Oral Diagnosis I Third Year

1. Liver Diseases
Dr. Suresh. C.S. BDS; MDS; MDSc ( UK )

2. Hepatitis
Infectious Non-infectious
-Viral.
-Secondary Syphilis.
-Tuberculosis.
-Alcohol.
-Halothane.
-Ketokonazole.
example example

3. Viral Hepatitis A, B, C, D, and E
Hepatitis A: Infectious Hepatitis. RNA-V
Hepatitis B: Serum Hepatitis. DNA-V
Hepatitis C: Non-A non-B Hepatitis [NANB]. RNA-V
Hepatitis D: Delta Hepatitis. RNA-V
Hepatitis E: RNA-V

4. Hepatitis A “Infectious Hepatitis”
Incidence:
150,000 people in the U.S. are infected each year by
hepatitis A. High risk geographic areas are Middle
East, South America, Eastern Europe, Central
America, Africa and Southeast Asia.
IP: 15 – 50 days.
Transmission:
is usually by drinking water or eating contaminated
food. Direct contact with an infected person, as kissing.

5. Signs and Symptoms:
A person infected with hepatitis A may not have any symptoms.
However, in those who do have symptoms, they resemble the
flu. These symptoms include:
-Fatigue, nausea, vomiting.
-Pain in the liver area,
-Dark urine or light colored stools and fever.
-Liver function tests are elevated, with many adults developing
jaundice.
Most people recover within six months.
Hepatitis A “Infectious Hepatitis”

6. Hepatitis B “Serum Hepatitis”
Transmission:
This disease is more infectious than AIDS and is transmitted through
infected blood and other body fluids (seminal fluid, vaginal
secretions, breast milk, tears, saliva and open sores).
IP: 45 – 180 days.
However, it is not spread by casual contact such as:
-Holding hands.
-Kissing on the cheek or dry lip kissing.
-Eating food prepared by a carrier.
-Visiting an infected person.
-Playing with a child who is a carrier.
-Sneezing or coughing.

7. Signs and Symptoms:
Most people who get hepatitis B have no recognizable signs
or symptoms.
Some People Have Symptoms That Mimic The Flu:
loss of appetite.
nausea and vomiting.
Fever.
weakness, tiredness, lasting weeks or even months.
abdominal pain.
dark urine.
yellowing skin and eyes (jaundice).
Hepatitis B “Serum Hepatitis”

8. Hepatitis C “NANB”
The hepatitis C virus was identified and described in 1989, and
in 1990 a hepatitis C antibody test (anti-HCV).
There are 3.5 million Americans chronically infected with HCV.
IP: 14 – 180 days.
Transmission:
HCV can be transmitted through blood transfusions.
Other individuals who may come in contact with infected blood,
instruments, or needles, such as IV drug users, health care
workers, dentists or laboratory technicians are also at risk.

9. Hepatitis D “Delta Hepatitis”
Hepatitis D occur only as a coinfection with
hepatitis B or as a superinfection in carrier
of hepatitis B.
Transmission is the same of hepatitis
B, however, signs and symptoms
frequently are more severe.
IP: 15-150 days.

10. Hepatitis E
Resembles hepatitis A. Transmitted via fecal-oral
contamination. Common in India, Northern
Africa, southeast Asia and Mexico.
IP: 15 – 60 days with viremia.
Hepatitis Non A-E
Unknown viruses and unknown etiology.
Hepatitis F and hepatitis G were linked to this type
of hepatitis

11. HBV-Ag: hepatitis B virus antigen test.
Anti-HCV: Antibody to hepatitis C virus.
ALT-Liver enzyme released from liver cells that are injured, eg.
by virus, alcohol, fat, drug, etc.
RIBA-2 - Supplemental test to detect antibody to hepatitis C
virus.
HCV-RNA test by polymerase chain reaction (PCR) determines
whether the virus is multiplying.
Laboratory Findings

12. Medical Managements
- Active immunization “vaccines”.
-Passive immunization “antibodies”
Must be given with interval of 5 months from MMR
prevention Treatment
-Treatment of viremia.
-Diet.
-Interferon (IFN) alpha-2b.

13. Dental Managements
- History.
- Clinical examination.
- Consultation with physician.
- Minimizing of drugs metabolized by liver such as:
[Lidocaine, Aspirin, Ibuprofen, Diazepam,
Ampicillin, Metronidazole, Tetracycline].
- Bleeding time, thrombin time, and prothrombin time
should be consider for surgical procedures.
contamination
Patient DentistInstrumentsPatient

14. Non-Infectious Diseases
Alcoholic Liver Disease

15. Alcoholic Liver Disease
Hepatitis Cirrhosis
Malnutrition and anemias
2
1
3

16. Alcoholic Liver Disease
Signs and Symptoms
Psychiatric problems.
Nausea.
Vomiting.
Anorexia.
Weight loss.
Fever.
Hepatomegaly.
Hepatic coma
General Oral
Enlargement of parotid G.
Xerostomia.
Bad oral hygiene.
Petechiae and ecchymoses.
Jaundiced oral mucosa.
Fungal infections.
Bruxism.
Alcohol breath odor.

17. Alcoholic Liver Disease
Medical managements
- Identification of the case.
- Withdrawal from alcohol.
- Mange the CNS depression.

18. Dental managements
Alcoholic Liver Disease
Screening for alcohol risk.
Providing alcohol prevention information.
Take in consideration:
[Risk of infection spread, bleeding
tendencies, metabolism of certain
drugs].