Risk Patients in Minor Oral Surgery Practice

Risk Patients in Minor Oral Surgery Practice
Suneel Kumar Punjabi*, Hassan Mehdi**, Habib ur Rehman***, Syed Mahmood Haider****

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J Pak Dent Assoc.2011; 20 (1): 000-000


To determine the association between seroprevalence of HBsAg and Anti HCV virus and high risk groups among patients attending minor oral surgery clinics.


This observational study was carried out in the Department of Oral & Maxillofacial Surgery Abbasi Shaheed Hospital/KMDC Karachi; patients above 18 years of age, with no previous history of seropositive Hepatitis B, C or chronic liver disease were included during a period from January 2008 to April 2008.


In a study of 200 patients Seroprevalence of Hepatitis B was 10 (5.0%) and that of Hepatitis C was 8 (4.0%). Out of total 10 HbsAg positive patients 8 (80%) were from high risk group and 2 (20.0%) were from low risk group. Among high risk groups 3 (30%)of patients had a history of surgery only in past one year followed by 2 (20%) of patients with a history of surgery and blood transfusion combined. HCV antibody titer was positive for 100% of I/V Drug Users.


In patients attending oral surgery clinicsOral prevalence of HBs antigen exceeds HCV antibody in this sample population. HCV antibody was particularly prevalent in I/V drug users. HBV was prevalent in both I/V drug users and patients with a history of surgery during the past one year.


Sero-prevalence, HbsAg, Anti HCV, Minor Oral Surgery.


Viral hepatitis is a major public health issue all over the world 1. HBV& HCV are the most frequent causes of chronic liver disease. Over 350 million people worldwide are affected with HBV infection 2 and up to 170 million people are infected with HCV 3 each year. In Pakistan prevenlance of HBV in young healthy population is between 3 to 4% 4, and of that HCV is 1 to 2 % 5. The hepatitis B and C viral infections are important consideration in minor Oral Surgery practice because of risk to cross infection and increased bleeding tendency 6-, 10. Oral surgeons have higher prevalence of HBV and HCV infection when compared with other health care workers11. The major route of infection transmission is through

blood and blood products 12 and saliva may be an additional source 13-16 . Needle stick injury during surgical procedures may result in transmitted surgeons and assisting staff. Hepatitis B virus can persist in dried blood on surfaces for or more than a week 17, even without the presence of visible blood HBV can be present on surfaces18, 19. HBV or HCV transmission in Oral Surgery setting should be rare, particularly if standard precautions along with sterlization protocol and routine vaccinations of operating, assisting staff are adopted 17


This observational study was carried out in the Department of Oral and Maxillofacial Surgery Abbasi Shaheed Hospital/KMDC. A total 200 patients from 18 to 60 years of age, with known no past history of viral hepatitis were screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C viral antibodies (HCV-Ab) during a period from January 2008 to April 2008. HBsAg and Anti HCV screening of these patients were done in hospital laboratory with Rapid Chromatographic Immunoassay System for qualitative detection of antibody to HCV and surface antigen to HBV in serum or plasma (Distinct® HCV and Distinct® HBV). Following consultation and taking written consent patient’s blood sample were collected and taken to the pathology laboratory Abbasi Shaheed Hospital for serological investigation for the Hepatitis B and C virus, patients were reviewed with their results after 2days; in case of serological positive result the patient was deferred, for further evaluation. Minor surgery was performed as routine procedure for patients with serological negative result; Minor oral surgical procedures included surgical extractions, soft tissue biopsies, dento-alveolar fractures, removal of IMF and arch-bars, apicectomies. The specificity of this test is more than 99%, sensitivity of 96.8% and accuracy 98.9%. Computerized record of all patients was maintained and all findings were analyzed using statistical package (SPSS) version 10.0. Descriptive statistics frequency was calculated for age, sex, HBV, HCV prevalence. Cross tabulation were performed for drug abuser, blood transfusion history and history of dental and surgical procedures with frequency of HBV, HCV


Mean age of the sample was calculated as 36.6 years (+/- 13.4) with peak volume coming in 20-40 year age group. A total number of 200 patients were screened for HBsAg, Anti HCV. The prevalence of HBsAg was 10 (5%). and for Hepatitis C Virus 8 (4.0%). table-1.The gender distrubution for HBsAg was higher in males 6 (60.0%) as compared to females 4 (40.0%) and for Hepatitis C Virus males 6 (75.0%) as compared to females 2 (25.0%) table-1

Link between Risk group and gender; Low risk group 73 (56.1%) of patients were male and 57 (43.8%) were female, in High risk group 37 (52.8%) were male and 33 (47.1%) were female. (Table 2) Risk group estimates with odds ratio for HbsAg and Anti-HCV positive patients as shown in table 3.

In total 10 HbsAg positive patients 8 (80.0%) were from high risk group and 2 (20.0%) were from low risk group. Among high risk groups 3 (30%) of patients had a history of surgery only, followed by 2 (20%) history of

Surgery and blood transfusion combined. The results were significant with (p<0.05 at 95% CI). (Table 4).

HCV antibody titer was positive for 100% of I/V Drug Users, followed by 3 (37.5%) of patients with a history of surgery only in past one year, 1 (12.5%) patients with surgery and blood transfusion history combined in past one year. The results were significant with (p<0.05 at 95%CI). (Table 4). The association of dental procedures with gender is shown in table 5


Oral surgeons and Dentists are at the high risk of HBV and HCV infection, the risk of HBV infection transmission exceeds than HCV infection 20. HBV has been isolated from blood, saliva, tears, semen, urine, vaginal secretions, cerebrospinal fluid, mother milk and amniotic fluid. Blood and blood products, semen and vaginal secretions have been directly linked to transmission of HBV. HBV and HCV appears to be incapable of penetrating intact skin and oral mucosa, but infection may occur from open wounds of skin and oral mucous membrane as a result of body fluids coming from open wounds. 21, 22 HBV is common cause of Chronic Hepatitis, liver Cirrhosis and Hepatocellular carcinoma all over the world. About one million peoples die each year from complications of this disease. Poor knowledge about HBV transmission in general population is the main cause of its spread. About 5% of patients with HBV infection become chronic carrier 23. Chronic carriage is more likely to occur when infection occurs in a newborn (90%) then in adult. The risk of progression to cirrhosis is 2-5.5% per year and for Hepatocellular carcinoma is at about 2% per year in those with cirrhosis. A high rate of Hepatocellular carcinoma occurs in chronic carriers. Hepatitis B is found worldwide but it is more prevalent in Asia.25 Prevalence of HBV in Pakistan is reported from 3% to 10% in different studies conducted at different places.25

Seroprevalence of HBV in our study was 10 (5.0%). On reviewing the literature in last five years the seroprevalence of Hepatitis B is 3% to 5.46% in Karachi (Pakistan) 24 and 4% from Jamshoro (Pakistan) 25. Hepatitis C virus was first identified in 1988. Since then it has become a major health problem worldwide. HCV spreads almost through same manner but it may be also transmitted by acupuncture, tattooing, sharing razors and nosocomail transmission 26.

Seventy five percentof the patients with HCV become chronically infected because of its long asymptomatic course that is often neglected and among them about 10% develop chronic active hepatitis, cirrhosis or Hepatocellular carcinoma 12, 13. The prevalence among general population is 3% to 7% in different parts of Pakistan 27. Seroprevalence of Hepatitis C observed in our study is 4.0%. Whereas the seroprevalence of Hepatitis C as reported in literature during last 5 years is 2.2% to 4.6% from Karachi (Pakistan)24.

Our results show a high prevalence of I/V drug users and patients with a history of surgery in past one year. More alarming is the fact that all the I/V drug users were found to be positive for HCV and one I/V drug user was positive for both HBV and HCV


Prevalence of HBV exceeds than HCV in present study of HCV was particularly prevalent in I/V drug users. While HBV was prevalent in both I/V drug users and Patients with a history of surgery during the past one year. Keeping in view the high frequency of HBV, HCV in Pakistan, we need at least nationwide efforts to identify peoples who are infected. All efforts should be made to train, educate and disseminate knowledge through the health care providers and general public about the spread and preventive of viral hepatitis


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