Oral conditions in hepatitis C virus-infected Iranian patients: a case-control study

Abstract Aim: Hepatitis C virus is now found worldwide, giving rise to concern that general populations might become infected. Extrahepatic manifestations might indicate latent disease. The aim of this study was to evaluate the association between oral lichen planus and xerostomia with hepatitis C virus infection in an Iranian population. Methods: The study (case) group consisted of 73 individuals with hepatitis C virus infection. The control group consisted of 139 age- and sex-matched individuals. All patients were examined for oral conditions, and their hepatitis C virus infection was confirmed by an antihepatitis C virus antibody and hepatitis C virus-RNA polymerase chain reaction. Results: The prevalence of oral lichen planus was 1.4% and 4.1% of individuals complained of a dry mouth. There were no statistically-significant differences between the case and control groups. Conclusion: Our findings reinforce other regional studies that there is no association between hepatitis C virus infection and oral conditions in the north of Iran, an area with a low prevalence of this infection.     

Oral lichen planus in patients infected or noninfected with hepatitis C virus: the role of autoimmunity

Serum proteins, serum immunoglobulins, anti-nuclear antibodies (ANA), antismooth muscle antibodies (ASMA), anti-mitochondrial antibodies (AMA), anti-liver-kidney antibodies (LKM), anti-parietal-cell gastric antibodies (APCA), anti-epithelial antibodies and concomitant autoimmune disease were studied in 27 OLP-HCV+ve subjects and in a comparable group of 23 who were OLP-HCV-ve. In addition, all the patients with chronic liver disease who were seropositive for ANA, AMA or LKM were scored using the new aggregate scoring system to detect those with the accepted criteria for the diagnosis of autoimmune hepatitis (AIH). Hypergammaglobulinemia was more frequent in OLP-HCV+ve than in OLP-HCV-ve ( P =0.008) subjects. Serum IgG and IgM levels were higher in HCV+ve than in HCV-ve (respectively, P=0.017 and P=0.018) individuals. However, there was no difference in the frequency of any autoantibody between OLP-HCV+ve and OLP-HCV-ve patients. Overall, immunologically-related abnormalities were found in 17(63%) OLP-HCV+ve and 11(48%) OLP-HCV-ve (P=0.43) patients. Three OLP-HCV-ve and no OLP-HCV+ve patients had score criteria of probable AIH. The present and our previous data suggest that OLP patients with HCV infection neither had evidence of autoimmune liver damage nor had abnormal humoral immune-responses, with the exception of higher than control levels of serum immunoglobulins. Cryoglobulins may be responsible.     

Prevalence of hepatitis virus infection in association with oral diseases requiring surgery

OBJECTIVE: We evaluated the prevalence of hepatitis virus infection in a large population of patients in terms of diseases requiring oral surgery. DESIGN: Retrospective case survey. SUBJECTS AND METHODS: Prevalence of hepatitis B and C virus (HBV, HCV) infection were compared between oral diseases such as inflammation, cysts, cancer, trauma, benign tumors, impacted teeth, or jaw deformity in dental inpatients (n = 5830) with adjustment for age, gender, and history of surgery. RESULTS: Of 4402 inpatients, 94 had HB surface(s) antigen (2.1%), while 151 of 2613 were seropositive for HCV (5.8%). Prevalences of HBs antigen and HCV antibody exceeded those in the general population. HBs antigen was more prevalent in patients with benign oral tumors than in patients with impacted teeth, whether or not adjustment was made for age (odds ratios, 4.246 and 5.055 with and without age adjustment, respectively; P < 0.05). On the other hand, HCV antibody was more prevalent in patients with oral cancer than in those with impacted teeth before adjustment for age (odds ratios, 2.433; P < 0.05), but this difference was reversed with age adjustment (odds ratios, 0.443; P < 0.05). CONCLUSION: HBs antigen was more prevalent in patients with benign oral tumors, while HCV antibody was higher in patients with oral cancer. However, this increased incidence of HCV antibody apparently was a reflection of age. HCV infection may not have an etiologically important association with oral cancer.     

No evidence of hepatitis C virus infection in Serbian patients with oral leukoplakia

BACKGROUND: A review of the literature reveals controversy regarding the relationship between hepatitis C virus (HCV) infection and oral leukoplakia (OL). The aim of this study was to determine the frequency of HCV antibodies in patients with OL and control subjects resident in Serbia. METHODS: In this cross-sectional study 73 consecutive patients with histologically proven OL and 90 control subjects, whose age and gender were matched, were examined for the presence of serological evidence of chronic hepatic disease, hepatitis B surface antigen (HBsAg) and anti-HCV seropositivity. RESULTS: None of the patients with OL or control subjects had antibodies to HCV or HBsAg. All patients with OL and control subjects had normal liver function. CONCLUSION: The present data indicate that patients with OL resident in Serbia do not have evidence of HCV or HBV infection.     

Oral lichen planus and hepatitis C virus infection

OBJECTIVE: This investigation was conducted to determine the possible association between oral lichen planus (OLP) and hepatitis C virus infection (HCV) in the population of São Paulo (Brazil). MATERIALS AND METHODS: Three groups of patients were studied: group 1 was composed of 68 patients with OLP lesions; group 2 had 126 patients with HCV infection; and the control group consisted of 898 individuals seeking dental treatment at our school, used to determine the prevalence of lichen planus in the general population. The prevalence of HCV in group 1 was determined and compared with that of the population of São Paulo ( 9 ) Brazilian J Infec Dis 2: 269), while the prevalence of OLP in group 2 was determined and compared with that of the control group. RESULTS: The results showed that the frequency of HCV in OLP patients was 8.8%, significantly higher than in the general population of São Paulo, which is 1.4% (P=0.002), and the frequency of OLP in HCV patients (4.7%) was also significantly higher (P=0.0003) than that of the control group (0.6%). CONCLUSION: These data suggest that, at least in São Paulo, there is an association between OLP and HCV infection.     

Oral diseases associated with hepatitis C virus infection. Part 2: lichen planus and other diseases

Some of the most frequent extrahepatic manifestations of hepatitis C virus (HCV) infection involve the oral region predominantly or exclusively. Part 2 of this review discusses the current evidences regarding the association of lichen planus (LP) and other diseases frequently involving the oral cavity with HCV. Epidemiological data suggest that LP may be significantly associated with HCV infections especially in southern Europe and Japan but not in northern Europe. These geographical differences are possibly influenced by immunogenetic factors, the duration of the HCV infection and the design of the published studies. Because of the fact that most of the studies published are retrospective, it is impossible to establish whether the HCV exposure occurred earlier to or after the onset of disease and more prospective studies are clearly warranted. As the virus may replicate in the skin and oral mucosa and HCV-specific T lymphocytes can be found in the oral mucosa of patients with chronic hepatitis C and LP, HCV may be implicated in the pathogenesis of LP. However, little attention has been paid to the variable effect of therapy with interferon-alpha (IFN-α), with or without ribavirin for LP. Conversely, it is unlikely that other oral diseases such as oral carcinoma, pemphigus and Behcet disease are triggered by HCV.     

Oral lichen planus and hepatitis C virus (HCV) infection: is there a relationship? A report of 10 cases

Ten patients are reported suffering from oral lichen planus (OLP) associated with chronic liver diseases linked to HCV. All patients were affected by varieties of erosive oral lichen planus. In six of these 10 patients the diagnosis of HCV was made as a result of the OLP diagnosis and four of them had unknown, but severe, chronic liver disease. These preliminary data support the possible existence of a relationship between oral erosive lichen planus and HCV infection.     

The increasing problem of hepatitis C virus infection

The widespread incidence of hepatitis C (HCV) infection throughout the community is of concern. Although many of those infected will not suffer significantly from their infection, up to one-third will have liver disease, fatigue and oral health problems. General dental practitioners need to be aware of the precautions necessary in treating people with severe liver disease. This paper discusses the issues associated with treating patients who have HCV infection including the importance of preventive programs to reduce dental pathology and maximise oral health.     

Hepatitis C virus infection in Italian patients with oral lichen planus: a prospective case-control study

To assess the aetiology of liver disease associated with lichen planus, we prospectively studied 70 consecutive newly diagnosed patients with oral lichen planus (OLP) living in northwest Italy (Piemonte) and 70 controls matched for age and sex with other oral keratoses coming from the same district. Twenty-two patients with OLP (3.4%) and 9 controls (12.9%) were found to be affected by chronic liver disease (CLD) ( P =0.014). In sixteen of the 22 OLP patients with CLD the liver disease was hepatitis C virus (HCV)-related. whereas 2 of the 9 controls had a HCV-related CLD ( P =0.016). In another OLP case, liver damage was related to a combination of HCV and alcohol abuse. The prevalence of HCV antibodies in the whole OLP group (27.1%) was significantly higher than in controls (4.3%) ( P =0.014). whereas no difference was found between the OLP and control groups regarding hepatitis B virus markers and other common causes of CLD. HCV infection was more frequently found in patients with erosive OLP (58.8%) than in patients with non-erosive OLP (13.2%) ( P =0.004). Serum HCV-RNA was detected by polymerase chain reaction (RT-PCR) in the majority (93.7%) of OLP patients who had HCV antibodies. Excluding OLP and control patients with HCV markers, there was no difference between the two groups regarding frequency of CLD. Our data show that HCV is probably the main pathogenic factor in liver disease of Italian patients with OLP. and suggests that HCV could be involved in the pathogenesis of OLP.     

Hepatitis C virus infection and lichen planus: a short review

OBJECTIVE: To review the current literature regarding the association of lichen planus (LP) and liver disease, with particular attention to the association of the oral variant of the disease with hepatitis C virus (HCV) infection.
MATERIALS AND METHODS: Available literature of the possible association of LP with systemic disorders, in particular chronic hepatic disease, has been reviewed. RESULTS: LP is sometimes associated with infectious or autoimmune disease and/or neoplasia, however an aetio-logical association between LP and these disorders seems unlikely. A more consistent association exists between LP and chronic hepatic disease. The precise cause of this association is not known. However, in the last 6 years a notable association between HCV infection and LP has been observed, particularly in patients in Spain, Italy and Japan. The pathogenesis of this possible HCV-associated LP is not known, but it may involve a cell mediated response to an altered epithelial antigen.
CONCLUSION: There is now evidence to suggest a significant association between HCV infection and LP in some groups of patients.     

Hepatitis C virus infection and oral lichen planus: a report from the Netherlands

The reported frequency of anti-hepatitis C virus (HCV) antibodies in groups of cutaneous lichen planus (CLP) and/or oral lichen planus (OLP) patients varies from about 4% to 65%. Most of these studies have been performed in countries with a high overall prevalence of HCV infection in the general population, such as the southern European countries and Japan. Limited data are available from areas with a low prevalence of HCV infection. Therefore, we investigated the prevalence of HCV infection in a series of 55 patients with OLP in the Netherlands, which apparently has a low prevalence of HCV infection. None of the 55 patients revealed serological evidence of antibodies to HCV. The present data suggest that HCV infection in OLP patients in the Netherlands is probably not very common. A larger study group with a sex- and age-matched control group is required to advise against routine serological examination for HCV infection in Dutch OLP patients.     

High prevalence of hepatitis C virus antibody and RNA in patients with oral cancer

We have investigated the correlation between the prevalence of hepatitis C virus (HCV), which is detectable in saliva, and oral cancer and other digestive tract cancers in the Northern Kyushu region of Japan. Anti-HCV antibodies were detected in sera from 24 of the 100 patients with oral cancer (24%, p<0.05 vs the control group, p<0.01 vs the stomach cancer group), in 11 of 104 patients with non-malignant diseases receiving dental treatment (the control group, 10.6%), and in 12 of 113 patients with stomach cancer (10.6%). HCV-RNA was detected in sera from 17 of 100 oral cancer patients (17%, p<0.05 vs the control group) and 4 of 104 patients of the control group (3.9%). These results indicate a high prevalence of HCV infection in oral cancer patients, which warrants a systematic study of etiological associations between oral cancer and HCV.     

Vasculitis of dental pulp associated with cryoglobulinemia in hepatitis C virus patients: case report

Introduction

This report presents a case of impacted lower third molar extracted for surgical reasons in patient with uncontrolled hepatitis C. After decalcification, dental pulp vasculature and its tissue quality were investigated.

Methods

Serial sections of 4-μm thickness along the midline buccolingually for the demineralized specimen were obtained, mounted on a glass slide, stained with hematoxylin-eosin, covered, and viewed under the light microscope.

Results

The histologic investigation of the pulp tissue revealed thickening, stenosis, and occlusion of the vessel wall, ectopic calcification of the pulp tissue in close association with pulpal blood vessels, interrupted and vacuolated odontoblastic layer in the coronal pulp chamber, with an inflammatory cell infiltrate throughout the pulpal tissue.

Conclusions

Cryoglobulinemia associated with uncontrolled hepatitis C virus infection in patients endangers the dental pulp vasculature and alters its normal tissue architecture.     

The IgG antibody profile to various antigen regions of hepatitis C virus differs in oral fluid and serum of patients with chronic hepatitis C

Antibodies to hepatitis C virus (HCV) can be detected not only in serum but also in oral fluid. The aim of the study was to determine IgG antibody reactivity directed to six antigen regions of HCV in oral fluid and to evaluate the significance of the antibody pattern in oral fluid compared to serum. Oral fluid and serum samples of 32 HCV viremic patients were collected to detect antibodies to six antigen regions incorporated as antigen bands into modified commercial updated third generation line immuno-assay. Compared to serum, a significantly lower cumulative antibody response and reactivity to five HCV antigens was found in oral fluid. The significantly highest prevalence of oral fluid reactivity was recorded with antigen C1 (78%), whereas in serum the most significantly frequent reactivity was detected with antigen NS3 (100%). The absence of antibody reactivity with antigen E2 was similar in both body fluids. The discrepancy in antibody pattern to HCV antigens between oral fluid and serum indicates the possible existence of local viral replication, viral mutants, viral inhibitors in oral cavity and, most probably, leakage of the muco-vascular barrier.     

Oral diseases associated with hepatitis C virus infection. Part 1. sialadenitis and salivary glands lymphoma

Morbidity associated with hepatitis C virus (HCV) infection is due not only to the sequelae of chronic liver disease, but also to a variety of extraheaptic manifestations (EHM). Some of the most frequently reported EHM of HCV infection involves the oral region predominantly or exclusively and they are the topics of this 2‐part review. The current part 1 discusses the evidences on the association of salivary glands disorders with HCV. HCV‐ infected patients may frequently have histological signs of Sjögren‐like sialadenitis with mild or even absent clinical symptoms. However, the pathogenetic role of HCV in Sjogren Syndrome (SS) development and the characteristics distinguishing classic SS from HCV‐related sialadenitis are still an issue. It is unclear if the virus may cause a disease mimicking primary SS or if HCV is directly responsible for the development of SS in a specific subset of patients. Notably, some patients may present a triple association between HCV, SS‐like sialadenitis and salivary gland lymphoma and the virus may be involved in the lymphomagenesis. The risk of having a salivary gland lymphoma is particularly high in patients with mixed cryoglobulinemia. Little attention has been paid to the effects of anti‐HCV treatment on sialadenitis or lymphoma development.     

Oral lichen planus in relation to transaminase levels and hepatitis C virus

BACKGROUND: Elevation of transaminase levels was reported earlier in patients with oral lichen planus. The association between hepatitis C virus (HCV) and lichen planus had given positive and negative results. The controversies and uncertainties regarding the association of HCV and the liver function status (transaminase levels) in oral lichen planus inspired us to conduct this study. PATIENTS AND METHODS: This study was performed on 40 patients with different types of oral lichen planus as a study group and 40 healthy cases as control group. All patients were subjected to routine blood test and urine analysis and the estimation of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels. The values of SGOT and SGPT levels < or =40 IU / l were considered within normal limits. Anti-HCV titer was estimated in all cases. RESULTS: Fourteen patients (35%) with oral lichen planus had diabetes mellitus, while six (15%) cases of the control group had diabetes mellitus (P = 0.04). Regarding SGOT and SGPT levels, it was elevated in 19 cases (47.5%) and in 4 cases (10%) of the study group and control group, respectively (P = 0.0002). In relation to the type of oral lichen planus, out of 15 erosive cases, 80% (12 cases) showed elevated SGOT/SGPT levels. Out of 25 non-erosive cases, 7 (28%) patients showed elevated SGOT/SGPT levels (P < 0.01). Anti-HCV titer was negative in all cases. CONCLUSION: We can conclude that diabetes mellitus and elevated transaminase levels might be related to the development of oral lichen planus lesions. There is a strong association between elevated SGOT/SGPT levels and detection of erosive type of such lesions. However, no correlation between oral lichen planus and HCV infection could be assessed in the present study.     

Self-reported oral health perceptions of Somali adults in Minnesota: a pilot study

Abstract: Objective: To assess self‐reported oral health perceptions and associated factors in an adult Somali population living in Minnesota, USA. Methods: We analysed data from a cross‐sectional study of Somali adults aged 18 to 65+ years attending a dental school clinic for care. A comprehensive oral examination was performed by the dental school outreach team on all patients who attended a 2‐week designated Somali dental clinic. Adults who consented were given an oral health questionnaire to collect information on sociodemographics, marital status, language preference and self‐rated oral and general health. We performed summary statistics and differences between proportions using Fisher’s exact test and a comparison of means using one‐way anova or a two‐sample t‐test. Results: The sample consisted of 53 adults, 75% of whom were females. About 49% of subjects reported poor/fair oral health and 38% reported poor/fair general health. Seventy‐four percent rated their access to dental care as poor/fair and 83% reported that they did not have a regular source of dental care. Self‐rated oral health was significantly associated with marital status (P < 0.05) and self‐rated general health (P < 0.01) using Fisher’s exact test. Conclusion: A substantial proportion of Somali adults rated their oral health and access to dental care as poor/fair. These findings suggest that this population would benefit from improved access to oral health care and culturally appropriate oral health education and promotion programs.     

Oral fluid and hepatitis A, B and C: a literature review

J Oral Pathol Med (2012) 41 : 505–516 Background and aims: Viral hepatitis is a significant global health problem that, depending upon the virus, affects individuals of the developing and/or developed world. In recent years, there has been renewed interest in whether oral fluids can be considered as a source of viral hepatitis transmission and whether oral fluid, in particular, whole saliva, may be a useful source for viral detection as part of the diagnosis and monitoring of viral hepatitis. The aim of this article was to review current data concerning the possible carriage of the hepatitis A, B and C viruses within saliva and gingival crevicular fluid. Such knowledge will indicate if (i) oral fluid is a possible source of infection and (ii) whether oral fluid can be used for diagnosis and monitoring of viral hepatitis. Data and sources: A literature search was conducted using PubMed (Medline), EMBASE/Excerpta medica, the Cochrane database and Scopus. The results were limited to published material after 2000. Relevant material was evaluated and reviewed. Conclusion: There is some evidence that hepatitis viruses A, B and C are present in oral fluids, particularly whole saliva and gingival crevicular fluid and may thus be possible sources of viral detection in clinical diagnosis and monitoring. However, the data are inconsistent and warrant the need for well‐planned longitudinal studies to explore the precise frequency of oral carriage of such viruses and to determine the virological and host factors that may influence the oral presence of hepatitis A, B and C viruses.     

Hepatitis C virus infection and lichen planus: a systematic review with meta‐analysis

Oral Diseases (2010) 16 , 601–612 Objective: Hepatitis C virus (HCV) is one of the major causes of chronic liver disease worldwide but its morbidity is also due to a variety of extra‐hepatic manifestations including mixed cryoglubulinemia, non–Hodgkin lymphoma, diabetes, porphyria cutanea tarda and lichen planus. The aims of this study were to conduct a systematic review and a meta‐analysis on the prevalence of HCV in lichen planus patients and on the prevalence of lichen planus in chronic HCV infection. Materials and Method: Bibliographic searches were conducted in several electronic databases. Pooled data were analysed by calculating odds ratios, using a random effects model. Results and Conclusions: Thirty‐three studies comparing the seroprevalence of HCV in lichen planus patients and six reporting the prevalence of lichen planus in patients with HCV infection were included in the meta‐analysis. The summary estimate showed that LP patients have significantly higher risk (odds ratio 4.85; 95% confidence interval 3.58–6.56) than controls of being HCV seropositive. A similar odds ratio of having lichen planus was found among HCV patients (4.47; 95% confidence interval 1.84–10.86). Sub‐analyses indicated that variability of HCV/lichen planus association seemed only partially depending on geographic effect.