Liver Diseases

LIVER DISEASES
SIDRA FAHIM
DEPARTMENT OF ORAL MEDICINE
COMMON TYPES OF LIVER DISEASE
• Infections (particularly viral
hepatitis)
• Obstructive jaundice
• Cirrhosis (often due to alcohol)
• Tumours
RELEVANCE TO DENTISTRY
IMPAIRED DRUG METABOLISM
• Most drugs are metabolised in the liver (no drugs

should be given to patients with liver disease)
• Drugs of dental relevance metabolised by the liver

include local anaesthetics, aspirin, diazepam and
intravenous sedatives, penicillins and metronidazole
HEPATITIS A
• Common form of infectious hepatitis

• Contaminated food or water
• Incubation period 2–6 weeks
• Jaundice is mild
• Spontaneous recovery takes 3 months
• Diagnosis is based on the signs and symptoms and on
serological testing for anti-HAV IgM and IgG antibodies
HEPATITIS E
• Transmission is also by the

faecal–oral route
• Reservoir of infection is in
animals
• Spontaneous recovery is
usual
HEPATITIS B
• Chief risk to dental personnel

• Hep B virus can carry within it the delta agent (Hep D)
• Spread vertically at birth
• Horizontally in families in endemic areas
• Transmission is also by sexual contact or through infected blood
• Risk of infection from blood transfusions and medical
procedures
• PEP available
HEPATITIS B
• Incubation period is at least 2–6 months
• Immune response to the virus clears infection, damaging the

liver in the process
• Majority of infections are subclinical (anicteric)
• Vaccine is the HBsAg engineered in yeast

C/F OF HEP B INFECTION
• 5%–10% of patients become persistent carriers

• Acute Hepatitis Loss of appetite, muscle pain, fever,
jaundice swollen, painful liver
• Acute illness is severe; followed by complete recovery
and long-lasting immunity
• Raised serum levels of liver enzymes, bilirubin and
often of alkaline phosphatase
• Confirmation of diagnosis is by serology
HEPATITIS D
• Delta agent is a defective RNA virus that can only infect and replicate in
the presence of HBsAg
• Delta infection is thus only transmitted with hepatitis B or to a person

already infected by it
• Delta infection causes acute hepatitis
• This rarely resolves; causes progressive liver disease with a high

mortality rate
• Immunisation against hepatitis B also protects against the delta agent

GUIDELINES FOR ZONING OF WORK AREA
FOR HEPATITIS (B, C) PATIENTS
Designated Treatment Areas
• Assign specific treatment rooms for patients with Hepatitis

B to minimize cross-contamination
• Ensure these rooms are equipped with all necessary

supplies to avoid moving equipment in and out.
PREVENTION PROTOCOLS
• Infection Control Protocols

• Follow strict infection control protocols, including the use of personal protective
equipment (PPE) such as gloves, masks, and gowns
• Use disposable items whenever possible and ensure proper sterilization of reusable
instruments
• Environmental Cleaning
• Clean and disinfect surfaces thoroughly after each patient. Use EPA-registered
disinfectants effective against Hepatitis B virus.
• Pay special attention to high-touch areas like dental chairs, countertops, and door handles
• Waste Management
• Dispose of sharps and other potentially infectious materials in designated
biohazard containers
• Follow local regulations for the disposal of medical waste
• Staff Training
• Ensure all staff are trained in infection control practices and the proper handling of
patients with Hepatitis B
• Regularly update training to keep up with the latest guidelines and

recommendations
HEPATITIS C
• No vaccination available
• Causes more severe infection; frequently fatal
• Patients become chronically infected without realizing
• Transmission is via blood, primarily through needle sharing by drug users or
tattooing
• 85% of patients progress to chronic hepatitis; causing cirrhosis and liver failure
• Detected serologically by anti-viral antibodies
• PCR is used to monitor treatment
• Liver damage can be assessed by circulating liver enzymes and confirmed by
biopsy
MANAGEMENT
• Interferon & hep C specific antiviral drugs such as ledipasvir prevent

chronic hepatitis
• Sharps injury is the main risk to dentists
• No dental treatment other than urgent care should be rendered for a

patient with acute viral hepatitis
CONTROL OF TRANSMISSION OF VIRAL
HEPATITIS
It must be history
emphasised
that only 1
in 4 carriers
gives a
positive
medical
ORAL MANIFESTATIONS OF LIVER DISEASE
• Reflect liver dysfunction perioral rash
• Bleeding disorders • In the case of infection caused by
• Foetor hepaticus HCV; lichen planus, xerostomia,
Sjögren’s syndrome and

• Cheilitis
sialadenitis
• Smooth tongue
• Chronic periodontal disease
• Xerostomia, bruxism and crusted

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LIVER DISEASES

• Infections (particularly viral

• Cirrhosis (often due to alcohol)

• Most drugs are metabolised in the liver (no drugs

• Drugs of dental relevance metabolised by the liver

• Common form of infectious hepatitis

• Transmission is also by the

• Chief risk to dental personnel

• Incubation period is at least 2–6 months

• Immune response to the virus clears infection, damaging the

• Majority of infections are subclinical (anicteric)

• Vaccine is the HBsAg engineered in yeast

• 5%–10% of patients become persistent carriers

• Delta infection is thus only transmitted with hepatitis B or to a person

• Delta infection causes acute hepatitis

• This rarely resolves; causes progressive liver disease with a high

• Immunisation against hepatitis B also protects against the delta agent

Designated Treatment Areas

• Assign specific treatment rooms for patients with Hepatitis

• Ensure these rooms are equipped with all necessary

• Infection Control Protocols

• Follow local regulations for the disposal of medical waste

• Regularly update training to keep up with the latest guidelines and

• Interferon & hep C specific antiviral drugs such as ledipasvir prevent

• Sharps injury is the main risk to dentists

• No dental treatment other than urgent care should be rendered for a

• Reflect liver dysfunction perioral rash

• Bleeding disorders • In the case of infection caused by

• Foetor hepaticus HCV; lichen planus, xerostomia,

Sjögren’s syndrome and

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