CDHO Advisory | Viral H epatitis COLLEGE OF DENTAL HYGIENISTS OF ONTARIO ADVISORY ADVISORY TITLE Use of the dental hygiene interventions of scaling of teeth and root planing including curetting surrounding tissue, orthodontic and restorative practices, and other invasive interventions for persons1 with viral hepatitis. ADVISORY STATUS Cite as College of Dental Hygienists of Ontario, CDHO Advisory Viral Hepatitis, 2020-05-19 INTERVENTIONS AND PRACTICES CONSIDERED Scaling of teeth and root planing including curetting surrounding tissue, orthodontic and restorative practices, and other invasive interventions (“the Procedures”). SCOPE DISEASE/CONDITION(S)/PROCEDURE(S) Viral hepatitis INTENDED USERS Advanced practice nurses Nurses Dental assistants Patients/clients Dental hygienists Pharmacists Dentists Physicians Denturists Public health departments Dieticians Regulatory bodies Health professional students ADVISORY OBJECTIVE(S) To guide dental hygienists at the point of care relative to the use of the Procedures for persons who have viral hepatitis, chiefly as follows. 1. Understanding the medical condition. 2. Sourcing medications information. 3. Taking the medical and medications history. 4. Identifying and contacting the most appropriate healthcare provider(s) for medical advice. 1 Persons includes young persons and children Page | 1 CDHO Advisory | Viral H epatitis 5. Understanding and taking appropriate precautions prior to and during the Procedures proposed. 6. Deciding when and when not to proceed with the Procedures proposed. 7. Dealing with adverse events arising during the Procedures. 8. Record keeping. 9. Advising the patient/client. TARGET POPULATION Child (2 to 12 years) Adolescent (13 to 18 years) Adult (19 to 44 years) Middle Age (45 to 64 years) Aged (65 to 79 years) Aged 80 and over Male Female Parents or guardians of children and young persons with viral hepatitis MAJOR OUTCOMES CONSIDERED For persons who have viral hepatitis: to maximize health benefits and minimize adverse effects by promoting the performance of the Procedures at the right time with the appropriate precautions, and by discouraging the performance of the Procedures at the wrong time or in the absence of appropriate precautions. RECOMMENDATIONS UNDERSTANDING THE MEDICAL CONDITION Nomenclature of viral hepatitis Adapted from . KidsHealth: Hepatitis . Medscape Hepatitis: Fulminant Hepatic Failure . WomensHealth: Viral Hepatitis 1. Hepatitis, inflammation of the liver a. termed i. viral hepatitis ii. non-infectious hepatitis b. occurs as i. acute hepatitis ii. chronic hepatitis Other terminology 1. Acute hepatitis, inflammation of the liver that persists for less than six months, which may a. be manifested by typical symptoms Page | 2 CDHO Advisory | Viral H epatitis b. or be asymptomatic. 2. Acute liver failure, also called fulminant hepatic failure or fulminant hepatitis in the most serious forms, is a rapidly developing medical emergency that arises when the cells of the liver die so quickly that the liver cannot keep up with its need for repairs. 3. Ascites, swelling of the abdomen due to build-up of fluid, usually caused by severe liver disease such as cirrhosis. 4. Blood-borne viruses, viruses that a. are carried in their blood b. may cause severe disease in some persons and few or no symptoms in others c. can spread to another person, whether the carrier of the virus is ill or not. 5. Cardiomyopathy, disease of the heart muscle which reduces the ability of the heart to pump blood. 6. Chronic hepatitis, inflammation of the liver that lasts at least six months. 7. Chronic infection of the liver, as evidenced for example by the presence of antigens in the blood for at least six months, which a. causes the person to be infectious to others b. may or may not exhibit symptoms of hepatitis c. occurs in some persons with hepatitis B; many, with hepatitis C infection. 8. Cirrhosis, non-reversible scarring of the liver that may result from chronic hepatitis, among other conditions. 9. Coinfection, the term used by virologists to describe the simultaneous infection of a single liver cell by more than one type of virus a. as may occur with hepatitis B virus and hepatitis D virus b. which can also occur as a superinfection. 10. Enteric, of or related to the intestines. 11. Fulminant hepatitis, a severe form of acute hepatitis that may be life threatening if not treated promptly, characterized by symptoms that develop abruptly, including a. mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations b. collapse with fatigue c. jaundice d. abdominal swelling. 12. Hepatic encephalopathy, manifested by a. excessive sleepiness b. mental confusion c. coma in the advanced stages. 13. Hepatitis B immune globulin, an injection that contains large amounts of hepatitis B antibodies taken from donated human blood. 14. Liver failure, occurs when large parts of the liver have become damaged beyond repair so that a. the liver is no longer able to function b. a life-threatening condition is created which demands urgent medical care. 15. Parenteral transmission, transmission that occurs through the piercing of the mucous membranes or the skin barrier through events such as a. needlesticks b. human bites c. cuts d. abrasions. 16. Perinatal, occurring during the period around birth. Page | 3 CDHO Advisory | Viral H epatitis 17. Superinfection, an infection following upon a previous infection. 18. Viral hepatitis, also called infectious hepatitis, inflammation of the liver caused by infection with a virus. 19. Zoonosis, the process by which an infectious disease can be transmitted from animals, both wild and domestic, to humans or from humans to animals. Overview of viral hepatitis Adapted from . College of Dental Hygienists of Ontario: Hepatitis A fact sheet . College of Dental Hygienists of Ontario: Hepatitis B fact sheet . College of Dental Hygienists of Ontario: Hepatitis C fact sheet . Heymann D (ed.). Control of Communicable Diseases Manual (20th edition). Baltimore: American Public Health Association; 2015. Centers for Disease Control and Prevention . Medscape Hepatitis A . Medscape Hepatitis B . Medscape Hepatitis C . Medscape Hepatitis D . Medscape Hepatitis E . National Digestive Diseases Information Clearinghouse: Viral Hepatitis . World Health Organization Viral hepatitis in general 1. is caused by viruses, chiefly a. hepatitis A virus (HAV) b. hepatitis B virus (HBV) blood-borne virus c. hepatitis C virus (HCV) blood-borne virus d. hepatitis D virus (HDV) blood-borne virus e. hepatitis E virus (HEV) 2. may be characterized a. by typical symptoms and signs, chiefly i. abdominal pain and tenderness ii. inflammation and swelling of the liver iii. jaundice 1. yellow discoloration of the skin and the whites of the eyes 2. tea-coloured urine 3. pale, clay-coloured or grayish feces 4. enlarged, tender liver iv. fever v. loss of appetite vi. nausea and vomiting vii. dehydration when associated with prolonged vomiting and diarrhea viii. severity that ranges from an asymptomatic or self-limiting condition to a rapidly developing medical emergency, acute liver failure b. by signs and symptoms, which are i. absent ii. or unnoticed Page | 4 CDHO Advisory | Viral H epatitis 3. may have a chronic phase, which can be associated with serious complications including a. cirrhosis b. liver failure c. liver cancer 4. comprises a. hepatitis A b. hepatitis B c. hepatitis C d. hepatitis D e. hepatitis E Hepatitis A 1. Nature of hepatitis A a. does not usually cause permanent liver damage b. normally recovers completely. 2. Signs and symptoms of hepatitis A a. reflect the full range of severity associated with viral hepatitis b. include the signs and symptoms typical of viral hepatitis c. also include i. diarrhea, especially in children ii. fatigue d. may be absent or unnoticeable e. are more likely to occur in older people than children f. last i. in most persons typically less than two months ii. in some 15 percent of persons for as long as 6 to 12 months, intermittently. 3. Course and prognosis of hepatitis A a. course; the first attack i. results in lifelong immunity ii. does not normally cause permanent liver damage b. prognosis i. normally recovers ii. does not recur. 4. Occurrence of hepatitis A a. with hepatitis B and C is one of the three most common hepatitis viruses in North America2 b. spreads through outbreaks and epidemics. 5. Persons at increased risk of hepatitis A include a. those who i. may come into contact with hepatitis A virus during their work 2 Since the introduction of hepatitis A vaccine in Canada (in 1996), the incidence of hepatitis A has declined substantially in Ontario and elsewhere in Canada. The number of cases of hepatitis A reported in 2012 was 246, with the actual number of cases estimated to be about seven times higher given under-diagnosis, under- reporting, and subclinical infections. Regions of the world with higher levels of endemicity and risk of HA transmission include much of Asia, Africa, Latin America, and Oceania. Page | 5 CDHO Advisory | Viral H epatitis ii. live or work in close quarters, such as dormitories, prisons, and residential facilities iii. work in or attend daycare facilities where strict personal hygiene measures are not observed b. household contacts of people infected with hepatitis A virus c. sexual partners i. of people infected with hepatitis A virus ii. men who have sex with other men d. international travellers, especially to areas with high rates of hepatitis A e. military personnel stationed in areas with high rates of hepatitis A f. users of substances of abuse, injected or non-injected g. persons with i. clotting factor disorders, such as hemophilia (CDHO Advisory) ii. chronic liver disease. 6. Infectiveness for others of the person with hepatitis A a. begins about one week after the person’s exposure b. exists even when the person is unaware of the infection. 7. Transmission of the hepatitis A virus occurs through or from a. food or drinking water contaminated with feces of a person infected with the hepatitis A virus b.