HBOT

1. FANNY MARGARETHA LAIHAD
HYPERBARIC OXYGEN THERAPY
IN
ORAL SURGERY

2. Air composition
www.sdm.scot.nhs.uk/gas_laws

3. AIR COMPOSITION
 AIR COMPOSITION :
 20,94 % Oxygen
 78,08 % Nitrogen
 0,04 % CO2 & Other Gases
 Absolute Pressure (ATA) in Air  760 mmHg
 Partial Pressure of oxygen (PO2) in Air
(760)(21/100) = 160 mmHg

4. OXYGEN FUNCTION

5. Oxygen
pathway
AMBIENT AIR
ALVEOLAR AIR
PULMONARY CAPILLARIES
VENOUS BLOOD
HEART
SYSTEMIC ARTERIAL BLOOD
CAPILARIES
INTERSTITIAL & INTERCELLULAR FLUID
THE CELL : PERIOXOME, ENDOPLASMIC RETICULUM
MITOCHONDRIA

6. Hyperbaric oxygen therapy
• HYPERBARIC OXYGEN Therapy (HBOT) is an systemic
treatment which involves breathing 100 % Oxygen
ATA pressure of more than 1 Atmosphere (ATM)
•
• * Treatment may be carried out either in a mono place
chamber pressurized with Oxygen 100% or in multi-
place chamber with compressed air, in which case the
patient receive pure Oxygen by mask, head tent
(hood), or endo tracheal tube
• (Guritno, 2013)

7. HYPERBARIC OXYGEN THERAPY
(GURITNO, 2013)
 HBOT SYSTEMIC TREATMENT USES HIGH PRESSURE OXYGEN
PRECENTAGE MORE THAN 1 ATMOSPHERE ABSOLUTE WITH 2
BENEFIT
 (1) MECHANICAL EFFECT OF BAROMETRIC PRESSURE
 (2) THE EFFECT OF AN INCREASE IN THE PARTIAL PRESSURE OF
OXYGENWILL CAUSE AN INCREASE IN ALVEOLAR PRESSURE OF
OXYGEN AND PARTIAL PRESSURE OF OXYGEN PLASMA AND TISSUE.
 INCREASE TISSUE OXYGEN PARTIAL PRESSURE  WILL INCREASE
THE PRODUCTION OF ROS (H2O2) & RNS (NO) CELLS

8. THEMECHANISMOF HYPERBARICOXYGEN
Journal of Applied Physiology ( Thom SR, 2009)
Gambar 2.19
Mekanisme Terapi Oksigen Hiperbarik
Disadur dari Journal of Applied Physiology ( Thom SR, 2009)
Gambar 2.19
Mekanisme Terapi Oksigen Hiperbarik
Disadur dari Journal of Applied Physiology ( Thom SR, 2009)

9. HYPERBARICOXYGENMOLECULARCYCLE IN CELL

10. DOSIS TERAPI OHB

11. HYPERBARIC OXYGEN THERApy
INTRO

12. Hyperbaric Oxygen Therapy

13. INDICATION
1. Gas Gangrene
2. Acute & Chronic Osteomyelitis
3. Necrotizing Soft Tissue Infection
4. Soft Tissue Swelling
5. Delayed Wound Healing
6. Fracture / Non Union
7. Bone Grafting
8. Osteoradionecrosis
9. Actinomycosis
10. Inflamatory Disease
11. Anaerobic Infection
12. Trigeminal Neuralgia

14. CONTRA INDICATION
Absolute :Untreated Pneumothorax
Relative :
1. Upper Respiratory Infections
2. Seizure Disorders
3. Emphysema With CO2 Retention
4. Asymptomatic Pulmonary Lesion
5. History of Thoracic Surgery or Ear Surgery
6. Uncontrolled High Fever
7. Malignant Disease
8. Pregnancy
9. Optic Neuritis

15. COMPLICATION
1. OticBarotrauma
2. Sinus Pain
3. Myopia & Cataract
4. Pulmonary Barotrauma
5. Oxygen Seizures
6. Decompression Sickness
7. ClaustroPhobia

16. Various cases of oral surgery that
have been treated with HBOT in
Naval Central Hospital dr. Ramelan
Surabaya
 1. TRAUMA
 2. JAW OSTEOMYELYTIS
 3. AVULSI
 4. PROPHYLAXIS BEFORE GENERAL ANASTHESIA
 5. FUNGAL INFECTION
 6. PARESTHESIA

17. 1. SEVERE TRAUMA CASES IN DENTISTRY
1. MULTIPLE EXTRACTION
2. MULTIPLE ODONTECTOMI
3. POST FRACTURE (?)
1 & 2 USUALLY GIVEN 3 UNTIL 5 TIMES HBOT

18. THE EFFECT OF HBOT IN POST TRAUMA PATIENTS
- Wound repair, promote wound healing
- Stimulate collagen sintesis to make new
transportation in blood vessel
- Vasoconstriction & reduction of blood
flow
- Control Proliferation of Fibroblast
- Prevent Infection

19. 2. JAW OSTEOMYELITIS

20. HBO : 1 SESSION (10 TIMES BEFORE TRETMENT)
1 SESSION (10 TIMES AFTER TREATMENT)

21. THE EFFECT OF HYPERBARICOXYGEN
IN OSTEOMYELYTIS
 Raise Tissue Oxygen Tension  for Partially
Ischemi Hypoxic Tissue
 -Enhance Leucocyte killing mechanism
 -Enhance Osteogenesis or Neovascularization to
fill dead space with vascular of structurally sound
bony tissue.
 -Enhance Osteoblastic Activity to remove bony
debri
- Enhance Host Factor

22. 3. AVULSED TEETH
 WE HAVE 2 PATIENT:
 1. 6 YEAR OLD GIRL BECAUSE WRONG TOOTH
EXTRACTION, WE MONITORED FOR 2 AND A HALF YEAR
 (Replantation and Suturing (5 times HBOT , after 2 an a
half year Curretage, bone graft and suturing, 10 times
HBOT)
 2. 8 YEAR OLD BOY BECAUSE OF TRAUMA
 Replantation-Fixation-HBOT 1 Session, After 3 month 
HBOT 1 Session

23. 6 YEAR OLD GIRL
1. 5 TIMES HBOT , 2. 10 TIMES HBOT AFTER
CURRETAGE AND BONE GRAFT

24. 8 YEAR OLD BOY
(HBOT 2 SESSION =20 TIMES)

25. THE EFFECT OF HYPERBARIC
OXYGEN in avulsed teeth
- WOUND REPAIRE, PROMOTE WOUND HEALING
- STIMULATE COLLAGEN SYNYHESIS TO MAKE
NEW TRANSPORTATION IN BLOOD VESSEL
 NO DISCOLORISATION
 RESTORE TO FUNCTION

26. 4. PROPHYLAXIS BEFORE GENERAL ANASTHESIA
 17 YEAR OLD GIRL WITH MULTIPLE IMPACTED
TEETH

27. 3 TIMES HBOT BEFORE
OPERATION
- Wound repair, promote wound
healing
- Stimulate collagen sintesis to make
new transportation in blood vessel
- Vasoconstriction & reduction of
blood
flow
- Control Proliferation of Fibroblast
- Prevent Infection

28. 5. ORAL FUNGAL INFECTION
 ORAL FUNGAL INFECTION IS DIFFICULT TO DETECT,
TO DIAGNOSIS ,TO TERAPHY. SOMETIMES NO
CLINICAL SIGN & USUALLY MISSDIAGNOSIS
 1.CANDIDIASIS FLORA NORMAL BUT SOMETIMES
PATHOGEN
 2. ASPERGILLOSIS RARE BUT SOMETIMES SEVERE
 3. MUCORMYCOS  RARE, PROGRESIVE,ACUTE AND
HIGH MORTALITY
 4. TRICOSPORONOSIS RARE, PROGRESIVE, AKUT &
HIGH MORTALITY
 2-4 SOMETIMES MANISFESTATION FROM SINUS
MAXILLARIS

29. In 2001, Suspected Mucormycosis after extract 25,
immunocompetent, no clinical sign.

30. Before Plastic Surgery
The Result of plastic surgery

31. SUSPECT CHRONIC MUCORMYCOSIS
HBOT 1 SESSION ( 10 TIMES)

32. Effect of hbot in fungal infection
EFFECT FOR NECROTIC
TISSUE
- Demarcate the necrotic area
- Salvaged Tissue
- Restore to Function
- Accelerated the Epithelization

33. 6. PARESTESI
 WE HAVE DONE ON DIFFICULT ODONTECTOMY PATIENT
 IT TAKES LONG TIME FOR NERVES TO HEAL WITH HBOT
 UNTIL 7 AND A HALF SESSION
 THE EFFECT OF HBOT I APPARENTLY NOT TOO
INFLUENTIAL ON NERVE INJURI ( PAULO TUMO JR ET AL,
1999 )

34. SUMMARY
• HBO therapy has been proven
efficacious
in adjunct management of this case
• HBO therapy is very usefol for healing
patient in dentistry
• HBO therapy can be use for another
case
in dentistry in the future

35. REFERENSI
 Mathieu D, Linke JC, Wattel F. (2006) Non Healing Wound. Daniel Mathieu, editor : Handbook on Hyperbaric Medicine. Dordrecht, the Netherland. Springer. P 401-427
 Widiyanti P.. (2013). The role of hyperbaric therapy in the growth of candida albicans. Indonesian journal o tropical disease. Volume 4 no 4 oct-December 2013
 Wibowo A. (2015. Oksigen Hiperbarik : Terapi Percepatan Penyembuhan luka. Juke Unila (volume 5) no 9 Maret 215
 Paulo Tumo Jr et al (1999). Effect of hyperbaric oxygen on the regeneration of experiment crush injuries of nerves. Rev. Hosp Clin vol 54 no 3 Sao Paolo June 1999.
 Laihad, Fanny Margaretha (2017). Mucormycosis in the Oral Cavity with Hyperbaric Oxygen Therapy. Lambert Academic Publishing. ISBN: 978-3-330-33226-3. ICS
Morebooks, Balti, Republic of Moldova.
 Laihad FM (2017). The Possibility of Using Hyperbaric Oxygen Therapy as A Prophylaxis in Oral Surgery. SPUMS & AHDMA Annual Scientific Meeting, May 2017,
Rama Candidasa Bali, Indonesia.
 Laihad Fanny M, I Ketut Sudiana, M. Guritno Suryokusumo ( 2015) Case Report : The Diagnosis, Treatment and Outcome of a Rare Case Suspected Mucormycosis
Pinnacle Medicine & Medical Sciences ISSN:2360-9516, Vol2(2), Article ID pmms_174,502-505.
 Laihad FM (2016). Mekanisme Perbaikan Jaringan Mukosa Maksila yang terinfeksi Mukormikosis pada Pencabutan Gigi setelah Terapi Oksigen Hiperbarik. Seminar
Nasional Hyperbaric Update, Hari Kesehatan TNI-AL, Rumkital dr. Ramelan, Hotel Novotel , Surabaya, Oktober 2016
 Laihad FM, Sudiana IK, Guritno MS (2017). Literature Review: Hyperbaric Oxygen Therapy on Mucormycosis in Oral Cavity. Folia Medika Indonesiana vol 53, no 2.
 Guritno SM (2013). The Basic Theory and Use of HBOT. International workshop and symposium on Medical Hyperbaric Oxygen Treatment and 1st Congress of
Indonesian Hyperbaric Medical Association, Nov 23-24: The Empire Palace Surabaya.
 Zimmermann A.. Bauer MA, Kroemer G, Madeo F, Gutierez DC (2014) When less is more : hormesis against stress and disease. Microbial cell 1(5):150-153