Types of hepatitis HEPATITIS - symptoms How To Diagnose Hepatitis? Treatment Main Prevention Measures for Hepatitis B and C Hepatitis in Pregnant Women Oral Manifestations of Hepatitis Management of patients with hepatitis B and C infection in dental office

2. Types of hepatitis
• Toxic
• Alcohol
• Viral

4. Global burden of hepatitis
• About 1 million people die each year from
causes related to viral hepatitis.
• Acute hepatitis B and C, cancer and cirrhosis
of the liver accounts for about 2.7% of all
deaths.

5. Adapted from Lauer and Walker, NEJM 2001
Healthy
Liver
Acute
Infection
Chronic
Infection
20%
Clear the
Virus
80% Virus
Continues
to Damage
Liver
Only 20% will
show symptoms
initially !

6. Chronic
Hepatitis
Cirrhosis
20-30%
Liver
Cancer
1-4%/year
Most symptoms begin to show only when liver is more
severely damaged

7. HEPATITIS - symptoms
• ACUTE:
• Malaise
• Muscle and joint ache
• Fever
• Nausea or vomiting
• Loss of apetite
• Abdominal pain
• CHRONIC:
• Malaise, tiredness,
weakness
• Weight loss
• Peripheral oedema
• Ascites

8. • A few may have specific liver related
symptoms initially:
– Pale stool
– Jaundice (yellowing of the skin or eyes)

9. Hepatitis A
• More common in children
• It causes prolonged illness for up to 6 months,
but usually only causes mild illness.
• It does not cause chronic liver disease.
• In milder cases, symptoms may be similar to a
stomach virus (with vomiting and diarrhea).

10. The CDC now recommends the vaccine for
hepatitis A to children at age 1 with special
recommendation for the following children:
 Blood clotting disorder, such as hemophilia
 Child care centers that have had outbreaks of
hepatitis A
 Chronic liver disease
 The vaccine is not recommended for children
younger than age 12 months.

11. How To Diagnose Hepatitis?
Several laboratory tests are done to
diagnose and monitor the hepatitis, which
includes:
• Abdominal ultrasound
• Autoimmune blood markers
• Hepatitis virus serologies
• Liver function tests
• Liver biopsy

12. Hepatitis virus serologies
Series of blood tests used to detect current or past infection by
hepatitis A, hepatitis B, or hepatitis C.
NEGATIVE RESULTS NORMAL
POSITIVE RESULTS HEPATITIS INFECTION

13. Hepatitis A test results:
 IgM anti-hepatitis A virus (HAV) antibodies – recent infection
 Total (IgM and IgG) antibodies to hepatitis A – past infection
Hepatitis B test results:
 HBsAg - 1-6 months after exposure
 HBeAg - 1-3 months after acute illness, high infectivity
 anti-HBc - past infection
 anti-HBs - implies vaccination
Antibodies to hepatitis C
Can usually be detected 4 - 10 weeks after the infection occurs. Other
types of tests may be done to decide on treatment and monitor the
hepatitis C infection.

14. Liver Function Test:
The test measures the levels of certain enzymes and proteins in your blood.
Hepatitis A : AST and ALT increases.
Hepatitis B : AST and ALT increases.

15. Treatment
 Hepatitis A:
No specific treatment, dietary food and
long rest recommended and avoid alcohol.
 Hepatitis B :
• Treatment to prevent hepatitis B infection after exposure
Hepatitis B immune globulin injection within 24 hours of coming in contact
with the virus may help protect you from developing hepatitis B.
• Treatment for acute hepatitis B infection
Hepatitis B infection is acute — reduce any signs and symptoms.
• Treatment for chronic hepatitis B infection
1. Antiviral medications : Lamivudine, Adefovir, Famciclovir.
2. Liver transplant: If the liver is severely damaged, a liver transplant may be
an option. Survival with transplant is now 70-80%

16. Hepatitis C:
Treated with a combination of pegylated
interferon and ribovarin.
Patients with chronic hepatitis C who are
receiving standard HCV treatment may benefit
significantly by taking vitamin B12
supplements.

17. Main Prevention Measures for
Hepatitis B and C
• Promote vaccination against hepatitis B.
• Avoid sharing injecting equipments such as needles and syringes
and ensure adequately sterilized medical equipment use.
• Promote hepatitis B and C testing and counselling services.
• Raise awareness of the diseases and their transmission mode.
• Individuals up to 18 years of age and adult participating at risk of
infection should be vaccinated. Three injections over a six to 12
month period are required to provide full protection.

18. Dispelling Myths
• Hepatitis C is not spread by:
Casual contact
Hugging/kissing
Sharing eating utensils and drinking glasses
Sneezing/coughing
Shaking hands
Sitting on a toilet seat

19. Hepatitis in Pregnant Women
• Hepatitis in pregnant women usually does not increase the risk of birth
defects or other pregnancy problems, and infection of the unborn baby is
rare.
• However, hepatitis E can be fatal to a pregnant woman during her third
trimester, and if the mother has hepatitis B, the baby is likely to contract
the disease at birth.
• If the pregnant mother is infected with hepatitis B then the baby will be
given immune globulin shots and a hepatitis vaccination.
• In addition, it is recommended that a mother with active HBV receive
treatment with an antiviral medication during the third trimester of
pregnancy.

20. Oral Manifestations of Hepatitis
• Morbidity associated with hepatitis C virus (HCV) infection can involve a
variety of extrahepatic conditions, such lichen planus (LP) and Sjögren-like
sialadenitis.

21. Management of patients with hepatitis B
and C infection in dental office
• Patients with hepatitis receiving dental treatment should be handled with
precautions as there is risk of Cross infection.
• Use of universal protective measures is recommended.
• In case of accidental perforation, careful washing of the wound ( without
rubbing, as this may inoculate the virus into deeper tissues) for several
minutes with soap and water, or using a disinfectant of established
efficacy against the virus (iodine solutions or chlorine formulations).
• If exposure through some mucosal membrane has occurred, abundant
irrigation with tap water, sterile saline solution or sterile water is advised,
for several minutes.

22. Therefore a detailed clinical history should be taken before
dental treatment and a thorough oral examination in order to
identify patients with possible risks.
Interconsultation with the patient physician or specialist is
advisable in order to establish a safe and adequate treatment
plan.
 Acute-phase viral hepatitis only emergency treatment
 Chronic hepatitis determine the possible existence of associated
disorders in order to prevent their direct complications and
problems

24. References
• Jump up to:a b Ryan KJ, Ray CG (editors), ed. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 551–
2. ISBN 0838585299.
• ^ Jump up to:a b Gravitz L. (2011). "A smouldering public-health crisis". Nature 474 (7350): S2-
4.doi:10.1038/474S2a. PMID 21666731.
• ^ Jump up to:a b c d "Hepatitis C". World Health Organization (WHO). June 2011. Retrieved 2011-07-13.
• ^ Jump up to:a b c Mohd Hanafiah, K; Groeger, J; Flaxman, AD; Wiersma, ST (2013 Apr). "Global epidemiology of
hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence.". Hepatology
(Baltimore, Md.) 57 (4): 1333–42.PMID 23172780.
• Jump up^ Houghton M (November 2009). "The long and winding road leading to the identification of the hepatitis
C virus". Journal of Hepatology 51 (5): 939–48.doi:10.1016/j.jhep.2009.08.004. PMID 19781804.
• Jump up^ Shors, Teri (2011-11-08). Understanding viruses (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
p. 535. ISBN 9780763785536.
• ^ Jump up to:a b c d e f g h i j k l Rosen, HR (2011-06-23). "Clinical practice. Chronic hepatitis C infection". The New
England Journal of Medicine 364 (25): 2429–38.doi:10.1056/NEJMcp1006613. PMID 21696309.
• Jump up^ Maheshwari, A; Ray S; Thuluvath PJ (2008-07-26). "Acute hepatitis C". Lancet 372(9635): 321–
32. doi:10.1016/S0140-6736(08)61116-2. PMID 18657711.
• ^ Jump up to:a b c d e f g h i j k l m n o p q r s t u Wilkins, T; Malcolm JK; Raina D; Schade RR (2010-06-01). "Hepatitis C:
diagnosis and treatment". American family physician 81 (11): 1351–7. PMID 20521755.
• Jump up^ Bailey, Caitlin (Nov 2010). "Hepatic Failure: An Evidence-Based Approach In The Emergency
Department". Emergency Medicine Practice 12 (4).
• ^ Jump up to:a b c d e Chronic Hepatitis C Virus Advances in Treatment, Promise for the Future. Springer Verlag.
2011. p. 4. ISBN 9781461411918.
• ^ Jump up to:a b c d Nelson, PK; Mathers BM, Cowie B, H