Fatal outbreaks of Hepatitis A are affecting several pockets of the country.
The Centers of Disease Control and Prevention defines Hepatitis A as a vaccine-preventable, communicable disease of the liver that is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water.
The CDC website states that while most children less than 6 years old with Hepatitis A do not have symptoms, adults with hepatitis A have symptoms that include fatigue, low appetite, stomach pain, nausea, and jaundice.
Hepatitis and the dental profession
According to a National Center for Biotechnology Information article”Hepatitis– Prevention and management in dental practice” by Parveen Dahiya, Reet Kamal, Varun Sharma and Saravpreet Kaurdentists, dentists are among the high-risk groups for hepatitis, as the virus is transferred via saliva.
“A dentist can play a major role in the prevention of hepatitis by considering each and every patient as a potential carrier of hepatitis. Proper infection control, sterilization, and prophylactic vaccination protocols should be followed in order to reduce the risk of hepatitis,” reads the article.
To decrease the burden of hepatitis in dental health care workers, the group recommends that dental professionals receive immunizations against the hepatitis viruses and should also use individual protective equipments such as gloves, head caps, masks, etc.
Exposures that might put a dental professional at risk are:
- Percutaneous injuries (needlestick or cut with a sharp object)
- Contact with potentially infectious blood, tissues, or other body fluids
- Mucus membranes of the eye, nose, or mouth or non-intact skin (exposed skin that is chapped, abraded, or afflicted with dermatitis).
Below is a list of guidelines created by the authors for determining treatment options for patients with a current or past hepatitis virus:
- No dental treatment other than urgent care should be rendered for a patient with acute viral hepatitis.
- Hepatitis B is of primary concern to the dentist. Individuals still carry the virus up to three months after the symptoms have disappeared, so any patient with a recent history of hepatitis B should be treated for dental emergency problems only.
- For patients with a past history of hepatitis, consult their physician to determine the type of hepatitis, course and length of the disease, mode of transmission, and any chronic liver disease or viral carrier state.
- For recovered hepatitis A or hepatitis E patients, perform routine periodontal care.
- For recovered hepatitis B and hepatitis D patients, consult with the physician and order hepatitis A hepatitis B patients laboratory tests.
- If hepatitis B tests are negative but hepatitis B is suspected, order another test.
- Patients who are hepatitis B positive are probably infective (chronic carriers); the degree of infectivity is measured by an hepatitis B test.
Treating patients with hepatitis infections
If a patient with active hepatitis requires emergency treatment, the authors recommend using the following precautions:
- Consult the patient’s physician regarding status.
- If bleeding is likely during or after treatment, measure prothrombin time (PT) and bleeding time. Hepatitis may alter coagulation; change treatment accordingly.
- All personnel in clinical contact with the patient should use full barrier technique, including masks, gloves, glasses or eye shields, and disposable gowns.
- Use as many disposable covers as possible, covering light handles, drawer handles, and bracket trays. Headrest covers should also be used.
- All disposable items (e.g., gauze, floss, saliva ejectors, masks, gowns, gloves) should be placed in a lined wastebasket. After treatment, these items and all disposable covers should be bagged, labeled, and disposed of, following proper guidelines for bio-hazardous waste.
- Aseptic techniques should be followed at all times. Minimize aerosol production by not using ultrasonic instrumentation, air syringe, or high-speed handpieces. Remember that saliva contains a distillate of the virus. Pre-rinsing with chlorhexidine gluconate for 30 s is highly recommended.
- When the procedure is complete, all equipments should be scrubbed and sterilized. If an item cannot be sterilized or disposed of, it should not be used.
- All working surfaces and environmental surfaces should be wiped with 2% activated glutaraldehyde (Cidex).