ORAL MEDICINE & RADIOLOGY

1. DEPARTMENT OF ORAL MEDICINE & RADIOLOGY
HEPATITIS A,B,C

2. CONTENTS
• INTRODUCTION
• HEPATITIS A
• HEPATITIS B
• HEPATITIS C
• PHASES
• CLINICAL FEATURES
• ORAL MANIFESTATIONS
• LABORATORY FINDINGS
• MANAGEMENT
• PREVENTION
• DENTAL CONSIDERATIONS
• CONCLUSION
• REFERENCE

3. INTRODUCTION
• Hepatitis is the Inflammation of liver.
• Hepatitis has number of potential
causes, both Infectious & Non
Infectious.
• Non infectious - Alcohol,
Presecription medications, Drug
abuse
• Infectious - Virus & Bacterial
infections
• There are mainly 6 types of viral
Hepatitis - Hepatitis A,B,C,D,E,G

4. HEPATITIS A
• It is also called INFECTIOUS HEPATITIS
• It is caused by the hepatitis A virus
[HAV],an enterovirus of picornaviridae
family
• Transmission is primarily by the orofecal
route
• It can be spread through contact of an
infected person,travelling to an endemic
region and ingestion of contaminted food
& water
• Incubation period: 15 to 45 days

5. HEPATITIS B
• It is also called SERUM HEPATITIS
• It is caused by the Hepatitis B virus [HBV] is a 42nm DNA Virus of the
Hepadnaviridae family
• Mode of transmission: parenteral,perinatal,sexual transmission
*Parenteral : Infected blood & blood products or body fluids [tears,saliva] ,
sharing of infected needles
*Perinatal : Carrier mother’s blood contaminates the mucous membrane of
the newborn during birth.
* Sexual : HBV is present in body fluids such as semen and vaginal
secretions,so it can be transmitted by sexual contacts

6. • 5 to 10 % infected people remain as the carriers
• Hepatitis B tends to have greater mortality and morbidity than
hepatitis A
• Incubation period : 60 to 90 days

7. HEPATITIS C
• Hepatitis C virus,previously known as one of the non-A non-B
hepatitis virus.
• It is a small ,positive-sense, single- stranded RNA virus of Flaviviridae
family
• It is responsible for sporadic viral hepatitis in intravenous drug users
and in patients with renal dialysis
• It has got less clinical severity as compared to Hepatitis B
• Incubation period : 45 to 50 days

8. PHASES OF HEPATITIS
• PRODROMAL PHASE
It is 1-2 weeks
Symptoms like anorexia,nausea,malaise,fever
• ICTERIC PHASE
It is 6-8 weeks
Symptoms like anorexia,nausea,vomiting,pain in the right
quadrant of abdomen, Hepatomegaly and splenomegaly
may also been seen
• RECOVERY PHASE
Symptoms disappears, but abnormal liver function values may persist

9. CLINICAL FEATURES
Fever Chills
Headache Malaise
Athralgia Anorexia
Pain Nausea
Vomiting Distaste for food
Disturbed smell Dark coloured urine
Pale /clay coloured stool Jaundice
Hepatomegaly Splenomegaly
Skin rashes Weight loss

11. ORAL MANIFESTATIONS
• Oral cavity may show evidence of liver dysfunction with the presence of
hemorrhagic changes, petechiae, hematoma, jaundiced mucosal tissues,
gingival bleeding, Icteric mucosal changes.
• Sjogren’s syndrome & chronic hepatitis have been associated with lichen
planus.
• Glossitis may be seen with alcoholic hepatitis, especially if combined
with nutritional deficiencies
• Ecchymosis and reduced healing after surgery may also be identified.
• In some cases parotid gland enlargement is evident.

12. Presenting pale gingiva with palatal Petechiae
Oral lichen planus

13. LABORATORY FINDINDS
• Plasma bilirubin level : plasma bilirubin level exceeds of
3mg/dl
• SGPT,SGOT level: SGPT,SGOT levels increase 10 times in
hepatitis
• Alkaline phosphatase level : Liver enzymes such as alkaline
phosphatase and lactic dehydrogenase show slight elevation
• WBC: WBC shows leukopenia,leukocytosis and atypical
lymphocytes

14. MANAGEMENT
• GENERAL TREATMENT
Symptomatic treatment : like
bed rest and prevention by
isolation of blood,saliva
contaminated objects ; use of
gloves and apron,and sterilised
instruments are must
Nutrition : A high calorie diet
should be given.It is usually given
in the morning because many
patients experience nausea in the
evening

15. Drugs : There is no specific drug useful for it. But interferon and
ribavirin have been tried with some sucess in chronic
hepatitis
Prevention : The patient should avoid salivary transmission to
others by avoid kissing, spitting and sharing food,
cigarettes, utensils and sexual contact

16. • Hepatitis A : It is self - limiting and resolves withinone month
Mortality is very low. Treatment is usually symptomatic.
• Hepatitis B : Chronic hepatitis B infection can be treated by
lamivudine or interferon . Treatment is needed for 1 to
3 years
• Hepatitis C : Chronic hepatitis C is treated by a combination of
ribavirin, interferon alpha or pegylated interferon

17. PREVENTION
• HEPATITIS A
People who are known to have contact with a patient, such that
they may have ingested minute amounts of fecal material or
have been injected with as little as 0.0004 ml of infected blood,
should be given prophylactic gamma globulin injections.
• HEPATITIS B
A vaccine has been prepared from the plasma of asymptomatic
carriers of hepatitis B. It is composed of non-infectious
hepatitis B surface antigen particles.It is recommended in all
high-risk groups

18. * IMMUNISATION
Passive immunisation : HBIG can be given in doses of 300-500 IU Intramuscularly.
Active immunisation: Plasma derived vaccine & Recombinant yeast hepatitis B
vaccine both are stored in cold but not frozen .Three doses 0,1 & 6 months are
administrated intramuscularly into deltoid muscle.
HEPATITIS C
There is no vaccine available for this hepatitis . Preventive
measures like not sharing personel items with infected person,
not sharing needles used by drug adducts,avoiding to
have tattoos without strict health precautions

19. DENTAL CONSIDERATIONS
• Risk to dental professionals
Hepatitis B,C and other types can be transmitted to the
dentist by blood-contaminated needles from an infected
patient in acute phase of the disease
• Clotting factors assessment
If surgery is necessary, obtain preoperative prothrombin time
and bleeding time,as in liver diseases,deficiency of clotting
factors may be present

20. • Universal infection precaution
Dental personnel may act as a source of infection to the patient.
* Dentists who are carriers of HBV and who do not practice
universal infection control precautions, can transmit the
infection to the patient. At the same time, it is required to avoid
infection from patient to be transmitted to dental personnel.
* Universal infection control measures should be practiced such as :
Professional immunisation against HBV
Proper handling of instruments

21. Sterilization of instruments
Disinfection of dental unit
Personal proctective equipments[
gloves, protective eye wear, masks,
protective clothing / gowns]
• Minimize aerosol production
By using a slow speed handpiece
and using air syringe

22. CONCLUSION
• Hepatitis is the inflammation of liver
• Viral hepatitis are of 6 type : Hepatitis A,B,C,D,E,G
• Malaise,arthalgia,skin rash,liver enlargements,jaundice,darkening of
urine, clay coloured stool,xerostomia,Ictreus seen on palate &
sublingual regions, oral lichen planus are the clinical features.
• Strict aspectic procedures,Universal infection precaution,clotting
factor assessments should be strictly follow.

23. REFERENCES
• Textbook of Oral medicine - Anil Govindrao Ghom,Savita Anil Ghom -
3rd Edition
• Textbook of Oral Medicine,Oral Diagnosis and Oral Radiology
Ravikiran Ongole,Praveen B N - 2nd Edition
• Textbook of Clinical Medicine for Dental Students - 5th Edition
Dr. S N Chugh, Dr. Anshul Chug

24. THANK YOU