Viral hepatitis has emerged as a serious global health problem and become epidemic worldwide affecting  two billion people. It is a cause of considerable morbidity and mortality in human population both in acute and chronic forms especially in Pakistan [1]. There are several routes of spread of viral Hepatitis in dentistry through direct contact with oral fluids, blood, droplet splatter and aerosol ect. Hepatitis B and C. [2] This  viruses can  exist  asymptotically  in its human host and may be transmitted from one individual  to other particularly in contact with the carrier’s blood  or blood contaminated body fluids .The use of general or selective screening of individuals for HBV coupled with passive immune  prophylaxis   with  immune globulin can prevent transmission of HBV to health worker .Since the vaccination against hepatitis C does not exist, the only other choice for prevention is to avoid exposure to virus [3].

Pakistan has huge burden of these viral diseases. The common risk factors are blood transfusions, hemodialysis, and unsterilized infected dental instruments. Majority of these patients are asymptomatic and pose greater danger of spreading these infections to society and medical /dental personals particularly [3].

Hepatitis B (HBV) was isolated by Blumberg in 196 [3] and is a DNA virus while Hepatitis C Virus (HCV) is a hepatotoxic viral infection was first cloned in 1989. [2] Hepatitis C virus is increasing more rapidly and has prevalence of about 2.2- 3% Worldwide [3].

The dental personals are exposed to a wide variety of microorganisms in saliva and blood of patients in their dental offices. Besides these bacterial infections, viral infections are also transmitted via blood and saliva through direct contact, droplets or aerosols in dental practices [4]. The indirect contact transmission of such infection is by contaminated instruments. These infections can be transmitted in medical and dental practices from patients to healthcare personnel, from patients to patients and rarely from practitioners to other patients [5].

Of these infections Viral hepatitis is one of the major public health occurring endemically in all areas of the World. [4] It is one of ten reportable diseases in Pakistan and Pakistan is endemic area for viral hepatitis B and has high carrier rate for Hepatitis B. There are seven main Hepatitis viruses referred to as A, B, C, D, E, F and G [6]. In particular type B and C leads to chronic disease in hundreds of millions of people and together are most common causes of Liver cirrhosis and cancer. [5] Dentists are at high risk of contracting HBV and HCV disease due to the procedures and instruments of dental treatment and occupational hazards in dental profession. A number of reports suggest a significantly higher incidence of HBV among dental staff. A high rate of HBV especially Oral Surgeons, Periodontists and Endodontists [5]. Vector of infection with HBV in dental practice are blood, saliva and nasopharyngeal secretions. Mostly HCV infected patients 60-70% are asymptotic. However, when symptoms occur they are not nonspecific acute infection may occur with limited or no symptoms or may include symptoms such as jaundice, dark urine, extreme fatigue, nausea, vomiting and abdominal pain. Patients with sub-clinical hepatitis cannot be reliably identified from medical history and it is impossible that the previous infection was never diagnosed. The incubation period is about two to six months and effect s range from sub-clinical infection without jaundice to fulminating hepatitis ,acute hepatitis and death. HBV can be prevented by routine   exercise of good clinical hygiene, universal precautions plus immunization program [7].

On the other hand, the presence of HCV-RNA in saliva provides a biological basis for saliva as a possible source of HCV infection, although it does not necessarily impact transmission. In Pakistan the prevalence of HCV varies from 14 % while carrier rate of HBS Ag is 10 % [6].

A small proportion of patients fail to eliminate the offending viruses and become victims of chronic infection [8-11]. With risk of transmission of infection to close contacts. The dental surgeon should know then potential transmission of hepatitis B and Hepatitis C in surgery through undetected chronic patients who act as carrier of disease. The aim of study was to find the frequency of undiagnosed carrier of this disease   who comes for different dental treatment at Khyber College of dentistry, Peshawar.

Materials and Methods

This descriptive study was conducted in the department of Oral diagnosis/ Oral Medicine of Khyber College of Dentistry, Peshawar from April 2014 to September 2014 on 4976 patients. The study got approval from ethical committee of the institution. The inclusion criteria were patients of both   age and sex who came to the department of Oral diagnosis/Oral Medicine for different types of dental treatments and unaware of Hepatitis. Known patient of Hepatitis B or C or patient under treatment were not included in this study. All other dental patients were screened for HBs Ag and anti HCV before starting their dental treatment. The initial screening was done for all patients by using immunochromatography (ICT) method while slight or positive cases were confirmed by Enzyme Linked Immunosorbent Assay (ELISA at Pathology department of KCD Peshawar free of cost.

Results

A total of 4976 healthy individuals were screened for HBs Ag and anti HCV by ICT method and then confirmed by Elisa and PCR. Out of 4976 patients, 2974(59.7%) were males Table 1 and 2002(40.3%) were females Table 2 with age range 5 years to 65 years.

There were 175 (3.5%) HBS positive in all   age group in both sexes. There were 119(4%) males with maximum of 45(1.5%) in age group of 21-30 years whereas 56(2.7%) were females with maximum of 14(0.6%) in age 11-20 years.

On the other hand, 265(5.3%) were HCV positive out of 4976 patients in age group of this study while in male patients (2974) 137(4.6%) were HCV positive with maximum in age group 21-30 and 30-40 years 35patients (1.1%) where as in female patients 2002 (40.3%) there were 128(6.3%) females were HCV positive with 47(2.3%) were in age group 31-40years.

Only 25 patients were aware of Hepatitis positive and were under the treatment were not included in this study while majority of patients who came for dental treatment were not aware of their Hepatitis status before they reported and screening was done.