MODUL FIX

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.

Capability of Interpersonal Communication and Anamnesis 1

Faculty of Dentistry UNAIR

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.



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



2.3. KEY WORDS

CONCEPT MAPPING





















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.



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 :



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.



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



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.



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.



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



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.



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.



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.



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.



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.



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



4.4 COUGH AND NARROW BREATH

http://en.wikipedia.org/wiki/Lung

http://en.wikipedia.org/wiki/Thoracic_cavity

http://en.wikipedia.org/wiki/Spasm

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.



http://en.wikipedia.org/wiki/Tietze's_syndrome

http://en.wikipedia.org/wiki/Fracture

http://en.wikipedia.org/wiki/Hernia

http://en.wikipedia.org/wiki/Urination

http://en.wikipedia.org/wiki/Uterus

http://en.wikipedia.org/wiki/Prolapse

http://en.wikipedia.org/wiki/Defecation

http://en.wikipedia.org/wiki/Red_eye_(medicine)

http://en.wikipedia.org/wiki/Subconjunctival_hemorrhage

http://en.wikipedia.org/wiki/Pneumothorax#Spontaneous_Pneumothorax

http://en.wikipedia.org/wiki/Bleb

http://en.wikipedia.org/wiki/Vomiting

http://en.wikipedia.org/wiki/Insomnia

http://en.wikipedia.org/wiki/Fainting

http://en.wikipedia.org/wiki/Chronic_(medical)

http://en.wikipedia.org/wiki/Acute_(medicine)

http://en.wikipedia.org/wiki/ACE_inhibitor

http://en.wikipedia.org/wiki/Chronic_bronchitis

http://en.wikipedia.org/wiki/Post-nasal_drip

http://en.wikipedia.org/wiki/Heartburn

http://en.wikipedia.org/wiki/Asthma

http://en.wikipedia.org/wiki/X-ray

http://en.wikipedia.org/wiki/Disease

http://en.wikipedia.org/wiki/Chronic_(medical)

http://en.wikipedia.org/wiki/Epiglottis

http://en.wikipedia.org/wiki/Esophagus

http://en.wikipedia.org/wiki/Bolus_(digestion)

http://en.wikipedia.org/wiki/Vertebrate_trachea

http://en.wikipedia.org/wiki/Phlegm

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-



http://familydoctor.org/online/famdocen/home/common/infections/cold-flu/073.html

http://familydoctor.org/online/famdocen/home/common/infections/cold-flu/073.html

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.*



http://familydoctor.org/online/famdocen/home/common/asthma/basics/014.html

http://familydoctor.org/online/famdocen/home/articles/280.html

http://familydoctor.org/online/famdocen/home/articles/280.html

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.



http://familydoctor.org/online/famdocen/home/common/cancer/types/727.html

http://familydoctor.org/online/famdocen/home/common/heartdisease/recovery/671.html

http://familydoctor.org/online/famdocen/home/common/heartdisease/recovery/671.html

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



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



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.



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.



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



*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



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



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



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.)



- 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



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



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.



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.



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



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.



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.



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.



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



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.



- 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.



- 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 :



- 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



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



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



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



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.



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 :



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.



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



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.



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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MODUL FIX

Documents

controlled

fewer mental

optioncomcontentamp

thoracic outlet

beritakesehatanamp

personal protective

reflectorical

pain nerve