Dr Michael Sultan
As dental professionals, we all face a certain number of occupational hazards. Among these is exposure to blood and other bodily fluids, which increases the risk of related infections such as hepatitis. Understanding how hepatitis viruses are transmitted, their potential impact on both patients and practitioners, and how to mitigate these risks is vital for maintaining a safe dental environment. With World Hepatitis Day promoted this month, I thought this a useful refresher to ensure we are all keeping ourselves as safe as possible.
The virus and its affects
There are several different types of hepatitis – A, B, C, D and E. They all affect the liver, although are caught via different transmission pathways. Hepatitis B (HBV) and C (HCV) are most common and can lead to chronic infection. They are both spread through contact with contaminated blood.[i] [ii]
Causing inflammation of the liver, hepatitis can cause a range of symptoms from muscle and joint pain to a fever, nausea, fatigue, loss of appetite, stomach pain, dark urine, itchy skin and jaundice.[iii] Possible indirect oral health consequences of a hepatitis infection include a higher risk of tooth loss, periodontitis and halitosis.[iv]
Estimated prevalence
It is estimated that 270,000 people in England have hepatitis B, with a higher-than-national-average percentage of the population affected in London.[v] Many of these people are believed to have acquired the infection overseas in endemic countries,[vi] with low mother-to-child transmission and high vaccination rates reported in the UK.[i]
Due to direct and indirect exposure to blood, dental professionals have been identified as at-risk of HBV and HCV infection. Historically, the risk of HBV was estimated at 3-4 times greater than the general population, but this has been reduced due to widespread vaccines and developed clinical precautions.[vii]
Implications for patient care
Where patients attend the practice with confirmed HBV status, their care may need to be tailored accordingly. For example, those with HBV are 38% more likely to have periodontitis compared to those without. This association means that gingival health should be closely monitored and high standards of oral hygiene maintained.[viii]
In addition, anyone with chronic liver disease will be immunocompromised. This puts them at a higher risk of bleeding and post-treatment infection, which must be considered throughout their dental care.[ix]
Knowing and reducing the risks
It has been suggested that the gingival sulcus contains the highest concentration of HBV infection intraorally,[x] highlighting the risk to dental professionals. There is also a potential danger of exposure to the virus via aerosol particles when treating an infected patient.[xi]
For any healthcare workers, percutaneous injuries are the most likely source of infection when it comes to HBV and HCV. Contact with blood splatter from infected individuals may also be cause for concern.[xii]
Prioritising prevention over cure, dental professionals who may have direct contact with patients’ blood are strongly recommended to be immunised against hepatitis B.[xiii] Antibody titres may be checked in the months following the primary vaccination course to support post-exposure prophylaxis decisions, should they be required.
Should accidental or potential exposure to blood-borne infections like HBV or HCV occur, individuals should follow the established post exposure prophylaxis protocols in the practice. These should be initiated as soon as possible after the incident and will likely include washing the wound, in the case of needlestick injury. Vaccination status should be reviewed and administered rapidly in the event of missing or unknown immunisation status. No treatment should be necessary for the appropriately vaccinated professional.[xiv]
Professional education and confidence
No matter how long you have worked in dentistry, what role you fulfil in the practice or how many patients you see in a day, it’s crucial that you understand the occupational risks you face and how to minimise them. Hepatitis is only one of the threats, and it can be reduced with meticulous preventive measures like vaccination and safe needlestick protocols.
To ensure you are confident in avoiding the dangers, there is a wealth of education and training on offer to the entire team. Online resources, training courses and seminars are widely available and should be utilised by all.
For further information please call EndoCare on 020 7224 0999
Or visit www.endocare.co.uk
EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.
[i] NHS. Hepatitis B. https://www.nhs.uk/conditions/hepatitis-b/ [Accessed May 2025]
[ii] NHS. Hepatitis C. https://www.nhs.uk/conditions/hepatitis-c/ [Accessed May 2025]
[iii] NSH. Hepatitis. https://www.nhs.uk/conditions/hepatitis/ [Accessed May 2025]
[iv] Gheorghe DN, Bennardo F, Popescu DM, Nicolae FM, Ionele CM, Boldeanu MV, Camen A, Rogoveanu I, Surlin P. Oral and Periodontal Implications of Hepatitis Type B and D. Current State of Knowledge and Future Perspectives. J Pers Med. 2022 Sep 26;12(10):1580. doi: 10.3390/jpm12101580. PMID: 36294719; PMCID: PMC9604856.
[v] UK Health Security Agency. Hepatitis B in England 2024. Updated February 2025. https://www.gov.uk/government/publications/hepatitis-b-in-england/hepatitis-b-in-england-2024#:~:text=UKHSA%20currently%20estimates%20that%20in,increases%20to%201.5%25%20in%20London. [Accessed May 2025]
[vi] NICE. Hepatitis B: How common is it? Revised September 2024. https://cks.nice.org.uk/topics/hepatitis-b/background-information/prevalence/ [Accessed May 2025]
[vii] American Dental Association. Hepatitis Viruses. https://www.ada.org/resources/ada-library/oral-health-topics/hepatitis-viruses [Accessed May 2025]
[viii] Chen, X., Song, J., Sun, J. et al. Hepatitis B infection is associated with periodontitis: the national health and nutrition examination survey (2009–2014). BMC Oral Health 24, 815 (2024).
[ix] Macpherson I, Brennan P, Dillon J. (2022). Hepatitis B, Hepatitis C and Liver Disease: A Review for the Dental Practitioner. Dental Update. 49. 26-30. 10.12968/denu.2022.49.1.26.
[x] Itharatana K. [Viral hepatitis B infection. Transmission and prevention for dentists]. J Dent Assoc Thai. 1988 Jul-Aug;38(4):180-7. Thai. PMID: 3270647.
[xi] Sheikh AN, Siddiquee B, Chahande J. Hepatitis B and C infection among dentists – Risk, prevention, and management. J Adv Dental Pract Res 2022;1:31-6.
[xii] Macpherson I, Brennan P, Dillon J. (2022). Hepatitis B, Hepatitis C and Liver Disease: A Review for the Dental Practitioner. Dental Update. 49. 26-30. 10.12968/denu.2022.49.1.26.
[xiii] Public Health England. Protecting and improving the nation’s health. Blood bore viruses – fact sheet for primary care dental teams. https://thebha.org.uk/wp-content/uploads/2022/12/BBV_Aug_2017_finalc7d0.pdf [Accessed may 2025]
[xiv] Utkarsha Lokesh, Srinidhi D, Sudhakara Reddy K. Post exposure prophylaxis to occupational injuries for general dentist. J Indian Prosthodont Soc. 2014 Dec;14(Suppl 1):1-3. doi: 10.1007/s13191-012-0176-z. Epub 2012 Oct 5. PMID: 26199484; PMCID: PMC4501978.
