Hepatitis B and C infection and it's clinical implication in Dental practice, how to management patients of hepatitis and what clinical features patients with hepatitis show in oral cavity.

1. Hepatitis B and C infection:
Clinical Implications in
Dental practice
Dr. Almas Muhammad Arshad

2. HEPATITIS??
• Hep- Liver
• Itis- Inflammation

3.  Causes of Hepatits:
Viruses (commonly)
Toxic substances (Alcohol, NSAIDs,
Amiodrone)
Autoimmune diseases
 Types of Hepatitis: A, B, C, D, E and G.
HEPATITIS:

4. PREVELANCE OF
HEPATITIS IN PAKISTAN
 Eastern Mediterranean Health Journal, suppl. Supplement16 (Aug 2010):
S15-23.
7.6%
4.8%
2.5%

5. Cntd..
Records of patient with hepatitis B and C of
were treated by Qureshi et al and a conclusion
was drawn that in the last 2 years:
 Among 7572 patients, only 3440 (45%)
completed the full 6 months therapy
 From 85 people diagnosed with Hep B, only
9 completed the 6 months therapy.
(Ref: Asian Pacific Journal of Tropical Biomedicine March 2015; vol 5)

6. WHO IS AT THE HIGHEST
RISK
 14.4% and 1.4% of hospital workers are
infected with HBV and HCV respectively.
(Ref: Europeon journal of General dentistry | vol 2 | Issue 1 | Jan-April 2013 )
Highest
Risk
Physicians
and
Dentists
NursesLaboratory
Staffs
Dialysis
Personals

7. RISK FACTORS

8. CLINICAL PRESENTATION
OF HEPATITIS B:
Early Symptoms: Malaise, fatigue,
anorexia.
Acute Phase: Nausea, vomiting,
abdominal pain and Jaundice.
Chronic Phase: Liver cirrhosis and
hepatocellular carcinoma.

9. CLINICAL PRESENTATION
OF HEPATITIS C:
 Mild symptoms
 Symtomatic: Malaise, nausea, vomiting,
abdominal discomfort, pale stools, dark urine
and jaundice.
 Silent storm
 Chronicity: in 70 to 80% of the cases.

11. IN THE ORAL CAVITY
Vectors: Blood, Saliva, Crevicular
fluid, nasopharyngeal secretions
Higher concentrations of Hep B
and HCV RNA are found in the
Gingival sulcus than in Saliva.

12. ORAL MANIFESTATIONS
Include:
Lichen planus
Sjogrens syndrome
Sialadenitis
Some forms of oral cancers

13. Petechies or excessive gingival
bleeding even with minor trauma
in patients liver disease

14. Thrombocytopenia in patients
undergoing Interferon therapy.

15. OLP & HEPATITIS:
 Epidemiological relationship between OLP
and Hep C have been reported notably in the
erosive type and asymmetric type in the
buccal mucosa.
 Because:
 Alternation in epithelial cells
 Alternation of immune response of host.

17. SALIVARY GLAND
DISORDERS AND HEPATITIS
Clinical implications:
 Xerostomia
 Dental decay
 Halitosis
SjogrenSialadenitis
HCV

18. HEP C AND DIABETES
 Increased prevelance of Diabetes in patients with
chronic liver failure.
 HCV may act as an INDEPENDENT
DIABETOGENIC FACTOR
 This is an imporatant association because it has
following implications:
 Increased frequency of periodontal disease
 Stomatitis
 Candidiasis
 Cheilitis
 Oral leukoplakia
 Dental caries

19. MANAGEMENT OF PTs
WITH HEP B AND C IN
DENTAL OFFICE
Considering cross infection control measures:
 Masks
 Gloves
 Barriers
 Correct sterilization protocols
 Disinfection of the surfaces
 The Hep C virus can remain stable for over 5 days
at room temperature in the operatory field.

20. ACCIDENTAL EXPOSURE:
1. Carefully washing the wound without rubbing
for several minutes with soap and water
2. Using a disinfectant (iodine solutions or
chlorine formulations)
 To reduce the number of viral units
3. Complete detailed medical and clinical
history of the patient

21. POST EXPOSURE
PROPHYLAXIS OF HEP B:
 Anti HBs must be performed 1-2 months after
the last dose of vaccine.

22. POST EXPOSURE
PROPHYLAXIS OF HEP C:
 Tests to be performed
 Anti HCV
 ALT
 RT-PCR
 Every 4 to 6 weeks

23. IMMUNIZATION:
 Hepatitis B Vaccination series –
Recombivax HB 10 mcg
Energix – B 20 mcg
At 0, 1 and 6 months.

24. TREATING A HEP+ive IN
THE DENTAL OFFICE:
1. Ensure a welcoming and Non judgemental
approach!!
2. Detailed history and oral examination
3. Consultation with the patients physician.
4. Determining the possible existence of
associated disorders (autoimmune,
diabetes.

25. 4. Consultation, cogulation and blood profile
incase of invasive procedure.
5. A stock up of local hemostatic agents,
antifibrinolytic agents, platelets, vitamin K,
fresh plasma in the dental office, incase of
elective procedure.
6. Antibiotic prophylaxis.

26. DRUGS TO AVOID!!
 TETRACYCLINES
 ERYTHROMYCIN
 AMINOGLYCOSIDES
 METRONIDAZOLE
 NSAIDS (should be used with care)

27. CONCLUSION
Hepatitis is one of the main diseases of
concern in the dental office. These
viruses can be transferred by a single
prick, therefore proper preventive
measures must be adopted and a strict
protocol to prevent transmission.