Hepatology Disorders in Dentistry

Learning Objectives

• Recognize the epidemiology, manifestations, complications, and management of hepatological disorders with dental implications.
• Develop skills to interpret clinical signs and laboratory results to establish diagnoses.
• Formulate evidence-based management plans for hepatological disorders impacting dental health.
• Identify emergency situations and create comprehensive management plans to maintain patient homeostasis.

Liver Diseases of Dental Interest

Viral Hepatitis

• Involves inflammation of the liver caused by various viruses, including Hepatitis A, B, C, D, and E, along with other viruses like EBV, HSV, and CMV.
• Hepatitis A:
  • An RNA virus transmitted via the faecal-oral route.
  • No carrier state exists; prophylaxis includes immunoglobulin and vaccination.
  • Immunity likely lasts for life after infection.
• Hepatitis B:
  • A DNA virus spread through percutaneous, sexual, or perinatal routes.
  • Incubation lasts 30-180 days; a carrier state is possible.
  • Prophylaxis involves Hepatitis B immunoglobulin and a vaccination.
• Hepatitis C:
  • An RNA virus transmitted through blood and occasionally sexually.
  • Incubation is 15-160 days, with a high carrier rate (50-80%).
  • No vaccine or prophylaxis is available.
• Hepatitis D:
  • Defective RNA virus that co-infects with Hepatitis B virus.
  • No prophylaxis available; the HBV vaccine provides some immunity.
• Hepatitis E:
  • Defective RNA virus spread via the faecal-oral route.
  • Risk for travelers in endemic areas; no carrier state or prophylaxis.
• Clinical features often include flu-like symptoms, transitioning through preicteric, icteric, and posticteric phases.
• Oral manifestations: jaundice may appear in the oral mucosa. Patients known to be carriers of HBV, HCV, or HDV should be treated with caution; all are considered potentially infectious.

Alcoholic Liver Disease (ALD)

• Refers to liver injury resulting from alcohol abuse, classified into fatty liver, alcoholic hepatitis, and cirrhosis.
• Symptoms of ALD include jaundice, fatigue, ascites, and various hematological abnormalities.
• Diagnosis often includes history-taking, breath analysis, and systemic examinations.
• Dental management involves physician consultation, screening for potential complications, and informed consent.

Liver Cirrhosis

• Chronic liver disease marked by fibrosis and loss of liver function due to various causes, including infections (Hepatitis B and C), alcoholism, and drug exposure.
• Symptoms: lethargy, itching, jaundice, hepatomegaly, splenomegaly, and ascites.
• Early diagnosis uses liver biopsy, blood tests, and endoscopy to detect esophageal varices.
• Management is typically palliative with liver transplant being a consideration in advanced cases.

Liver Cancer (Hepatocellular Carcinoma)

• A malignant liver tumor, commonly developed from chronic hepatitis or cirrhosis.
• Symptoms include abdominal pain, weight loss, jaundice, and hepatomegaly.
• Diagnosis relies on liver biopsy, imaging, and serological markers like alpha-fetoprotein.
• Management strategies may include resection, transplantation, or chemotherapy.

Jaundice

• Characterized by yellow discoloration due to elevated bilirubin levels.
• Causes include hemolysis, liver disease, and biliary obstruction.
• Symptoms: yellowing of skin and sclera; in prehepatic jaundice, family history and drug exposure are important.
• Management focuses on identifying and addressing the underlying cause.

Ascites

• Defined as the accumulation of excess fluid in the peritoneal cavity, often arising from cirrhosis or malignancies.
• Symptoms include abdominal discomfort and increase in girth.
• Dental considerations include avoiding hepatotoxic substances and ensuring medical evaluations prior to any procedures.