v ABSTRAK
Hipersensitivitas dentin merupakan salah satu masalah gigi yang paling sering dijumpai. Hipersensitivitas dentin ditandai sebagai nyeri akibat dentin yang terbuka jika diberikan stimulus termal, taktil, osmotik dan mekanis. Hipersensitivitas dentin dapat diatasi dengan pasta gigi yang mengandung strontium chloride dan sodium monofluorophosphate. Penelitian ini bertujuan untuk mengetahui pasta gigi yang lebih efektif terhadap hipersensitivitas dentin antara strontium chloride hexahydrate 10% dan sodium monofluorophosphate. Penelitian ini merupakan penelitian eksperimental komparatif. Desain penelitian yang digunakan adalah desain paralel. Semua data yang diperoleh dianalisis menggunakan uji Wilcoxon dan Mann-Whitney.
32 subjek penelitian yang memenuhi kriteria inklusi dibagi menjadi 2 kelompok yang menggunakan pasta gigi strontium chloride hexahydrate 10% dan sodium monofluorophosphate dan diukur nyeri dentin dengan visual analogue scale (VAS). Setelah 4 minggu, subjek penelitian kemudian diukur kembali skala nyerinya dengan visual analogue scale (VAS).
Penelitian menunjukkan bahwa terdapat perbedaan efektivitas yang signifikan dari pasta gigi yang mengandung strontium chloride hexahydrate 10% dan sodium monofluorophosphate terhadap hipersensitivitas dentin. Disarankan untuk dilakukannya penelitian lebih lanjut dengan pengaruhnya terhadap jenis keausan gigi, usia, dan lamanya penelitian.
vi ABSTRACT
Dentin hypersensitivity is one of the most commonly encountered dental problems. Dentin hypersensitivity is characterized as pain caused the exposed dentin when thermal, tactile, osmotic and mechanical stimuli are applied. Dentin hypersensitivity can be treated with toothpaste containing strontium chloride and sodium monofluorophosphate. This study aims to determine which toothpaste was more effective to dentin hypersensitivity between strontium chloride hexahydrate 10% and sodium monofluorophosphate.
This study was comparative experimental study. Experimental design was a parallel design. All data obtained were analyzed using Wilcoxon and Mann-Whitney test.
32 subjects whose fullfill the inclusion criteria were divided into 2 groups using toothpaste strontium chloride hexahydrate 10% and sodium monofluorophosphate and measured the dentin pain with visual analogue scale (VAS). After 4 weeks, the subjects re-measured their pain scale with a visual analogue scale (VAS).
The study showed there was significant difference in the effectiveness of toothpaste containing strontium chloride hexahydrate 10% and sodium monofluorophosphate to dentin hypersensitivity. It was recommended to do further studies with its influence on the type of tooth wear, age, and duration of the study.
ix DAFTAR ISI
Halaman
JUDUL... i
LEMBAR PERSETUJUAN... ii
SURAT PERNYATAAN... iii
LEMBAR PERSETUJUAN PERBAIKAN (REVISI) SIDANG SKRIPSI PROGRAM SARJANA (S1)………... iv
ABSTRAK... v
ABSTRACT... vi
PRAKATA... vii
DAFTAR ISI... ix
DAFTAR TABEL... xv
DAFTAR GAMBAR... xvi
DAFTAR GRAFIK... xix
DAFTAR LAMPIRAN... xx
BAB I PENDAHULUAN 1.1 Latar Belakang... 1
1.2 Identifikasi Masalah... 3
1.3 Tujuan Penelitian... 3
1.4 Manfaat Penelitian... 3
1.4.1 Manfaat Akademis... 3
x
1.5 Kerangka Pemikiran dan Hipotesis... 4
1.5.1 Kerangka Pemikiran... 4
1.5.2 Hipotesis... 6
1.6 Metodologi... 7
1.7 Lokasi dan Waktu Penelitian... 7
BAB II TINJAUAN PUSTAKA 2.1 Tinjauan Umum Anatomi Gigi dan Histologi Gigi... 8
2.1.1 Email…... 8
2.1.1.1 Lokasi Email... 8
2.1.1.2 Sifat Fisik Email…... 9
2.1.1.3 Komposisi Email... 9
2.1.1.4 Struktur Makroskopik Email…... 9
2.1.1.5 Struktur Mikroskopik Email... 11
2.1.1.5.1 Prisma Email…... 11
2.1.1.5.2 Cross-Striations... 12
2.1.1.5.3 Striae of Retzius... 12
2.1.1.5.4 Permukaan Email... 13
2.1.1.5.5 Dentinoenamel Junction dan Email Spindles.. 14
2.1.1.5.6 Tuft Email... 15
2.1.1.5.7 Lamella Email... 16
2.1.1.5.8 Bands of Hunter and Schreger... 17
xi
2.1.2.1 Lokasi Dentin... 18
2.1.2.2 Sifat Fisik Dentin... 18
2.1.2.3 Komposisi Dentin... 19
2.1.2.4 Tipe-Tipe Dentin... 19
2.1.2.4.1 Dentin Primer... 19
2.1.2.4.2 Dentin Sekunder... 20
2.1.2.4.3 Dentin Tersier... 20
2.1.2.5 Histologi Dentin... 21
2.1.2.5.1 Tubulus Dentin... 21
2.1.2.5.2 Dentin Peritubular atau Intratubular... 23
2.1.2.5.3 Dentin Sklerotik... 24
2.1.2.5.4 Dentin Intertubular... 25
2.1.2.5.5 Dentin Interglobular... 26
2.1.2.5.6 Incremental Lines... 27
2.1.2.5.7 Granular Layer of Tomes... 28
2.1.2.6 Dentinogenesis... 28
2.1.2.6.1 Diferensiasi Odontoblas... 28
2.1.2.6.2 Formasi Mantle Dentin... 30
2.1.2.6.3 Suplai Vaskular... 32
2.1.2.6.4 Kontrol Mineralisasi... 32
2.1.2.6.5 Pola Mineralisasi... 33
2.1.2.6.6 Formasi Dentin Akar... 34
xii
2.1.3 Pulpa... 36
2.1.3.1 Lokasi Pulpa... 36
2.1.3.2 Komposisi Pulpa... 37
2.1.3.3 Komponen Pulpa... 37
2.1.3.4 Kompleks Dentin Pulpa Terhadap Perubahan Usia... 39
2.1.3.5 Kompleks Dentin Pulpa Terhadap Respon Stimuli... 42
2.2 Tinjauan Umum Hipersensitivitas Dentin... 42
2.2.1 Definisi Hipersensitivitas Dentin... 43
2.2.2 Etiologi Hipersensitivitas Dentin... 43
2.2.3 Teori-Teori Terjadinya Hipersensitivitas Dentin... 44
2.2.4 Manajemen Hipersensitivitas Dentin... 48
2.3 Tinjauan Umum Atrisi... 52
2.3.1 Definisi Atrisi... 52
2.3.2 Jenis-Jenis Atrisi... 52
2.3.3 Penyebab Atrisi Patologis... 53
2.3.4 Gambaran Klinis Atrisi... 54
2.3.5 Perawatan Atrisi... 55
2.4 Tinjauan Umum Pasta Gigi... 55
2.4.1 Definisi Pasta Gigi... 56
2.4.2 Bahan-Bahan Pasta Gigi... 56
2.4.2.1 Bahan Aktif Pasta Gigi... 57
2.4.2.2 Bahan Tidak Aktif Pasta Gigi... 57
xiii
2.6. Tinjauan Umum Sodium Monofluorophosphate……….. 62
2.7 Tinjauan Umum Visual Analogue Scale (VAS)... 64
2.7.1 Definisi Visual Analogue Scale (VAS)... 65
2.7.2 Wong-Baker Faces Pain Rating scale... 65
2.7.3 Kelebihan dan Kekurangan Visual Analogue Scale (VAS)... 65
BAB III METODE PENELITIAN 3.1 Metode Penelitian... 67
3.1.1 Desain Penelitian... 67
3.2 Populasi dan Sampel... 67
3.3 Variabel Penelitian... 69
3.4 Definisi Operasional... 69
3.5 Alat dan Bahan Penelitian... 70
3.5.1 Alat Penelitian... 70
3.5.2 Bahan Penelitian... 71
3.6 Cara dan Alur Penelitian... 71
3.6.1 Cara Penelitian... 71
3.6.2 Alur Penelitian... 73
3.7 Cara Pemeriksaan... 73
3.8 Aspek Etik Penelitian... 74
xiv
4.2 Hasil Uji Statistik... 77
4.2.1 Uji Normalitas Data... 77
4.2.2 Uji Wilcoxon... 77
4.2.3 Uji Mann-Whitney... 78
4.3 Pembahasan... 78
BAB V SIMPULAN DAN SARAN 5.1 Simpulan... 81
5.2 Saran... 81
DAFTAR PUSTAKA... 82
LAMPIRAN... 87
xv
DAFTAR TABEL
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Tabel 2.1 Bahan Aktif dan Fungsinya... 57
Tabel 2.2 Bahan Tidak Aktif dan Fungsinya... 58
Tabel 4.1 Skala Nyeri Sebelum dan Sesudah Menggunakan Pasta Gigi
yang Mengandung Strontium Chloride Hexahydrate 10%... 75 Tabel 4.2 Skala Nyeri Sebelum dan Sesudah Menggunakan Pasta Gigi
xvi
DAFTAR GAMBAR
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Gambar 2.1 Tanda A Menunjukkan Lokasi Email pada Bagian
Fasiolingual Longitudinal Gigi Kaninus………... 8
Gambar 2.2 Perikymata pada Permukaan Labial Insisif Sentral Maksila…… 10 Gambar 2.3 Mamelon pada Dua Insisif Sentral Maksila………. 10 Gambar 2.4 Transmisi Mikrograf Elektron dari Rod Email pada
Bidang Longitudinal (A) dan Melintang (B)………... 11
Gambar 2.5 Striae of Retzius pada Penampang Longitudinal Gigi………….. 12 Gambar 2.6 Striae of Retzius pada Penampang Melintang Gigi (panah)…….. 12 Gambar 2.7 Bagian Dasar Email Menunjukkan Hubungan antara Striae
of Retzius dan Permukaan Perikymata……….... 13
Gambar 2.8 Scanning Mikrograf Elektron dari Permukaan Labial
Gigi, Menunjukkan Perikymata………... 14
Gambar 2.9 Dentinoenamel Junction……….. 15 Gambar 2.10 Spindel Email (panah) Meluas dari Dentinoenamel Junction
ke Email dan Sering Ditemukan di Ujung Cusp………... 15
Gambar 2.11 Tuft Email Pada Penampang Melintang Meluas dari Dentinoena mel junction ke Email………... 16 Gambar 2.12 Lamella Email (panah)………...… 16
Gambar 2.13 Band Hunter and Schreger Gelap dan Terang pada
Penampang Longitudinal………. 17
Gambar 2.14 Penampang Longitudinal Labiolingual Molar Pertama Maksila.. 18
Gambar 2.15 Tipe-Tipe Dentin dan Distribusi……… 19
Gambar 2.16 Bagian Dentin………..……….. 20
xvii
Gambar 2.18 Tubulus Dentin pada Penampang Melintang………... 22
Gambar 2.19 Percabangan Terminal dari Tubulus Dentin Lebih Banyak di Akar Dentin (A) Dibandingkan dengan Dentin Koronal (B).
C, Scanning Mikrograf Elektron Menunjukkan Percabangan…. 23
Gambar 2.20 Dentin Peritubular Terlihat pada Mikroskop Cahaya dan
Scanning Mikroskop Elektron……….. 24 Gambar 2.21 Fotomikrograf dari Bagian Fasiolingual Gigi Insisivus
Rahang Bawah adalah Dead Tract yang Tampak Putih ………. 25
Gambar 2.22 Dentin Interglobular………. 27
Gambar 2.23 Penampang Longitudinal Lapisan Granular Tomes………. 28
Gambar 2.24 Diferensiasi Odontoblas………... 29
Gambar 2.25 Mikrograf Elektron Menunjukkan Deposisi Karakteristik Serat Kolagen Pertama untuk Membentuk Mantel
Predentin Koronal……… 30
Gambar 2.26 Struktur Serat Von Korff seperti Benang (panah) yang
Berasal di antara Odontoblas………... 30
Gambar 2.27 Fotomikrograf Cahaya dari Lapisan Odontoblas……… 32
Gambar 2.28 Pola Mineralisasi (A) Linear dan (B) Globular……… 34
Gambar 2.29 Mikrograf Elektron Menggambarkan Dentinogenesis
Akar Awal……….... 36
Gambar 2.30 Dentin Reparatif Miskin Kolagen dan Kaya dengan
Protein Matriks Nonkolagen, seperti Bone Sialoprotein (BSP) dan Osteopontin (OPN)……….. 36
Gambar 2.31 Fibroblas dalam Pulpa pada Mikroskop Cahaya……… 38
Gambar 2.32 Odontoblas adalah Sel Kolumnar Berwarna Gelap…………... 38
Gambar 2.33 Pembuluh Limfe (panah) dalam Pulpa……… 39
Gambar 2.34 Penurunan Volume Pulpa dengan Usia……….. 40
Gambar 2.35 Perbedaan Volume Pulpa antara Gigi Muda (A) dan Gigi
xviii
Gambar 2.36 A, Kalsifikasi yang Difus Terkait dengan Bundel Kolagen di tengah Ruang Pulpa. B, Batu Pulpa dan Kalsifikasi
Distrofik dimulai pada Dinding Pembuluh... 41
Gambar 2.37 Bahan Kimia dapat Digunakan untuk Menutup Tubulus Dentin dan untuk Menghilangkan atau Mengurangi Sensitivitas Dentin……….. 49
Gambar 2.38 Strontium………. 59
Gambar 2.39 Strontium Chloride……….. 60
Gambar 2.40 Strontium Chloride Hexahydrate……… 61
Gambar 2.41 Sodium Monofluorophosphate……… 63
xix
DAFTAR GRAFIK
No Teks Halaman
xx
DAFTAR LAMPIRAN
No Teks Halaman
Lampiran 1 Dokumentasi Penelitian……… 87
Lampiran 2 Hasil Analisis Statistik………. 91
Lampiran 3 Informed Consent……… 97
81 BAB V
SIMPULAN DAN SARAN
5.1 Simpulan
Dari hasil penelitian ini dapat disimpulkan bahwa pasta gigi yang mengandung
strontium chloride hexahydrate 10% memiliki efektivitas yang signifikan dalam menurunkan hipersensitivitas dentin dibandingkan pasta gigi yang mengandung
sodium monofluorophosphate.
5.2 Saran
1. Penelitian ini merupakan penelitian awal, sehingga perlu dilakukan penelitian lebih lanjut dengan pengaruhnya terhadap jenis keausan gigi, usia, dan lamanya penelitian berlangsung.
2. Perlu dilakukan penelitian lebih lanjut untuk membandingkan strontium chloride hexahydrate 10% dan sodium monofluorophosphate dengan bahan lain terhadap hipersensitivitas dentin.
82
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