The role of the OHT in the management of Hepatitis

Question 1

Define “hepatitis”, and mention:

• which strains of hepatitis are responsible for the disease

- How the virus attacks the body and causes inflammation

Answer 1

Definition:
• Viral Hepatitis is defined as inflammation of the liver

Strains of hepatitis:
• This inflammation is caused by a group of viruses categorised from A-E

How the virus attacks the body and causes inflammation:
• The hepatitis virus enters the body and travels to the liver via different modes of contamination/infection
• In the liver, the virus attaches to healthy liver cells and multiplies
• This replication triggers a response from the immune system
• The body’s immune response to the virus causes inflammation and damage to the liver. i.e. cirrhosis of the liver

Question 2

Describe “hepatitis A” by stating:

• Transmission route
• Its significance (symptoms/ immunity)
• Whether a vaccine is available

Answer 2

Transmission route:
· Oro-faecal route

Its significance (symptoms/ immunity):
· Symptoms can be debilitating but most people recover completely with in a few months 
· Once you have had hepatitis A you are lifelong immune

Whether a vaccine is available:
· Yes

Question 3

Describe “hepatitis B” by stating:

• Transmission route
• Its significance including people at risk and its outcomes
• Groups at risk
• Whether a vaccine is available

Answer 3

Transmission route:
· Blood contact
· Bodily fluid like saliva

Its significance including people at risk and its outcomes
· Most common liver infection in the world, being most prevalent in Africa and East Asia
· Groups at risk: Indigenous people, high risk sexual activity and drug users
· If left untreated, it can lead to cirrhosis, liver cancer and liver failure

Whether a vaccine is available
· Yes

Question 4

Describe “hepatitis D” by stating:

• Transmission route
• Its prevalence
• Whether a vaccine is available

Answer 4

Transmission route:
· Blood contact

Its prevalence:
· NOT a common cause of liver disease in Australia

Whether a vaccine is available:
· No, but a Hepatitis B vaccine works for it

Question 5

Describe “hepatitis E” by stating:

• Transmission route
• Its significance (where it is found, its outcomes)
• Whether a vaccine is available

Answer 5

Transmission route:
· Oro-faecal route

Its significance (where it is found, its outcomes):
· Found commonly in developing countries like India, Asia, Africa and Central America
· Only causes acute infection
· Does not cause chronic infection
· Similar symptoms as with Hepatitis A

Whether a vaccine is available:
· No

Question 6

Discuss the most common types of hepatitis C in Australia

Answer 6

· There are at least 6 different genotypes of hepatitis C in Australia, which are numbered 1, 2, 3, ect
· There are also subgroups within each genotype
· The most common genotypes found in Australia are type 1 and to a lesser extent type 3
· It is possible to be infected with multiple hepatitis C genotypes

Question 7

Explain whether a vaccine is available for hepatitis C

Answer 7

· No, and it is considered not possible
· Unlike antibodies to other diseases, such as hepatitis A/B, hepatitis C antibodies do not provide any immunity to hepatitis C
· Even people who have been infected with hepatitis C and cleared the virus, re-infection can still occur

Question 8

Discuss the oral manifestations of hepatitis C, its effects on the individual and the OHTs role

Answer 8

Oral manifestations
· People with active and/or undiagnosed Hep C are prone to the tooth decay
· Increased incidence of xerostomia, especially those who also take antidepressants

Xerostomia leads to: 
· caries
· burning mouth
· candida
· dry lips
· altered taste
· halitosis
· difficulty wearing dentures
· difficulty chewing/ swallowing and talking

Question 9

Discuss the effects of the oral manifestations of Hepatitis C on the individual and the OHTs role

Answer 9

Effect on the individual:
· Caries leads to poor self esteem because of poor aesthetics
· Caries leads to poor oral health leading to difficulty with diet

OHTs role:
· An effective preventive care programme for a patient diagnosed with HCV should be the dental practitioner’s goal

Question 10

Discuss the previous medical management of hepatitis C

Answer 10

· Treatment was a combination of pegylated interferon injection and ribavirin oral medication

· They worked by decreasing the viral load and increasing the host immune response

· However, they caused significant side-effects and they increased the chances of relapse

Question 11

Discuss the current treatment options, what determines the length of treatments and the treatment time for the Type 1 genotype

Answer 11

· A new class of medication called protease drugs were released in 2016 
· Newer treatment involves identifying the genotype of the virus from blood testing and then providing medications based on that
· The treatment duration is determined by virus genotype and presence of cirrhosis of the liver
· General treatment length is 12- 24 weeks
· Type 1 genotype: 12 weeks
· These new class of medications can achieve 95% clearance rate in people by taking a course of tablets

Question 12

List the 4 side effects of the new medications used for HCV

Answer 12

· Significant fatigue
· Disturbed sleep
· Nausea
· Headache

Question 13

Discuss the 3 dental considerations when managing an HCV patient

Answer 13

· Drug Interactions with LA are still unknown, but usually none with anti-viral medications. Check with the patients GP before tx
· Consult supervising dentist, patients G.P./ Medical Specialist to determine the appropriate timing of any dental treatment during this period

· Needle-stick injury: The chance of catching hep C this way is possible, but the risk is extremely low
○ If you do get a needle-stick injury, you should wash the source of the wound with soap and water (or alcohol-based rub if soap and water are not available) and see a doctor immediately.