Hepatitis Patient Care in Dentistry

Questions and Answers

Which type of patient is considered to be at low risk for Hepatitis infectivity?

Patient with positive HBsAg

Patient with histories compatible with Hepatitis A & E infection who have normal liver tests and negative antigen (correct)

Patient with jaundice and symptoms of viral Hepatitis

Patient with abnormal liver function tests

What is the significance of a patient being HBsAg positive?

They have normal liver function tests

They are carriers of Hepatitis B (correct)

They are not infectious

They are recovered and immune to HBV

What should be done before performing any invasive procedure on a patient with a history of hepatitis?

Prescribe acetaminophen as a pain reliever

Administer a local anesthetic without hesitation

Start antibiotic prophylaxis immediately

Consult with the patient's physician to discuss medications and interactions (correct)

What is the recommended course of action for patients with abnormal liver function tests?

Refer to physician for medical diagnosis and treatment Signup and view all the answers

What test should be conducted to assess a patient's coagulation and hemostasis before dental treatment?

All of the above Signup and view all the answers

Why is it recommended to avoid drugs metabolized in the liver for patients with Hepatitis?

To prevent further liver damage Signup and view all the answers

Why is it recommended to obtain preoperative prothrombin time and bleeding time in patients with Hepatitis?

To assess the patient's risk for bleeding complications Signup and view all the answers

When should a face shield be worn?

During procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions Signup and view all the answers

What local hemostatic measures may be necessary during dental treatment?

Both a and b Signup and view all the answers

What is the consequence of finding a patient to be a carrier of Hepatitis?

The information could be of extreme importance for lifestyle modification Signup and view all the answers

What may be necessary in some cases to prevent excessive bleeding during dental treatment?

Pre-operative optimization with vitamin K therapy or transfusions Signup and view all the answers

When should hand hygiene be performed?

Immediately after touching blood, body fluids, secretions, excretions, and contaminated items Signup and view all the answers

Why should caution be used when prescribing medications to patients with hepatic impairment?

Because they may be metabolized in the liver Signup and view all the answers

What may be required for patients with immune impairment?

Antibiotic prophylaxis Signup and view all the answers

What is the purpose of screening for HBsAg and anti-HCV?

To determine the patient's risk for Hepatitis infectivity Signup and view all the answers

What local anesthetics can be administered to patients with hepatic impairment?

Articaine and prilocaine Signup and view all the answers

What is a potential complication of undetected chronic active Hepatitis?

Bleeding complications Signup and view all the answers

Why is attention to minimization of surgical trauma important in patients with hepatic impairment?

To minimize the risk of further liver damage Signup and view all the answers

What is the purpose of wearing gloves?

To prevent touching mucous membranes and non-intact skin Signup and view all the answers

What is the significance of a patient having negative antigen and positive antibody tests for Hepatitis B?

They are recovered and immune to HBV Signup and view all the answers

How should soiled patient-care equipment be handled?

By wearing gloves and performing hand hygiene Signup and view all the answers

How should needles and other sharps be handled?

By placing them in a puncture-resistant container Signup and view all the answers

What is a key principle of injection safety?

Never administering medications from the same syringe to more than one patient Signup and view all the answers

What is a key aspect of respiratory hygiene/cough etiquette?

Covering the mouth and nose when sneezing or coughing Signup and view all the answers

What is recommended for environmental surfaces?

Develop procedures for routine care, cleaning, and disinfection Signup and view all the answers

What is recommended for textiles (linen and laundry)?

Handle them in a manner that prevents transfer of microorganisms Signup and view all the answers

Study Notes

Patients with Viral Hepatitis

Patients in the acute stage of viral hepatitis are not treated for anything other than urgent care and are managed as potentially infectious.
Before any invasive procedure, the patient's physician should be consulted to discuss which drugs are used and their possible interactions.

Coagulation and Hemostasis Tests

Coagulation tests including Prothrombin time, Activated partial thromboplastin time, and International normalized ratio (INR) should be conducted.
Liver function tests including Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) should be performed.
If test results are significantly abnormal, any dental treatment must be provided only after consultation with the relevant medical specialist.

Medication Precautions

Caution should be used in prescribing medications metabolized in the liver, such as acetaminophen and non-steroidal anti-inflammatory agents.
Local anesthetics should be administered cautiously to patients with hepatic impairment.
Articaine (plasma) and prilocaine (partly in lungs) have other sites of metabolism.

Drug Dosage and Administration

In some cases, lower drug dosages are required (e.g., ampicillin).
Some drugs (e.g., erythromycin, metronidazole, tetracycline's) should be avoided completely.
Local hemostatic measures may be necessary, including compression, sutures, dressings such as oxidized cellulose, and antifibrinolytic agents such as tranexamic acid.

Pre-operative Optimization

Pre-operative optimization with vitamin K therapy or transfusions may be necessary.
Where immune impairment is present, antibiotic prophylaxis may be necessary.
Attention should be paid to minimization of surgical trauma.

Assessing the Risk of Hepatitis Infectivity

Based on history, examination, and laboratory profile, the relative risk of Hepatitis infectivity can be assessed.
Patients can be categorized as low risk, high risk, or substantial risk (HBV or HCV).

Management of Patients with Hepatitis

Patients at low risk can be managed utilizing normal protocols with the single addition of masks and gloves for the dentists and assistants.
Patients with positive HBsAg or abnormal liver function tests require no elective dental treatment and should be referred to a physician for medical diagnosis and treatment.
An isolated operatory and adherence to strict standard precautions are recommended.
Minimal aerosol production is recommended.

Infection Control Precautions

Hand hygiene should be practiced immediately after touching blood, body fluids, secretions, or contaminated items.
Personal protective equipment (PPE) including gloves, masks, eye protection, and gowns should be worn as necessary.
Soiled patient-care equipment should be handled in a manner that prevents transfer of microorganisms to others and the environment.
Environmental surfaces should be cleaned and disinfected regularly, especially frequently touched surfaces in patient-care areas.
Needles and other sharps should be handled safely and disposed of properly.
Injection safety practices should be followed during administration of injected medications.
Respiratory hygiene/cough etiquette should be followed to prevent the spread of infectious respiratory secretions.

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Description

This quiz covers the guidelines for treating patients in the acute stage of viral hepatitis in a dental setting, including necessary precautions and consultations.