Oral medicine series: Hepatitis

Introduction

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• Presenter: Ryan
• Series focus: Oral medicine
• Topic: Hepatitis

What is Hepatitis?

• Definition: Inflammation of the liver
• Causes: VIRAL HEPATITIS (most common)
• Other types: Alcoholic, Toxic, Autoimmune Hepatitis
  • Alcoholic: Heavy and chronic alcohol use
  • Toxic: Poisons, chemicals, medicines, supplements (hepatotoxins)
    • Examples: phosphorus, carbon tetrachloride, acetaminophen (large doses), chloroform
  • Autoimmune: Body attacks its own liver (genetics + environmental factors)

Chronic Viral Hepatitis

• Major causes of: Liver cirrhosis (scarring) and liver carcinoma (cancer)

Immunology Review

• B lymphocytes (B cells): Humoral immunity (secreted antibodies, complement proteins)
• T lymphocytes (T cells): Cellular immunity (helper & cytotoxic T cells)
• Antibodies:
  • Salivary IgA: Main antibody in saliva
  • IgE: Involved in allergic response
  • IgG: Most common antibody
  • IgM: First responder, produced by neonatal B cells

Viral Hepatitis

Transmission

• Hepatitis A & E: Fecal-oral route (contaminated food/water)
• Hepatitis B & C: Percutaneous contact (contaminated blood/body fluids)
• Hepatitis D: Direct contact with bodily fluids, often co-infection with Hepatitis B

Memory Tricks

• Contaminated blood: C & B
• Direct: D
• Fecal-oral: E & A (vowels in fecal)

Hepatitis A (HAV)

• Transmission: Fecal-oral route
• Incubation period: 2-6 weeks
• Onset: Acute, rapid
• Symptoms: Jaundice, fever, malaise, loss of appetite, nausea
• Vaccine: Available No chronic disease or carrier state

Hepatitis B (HBV)

• Transmission: Blood/body fluid, percutaneous contact
• Incubation period: 1-6 months
• Type: DNA virus (unique among hepatitis viruses)
• Intraoral concentration: High at gingival sulcus
• Symptoms: 1/3 cases asymptomatic, rest similar to HAV
• Vaccine: Available (effective), mandatory offer by OSHA for employees
• Prophylaxis: Vaccine + immunoglobulin therapy post-exposure

Hepatitis B Serologic Tests

• Surface antigen: Diagnostic for infection
• Surface antibody: Indicates immunity (recovery or vaccination)
• Core antibody: Indicates natural immunity (infection history)
• IgM antibody to core: Acute/recent infection

Hepatitis C (HCV)

• Transmission: Contaminated blood (C & B)
• Incubation period: 2 weeks - 6 months
• Prevalence: Most common blood-borne pathogen in the US
• Symptoms: Often asymptomatic, milder when present
• Vaccine: None currently
• Treatment: Interferon alpha and ribavirin (90% cure rate)

Dental Considerations

• Avoid elective non-urgent care for active hepatitis patients
• Isolate specific room for urgent care
• Precautions: Gloves, masks, eyewear, gowns, disinfect
• Avoid or lower doses of liver-metabolized drugs (lidocaine, acetaminophen, diazepam, ampicillin)

CDC Recommendations

• Acute Hepatitis A: Stay home for a week post-jaundice onset
• Recovered/Carriers: Follow standard precautions
• Importance of medical history review

Oral Manifestations of Liver Dysfunction

• Jaundice: Yellowing of skin, eyes, oral mucosa
• Petechiae: Pinpoint bleeds, roof of mouth
• Spontaneous gingival bleeding: Coagulation issues
• Fetor hepaticus: Bad breath from liver disease
• Atrophic glossitis: Smooth tongue, no papilla
• Xerostomia: Dry mouth
• Association with Lichen Planus: Higher incidence in Hep B & C
• Risk of hepatocellular carcinoma: Rare jaw metastasis, hemorrhagic mass in mandible

Conclusion

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