- Efek samping pemberian anestesi lokal

*Manifestasi klinis obat :

Pada kulit 80-90 % Kardiovaskuler 10-45%
Pernapasan 70% Pencernaan 10-45%

Grade keparahan reaksi hpersensitivas immediate :

I. Tanda-tanda kulit : generalized erythema, urticaria, angiodema
II. Simtom tidak mengancam jiwa : tanda-tanda kulit hypotension, tachycardia, gangguan pernapasan
III. Simtom yang mengancam jiwa : collaose,tacycardia, bronchospasm
IV. cardiac / respiratory arrert
V. Kematian

* Syarat penggunaan anestesi lokal

- Tidak mengiritasi / merusak jaringan secara permanen
- Batas keamnan lebar
- Mulai kerja singkat
- Masa kerja cukup
- Larut dalam air
- Stabil dalam larutan, dapat dilarutkan tanpa mengalami perubahan
- Tidak terlalu mahal

Cara pemberian anestesi lokal pada gigi anterior maksila [Anterior Superior Alveolar Nerve
Blok ( paraperiosteal Injection)]
- Saraf yang teranestesi : nervus alveolaris superior anterior
- Area yang teranestesi : gigi insisif sentral, lateral dan kaninus beserta ligamen periodontal ,
tulang alveolar dan mukosa gingival labial
- Pedoman anatomis : lipatan mukosa labialn dan apeks gigi anterior rahang atas
- Indikasi : pencabutan lebih dari satu gigi anterior rahang atas
- Teknik : Insersi jarum dilakukan pada mukosa labial sedikit lebih ke mesial dari gigi kaninus.
Jarum di insersikan sedalam beberapa milimeter 0,9-1,2 dan dimasukkan sebanyak 1,5 ml
larutan anestesi.

[ Chapter 16. Anesthetic Agents : General & Local Anesthetics. Timothy J. Maher ]

[ Micher Mertespaul. Allergic to anesthetic agent. May 2013 ]

 Hal yang perlu diperhatikan dokter ketika akan melakukan ekstraksi, yang perlu di
pertimbangkan pada pasien gangguan sistem kekebalan tubuh

1. Local Anaesthetic :- Use local anaesthetic with a vasoconstrictor .

- Avoid regional nerve blocks where possible. If necessary, then ensure an
aspirating syringe is always used.

2. Minimize Trauma : As with all extractions, the aim is to minimize trauma as much as possible.
3. Haemostatic Agents : Consider the use of a haemostatic resorbable dressing following an extraction,
such as oxidized regenerated cellulose (Surgicel), synthetic collagen or gelatine sponge to
promote and stabilize clot formation by providing a mechanical matrix
.
4. Suture :Suture the socket with resorbable sutures to achieve primary closure where
possible and then apply pressure to the socket with a gauze pack until haemostasis is achieved.

5. Post-operative instructions : Give clear post-operative instructions to the patient, both verbal and written.

6. Tranexamic Acid Mouthwash: - The use of tranexamic acid post-operatively is not routinely advocated in
patients on warfarin as it can be expensive, difficult to obtain and, when used in combination
with other haemostatic measures, provides little additional reduction in post-
operative bleeding.
-However, tranexamic acid mouthwash may be useful as an antifibrinolytic agent
for patients with congenital and other acquired bleeding disorders.

[Special Care Dentistry: Part 3. Dental Management of Patients with Medical Conditions causing Acquired
Bleeding Disorders , December 2013 ]

PROGNOSIS

Although a potentially debilitating disease, survival rates for SLE have doubled since the
1950s.13 Death due to SLE was more than 5 times higher in women than in men, and more than 3 times
higher in black than white women.14 The major cause of death in the first few years of the onset of SLE
is active disease that involves multiorgan systems or infection from drug-induced or lupus-related
immunosuppression.4,5,10 Delayed deaths are caused by SLE, or associated with end-stage renal
disease or complications of treatment, including infection, coronary disease and malignancy.

Poor prognostic factors are being young at onset, being male, having a poor socioeconomic
status and having positive titres of antiphospholipid antibodies.

[Jonathan B. Albilia,Cameron M.L. George K.B. Sndor. Systemic Lupus Erythematosus:A Review for
Dentists. November 2007, Vol.73 , No.9 ]
 Definisi

Merupakan penyakit autoimun kronis yang menyerang banyak organ tubuh, salah satunya
mempunyai manifestasi pada mukosa mulut. Dokter gigi dapat berperan dalam deteksi awal
penyakit dengan mengenali lesi LES yang bermanifestasi di Rongga Mulut.
Memiliki gejala yang tidak spesifik, sehingga disebut penyakit seribu wajah, karena gejala
yang ditunjukkan menyerupai gejala penyakit lain

[ Shelly Lelyanana. Manifestasi oral lupus erythematous sistemik. Jurnal Ilmiah Fakultas Kedokteran gigi,
Universitas Kristen Maranata. Vol.1 No.1 , September 2015 ]