Hepatology Disorders and Dental Implications

Learning Objectives

• Understand the epidemiology, manifestations, complications, and management of hepatology disorders with dental implications.
• Interpret clinical manifestations and laboratory investigations to diagnose hepatology disorders impacting dental care.
• Apply evidence-based management plans for dental patients with hepatology disorders.
• Identify emergency situations in hepatology to maintain patient homeostasis.

Viral Hepatitis

• Inflammation of the liver caused by hepatitis viruses A, B, C, D, E, and other viruses like EBV and CMV.
• Acute and chronic forms present, with hepatitis A primarily spreading via the faecal-oral route.
• Hepatitis A: RNA virus; risk groups include food handlers with poor hygiene; no carrier state; lifelong immunity after infection.
• Hepatitis B: DNA virus; spread through percutaneous, sexual, or perinatal routes; incubation period of 30-180 days; can be a carrier; lifelong immunity possible; prophylaxis via vaccine and immunoglobulin available.
• Hepatitis C: RNA virus; primarily transmitted percutaneously; incubation period of 15-160 days; high carrier rate; no prophylaxis or vaccine available.
• Hepatitis D: Defective RNA virus that only co-infects with Hepatitis B; similar transmission routes and risk groups as Hepatitis B; no prophylaxis.
• Hepatitis E: Defective RNA virus; faecal-oral transmission; primarily affects travellers to endemic regions; no carrier state or available prophylaxis.

Clinical Features of Viral Hepatitis

• Early symptoms resemble flu; three infection stages:
  • Preicteric Phase: Anorexia, fatigue, malaise (1-2 weeks before jaundice).
  • Icteric Phase: Jaundice, right upper quadrant pain; lasts 2-8 weeks; hepatomegaly and splenomegaly common.
  • Posticteric Phase: Symptom resolution but persistent hepatomegaly; recovery within four months.

Oral Manifestations and Dental Management

• Oral mucosal jaundice during icteric phase; all patients considered potentially infectious.
• Urgent dental treatments only for patients with active hepatitis; avoid hepatotoxic drugs.
• Implement standard precautions; screen patients for HBV before treatment.
• Consult with physician for patients known to be hepatitis carriers, following strict infection control protocols.
• Continuous testing for hepatitis status recommended for dentists.

Alcoholic Liver Disease (ALD)

• Liver damage from alcohol abuse; classified into:
  • Fatty Liver: Mild and reversible.
  • Alcoholic Hepatitis: Involves hepatocellular damage; jaundice, fever, ascites present.
  • Cirrhosis: Irreversible; fibrosis and nodule formation.
• Symptoms include jaundice, ascites, memory deficits, and prolonged bleeding.
• Diagnosis through patient history, clinical examination, and breath analysis for alcohol.

Dental Considerations in ALD

• Referral for physician consultation on health status and medications before dental procedures.
• Laboratory tests for liver function to inform treatment decisions.
• Avoid liver-metabolized drugs; consider blood products for surgery.

Liver Cirrhosis

• Chronic liver damage resulting in scar tissue and loss of function.
• Caused by infections (HBV, HCV), alcohol abuse, and certain medications.
• Symptoms include jaundice, edema, ascites; signs include hepatomegaly and spider nevi.
• Diagnosis confirmed by liver biopsy; manage complications and consider liver transplant in end-stage cases.

Liver Cancer (Hepatocellular Carcinoma)

• Malignant tumor linked to chronic HBV or HCV infections.
• Symptoms: abdominal pain, jaundice, weight loss; predominantly affects males.
• Diagnosis via liver biopsy; elevated alpha-fetoprotein present in many patients.
• Treatment options include resection, chemotherapy, and liver transplant.

Jaundice

• Visible yellow discoloration primarily in skin and sclera due to bilirubin accumulation.
• Classified into prehepatic, hepatic, and cholestatic types based on causes.
• Symptoms and signs vary by type, including family history, drug use, and signs of liver failure.
• Management focuses on identifying and eliminating underlying causes.

Ascites

• Excess fluid accumulation in peritoneal cavity, often linked to liver cirrhosis and other conditions.
• Symptoms: abdominal discomfort, increased girth, potential shortness of breath.
• No specific oral manifestations; focus on treating underlying conditions for management.