HEPATITIS

DR. ASMS ALMESLET

B.D.S, MSc.
DEPARTMENT OF OMFS & DIAGNOSTIC SCIENCES, REU
 Hepatitis (WHO)
• Hepatitis is an inflammation of the liver.
I
• The condition can be self-limiting or can progress to fibrosis or
cirrhosis= (scarring), or liver cancer.

• Hepatitis viruses are the most common cause of hepatitis in the world but
other infections, toxic substances (e.g. alcohol, certain drugs), and
autoimmune diseases can also cause hepatitis.
 Liver
• Is located in the upper right quadrant of the abdomen
✓Cleans the blood
✓Regulates hormones
✓Helps with blood clotting
✓Produces bile
✓Produces important proteins
✓Maintains blood sugar levels
✓And much, much, more
 Viral Hepatitis
5 types:
• A: fecal-oral transmission É

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• B: sexual fluids & blood to blood d
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• C: blood to blood
• D: travels with B
•OE: fecal–oral transmission
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• F: HFV is latest, Discovered in 1994 in FRANCE
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• G: HGV latest, identified in 1995,
✓Genetically identical to hepatitis C
✓Does not cause damage to the liver

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Symptoms of hepatitis
• Symptoms may not be obvious until serious liver damage has occurred
• Muscle and joint pain
• A high temperature (fever) of 38C (100.4F) or above
• Feeling and being sick
• Feeling unusually tired all the time
• A general sense of feeling unwell
• Loss of appetite
• Abdominal (tummy) pain
• Dark urine
• Itchy skin
• Yellowing of the eyes and skin (jaundice)
 Diagnostic of hepatitis
• Physical Exam for signs and symptoms of
viral hepatitis. ...

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• Blood Tests ( liver function test)
• Imaging Tests. (ultrasound)
• Liver Biopsy.
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 Hepatitis can lead to
• Liver damage (cirrhosis)
• Liver cancer
• liver transplant
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 Hepatitis A
floral
• Caused by the hepatitis A virus
(HAV).
• Can affect anyone.
• Hepatitis a can occur in situations
ranging from isolated cases of
disease to widespread epidemics.
• Incubation period – 15-45 days
• More common in children
• It causes prolonged illness for up to
6 months, but usually only causes
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mild illness.
• It does not cause chronic liver
disease.
• In milder cases, symptoms may be É
similar to a stomach virus (with
vomiting and diarrhea).
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• Flu like symptoms
 Diagnosis
• The detection of IgM antibody is the most important test
• IgG???

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5
pi ad
 Treatment

• No specific treatment, dietary

-
food.
• long rest recommended and avoid alcohol.
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s
 Hepatitis B
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that attacks the liver.
• DNA virus
A
• Is a serious disease caused by a virus

• Incubation period -30-180 days

• The virus, which is called hepatitis B
s
virus (HBV), can cause lifelong
infection, cirrhosis (scarring) of the
liver, liver cancer, liver failure, and
death.
To
 Hepatitis B Diagnosis
• HBsAg - 1-6 months after exposure

8
• HBeAg - 1-3 months after acute illness, high infectivity
 Treatment 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.

ED
• Treatment for acute hepatitis B infection
• Hepatitis B infection is acute — reduce any signs and symptoms.

• Treatment for chronic hepatitis B infection

D
• 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%
 MODES OF TRANSMISSION

Three important modes of transmission-

• Parenteral
• Perinatal
• Sexual
 Hepatitis C
• Clinical Manifestations
• Resembles HBV
• 1.persistent carrier state
• 2..50% of patients have chronic liver damage
• 3. Associated with hepatocellular carcinoma
 Treatment
• Treated with a combination of interferon and ribovarin.

• HCV treatment may benefit significantly by taking vitamin B12

supplements.
 Hepatitis D
• Depend virus, it is defective and cannot produce infection unless the
cell is also infected with HBV.

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EB I am
DX at my
 Hepatitis E
• Fecal/oral route predominantly found in developing countries but is
world wide.
• symptoms similar to HAV but mortality 1-2% (ten times that of
Hepatitis A).
• epidemics - India, Pakistan, Nepal, Burma, North Africa and Mexico.
 Oral Manifestations of Hepatitis
Lichen planus
Sjogrens syndrome
Sialadenitis
Some forms of oral cancers
 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.
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toy
• Petechies or excessive gingival bleeding even with minor trauma in
patients liver disease

• Thrombocytopenia in patients undergoing Interferon therapy.

Main Prevention Measures for Hepatitis B
• Promote vaccination against hepatitis B.
• Avoid sharing injecting equipments such as needles and syringes and
ensure adequately sterilized medical equipment use.
• Promote hepatitis B testing and counselling services.
• it is recommended that the dental professionals should receive
immunization against hepatitis virus and should use individual
protective equipments such as gloves, head caps, masks, etc.
Prevention and management of hepatitis in dental clinic

• it is recommended that the dental professionals should receive

immunization against hepatitis virus and should use individual
protective equipments such as gloves, head caps, masks, etc.
 Following are the guidelines for treating hepatitis patients
• No dental treatment other than urgent care should be rendered for a patient with acute viral
hepatitis
• Hepatitis B is of primary concern to the dentist. Individuals still carry the virus up to 3 months after
the symptoms have disappeared, so any patient with a recent history of hepatitis B should be
treated for dental emergency problems only.
• For patient with a past history of hepatitis, consult the physician to determine the type of
hepatitis, course and length of the disease, mode of transmission, and any chronic liver disease or
viral carrier state
• For recovered HAV or HEV, perform routine periodontal care
• For recovered HBV and HDV, consult with the physician and order HBsAg and HBs laboratory tests.
• If HBsAg and anti-HBs tests are negative but HBV is suspected, order another HBs determination
• Patients who are HBsAg positive are probably infective (chronic carriers); the degree of infectivity
is measured by an HBsAg determination
• Patients who are anti-HBs positive may be treated routinely
• Patients who are HBsAg negative may be treated routinely.

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 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
 Post Exposure Prophylaxis Of HEP B
• Anti HBs must be performed 1-2 months after the last dose of
vaccine.
 Post Exposure Prophylaxis Of HEP C
• Tests to be performed Anti HCV, ALT, PCR Every 4 to 6 weeks
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 Treatment
❑ Hepatitis A: É
No specific treatment, dietary food and
long rest recommended and avoid alcohol.

J ❑ Hepatitis B:
• Treatment to prevent hepatitis Binfection after exposure

t
Hepatitis Bimmune globulin injection within 24 hours ofcoming in contact
with the virus may help protect you from developing hepatitis B.

• Treatment for acute hepatitis Binfection

A
Hepatitis Binfection is acute —reduce any signs andsymptoms.

• Treatment for chronic hepatitis Binfection

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%
❑Hepatitis C:
Treated with a combination of pegylated
interferon and ribovarin.
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HCVtreatment may benefit significantly by
taking vitamin B12 supplements.
 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. É
 HIV
• HIV originated in Kinshasa ( congo), in 1920 the virus spread from
chimpanzees to humans, during “bush meat trading.” While hunting
chimpanzees, hunters would have come in contact with animal blood..

• HIV (human immunodeficiency virus) is the same virus that can lead to
AIDS (acquired immunodeficiency syndrome).
• Infection with human immunodeficiency virus (HIV) predisposes people
to certain oral health problems.

• HIV-positive patients can receive routine dental care.

• Careful medical histories can capture insight about patients to help
identify those who require treatment plans adapted to their unique
medical condition(s).

• Dentists and all staff with direct patient contact should follow Standard
Precautions with all patients
• (HIV) destroys specific cells in the immune system, rendering infected
people more susceptible to infection with other organisms and infection-
related cancers.

• Over time, in the absence of effective treatment, HIV can develop into
acquired immunodeficiency syndrome (AIDS), characterized by a low CD4+ T
lymphocyte count (<200 cells/mm3) or one or more opportunistic
 CLINICAL FEATURES OF HIV INFECTION
• 1.Acute Primary Illness
• This infection passes unrecognized as majority of its features are
NON-SPECIFIC (2-6 weeks)
• In some individuals during the 4-7weeks of Rapid Viral Replication
immediately following exposure there can be:
• Fever
• Malaise
• Lymphadenopathy
• CD4 count- 1000-500 cells/cub.mm
 at
• 2.Clinical latency stage
• This is an Asymtpomatic phase often of years (median 10
y yrs?) when the
virus is LATENT.

• The host defense responds but some of the viruses escape which gradually
destroy the immune cells
• CD4 count -750-500cells/cub.m
 • HIV DISEASE (SYMPTOMATIC HIV INFECTION)
• HIV DISEASE appears as CD4 count progressively declines over a long
incubation period. Then the person develops:
✓INFECTIONS
✓NEOPLASMS
✓AFFECTS ON AGING,WEIGHT & BLOOD
✓NEUROPSYCHIATRIC DISEASES
 • AIDS

• MOST SEVERE Manifestation of HIV infection

• Numerous Neoplasms & Opportunistic Infections in presence of HIV

infection including the CD4 T-Cell count below 200 / ml constitutes
an AIDS DIAGNOSIS
 Classification Of Oral Lesions In AIDS

GROUP 1 (STRONGLY ASSOCIATED LESIONS)

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• CANDIDIASIS (Erythematous, Hyperplastic, Thrush)
• Hairy Leukoplakia (EBV)
• HIV Gingivitis
• Necrotizing Ulcerative Gingivitis / Periodontitis
• Kaposi Sarcoma
• Non-hodgkin’s Lymphoma
 Classification Of Oral Lesions In AIDS

GROUP 1 (LESS COMMONLY ASSOCIATED LESIONS)

• Oropharyngeal Ulceration
• Thrombocytopenic
• Unilateral Or Bilateral Parotid Swelling
• Xerostomia
• HSV Infection
• VZV Infection
• HPV Lesions
 HIV Related Oral Candidiasis

• Most Common Opportunisitic Infection In AIDS. In About 90 % Of

Cases

• Often Initial Manifestation Of Symptomatic HIV Infection

• Seen In All Groups At Risk, Specially Intravenous Drug Users

Hairy leukoplakia
Oral Candidiasis (Pseudomembranous, thrush)
ERYTHEMATOUS CANDIDIASIS
Kaposi’s Sarcoma
 fluid filled son

Herpes zoster infection I

Human Papilloma Virus
ANUG
 Diagnosis
• Oral lesions are among the earliest and most common clinical signs of HIV,
and detection of oral lesions may signal progression of HIV disease or
increase in the plasma HIV-1 RNA level.

• HIV infection can be diagnosed by serologic tests that detect antibodies

against HIV and by virologic tests that detect HIV antigens or ribonucleic acid
(RNA).

• Testing begins with a sensitive screening test, usually an antigen/antibody

combination or antibody immunoassay.
 TESTS

• In practice, current laboratory tests depend on ANTIBODY

DETECTION
a t
to Confirm
• 1.ELISA is performed initially for detection of HIV
ANTIBODY. Lintialtes p
Diggs

• POSITIVE RESULTS are always confirmed by examining a

further blood sample from same patient using ELISA again.
 MANAGEMENT OF HIV

• While no cure for HIV currently exists, with effective medical treatment
and care, HIV can be controlled.
to

• The medication used to treat HIV is termed antiretroviral therapy.

 STAGES OF MANAGEMENT OF AIDS
1. Treat Opportunistic Infections

2. Treat Kaposi Sarcoma & Other Mallignancies

3. Highly Active Anti-retroviral Therapy (Haart)

4. Psychological Therapy
 DENTAL MANAGEMENT OF HIV PATIENTS
• Avoiding exposure to blood and bodily fluids is the primary way to prevent
transmission of HIV in dental care settings
• During dental procedures saliva tends to become contaminated with blood,
increasing the risk of HIV transmission from saliva

• Dental treatment for asymptomatic HIV-positive patients requires

no special considerations / changes in treatment protocol.
 Guidelines to prevent transmission of HIV (“Universal
precautions”)
1. Use pre-sterilized disposable materials
2. Health care workers should always treat all blood and body fluids as if they
were infectious .
3. Use of impervious apron if the procedure is likely to generate splashes of
blood or other body fluids
4. Impervious gloves if a glove is torn , it should be removed and a new one
used.
a. Double gloving –inner glove should be half a size larger than the usual size which is worn
on the outside.
b. Biogel Reveal gloves
5. Impervious mouth mask and eye / face shield to prevent exposure of mucous
membranes of mouth, nose and eyes
6. impervious boots/ shoes
7. no hand to hand passage of sharp instruments
• 8. To minimize the need for mouth to mouth resuscitation instead
rescuscitation bags or ventilation devices should be used
• 9. Health care workers / dentists who have exudative lesions or
weeping dermatitis should stop/ refrain all direct patient care
• 10. Pregnant health care workers avoid contact with aids positive
patients .
• In the case of exposure to material known or suspected to be infected
with HIV, the incident should be reported to a supervisor (if
applicable) and the exposed individual should consult with a doctor
immediately.
• Antiretroviral drugs may be prescribed as post exposure prophylaxis
(PEP) within the first 72 hours of exposure in order to help prevent
HIV infection.
• The sooner PEP is started, the more effective it is
• Basic medical information required for Dental procedures In patients with
HIV+
complications of HIV Positive
1.Leucopenia
2. Anemia
3. Thrombocytopenia
4. Fungal infections
5. Liver function test
6. Drug interaction