Other Types Of Hepatitis
- Autoimmune hepatitis: Autoimmune hepatitis is when the body forms antibodies to attack its own liver cells. The immune system mistakes the liver as harmful and causes ongoing mild to severe inflammation that eventually hinders proper liver function.
- Type 1 autoimmune hepatitis: The most common type and occurs at any age. About 50% of this type have other autoimmune diseases.
- Type 2 autoimmune hepatitis: This occurs at any age yet more so in children and young people. May have other autoimmune diseases.14
Autoimmune hepatitis risk factors are being female and heredity . A history of infections with measles, herpes simplex, or Epstein-Barr virus. Autoimmune hepatitis may have an increased risk with other autoimmune diseases such as rheumatoid arthritis, celiac disease, and hyperthyroidism.3
Genetic hepatitis Genetic hepatitis is an inherited medical condition that affects normal liver function and causes liver inflammation. A few medical conditions involve abnormal storage of minerals. Hemochromatosis causes the body to accumulate too much iron and, in effect, disturbs the heart, pancreas, and liver. Wilsons disease stores an excess of copper in the brain and liver. Both conditions cause cirrhosis.2,11
Ischemic hepatitis Ischemic hepatitis is also known as shock liver. This is from reduced or inadequate blood flow and supply to the liver. Reasons for this may be heart or respiratory failure or when both the hepatic artery and the portal vein are blocked.
Two: Report And Documentation
Occupational exposure should be reported immediately. Details regarding the circumstances under which the exposure happened and the employee was administered prophylaxis should be recorded in the employee’s medical record. The documentation should include: Date and time of exposure, details of the accident , details of exposure accident , severity of injury , and details about the source of infectious material. The following should be checked:
- Does the source of potentially infectious material have HBV, HCV, or HIV infection?
- If a patient, the source of material, is HIV positive, the stage of disease or the level of infectious particles in the blood should be determined
- It is important to note the history of taking antiretroviral therapy, or antiretroviral resistance
- It is necessary to record the details of the exposed person .
Control Testing And Advising After Exposure To Hcv Include The Following
- Repeat the test for anti-HCV antibodies and ALT at the earliest 46 months after exposure
- Do the test for HCV RNA for 46 weeks for early diagnosis
- During the testing period, the exposed person must not donate blood, plasma, organs, tissue, or sperm
- Exposed person should abstain from changes in sexual activity, pregnancy, breastfeeding, or professional activities
- Counseling services should be offered.
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Talking To The Dentist About Hepatitis
The viruses known as HPV and HCV are the cause of chronic liver disease and a host of other health problems. Its a contagious disease that can affect the way that your body responds to dental care and it can also influence the type of dental care that you receive. Dentists in the New Holland PA area are required to be immunized against these viruses, and they are also trained to provide high-level dental care for patients who are living with the disease. Heres what you should know about Hepatitis and your dental health:
Presentation On Theme: Dental Management Of Patients With Liver Disease Abbas Alaboudy Presentation Transcript:
1 DENTAL MANAGEMENT of Patients with Liver Disease ABBAS ALABOUDY
2 PLEASE READ THIS CAREFULLY: Hepatitis B vaccine is made from parts of the hepatitis B virus. It cannot cause hepatitis B infection. The vaccine is usually given as 2, 3, or 4 shots over 1 to 6 months. Infants should get their first dose of hepatitis B vaccine at birth and will usually complete the series at 6 months of age Vaccination of Hepatitis B virus for the students is mandatory before starting any clinical exposure or dealing with the patients
3 What is the liver? The liver is a large organ, and occupies the upper right quadrant of the abdomen. It develops as an outgrowth of the gut.Veins returning from the gut come together to form the portal vein. Hepatic veins join the vena cava. The liver will retain normal function until 85% damaged..Often enjoyed with fava beans and a nice chianti Function of the Liver Metabolism / Detoxification, Metabolizes products of digestion, Glucose regulation, Vitamin storage Metabolizes drugs (Some of the common drugs used in Dentistry, Ethanol. Breaks down bilirubin Synthesis and Secretion Components of clotting factors Cholesterol, triglyceride synthesis Bile production Other proteins and hormones Storage and Filtration of Blood Acts as a blood reservoir Contains phagocytic cells Part of the reticuloendothelial system.
27 Dental Management of Liver Patients
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Dental Patients With Liver Disease
Medical considerations in dental treatment of patients with liver disease. Main types of liver disease, clinical manifestations, lab tests, treatment considerations.
Medical considerations in dental treatment of patients with liver disease. Main types of liver disease, clinical manifestations, lab tests, treatment considerations.
Exposure That Might Place A Dentist At Risk Of Hepatitis Infection Includes The Following
- Percutaneous injuries
- Contact with potentially infectious blood, tissues, or other body fluids
- Mucus membranes of the eye, nose, or mouth or non-intact skin .
Percutaneous injuries pose a greater risk of transmission. The majority of exposures in dentistry are preventable, and methods to reduce the risk of blood contacts have included use of standard precautions and engineering controls and modifications of work practice. These approaches might have contributed to the decrease in percutaneous injuries among dentists during recent years. However, needlesticks and other blood contacts continue to occur, which is a concern because percutaneous injuries pose the greatest risk of transmission.
When a patient enters a dental clinic, his/her medical history should be recorded. All patients with a history of hepatitis must be managed as they are potentially infectious. Whether or not an individual becomes a chronic carrier of hepatitis B depends on geographic, socioeconomic, immunologic, and genetic factors. A high carrier rate is found among patients with the following:
- Lepromatous leprosy
- Patients on chronic renal dialysis
- Down syndrome
- Drug abusers having history of hepatitis.
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What Causes Hepatitis In A Child
Hepatitis in children can be caused by many things. Your child can get hepatitis by being exposed to a virus that causes it. These viruses can include:
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Hepatitis viruses. There are 5 main types of the hepatitis virus: A, B, C, D, and E.
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Cytomegalovirus. This virus is a part of the herpes virus family.
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Epstein-Barr virus. The virus causes mononucleosis.
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Herpes simplex virus. Herpes can affect the face, the skin above the waist, or the genitals.
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Varicella zoster virus . A complication of this virus is hepatitis. But this happens very rarely in children.
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Enteroviruses. This is a group of viruses often seen in children. They include coxsackie viruses and echoviruses.
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Rubella. This is a mild disease that causes a rash.
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Adenovirus. This is a group of viruses that causes colds, tonsillitis, and ear infections in children. They can also cause diarrhea.
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Parvovirus. This virus causes fifth disease. Symptoms include a slapped-cheek rash on the face.
Conditions can also cause hepatitis in children. These can include autoimmune liver disease. For this disease, your childs immune system makes antibodies that attack the liver. This causes inflammation that leads to hepatitis.
Key Points About Hepatitis In Children
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Hepatitis is an inflammation of the liver. It can damage and destroy liver cells.
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Hepatitis in children can be caused by many things. Your child can get hepatitis by being exposed to a virus that causes it.
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There are 5 main types of the hepatitis virus: A, B, C, D, and E.
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The most common symptoms of hepatitis include a yellowish color to the skin and whites of the eyes and flu-like symptoms.
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Some children don’t have any symptoms.
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Getting vaccinated and having good hygiene can prevent hepatitis.
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History And Physical Exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
During a physical examination, your doctor may press down gently on your abdomen to see if thereâs pain or tenderness. Your doctor may also check for any swelling of the liver and any yellow discoloration in your eyes or skin.
Three: Evaluation Of Exposure
The potential for spreading the infection of HBV, HCV, or HIV should be evaluated based on the type of infective material, the site of entry of material into the body of the exposed person, and the severity of exposure. Significant exposure may be a risk for further transmission of pathogens by blood and requires further evaluation of body fluids: Blood, sperm, vaginal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluid. Body fluids that do not present the risk of transmitting infectious agents of this type, unless they clearly contain blood, are urine, sputum, saliva, stool, vomit, nasal excrete, tears, and sweat.
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Common Symptoms Of Hepatitis
If you are living with a chronic form of hepatitis, like hepatitis B and C, you may not show symptoms until the damage affects liver function. By contrast, people with acute hepatitis may present with symptoms shortly after contracting a hepatitis virus.
Common symptoms of infectious hepatitis include:
It is crucial to understand what is causing hepatitis in order to treat it correctly. Doctors will progress through a series of tests to accurately diagnose your condition.
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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.
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.
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Four: Evaluation Of Sources
When the patient source of infectious material is known, it is necessary to follow these:
- Test the patient for anti-HBsAg, HCV and HIV antibodies
- Evaluation of viral load for routine control of a patient source is NOT recommended
- Test the patient by rapid HIV test.
If the patient is NOT infected with either of these viruses, after primary test of the exposed person, further control monitoring is not required.
When the patient source is not known, it is necessary to evaluate the possibility and the level of risk of exposure. To consider the possibility of infection by these viruses in patients, who were connected to the circumstances of exposure . do not test the wasted needles for these pathogens because the reliability of obtained results is not known.
Dental Management Of The Hemophilic Patient
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Hepatitis: Different Types Of Hepatitis Dental Professionals Should Know About
Hepatitis is an inflammation of the liver that ranges from minimal symptoms to severe liver failure. Hepatitis is mainly viral with the common A, B, and C strains and these strains are the ones dental professionals are mostly aware of. Other hepatitis categories include infectious, metabolic, autoimmune, genetic, and ischemic.
As discussed below, the dental management of hepatitis patients is very important. Also, as most dental professionals are aware, infection control practices are developed to minimize infection to the caregiver.
Knowing which hepatitis a patient has or had will help determine if any additional precautions are needed. According to the American Dental Association, dental providers are at a three- to four-fold risk of contracting the hepatitis B virus compared to the general population. The hepatitis B vaccine that we are required to have as dental professionals and the precautionary methods we take greatly decreases the risk of obtaining the virus.5 According to the Centers for Disease Control and Prevention, completing the series of vaccine shots for the hepatitis B virus protects us from becoming infected.18
Causes Of Noninfectious Hepatitis
Although hepatitis is most commonly the result of an infection, other factors can cause the condition.
Alcohol and other toxins
Excess alcohol consumption can cause liver damage and inflammation. This may also be referred to as alcoholic hepatitis.
The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to thickening or scarring of liver tissue and liver failure.
Other toxic causes of hepatitis include misuse of medications and exposure to toxins.
Autoimmune system response
In some cases, the immune system mistakes the liver as harmful and attacks it. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. Itâs three times more common in women than in men.
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Dental Concerns Of Hepatitis
The goal is to prevent the spread of bloodborne pathogens and aerosols between patients and patients to the dental provider in the operatory. Although bloodborne pathogens can be transmitted through mucous membranes, according to the CDC, there are no known instances of bloodborne pathogens transmitted by an aerosol in the dental environment. Hepatitis is spread through direct contact with saliva, blood, or bodily fluids not by aerosols.17
Dental management is important for hepatitis patients. A patient with acute viral hepatitis should be limited to urgent care.5 Dental manifestations of hepatitis with liver dysfunction may include mucosal membrane jaundice, bleeding disorders, petechiae, gingivitis, bleeding gingiva, cheilitis, smooth and atrophic tongue, xerostomia, bruxism, crusted perioral rash, and fetor hepaticus.
Liver disease may cause decreased plasma coagulation. It may also result in adjustments to certain medications due to metabolism.5
Hepatitis And Dental Professionals
In a dental office, infections can be expedited through several routes, including direct contact with blood, oral fluids, or other secretions indirect contact with contaminated instruments, operatory equipment, or environmental surroundings or contact with airborne contaminants present in either droplet splatter or aerosols of oral and respiratory fluids. HBV is the major causative agent of acute and chronic liver infection, cirrhosis, and primary hepatocellular carcinoma worldwide. There are more than 300 million carriers of the virus globally, and about 90% of these live in developing countries. Among the global carriers, 75% are from the Asian continent, where between 8% and 15% of the population carries the virus.
It has been documented that HBV infection is the most important infectious occupational hazard in the dental profession.
A number of reports suggest the following:
- A significantly higher incidence of HBV infection among dental staff
- A higher rate of HBV infection especially among oral surgeons, periodontists, and endodontists.
Vectors of infection with HBV in periodontal practice are blood, saliva, and nasopharyngeal secretions. Intraorally, the greatest concentration of hepatitis B infection is in the gingival sulcus. Also, periodontal disease, severity of bleeding, and bad oral hygiene are said to be associated with the risk of HBV.
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General Picture Of Types Of Viral Hepatitis
Viral hepatitis is almost always caused by one of the specific hepatitis viruses. All these viruses give rise to illnesses which are similar in their clinical and pathological features and are frequently anicteric or asymptomatic.
The term viral hepatitis is usually applied to the acute stage of the disease which is characterized by fever, malaise, and jaundice, but seldom causes death. Chronic manifestations of the disease are classified either as chronic hepatitis or massive liver necrosis. In mild forms of the disease, the patient has flu-like symptoms of nausea and vomiting and a smoker may develop distaste for cigarettes. The patient may have arthritis or rash involving distal joints.
Infectious hepatitis was thought to be orally acquired, with a short incubation period of about 50 days and tending to occur primarily in children and young adults, sporadically and in epidemics. The course runs from 6 to 8 weeks and the disease normally resolves with no sequelae.
Serum hepatitis was thought to be parenterally transmitted, with an incubation period of 50100 days. It occurs sporadically in any age group, but older individuals are more affected.
Chronic hepatitis caused by HBV and HCV is a major health care problem with an estimated worldwide prevalence of hepatitis B being 28% and of hepatitis C being around 3%.