Modul Fix

1st CHAPTER INTRODUCTION 1.1.
BACKGROUND
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.
1.2. PURPOSE
To explain about the relation between human and environment holistically.
Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR
2nd CHAPTER BRAIN STORMING
2.1. SCENARIO 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.
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.
2.2. MAIN PROBLEM
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 ?
2.3. KEY WORDS
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 CONCEPT MAPPING
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4th CHAPTER LITERATURE REVIEW
4.1. ENVIRONMENT
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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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 reddishbrown 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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4.2. DENTAL MATERIAL 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. 4.3. STIFF AND PAIN ON THE MUSCLE
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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. 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. When blood
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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 lungs 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 lungs 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 necks area often included in that uncomfortable area. Although position of neck is not influence censorics 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.
4.4 COUGH AND NARROW BREATH Cough

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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 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.
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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. 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.
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SYMPTOMS
DIAGNOSIS
SELF-CARE
1. Has your cough begun recently?
Go to Question 12.**
EMERGENCY 2. Are you very short of breath, mucus? and are you coughing up pink, frothy Your symptoms may be from a serious condition called lungs). PULMONARY EDEMA (fluid in the GO TO THE NEAREST EMERGENCY ROOM AWAY. RIGHT
Get plenty of rest, 3. Does your cough produce clear or pale yellow mucus? You may have a viral illness such as a COLD or the FLU. and drink lots of fluids. Try overthe-counter medicines to treat your symptoms.
You such 4. Does your cough produce yellow, tan or green mucus?
may as
have
an
See your doctor. He or she can prescribe medicine to relieve your symptoms. Get plenty of rest, and drink lots of fluids. smoke, smoking. If you stop
infection of the airways CHRONIC If you BRONCHITIS.
have a fever with shaking chills and are very ill, you may have a more serious infection such as PNEUMONIA.
Asthma 5. Does the cough come with shortness of breath and wheezing? These symptoms may be a sign of ASTHMA, of a the constriction airways.
can
be and be and your
dangerous should diagnosed treated 29 doctor. by
6. Do you have swelling in
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 patients 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 isnt always happening automatically to his children. Or the parents dont have shortness of breath, but have a nose resistance problem that signed by dizzy in the morning, nose cant work well if the weather is cold, or having another resistance problem, so their children have a probability to be narrow breath.
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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, theyll 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 cant receive all medicine. Theres some medicine can make people allergy. 6. Perfume Some people have a problem with perfume or the smell of that perfume.
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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 cant 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 doesnt treat well, it will make the pulmonary hard and cant develop well. If this situation is happened in long time, the pulmonary function will be lost. If the patient doesnt 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.
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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 doesnt 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 STYLE Ergonomic 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 somebodys 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 Somebodys Helathy Our life style is very influence our healthy today, tomorrow, and at the future. Therefore, its 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.
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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 *2. Alcohol *3. Tobacco 4. Infection disease 5. Poisoned *6. Fire weapon *7. The habit of sex 8. Vehicle *9. Prohibitive medicine 582.000 107.000 468.000 90.000 60.000 35.000 35.000 25.000 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.
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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
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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 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
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4.6. ERGONOMIC
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
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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 tools places, suitable with workers 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
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"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 operators physical fatigue are strained posture caused by the tilting of patients, use of non-ergonomic instruments, the failure to
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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 operators 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 patients 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 workers 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 operators 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:
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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 operators 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 dentists 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
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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 patients head from 2 oclock to 10 oclock, unobstructed by any supporting structures or by the assistant (see Fig. 3). The "orbiting range" from 12:30 to 10 oclock is common for right-handed operators. For left-handed operators, the common orbiting range is from 2 oclock to 11 oclock.
Figure 3- The orbiting range around the patients 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 patients "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 patients 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 42
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 dentists 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 operators 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 patients head to be lifted or lowered into position and/or rotated side-to-side upon the axis of rotation of the patients cervical spine. The headrest should not interfere with the patients 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.
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Figure 5- An ergonomic headrest also provides for axial rotation of the patients 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 patients shoulder and chest during intraoral procedures. Compromise of the operators best finger control begins when the shoulder of the patent interferes with the orbiting operators elbow. It is the lifting of the elbow, as well as the offaxis rotation of the operators 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 patients mouth within the reach range of the operator and without compromising the operators orbiting range.
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Figure 6 Type 1: Instruments and tubing supports move with the patients body.
Type 1 (Figure 6): Instrument and tubing supports that move with the patients 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 patient. hand or motorized positioning. Type 2.1: No instrument supports (includes tray) on top of or in front of the
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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.
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Furthermore, placing the operating point at a height that facilitates the best control of the operators 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 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.
4.7 MANAGEMENT CLINIC IN DENTISTRY 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.
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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 airwater 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. 48
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 doesnt 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 manufacturers 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 patients blood, saliva, or mucous membranes. There are many types of gloves, such as : examination
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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.
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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
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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 .
5.1. ENVIROMENT 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:
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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 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
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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.
5.2. DENTAL MATERIAL
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 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.
5.3. STIFF AND PAIN ON THE MUSCLE
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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 its 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.
5.4. COUGH AND NARROW BREATH 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
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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.
5.5. THE DENTISTS LIFE STYLE
The dentists life style is not a healthy life style, but an unhealthy life style. As we know that he is a heavy smoker. Its so contradictive with his profession as a dentist. He should know that smoking is a bad habit. Because, all most of the cigarettes composition is a toxic substance. The Cigarettes Composition : 1. TAR Contain toxic chemicals, as it damages lung cell and cause cancer. 2. CARBON MONOXIDE (CO) Its 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
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smoke is risker than mainstream smoke. Because its 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 somebodys 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.
5.6. THE ERGONOMIC
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 tools places, suitable with workers 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
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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. 5.7. MANAGEMENT CLINIC
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 doctors 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
DETOLONG DI ISI ISINYA CONCLUSSION AMA SUGGESTION DI PRINT JUGAK YA!!!! BESOK DI KUMPULIN
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OH YA DAFTAR ISI AMA COVER JUGAK YA
References
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1st CHAPTER INTRODUCTION 1.1.

To explain about the relation between human and environment holistically.

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

2nd CHAPTER BRAIN STORMING

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

2.2. MAIN PROBLEM

2.3. KEY WORDS

Hard Smoker Hard worker Dislike exercise Careless about environment

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

3th CHAPTER CONCEPT MAPPING

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

4th CHAPTER LITERATURE REVIEW

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Mechanism or referred pain

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Localization of visceral pain-Referred Visceral Pain

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

4.4 COUGH AND NARROW BREATH Cough

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

1. Has your cough begun recently?

infection of the airways CHRONIC If you BRONCHITIS.

be and be and your

dangerous should diagnosed treated 29 doctor. by

6. Do you have swelling in

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

The right ergonomic for dentist

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Figure 2- The preferred operating position for most dental procedures.

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR

5rd CHAPTER DISSCUSION .

Capability of Interpersonal Communication and Anamnesis Faculty of Dentistry UNAIR