Hepatitis: an insidious threat to oral health

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BSDHT Chair Helen Minnery issues a call to arms against Hepatitis in all its forms

It may be an illness that individuals will have heard of, but when asked about the effects and symptoms of hepatitis it’s likely that many people would be clueless. This is worrying for many reasons, not only does the condition have many guises but some of the strains can be life threatening. Some manifestations of the disease can also impact an individual’s oral health, and therefore it is necessary for dental hygienists and dental therapists to raise awareness of the issue and provide tailored care to those affected.

Hepatitis is a wide-ranging term that is used to describe the inflammation of the liver. Usually caused by viral infections or even excessive alcohol intake, these conditions are categorised into different types, have different causes and vary greatly in severity.

While some of the strains are hardly serious and are likely to be fought off by the body’s natural defences, others are much more damaging, and many have been linked to serious conditions such as cirrhosis and liver cancer if left untreated [1].

What are the symptoms?

Due to the sheer variety of hepatitis the symptoms can be varied, and in some cases, sufferers may not even exhibit any symptoms. Despite this, some common complaints include muscle and joint pain, a high temperature, a loss of appetite and generally feeling unwell. These symptoms can be associated with a huge array of other illnesses, which can sometimes make diagnosing hepatitis so difficult.

However, more specific side effects can include jaundice, dark urine and grey, pale faeces. If left untreated some forms of hepatitis may also cause swelling of the limbs, confusion, and blood in stools and vomit [2].

Among all strains, hepatitis C is thought to pose the biggest threat to those living in the UK. It’s estimated that as many as 170 million people worldwide are infected with the chronic version of the condition [3], and as it often presents no symptoms or only mild flu-like symptoms, it means that many may be unaware they are infected.

The disease is spread through blood-to-blood contact and can cause severe problems such as liver failure. Furthermore, it has been linked to several conditions that can also affect oral health.

Oral conditions

Alongside uncomfortable, unsightly conditions such as lichen planus [4] (red, white or erosive patches affecting the soft tissue in the oral cavity) hepatitis C is also linked to ailments that affect the salivary glands such as Sjögren’s syndrome. Sufferers produce less saliva and are therefore at higher risk of tooth decay because saliva actively protects teeth by washing away harmful bacteria and neutralising plaque acids [5].

Research also suggests that those with hepatitis C are more vulnerable to dental and oral diseases derived from biological mechanisms, and are more likely to suffer mental side effects such as low self-esteem thanks to the poor appearance of their teeth [6].

This strain has also been linked to the development of mouth cancer, a voracious form of the disease that is responsible for around 200,000 deaths per year [7].

What can you do?

Taking all this into account, it’s important that dental hygienists and dental therapists act against hepatitis and provide patients who suffer from the disease with special care. By encouraging patients with the condition to visit regularly for routine appointments, you can help protect their teeth from caries in cases where they have xerostomia caused by Sjögren’s syndrome, and alert them to any signs of oral cancer that you may identify during checkups.

On 28 July 2018 World Hepatitis Day provides the perfect opportunity for us to get involved and help raise awareness of the disease. Operating under the slogan “Find the Missing Millions” this year’s campaign aims to motivate the millions of people living with undiagnosed hepatitis to get checked so that they can receive the care they deserve and so prevent unnecessary illness or deaths.

Campaign materials including posters and social media graphics can be downloaded here: http://www.worldhepatitisalliance.org/world-hepatitis-day/campaign-materials/ and provide tools to help raise awareness in your practice and across social media channels.

Hepatitis is often a silent danger and one that can affect both oral and systemic health alike, we need to act. By helping raise awareness and offering tailored care to those affected we can all make a real difference.

For more information about the BSDHT visit www.bsdht.uk,
call 01788 575050 or email This email address is being protected from spambots. You need JavaScript enabled to view it. 

References:

1] NHS Choices. Hepatitis. Link: https://www.nhs.uk/conditions/hepatitis/  [Last accessed June 18].
2] NHS Choices. Hepatitis. Link: https://www.nhs.uk/conditions/hepatitis/  [Last accessed June 18].
3] Alavian, S., Mahboobi, N., Mahboobi, N., Karayiannis, P. Oral Conditions Associated with Hepatitis C Virus Infection. Saudi J Gastroenterol. 2013; 19(6): 245–251.
4] Carrozzo, M., Scally, K. Oral Manifestations of Hepatitis C Virus Infection. World J Gastroenterol. 2014; 20(24): 7534–7543.
5] Stookey, G. The Effect of Saliva on Dental Caries. JADA. 2008; 139(2): 11S-17S.
6] Alavian, S., Mahboobi, N., Mahboobi, N., Karayiannis, P. Oral Conditions Associated with Hepatitis C Virus Infection. Saudi J Gastroenterol. 2013; 19(6): 245–251.
7] Alavian, S., Mahboobi, N., Mahboobi, N., Karayiannis, P. Oral Conditions Associated with Hepatitis C Virus Infection. Saudi J Gastroenterol. 2013; 19(6): 245–251.