JICDRO is a UGC approved journal (Journal no. 63927)

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ORIGINAL RESEARCH
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 18-20

Asymptomatic hepatitis B virus-positive patients visiting dental outpatient department in North India: A multicentric study


1 Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, IMS, Banaras Hindu University, Varanasi, India
2 Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, Varanasi, India
3 Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
4 Military Dental Centre, Jhansi, Uttar Pradesh, India
5 Department of Oral and Maxillofacial Surgery, SCD Dental College, Cuttack, Odisha, India
6 Department of Conservative and Endodontics, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India

Date of Submission30-Aug-2019
Date of Decision18-Sep-2020
Date of Acceptance03-Oct-2019
Date of Web Publication29-Jul-2020

Correspondence Address:
Dr. Nidhi Singh
Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, IMS, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_25_19

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   Abstract 


Background: In India, it is estimated that nearly 3%–4% of the population is affected by hepatitis-B virus (HBV). During the initial stage of the disease, the patient is asymptomatic, and there is a possibility for cross infection to dental surgeons and to other patients. The purpose of this study was to find the incidence of such HBV-infected asymptomatic patients visiting dental clinics of North India. Materials and Methods: This prospective study was conducted in the outpatient department at five different centers of North India. Three centers in Uttar Pradesh, one centre in Bihar, and one centre in Himachal Pradesh. All the patients visiting dental OPD were advised hepatitis-B surface antigen (HbsAg) screening test day before dental procedure, and the procedure was planned on the next day or on the second day after reports were submitted. Those patients who were found positive for HbsAg were further tested for HBV DNA using polymerase chain reaction technique. Results: Five thousand patients were screened, of 5000 patients, 4840 patients submitted complete blood test reports. One thousand six hundred and ninety patients were female and 3150 patients were male. The male-to-female ratio was 1:2.5. Fifty patients were found to be hepatitis B positive. Thirty patients of hepatitis B were in early infective stage. It was found that forty patients were positive for HBV DNA, whereas ten patients were negative. Conclusion: Incidence of asymptomatic hepatitis-B positive patients visiting oral surgery outpatient department in North India is 1%. We recommend routine HbsAg testing and proper sterilization of dental instruments in all dental surgical procedures.

Keywords: Asymptomatic, hepatitis B virus, screening test


How to cite this article:
Tripathi R, Singh N, Dubey P, Thakural H, Samal D, Laha A. Asymptomatic hepatitis B virus-positive patients visiting dental outpatient department in North India: A multicentric study. J Int Clin Dent Res Organ 2020;12:18-20

How to cite this URL:
Tripathi R, Singh N, Dubey P, Thakural H, Samal D, Laha A. Asymptomatic hepatitis B virus-positive patients visiting dental outpatient department in North India: A multicentric study. J Int Clin Dent Res Organ [serial online] 2020 [cited 2020 Aug 4];12:18-20. Available from: http://www.jicdro.org/text.asp?2020/12/1/18/291108




   Introduction Top


India is one of the largest and among the most populated countries in the world, with over one billion inhabitants. It is assumed that nearly 3%–4% of the population is infected by hepatitis B virus (HBV).[1],[2] Chronic hepatitis B constitutes more than 50% of the hepatitis cases in India.[2],[3]

Despite an increasing number of HBV-infected patients in India, the screening test for this disease is not routine in dental surgical procedures. These tests are considered only in case of major oral surgical procedures. Strict aseptic conditions and sterilization technique are lacking in most of the general hospitals where dental procedures are performed. This puts a serious threat to both dental surgeons and other patients undergoing dental treatment. This study is aimed to find the incidence of asymptomatic HBV patients who visit dental outpatient department (OPD).


   Materials And Methods Top


This prospective study was conducted in the outpatient department at five different centers of North India. Three centers in Uttar Pradesh, one center in Bihar, and one center in Himachal Pradesh were elected for patient selection. Permission to conduct the study was taken from the ethical committee of institute. Patients were informed about study procedure, and written consents were obtained from patients as per the Declaration of Helsinki. All the patients visiting dental OPD were advised hepatitis B surface antigen (HbsAg) screening test day before dental procedure, and the procedure was planned on the next day or on the 2nd day after reports were submitted. Those patients who were found positive for HbsAg were further tested for HBV DNA using polymerase chain reaction technique. HbsAg screening was done using ELISA test. Patients in the age group between 14 and 70 years were selected. Those who are undergoing treatment for hepatitis B or those who inform about their HBV-positive status were ruled out from this study. Five thousand patients were screened, and the total number of positive cases was compared to find the exact incidence of the disease.


   Results Top


Of 5000 patients, 4840 patients submitted complete blood test reports. One thousand six hundred and ninety patients were female and 3150 patients were male. The male-to-female ratio was 1:2.5. Fifty patients were found to be hepatitis B positive. Thirty patients of hepatitis B were in early infective stage. It was found that forty patients were positive for HBV DNA, whereas ten patients were negative [Graph 1]. Of fifty HBV-positive patients, ten patients were female and forty patients were male [Graph 2]. Their liver function test revealed a marked increase in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) while bilirubin was mildly elevated. Twenty patients had a history of hepatitis B, and their liver function test showed mildly elevated AST and ALT while bilirubin was within the normal limit.



Only twenty patients were aware of their history of hepatitis B infection, but they did not admit it during history taking and initial examination. Possibly, they were not aware of what kind of disease they had or they wanted hassle-less execution of dental procedure.

The overall incidence of asymptomatic hepatitis B-positive patients visiting dental outpatient department in North India was 1% [Graph 3].




   Discussion Top


Asymptomatic hepatitis B patients pose a serious threat to dental staff as well as to other patients undergoing dental extraction at the same clinic. In general hospitals, the condition is even more worse as the patient load is higher, and there is a shortage of well-trained working staff. Employing extensive measures for infection control puts an additional financial burden on patients. Hence, in developing countries such as India, strict infection control measures are not always employed. In India, the carrier rate of HBV in hospital staff has been found to be higher (10.87%) than in voluntary blood donors (6%) and in the general population (5%).[3],[4] HBV vaccination status among dental students is between 61% and 65%, and protective clothing and eyewear were used only by 30% of students.

Most dental instruments and forceps are sterilized using boiling water (70%),[5],[6],[7] but during high load of dental extraction patients, dental staff often reuse the instrument in <10 min, thus preventing instruments from complete disinfection. We strongly criticize the use of boiling water as a method of disinfection for dental extraction instruments because of two reasons: first, complete sterilization is not possible using boiling water, and second, there is no limit over boiling time for complete disinfection of instruments. Dentists often reuse the instrument without waiting for appropriate time. Autoclaving has a definite advantage over boiling water as complete sterilization is achieved, and recently launched autoclaves have automatic locking doors. Doors are unlocked only after release of pressure or after completion of sterilizing cycle, thus preventing dentists from reusing the instrument without completely sterilizing it. The most surprising data that we received from dental clinics of North India were that only 10%–13%[8],[9] of dental students or dentists use barrier technique (double gloves, eyewear, head cap, and safe disposal of needles) to prevent themselves from cross infection.

We recommend routine HbsAg testing in dental extraction patients. There must be regular survey in general hospitals or clinics to estimate the daily dental extraction patient load. The dental extraction instruments should be increased to match the load and should be kept in two sets.[10] After the use of one set of instrument, they should be sent for cleaning and autoclaving, and another set can be used for rest of patients. To prevent cross infection to dentists, one should imagine every patient as a possible HBV-infected patient and must perform extraction using strict aseptic technique and using adequate barriers including eyewear.[11]

To increase awareness, there must be regular awareness program on infection control measures for dentists and other working staff every once in a year. We feel that informing about the increasing number of HBV patients as well as the incidence of asymptomatic patients visiting dental clinics not only generates fear in them but also forces them to use aseptic and barrier techniques.

Overall picture is very horrible as there are clear chances of cross infection to dental staff and other patients during high patient load. We strongly advocate HBV testing before dental extraction, especially in general hospitals where patient load is high.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Health Situation in South East Asia Region 1994-97, South East Asia Region, New Delhi. Geneva: World Health Organization; 1999.  Back to cited text no. 1
    
2.
World Health Organization. Health Situation in the South East Asia Region 1998-2000, New Delhi. Geneva: World Health Organization; 2002.  Back to cited text no. 2
    
3.
Palenik CJ. Strategic planning for infection control. J Contemp Dent Pract 2000;1:103.  Back to cited text no. 3
    
4.
Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50:1-62.  Back to cited text no. 4
    
5.
Park K. Text Book of Preventive and Social Medicine: Epidemiology of Communicable Disease. 18th ed.. Jabalpur: Banarsidass Banot Publishers; 2015. p. 273-4.  Back to cited text no. 5
    
6.
Mehta S, Mehta AJ, Lodha S. Study of Infection Control Procedures among Dental Clinics: A Pilot Study. J Interdiscipl Med Dent Sci 2017;5:222-6.  Back to cited text no. 6
    
7.
Singh BP, Khan SA, Agrawal N, Siddharth R, Kumar L. Current biomedical waste management practices and cross-infection control procedures of dentists in India. Int Dent J 2012;62:111-6.  Back to cited text no. 7
    
8.
Kishore J, Goel P, Sagar B, Joshi TK. Awareness about biomedical waste management and infection control among dentists of a teaching hospital in New Delhi, India. Indian J Dent Res 2000;11:157-61.  Back to cited text no. 8
    
9.
Puttaiah R, Shulman JD, Youngblood D, Bedi R, Tse E, Shetty S, et al. Sample infection control needs assessment survey data from eight countries. Int Dent J 2009;59:271-6.  Back to cited text no. 9
    
10.
Centers for Disease Control (CDC). Recommendations for prevention of HIV transmission in health-care settings. MMWR Suppl 1987;36:1S-18S.  Back to cited text no. 10
    
11.
Ramesh N, Anuradha KP. A survey on infection control knowledge, attitude, and practice among Bangalore and Chennai dentists. J Indian Dent Assoc 2000;71:116-7.  Back to cited text no. 11
    




 

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