1. Why dentist are interested in HB& HCV?
1. Dentists were in a high risk of contracting these diseases due to the procedures and instruments of dental treatment.
2. Patients with liver disorders are of significant interest to the dentist because liver plays a vital role in coaggulation factors synthesis and drug metabolism.

2. Impairment of liver function can lead to: Abnormalities of the metabolism of amino acid, protein, carbohydrates and lipid. Impaired synthesis of coagulation factors Alteration of drug metabolism.

3. Dental Management
Most of dentist were unwilling to treat virus-infected persons.
All patient with a history of hepatitis must be managed as they are potentially infectious

4. 1. Acute Hepatitis
No dental treatment other than urgent care (absolutely necessary work) should be rendered for a patient with acute viral hepatitis Aerosols should be minimized and drugs metabolized in the liver avoided as much as possible

5. Dental drugs metabolized primarily by the liver
1.Local anesthetics (appear safe for use during liver disease when used in appropriate amounts)
2.Anelgesics:
Aspirin
Codein
Ibuprofen
Acetaminophen

6. 3. Sedatives: Diazepam Barbiturates 4
3. Sedatives: Diazepam Barbiturates 4. Antibiotics: Ampicillin Tetracycline Metronidazole (avoid if sever liver disease (active hepatitis and cirrhosis) present. Vancomycin (avoid if sever liver disease (active hepatitis and cirrhosis) present.

7. HB
HBV infection is the most important infectious occupational hazard in the dental profession. A number of reports suggest a significantly higher incidence of HBV among dental staff especially oral surgeons, periododontists and endodontists. Improperly sterilized instruments, needles, and syringes, when contaminated by blood or blood products of infected patient, can serve as a source of HBV transmission

8. Vectors of infection in dental practice
Blood Saliva Nasopharyngeal secretions In intraorally, the greatest concentration of hepatitis B infection is the gingival sulcus Also periodontal disease, severity of bleeding and bad oral hygiene were associated with the risk of HBV

9. Recommendations to Dental Practitioners
How can dentist protect themselves and their patients? 1. HBV vaccination for all clinical staff 2. Use of infection control manuals 3. Post-exposure protocols

10. 1. Vaccination
Vaccination Requirements: 1. All staff who may come into contact with blood and contaminated equipment need vaccination and certificate of immunity before working to be safe. A course of three injections should be administered, HBV vaccination for all clinical staff - 0, 1, 6 month. 2. One month later antibody titer (anti-HBs antibody) should be tested 3.Retest for anti -HBs every 4 years 4. One further booster at 5 years is recommended.

11. 5. People who do not develop an adequate antibody response (i. e
5. People who do not develop an adequate antibody response (i.e., anti-HBs <10 mIU/mL) to the primary vaccine series should complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive 6. Nonresponders to vaccination need to obtain HBIG prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood

12. 2. Infection Control Measures
1. Hand washing before treating patients.
2. Routine use of gloves and protective eyewear.
3. Using masks and uniforms to protect against splatter of blood and saliva.

13. Recommendations for Gloving
- Remove gloves when they are torn, cut or penetrated. - Do not wash, disinfect,or sterilize gloves. Washing gloves can cause a condition known as “wicking” or penetration of liquids through undetected holes in the gloves. These circumstances may increase the risk of wound contamination and expose the hands to microorganisms from patients.

14. HBV-Postexposure
After an occupational blood exposure, first aid should be administered as necessary. Puncture wounds and other injuries to the skin should be washed with soap and water; mucous membranes should be flushed with water. No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of bloodborne pathogen transmission; however, use of antiseptics is not contraindicated. The application of caustic agents (e.g., bleach) or the injection of antiseptics or disinfectants into the wound is not recommended

15. Exposed people should immediately report the exposure to the infection-control coordinator or other designated person, who should initiate referral to the qualified health-care professional and complete necessary reports

16. Prompt and appropriate postexposure prophylaxis (PEP) intervention reduces this risk
1. Passive: using HBIG
2. Active: HBV vaccine
Indication:
PEP for HBV will be warranted for previously unvaccinated persons if wounds, non-intact skin, or intact mucous membranes might have been exposed to blood or body fluids from another person or persons

18. HCV

19. HCV-RNA is present in the saliva.
Contamination of considerable portion of toothbrush used by hepatitis C patients has been demonstrate.

21. Infection Control Measures
No work restrictions are recommended for HCV-infected healthcare workers. Routine screening of all healthcare workers is not recommended unless they have been accidentally exposed to blood where there is a risk of hepatitis C transmission. Adherences to standard precautions are considered adequate in controlling the spread of HCV from worker to patient, patient to worker and patient to patient

22. HCV Postexposure
HCV is not transmitted efficiently through occupational exposures to blood
Transmission rarely occurs through mucous membrane exposures to blood
The risk of contracting hepatitis C through general dental practice is low
Both passive and active vaccine are not available

23. It is worth reiterating that the majority of people infected with hepatitis C are unaware of their condition, therefore ensuring high levels of sterilization, disinfection and general hygiene is important