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)|