Hepatitis in dental practice

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. Supplement 16 (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 )

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.

10. 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.

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

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

13. Thrombocytopenia in patients undergoing Interferon therapy.

14. 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.

15. SALIVARY GLAND DISORDERS AND HEPATITIS Clinical implications: Xerostomia Dental decay Halitosis Sjogren Sialadenitis HCV

16. 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

17. 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.

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

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

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

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

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

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

24. DRUGS TO AVOID!! TETRACYCLINES ERYTHROMYCIN AMINOGLYCOSIDES METRONIDAZOLE NSAIDS (should be used with care) T E A M

25. 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.