Hepatitis

By definition, hepatitis is an inflammation of the liver caused by a viral infection. While there are five types of hepatitis (A-E), the three main types (A-C) are the focus of this section.

First, Hepatitis A is transmitted via the fecal-oral route and a vaccine does exist. Due to the route of transmission, there is not a high risk of dental health care workers transmitting the disease. While Hepatitis A does not result in chronic infection, it can result in significant liver failure.

Second, Hepatitis B is transmitted through blood, saliva and semen/vaginal fluid (e.g., needle stick, IV drug use, sex). A three-part vaccine exists to prevent acquiring the disease. Hepatitis B can result in both acute and chronic infection that can eventually lead to liver cancer.

Third, Hepatitis C is most frequently transmitted from IV drug use and more than half of patients develop chronic infection, which may lead to liver failure and/or cancer. A vaccine is currently not available.¹⁹ Table 12 provides a summary of the various types of Hepatitis, the mode of transmission, prevention and the level of occupational risk associated with each type.

Table 12. Summary of Hepatitis⁽¹⁾
	Mode of Transmission	Prevention	Risk to You / Occupational Exposure
Hepatitis A	Fecal, oral	Vaccine Hand washing	Little to none
Hepatitis B *Chronic	Blood or bodily fluids	Vaccine Universal Precaustions Avoid High risk behaviors	Up to 30% risk of trasmission with needle stick
Hepatitis C *Chronic	Blood or bodily fluids	Universal Precaustions Avoid High risk behaviors	About 2% risk of transmission
Hepatitis D	Blood or bodily fluids	Hep B Vaccine	Little to none
Hepatitis E	Fecal, oral travel	Hand Washing	Little to none

When providing dental care for patients with hepatitis, limit local anesthetic with vasoconstrictor to 2-3 cartridges.¹ If they have a known history of infection, use standard precautions and be aware that they may have bleeding tendencies as well. One of the most important modifications for dental treatment in a patient with active hepatitis (acute infection) is that elective treatment should be postponed and that a medical consult is required before treatment.

Some helpful follow-up questions to ask patients with hepatitis are listed in Table 13.

Table 13. Follow-Up Questions for Hepatitis Patients⁽¹⁾
When were you diagnosed with hepatitis? What type of hepatitis did/do you have? What type of treatment did you receive? Have you been tested to determine if you are a carrier? Do you have any liver problems/damage?

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