style.
Healthy life style is a good habit which it done by somebody routinely and affect
positive towards our healthy. Healthy life style can increase our healthy degree or
also can prolong somebody a spark of life. On the contrary, alive pattern
indisposed can demote somebody healthy degree. Easy attacked disease and the
alive hope when be compared with one who apply a healthy life style.
If somebody died because heart attack, stroke, or another fatal condition.
So, what are causes that fatal disease in somebody life spans? The researchers
analyzed why does American died and found that there are nine primary cause
deaths which it very related to our life style choice. That is what we influx into
our body and what we do into our body :
*1. Wrong foods and dislike exercise 582.000
*2. Alcohol 107.000
*3. Tobacco 468.000
4. Infection disease 90.000
5. Poisoned 60.000
*6. Fire weapon 35.000
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*7. The habit of sex 35.000
8. Vehicle 25.000
*9. Prohibitive medicine 20.000
All cause factors with the asterisk sign are related with a life style directly.
We see that the major death is happened cause a healthiness life style. And many
deaths were happened because an infection disease which it caused by the weak
immunity from a wrong life style consequence. Now, scientific is so watchfulness
that large part principal deaths cause preventable. And of course the manner to
prevent it is by applying healthy life style in our life anytime.
The Example of Healthy Life Style
Dr. Nedo Belloc and Dr. Lester Breslow, a expert researcher from
America, do some watchfulness towards 7.000 person at Alameda, California
about life style and the dependability with somebody life spans. They found that
there are seven life style factors that influence how long that somebody can alive.
After nine years, amount of healthy life style practice that followed by somebody
directly with alive inclination better from previous. For example, whom practiced
6-7 habit that well longer alive 11,5 years from them that only practice 0-3 that
habit practice.
The Seven Healthy Life Style Practice
1. Slept 7-8 a day
Whom slept to exceed or less according to convince from this experience
enhanced 60 % until 70 % have a risk dies within nine year.
2. Do not eat between the time to eat.
3. Have a regularly breakfast
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Breakfast can increase our longevity. Whom not breakfast consecutively
increase 50% death risk will be compared with them that have breakfast
regularly.
The benefit:
- increase recall
- increase the fluent pronunciation
- - increase concentration power
4. Watch over the heavy body
if heavy body a more 20% on ideal heavy body (tallness - 100, tolerance
10%), so that man belongs in categories overweight. He risky 3 bigger times
will get heart attack, 6 colon cancer risk bigger times, rektum and prostate for
man. increase cancer risk cervix, uterus and ovary for woman.
5. Regularly exercise
The benefits of exercise are:
- decrease some depression
- Have a good digestive system and less constipations
- Have a strong bone
- Decrease some cancer risk
5. Stay Away from Alcohol
The ability from somebody to assault bacteria and viruses that come into body
(immunity) will decrease until 76% although he only drinks light drink twice
(will be suggested to will not use alcohol). Alcohol heavy drunkard increases
canker risk, throat, respiration channel, heart, breast, and anus. Latest
watchfulness finds that use alcohol increases risk AIDS.
7. Stay Away from Cigarette
Tobacco is the major cancer cause at America and at many another world
parts. In general estimated 400.000 America people die from all diseases that
caused by smoke every year, with treatment cost expenditure every year 50
billion dollar. In all the world death per annum consequence smokes around 3
million people. This matter is equal to one person dies every 10 second. All of
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4.6. ERGONOMIC
these deaths will not happen if everyone will hold true choice for life and
well-being.
The Benefit of Doing Healthy Life Style
There are some benefits when we do healthy life style:
1. Can slept soundly
2. Can work more maximal and increase the performance
3. Can study well
4. Positive thinking
5. Felt peace and pleasant
6. Has a good appearances
7. Get life and a good social interaction
8. More confidence
9. Save expenditure for our healthy
10. Escape from disease
Introduction to ergonomic
The Ergonomic Standard mandated by the Occupational Safety and Health
Administration (OSHA) recommended that the most efficient and effective way to
remedy "ergonomic hazards" causing musculoskeletal (MSK) strain should be
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through engineering improvements in the workstation. Although Congress
withdrew the OSHA ergonomic regulations before they were to be implemented,
Secretary of Labor Elaine Chao has promised to "pursue a comprehensive
approach to ergonomics, which may include new rulemaking." Making employers
more accountable for the physical environment in which they and their employees
practice in turn encourages manufacturers to develop more ergonomically
designed delivery systems.
According to OSHA, ergonomic conditions are desirable because they
prevent repetitive MSK injuries and reduce errors that lead to accidental injuries
to employees. Ergonomic conditions also provide a safer environment for
patients-fewer mental distractions and reduced positioning and avoidance acts all
result in less physical strain on the operator. The word "ergonomic" was defined
as the amount of effort, measured in ergs and dynes, which were necessary to
perform a task. Less effort expended indicated a more ergonomic condition.
OSHA refers to the word "ergonomic" as the relationship of the
human/environmental interface that does not produce injury. This definition
carries more meaning than the term originally did when it was first introduced
over a century ago. To include how the human/environmental interface affects us,
this more expanded definition of the word "ergonomic" rates the ergonomics of
the human/environmental interface according to four human functions: sensing,
working, positioning, and avoiding. Ergonomic also knowledge about adaptation
and how they can adapt with their works. To investigate this adaptation,
ergonomics’ experts consider a few aspects. The exposure about ergonomic in
working places has probability to decrease pain, stress and increase the working
quality.
They are:
- The works that they are doing and workers claim.
- Instruments that they use (the right measurement, the right shape and how
this tools suitable for their works.)
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- Physic environment (temperature, humidity, light) and social environment.
Investigate about physic aspects:
- About measurement and posture body.
- The right posture
- Muscle strain and nervousness, these problems will lead to stress.
About physiology aspects:
- Mental ability, always be well prepared.
- Personality- shows the profession.
- Increase the working level and productivity.
Ergonomic reduce:
- Pain in the working places, such as pain in hand, shoulder and other part of
the body.
- Consider about tool’s places, suitable with worker’s ability.
- Those tools must be place in the right position in order the workers should
not strain or bent their body.
The right ergonomic for dentist
"Ergonomic Summit" to endorsement in August of 2000, dental
manufacturers began to look more intently at ways to improve the ergonomics of
the equipment and instruments they provide to the profession. Ergonomic
conditions are simply the safest, most efficient, and easiest way to work. The good
and suitable position, to improve the ergonomic delivery of dental services and
accounting for working conditions in dental offices enhance the well-being and
safety of patients, staff, and practitioners.
Ergonomic conditions also provide a safer environment for patients-fewer
mental distractions and reduced positioning and avoidance acts all result in less
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physical strain on the operator. Studies of human factors have established the best
position for controlling the fingers during clinical operations that require fine
motor skills. It may be time to look at this body of knowledge to establish a
direction for dental equipment design. Because the ergonomic standard has been
rescinded, the standards it set are not officially a concern for dentists as
employers. Nonetheless, the well-being of dental care workers should still remain
a primary concern, given recent research findings concerning the MSK health
status of dental professionals.
Avoiding objects such as chair backs, headrests, patients’ shoulders, and
trays is the worst physical accommodation dental care providers make. These
accommodations are reflected in clinicians and staff twisting and bending,
laterally extending elbows, tilting the head off-center to the shoulders, and
straining against gravity for hours at a time. The more positioning that is required
of instruments, devices, materials, patients, and us, the less likely that dental
operators will re-establish their best position. The act of repositioning leads to
compromised postures, compromised control of the fingers, errors of cognition
that cause injuries such as bur and needle sticks, collisions with operating lights,
reaching out of the "clean operating zone”.
Also contributing to the operator’s physical fatigue are strained posture
caused by the tilting of patients, use of non-ergonomic instruments, the failure to
use the dental mirror, and inadequate lighting. Both avoiding and positioning
other objects, such as operating lights and hand piece holders, compromises
operator attention while performing intraoral tasks. Randomly positioned devices
increase the chance of error proportional to the range of positions that the device
can be placed. Constantly keeping track of an unstable environment challenges the
operator cognitively to pay attention to multiple decisions unrelated to the actual
operation. Cognitive demands associated with sighting off the level horizon and
off the midline of the operator’s body are additional conditions that are hazardous
to both the operator and the patient. Sighting off the horizon, or tilting the head so
that the ocular plane is no longer parallel to the horizon, is hazardous since this
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further challenges dentists’ ability to control their fingers accurately in the
patient’s mouth, resulting in mental fatigue and the likelihood of more errors.
Dental operators have long done an excellent job of providing their services.
These studies suggest a need for a work pattern analysis in dentistry,
particularly because
a large number of worker’s compensation and disability insurance claims are
forcing early retirement and workdays lost due to an MSK injury. To maintain this
position of optimal control, an equipment setting should fit the operator like a suit
of clothes, preventing the operator from straying from this best position. The best
position of the
operator’s head, body, and fingers are determined by masked-eye tests using the
proprioceptive (feel-based) senses of the body. The location where subjects report
they feel their fingers have maximum control for fine motor operation has been
determined from the results of thousands of masked-eye tests. The masked-eye
studies were conducted by asking individuals with their eyes covered to avoid
thinking about existing equipment, instruments, or past habits. These subjects then
placed their dominant index finger in a position they felt provided them with
maximum control of it while imagining performing the "most" minute movement
possible. The results of these tests for the most comfortable, preferred operating
position for performing various simulated dental procedures were as follows:
1. The dominant-hand index finger is positioned at or about the armpit level.
2. The dominant-hand index finger is positioned in the midline of the seated
dental operator’s chest.
3. The operator sits in a free upright posture without back support.
These individually determined operating conditions, illustrated in Fig. 2, maintain
the alignment of the vertebrae-and hence, the health of the dentist’s neck and back
during his or her career.
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Figure 1-illustrates a popular operating posture that may cause such problems.
Figure 2- The preferred operating position for most dental procedures.
The position that sitting subjects (including those not trained in the dental
profession) reported feeling most physically comfortable while pantomiming
precise operations with their fingers (with no preconceptions or defense against
past habits) was, on average, 103.2 cm from the floor for men and 96.2 cm from
the floor for women. This location, termed the "zero point" for the mouth of the
patient, can be specified by the intersection of the occlusal plane and the midline
of the maxilla and is dependent on the proprioceptively derived seat height of the
operator. From this optimal position, the operator should be able to orbit around
the patient’s head from 2 o’clock to 10 o’clock, unobstructed by any supporting
structures or by the assistant (see Fig. 3). The "orbiting range" from 12:30 to 10
o’clock is common for right-handed operators. For left-handed operators, the
common orbiting range is from 2 o’clock to 11 o’clock.
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Figure 3- The orbiting range around the patient’s head should be unobstructed.
Operating height is the most important condition for maintaining the
unstrained posture of the dental operator. An ergonomic dental treatment setting
should allow the free orbiting range of the operator at an operating height
determined by the provider. The patient lies in a full rest (supine) position because
this has provided the dentist with the best position for applying vector forces to
the teeth and the best access to the mouth, according to proprioceptive derivation.
The distance from the floor to the patient’s "zero point" is the most important
dimension for the dental care worker to acquire before beginning intraoral
treatment on each patient. Data indicate that dentists typically do not take enough
time to adjust the height of the patient’s support to secure the best operating
height for their personal anatomic requirements. The amount of time it takes the
seated operator to elevate a patient to optimal height in most dental chairs is
approximately five seconds. The average adjustment of the height of the patient
support from entry level to operating height is taking dentists less than three
seconds (T. Taniguchi, personal communication, March 1, 2001). Because many
patients are not optimally positioned, a function automatically returning the chair
to the desired height could break the habit of stopping patient elevation before
achieving the best operating height. This individually determined operating
condition maintains the alignment of the vertebrae and hence, the health of the
dentist’s neck. These positions, as illustrated in Figures 4 and 5, give the best
access to the mouth and provide stabilization of the fingers on intraoral points.
Headrests should be designed to position the maxillary plane of the patient in this
range to also enhance the operator’s ability to achieve sightings of operating
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points. While positioning the head of the patient to provide for neutral posturing,
the operator decides whether indirect (reflected) vision is needed for the procedure
to be performed. Positioning of the mirror, if needed, is coordinated with the
movements of the fingers of the operating hand. The headrest design should
readily allow the patient’s head to be lifted or lowered into position and/or rotated
side-to-side upon the axis of rotation of the patient’s cervical spine. The headrest
should not interfere with the patient’s ears when the head it rotated.
Figure 4 -An ergonomic headrest provides the best access to the mouth, finger
stability, and views of the mouth with a few simple adjustments in the "Y" plane.
Figure 5- An ergonomic headrest also provides for axial rotation of the patient’s
head in the "X" plane.
Most dentists will need to complete skill courses to master access, contacts
on instruments, stabilization of the fingers, and views of the operating point.8, 9
Headrest design is instrumental in the positioning of the oral cavity for the
application of these new skills.
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Because the patient now is lying horizontally, the dentist needs to avoid the
patient’s shoulder and chest during intraoral procedures. Compromise of the
operator’s best finger control begins when the shoulder of the patent interferes
with the orbiting operator’s elbow. It is the lifting of the elbow, as well as the off-
axis rotation of the operator’s head on his or her spine, that require more effort to
control the fingers. Strain on the cervical spine should not be overlooked when
considering conditions for optimal performance. Designing patient supports and
instruments that limit the need for the operator to change positions and that
prevent operators from straying out of their preferred operating zone will enhance
the dental care provided, will minimize stress and strain, and consequently, will
reduce the risk of musculoskeletal injuries. Thus, equipment designed to optimize
the ability of seated dental care workers to work skillfully in the preferred orbiting
range will reduce the need to work in compromised positions. Further refinement
of finger skills and operating views allows the provider to operate from a few
choice positions within this range.
Dental operators should assume their best position and then, through the
least-strained,masked-eye movements of the arms, determine the position of the
instrument holders. This position should allow pick-up of instruments and devices
from a stable location and at an angle that requires the least positioning of the
instrument once it is contacted. This instrument pick-up zone extends laterally and
downward from the patient’s mouth within the reach range of the operator and
without compromising the operator’s orbiting range.
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Figure 6 Type 1: Instruments and tubing supports move with the patient’s body.
Type 1 (Figure 6): Instrument and tubing supports that move with the patient’s
upper body. Outlets for air, water, vacuum, and electricity that supply the
instruments extend from the outline of the patient support at the shoulder and
upper-arm locations.
Type 1.1: Stable type (does not tilt the patient)
Type 1.2: Chair type.
Figure 7 Type 2: Instruments and tubing supports are chair-mounted.
Type 2 (Figure 7): Instrument and tubing supports are chair-mounted and
designed for hand or motorized positioning.
Type 2.1: No instrument supports (includes tray) on top of or in front of the
patient.
Type 2.2: One or more instrument or tubing supports on top of or in front of the
patient.
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Figure 8 Type 3: Patient supports and instrument/tubing supports are separate.
Type 3 (Figure 8): Patient supports and instrument/tubing supports are separate.
Type 3.1: Fixed on floors, walls, and ceiling or into cabinets (non-mobile).
Type 3.2: Moves on wheels, slides, or on hinged arms.
When making a decision to choose ergonomic dental equipment, this
question must be answered: "What body conditions and position(s) do I want in
order to perform the safest, most efficient dental procedures?" Because of interest
in ergonomic standards, dentists must now ask themselves if they are happy with
their present delivery conditions. Repositioning and avoiding equipment to
achieve and/or maintain the best posture are "ergonomic hazards" in the dental
treatment setting. Repositioning and avoiding create fatigue, confusion, and
repetitive musculoskeletal injuries for dentists, hygienists, and assistants.
Stabilizing the adjustable operator setting, improving finger skills, and developing
human-centered instrument and equipment designs will eliminate these problems
and enhance the performance of the operator and the well-being of the operator
and the patient.
Furthermore, placing the operating point at a height that facilitates the best
control of the operator’s fingers also stabilizes the vertebrae against gravity.
Unfortunately, prevailing dental chairs with limited vertical rise force dentists and
hygienists to crouch over their patients, who are positioned horizontally. Finally,
the distance from the floor to the position some individuals need for the best
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4.7 MANAGEMENT CLINIC IN DENTISTRY
control of their fingers may be as much as 120 cm. The best position of the
operator for finger control and views of the oral cavity (direct and/or indirect) is
the starting point for designing the ergonomic dental workstation of the future.
Personal Protective Equipment
Protective clothing
The purpose of protective clothing is to protect the skin and underclothing of
worker fom exposure to contaminated material. Protective clothing can include
smocks, slacks, skirts, laboratory coats, surginal scrubs (hospital operating room
clothing), scrub (surgical) hats, pants, and shoe covers.
Protective clothing requirements
- Protective clothing should be made of fluid-resistant material. Cotton,
cotton/polyester, or disposable jackets or gowns usually are
satisfactory for routine dental procedures.
- To minimize the amount of uncovered skin, clothing should have long
sleeves and high neckline.
- The design of the sleeve should allow the cuff to be tucked inside the
band of the glove.
- During high-risk procedures, protective clothing must cover dental
personnel at least to the knees when seated.
- Buttons, trim, zippers, and other ornamentation (which may harbor
pathogens)should be kept to a minimum.
Guidelines for the use of protective clothing
- Because protective clothing can spread contamination, it is not worn
out of the office fo any reason, including travel to and from the office.
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- Protective clothing should be changed at least daily and more often if
visibly soiled.
- If a protective garment becomes visibly soiled or saturated with
chemicals or body fluids, it should be changed immediately
- Protective clothing must not be worn in staff lounge areas or when
workers are eating or consuming beverages.
Protective masks
A mask is worn over the nose and mouth to protect the wearer from inhaling
possible infectious organisms spread by the aerosol spray of the handpiece or air-
water syringe and accidental splashes.
The two most commonly used types of masks are the dome-shaped and flat types.
Some operators prefer the dome-shaped types, particularly during lengtly
procedures, because it conforms more effectively to the face and creates an air
space between the mask and the wearer.
Guidelines for the use of protective masks
- Masks should be changed for every patient or more often, particularly
if heavy spatter is generated during the treatment or the masks
becomes damp.
- Masks should be handled by touching the side edges only to avoid
contact with the more heavly contaminated body of the mask.
- The mask should conform well to the shape of the face.
- Masks should not contact the mouth when being worn because the
moisture generated will decrease the mask filtration effiency . A damp
or wet mask is not an effective mask.
- If the procedure is long, changes the mask about once each hour.
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- A face shield doesn’t substitute for mask because it provides no
protection from aerosol.
Protective eyewear
Protective eyewear is wor to protect against the potential danger of eye damaged
resulting from aerosolized pathogens and from debris such as flying scrap
amalgam or tooth fragments.
Protective eyewear also prevents splattered solution or caustic chemical from
injuring the eyes. Such damage may be irrepable and lead to permanent visual
impairment or blindness.
If prescription glasses are worn, protective side and bottom shields must be added.
Protective eyewear that can be wortective eyewearn over prescription glasses are
available. Contact lens wearers must wear pro with side shields or a face shields.
After each treatment or patient visit, protective eyewear should be cleaned and
decontamined according to the manufacturer’s instructions.
Two types of protective eyewear are used during patient care : (1) glasses with
side shields and (2) clear face shields.
Gloves
Gloves must be worn by the dentist, assistant, and hygienist during all patient
treatment wich there is the possibility of contact with the patient’s blood, saliva,
or mucous membranes. There are many types of gloves, such as : examination
gloves, gloves during the treatment, overgloves, maintaining infection control
while gloved
Guidelines for using the gloves :
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- All gloves used in patient care must be discarded after a single use.
These gloves may not be washed, disinfected or sterilized; however
they may be rinsed with water or remove excess powder.
- Latex, vinyl, or other disposable medical quality gloves may be used
for patient examination and dental procedures.
- Torn and damaged gloves must be replaced immediately
- Do not jewelry under gloves
- Change gloves frequently
- Contaminated gloves should be removed before leaving the chair side
during patient care and replaced with new gloves before returning the
patients.
- Hand must be washed after glove removal and before regloving.
General Protective Equipment
Medical Waste Management
All waste must be disposed of according to applicable federal, state, and local
regulations. Although the term medical waste is commonly used, the more
accurate terms are contaminated waste and infectous / regulated waste.
Classification of waste :
1. General Waste
General waste is all nonhazardous , nonregulated waste and should be
discarded in covered containers made of durable material, such as plastic
or metals receptacles. For case in handling, general waste receptacles
should be lined with plastic bags. General waste includes disposable paper
towels, paper mixing pads, and empty food containers.
2. Hazardous Waste
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Hazardous waste refers to hazardous and toxic chemicals and materials.
Some items, such as extracted teeth with amalgam restorations, may be
both hazardous (because of amalgam) and infectious (because of the
blood).
3. Contaminated Waste
Waste that has had contact with blood or other body fluids is considered
contaminated waste; examples include used barriers and patient napkins.
Contaminated waste, in most states, is disposed of as general waste
(regular house-hold-type waste). In some states, however, it may be
considered and defined as regulated or infectious waste.
4. Infectious or Regulated Waste (Biohazard)
Infectious waste also called regulated or biohazardous waste, is
contaminated waste that is capable of transmitting an infectious disease.
For waste to be infectious, there is pathogens that are strong enough and in
great enough numbers to infect a susceptible individual. Infectious waste
is never disposed of as a general waste. There are 3 types of infectious
waste in most dental officers :
- Blood and blood soaked materials
Blood or saliva can be squeezed out, or dried blood may flake off from
the item.
- Pathological waste
Soft tissue and extracted teeth the examples.
- Sharps
Examples are all contaminated sharp objects used for patient care
5rd CHAPTER
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DISSCUSION
.
Environment is the important factor that influences the human health. If
the environment was contaminated, so the human health must be disturbed. In this
case, we analyzed deeply about the environment pollution, especially the air
pollution.
The composition of air pollution can be called pollutant. Some pollutant
that contaminated the air are nitrogen oxide, sulfur oxide, carbon dioxide, and
carbon monoxide. These sources of the pollutant can be classified into two major
categories which are:
1. Anthropogenic sources (human activity) mostly related to burning
different kinds of fuel
a. "Stationary Sources" as smoke stacks of power plants, manufacturing
facilities, municipal waste incinerators.
b. "Mobile Sources", for example are motor vehicles, aircraft etc.
c. Marine vessels, such as container ships or cruise ships, and related port
air pollution.
d. Burning wood, fireplaces, stoves, furnaces and incinerators .
e. Oil refining, and industrial activity in general.
f. Chemicals, dust and controlled burn practices in agriculture and
forestry management, (see Dust Bowl).
g. Fumes from paint, hair spray, varnish, aerosol sprays and other
solvents.
h. Waste deposition in landfills, which generate methane.
2. Natural sources
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5.1. ENVIROMENT
Dust from natural sources, usually large areas of land with little or no
vegetation.
a. Methane is emitted by the digestion of food by animals, for example
cattle.
b. Radon gas is from radioactive decay within the Earth's crust.
c. Smoke and carbon monoxide are from wildfires.
d. Volcanic activity produces sulfur, chlorine, and ash particulates.
The health effects caused by air pollutants may range from subtle
biochemical and physiological changes to difficulty in breathing, wheezing,
coughing and aggravation of existing respiratory and cardiac conditions. These
effects can result in increased medication use, increased doctor or emergency
room visits, more hospital admissions and premature death. The human health
effects of poor air quality are far reaching, but principally affect the body's
respiratory system and the cardiovascular system. Individual reactions to air
pollutants depend on the type of pollutant a person is exposed to, the degree of
exposure, the individual's health status and genetics.
The quantity and the quality of the pollutant influence the human health, if
the quantity and the quality of air pollution increased, so the human health would
be disturbed, especially in the respiration system. The dentist, in this case, was the
active smoker, so the air condition must be polluted by the smoke. The smoke is
the main role in respiratory system decreased. If the smoke was produced
frequently in large amount, so it might cause cough and narrow breathe. Cough
and narrow breathe are the ones of bronchitis symptoms.
One problem is that the symptoms of mercury poisoning, which include
headache, tiredness, dizziness, and irritability, are non-specific. It is easy for the
detractors of amalgam to attribute these to the amalgam. Likewise, diseases with
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5.2. DENTAL MATERIAL
5.3. STIFF AND PAIN ON THE MUSCLE
5.4. COUGH AND NARROW BREATH
unknown causes have also been attributed to amalgam restorations - these include
multiple sclerosis, Alzheimer's disease, Parkinson's disease, and epilepsy. Yet no
firm evidence of any association has been published. A few years ago aluminium
was considered to be a possible causal factor in Alzheimer's disease, and many
patients expressed concern about the amounts of aluminium in some resin based
composite restorations. Now a recent television programme in Britain has
implicated the mercury in amalgam as a cause of Alzheimer's disease (Panorama,
BBC1, 11 July) - but it flies in the face of the available, carefully reviewed,
evidence.
Muscular pain on neck and arm that severed a dentist, can causing general
muscular fatigue or maybe shown clinic symptom that indicated disease. Based on
the scenario, the dentist is a workaholic person that dislike to exercise. If the
muscular pain related on both, the possibility is general muscular fatigue. The
high work activity demanded him to maximize his arm movement, so that often
happen muscular contraction continuously that almost nothing relaxation.
Improper ergonomics when working can cause this muscular fatigue too. But, if
related with the smoke habitual that have the dentist, this neck and arm pain
maybe it’s a referred pain from the disease that arise from smoking habit. The
disease that often arise causing smoking, most of them severed respiratory system.
Based on discussion, our team conclude three possible disease: TBC, bronchitis
and lung cancer. The three disease almost has some same clinic symptom include
pain on the neck and arm area. For example on lung cancer, one of the clinic
symptom in this disease is pain on neck area that creeping to the shoulder then
until to the arm that called poncoast syndrome.
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5.5. THE DENTIST’S LIFE STYLE
Chronic cough, which was experienced by the dentist, was the signals of
the narrow breath that was experienced by the dentist. That chronic cough happen
because of the respiratory canal swallow that cause respiratory pipe become small
so the mucous is difficult and the cough become chronic. This chronic cough can
cause stiff and pain on the muscle of head and neck. May be this stiff and pain on
the muscle of head and neck spread into the upper arm area. This is happen
because the dentist still does the action which use that muscles, so he feels the
complication in his upper arm muscle. Narrow breath in that dentist is happen
because he is the hard smoker. As we know that cigarette has at least 4000 toxic
materials which is carcinogenic. The example is vinyl chloride. Vinyl chloride is
used as a benzopyrene or as a preservative. This benzopyrene is carcinogenic and
can change the gen function of the human. This benzopyrene makes P53 gen,
which in the beginning is used to protect from the cancer gen, become the gen
that cause cancer and tumor. These toxic materials sediment years by years on that
dentist. Finally that will make his respiratory pipe full of those sediment toxic
materials of the cigarette. This sediment toxic materials will make a throat that
will make the dentist feels chronic narrow breath. This chronic cough and chronic
narrow breath cause the inflammation happen. This inflammation are destructive
and irreversible. Finally this inflammation will cause the bronchitis on that
dentist. This situation is worst because the dentist dislike the exercise. Because
with the exercise will make his respiratory muscle become more freely.
The dentist’s life style is not a healthy life style, but an unhealthy life style. As we
know that he is a heavy smoker. It’s so contradictive with his profession as a
dentist. He should know that smoking is a bad habit. Because, all most of the
cigarette’s composition is a toxic substance.
The Cigarette’s Composition :
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5.6. THE ERGONOMIC
1. TAR
Contain toxic chemicals, as it damages lung cell and cause cancer.
2. CARBON MONOXIDE (CO)
It’s a toxic gas that can cause the decrease of blood capability to bring and
tie up oxygen.
3. NICOTINE
Nicotine is one of the aphrodisiac kinds that can damage heart and blood
circulation, nicotine makes addicted the user.
4. MAINSTREAM SMOKE
Mainstream smoke that sucked by smoker is only 4% while cigarette
smoke that produced by cigarette on fire moment not sucked (side stream
smoke) magnitude 96% from cigarette burning time total. Side stream
smoke is risker than mainstream smoke. Because it’s on fire in high
temperature and without filter, free into the air. Side stream smoke also
contain a dangerous substances than mainstream smoke that sipped by
smoker.
As we known that smoke is the major cause a disturbed respiratory
system. For example, bronchitis, lung cancer and TBC. Besides he is a heavy
smoker, he also dislikes exercise. If somebody’s dislike to do exercise so fat and
calorie exist in his body will be kept. When in body found amount of calories and
fats it can increase some diseases assorted risk. For the example, heart coroner,
hypertension, diabetes mellitus, stroke, and also lung cancer. He is a workaholic
too. So, his immunity is easy to drop. If his immunity is easy to drop, he is easy to
attack some disease too.
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5.7. MANAGEMENT CLINIC
Ergonomic can increase health and safety in working places, so applying
this while working can reduce accident potential which can result in injury and
pain and can increase production. The exposure about ergonomic in working
places has probability to decrease pain, stress and increase the working quality.
Ergonomic also can decrease pain while working, such as pain in hand, shoulder
and other part of the body. The instruments that they use must have right
measurement, right shape and how this tools suitable for their works. Consider
about tool’s places, suitable with worker’s ability. Those tools must be place in
the right position in order the workers should not strain or bent their body. Always
strain and bent body will also lead to continuous pain in hand, neck and other part
of the body. Mostly dentist always use their right side compared to the other side,
so no wonder if dentist do not apply right ergonomic, they will surfer pain in their
body especially on the right side. Fatigue in muscle and continuous pain in muscle
also can lead to cough and take time to heal this cough.
According to this case, the dentist is a workaholic person and does like to
exercise or sport. He also a active smoker. According to my survey, a big
probability that this dentist does not apply good and healthy ergonomic, so this
will cause he suffer pain in hand, neck and other part of his body, in addition, he
always working in a long time without resting. Suffering continuous pain in
muscle will lead to cough. Furthermore, he also does not apply a great life pattern
such as does like to exercise and smoking. So, no wonder if he always complains
about pain in his muscle.
Management Clinic in dentistry include of Personal Protective
Management and General Protective Management. Personal Protective
Management is a way to protect the body, and General Protective Management is
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a way to protect their surrounding. The examples of Personal Protective
Management are to protect our cloth, our mouth and nose, our eyes and our hand,
with wear right clothing, a mask, protective eyewear and gloves and the
examples of General Protective Management are protect our self out of the body,
such as cleaning our hand washing place and do the right management of waste.
One of the factors that can make the doctor sickness is management clinic. It may
happened because the doctor does not do the right management clinic, for the
example, does not use the mask, protective eyewear, or does not wash his hand
after examine the patient, so then the doctor get the risk from that. The viruses or
the bacteria which are carcinogenic can enter to the doctor’s body, so, the immune
of the doctor become drop and can be definite as a disease that is bronchitis.
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6th CHAPTER
CLOSING
DE…TOLONG DI ISI…
ISINYA CONCLUSSION
AMA SUGGESTION
DI PRINT JUGAK YA!!!!
BESOK DI KUMPULIN…
OH YA…
DAFTAR ISI AMA COVER JUGAK YA…
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