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Medically Compromised Patient Care

Course Number: 628


By definition, hepatitis is an inflammation of the liver caused by a viral infection. While there are five types of hepatitis (A-E), the three main types (A-C) are the focus of this section.

First, Hepatitis A is transmitted via the fecal-oral route and a vaccine does exist. Due to the route of transmission, there is not a high risk of dental health care workers transmitting the disease. While Hepatitis A does not result in chronic infection, it can result in significant liver failure.

Second, Hepatitis B is transmitted through blood, saliva and semen/vaginal fluid (e.g., needle stick, IV drug use, sex). A three-part vaccine exists to prevent acquiring the disease. Hepatitis B can result in both acute and chronic infection that can eventually lead to liver cancer.

Third, Hepatitis C is most frequently transmitted from IV drug use and more than half of patients develop chronic infection, which may lead to liver failure and/or cancer. A vaccine is currently not available.19 Table 12 provides a summary of the various types of Hepatitis, the mode of transmission, prevention and the level of occupational risk associated with each type.

Table 12. Summary of Hepatitis(1)
Mode of TransmissionPrevention Risk to You / Occupational Exposure
Hepatitis A Fecal, oralVaccine Hand washingLittle to none
Hepatitis B *Chronic Blood or bodily fluidsVaccine Universal Precaustions Avoid High risk behaviorsUp to 30% risk of trasmission with needle stick
Hepatitis C *Chronic Blood or bodily fluidsUniversal Precaustions Avoid High risk behaviorsAbout 2% risk of transmission
Hepatitis D Blood or bodily fluidsHep B VaccineLittle to none
Hepatitis E Fecal, oral travelHand WashingLittle to none

When providing dental care for patients with hepatitis, limit local anesthetic with vasoconstrictor to 2-3 cartridges.1 If they have a known history of infection, use standard precautions and be aware that they may have bleeding tendencies as well. One of the most important modifications for dental treatment in a patient with active hepatitis (acute infection) is that elective treatment should be postponed and that a medical consult is required before treatment.

Some helpful follow-up questions to ask patients with hepatitis are listed in Table 13.

Table 13. Follow-Up Questions for Hepatitis Patients(1)
  • When were you diagnosed with hepatitis?
  • What type of hepatitis did/do you have?
  • What type of treatment did you receive?
  • Have you been tested to determine if you are a carrier?
  • Do you have any liver problems/damage?