European Journal of Cardiovascular Medicine

Viral hepatitis remains a critical public health concern globally, particularly in developing nations like India, where healthcare access, awareness, and preventive strategies remain inconsistent. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections contribute significantly to the burden of chronic liver disease, cirrhosis, and hepatocellular carcinoma, often progressing silently until advanced stages of hepatic dysfunction are evident[1]. The asymptomatic nature of these infections in the early stages facilitates unintentional transmission, particularly in clinical settings, including dental departments, where invasive procedures may involve exposure to blood and bodily fluids[2].

India is considered an intermediate endemic zone for HBV, with an estimated prevalence ranging from 2% to 7%, and varying significantly between different geographical regions and populations[3]. Similarly, HCV prevalence varies, though certain regions report seropositivity rates between 0.5% and 2%, with increased rates observed among high-risk groups such as healthcare workers, intravenous drug users, and patients undergoing repeated invasive procedures[4]. The reuse of inadequately sterilized instruments and limited use of barrier methods in resource-limited dental setups further elevate the risk of nosocomial transmission of blood borne viruses [5].

Routine blood investigations in outpatient departments offer an opportunity for early identification and prevention of disease transmission. Studies conducted in tertiary care centers have shown incidental findings of HBV and HCV during pre-operative or diagnostic workups, underlining the value of routine screening even among asymptomatic patients [6]. While significant attention is paid to screening in surgical, obstetric, or dialysis units, dental departments are often underrepresented in surveillance efforts, despite the inherent risk associated with procedures like tooth extraction, periodontal surgeries, and root canal treatments [7].

Furthermore, co-infection with other blood borne viruses such as HIV has been reported in the Indian population, complicating clinical management and highlighting the necessity of comprehensive viral screening before any invasive medical intervention[8]. The prevalence of HBV and HCV among dental patients has been sparsely studied in Bihar, a state with significant healthcare disparities. In this context, dental professionals are not only at occupational risk but may also act as vectors for cross-transmission if adequate universal precautions are not maintained [9].

This study retrospectively reviews data from patient records to assess the incidence of HBsAg and HCV positivity, emphasizing the hidden burden of viral infections in dental care recipients. By identifying the frequency of such infections in a dental outpatient population, the study emphasizes the need for integrating viral screening protocols into dental healthcare practices. Establishing local epidemiological data will also aid in devising targeted public health policies, improve infection control protocols, and reinforce the importance of universal precautions in dental settings [10].

Study Design and Setting

This was a retrospective, record-based study conducted in the Department of Dentistry at Nalanda Medical College & Hospital (NMCH), Agamkuan, Patna, Bihar. The study spanned over a period of 18 months and involved patients attending the dental outpatient department (OPD) for various dental treatments requiring routine pre-procedural blood investigations.

Study Population and Sampling

Archived blood test records of 500 dental outpatients from the departmental database were retrospectively analyzed. Inclusion criteria included adult patients (18+ years) who had undergone blood screening prior to dental procedures during the study period (Month Year to Month Year). Patients with incomplete records or known prior HBV/HCV diagnosis were excluded.

Data Collection and Laboratory Investigations

Data on viral markers (HBsAg, HCV, HIV 1 & 2) were extracted from archived laboratory records of routine preoperative blood tests conducted during dental treatment preparation.:

•          Complete Blood Count (CBC)

•          Random Blood Sugar (RBS)

•          Bleeding Time (BT)

•          Clotting Time (CT)

•          Prothrombin Time (PT)

•          International Normalized Ratio (INR)

•          Viral markers: HIV 1 & 2, HBsAg (Hepatitis B surface antigen), and anti-HCV antibodies (Hepatitis C Virus)

Blood samples were collected under aseptic precautions and sent to the central laboratory of the hospital. The viral markers were tested using third-generation enzyme-linked immunosorbent assay (ELISA) kits, as per manufacturer instructions. HBsAg and HCV positive cases were referred for confirmatory testing and further management in the Department of General Medicine.

Data Analysis

All data were compiled in Microsoft Excel 2019 and descriptive statistics were applied. The incidence rates of HBsAg and HCV positivity were calculated as a percentage of total screened patients. No inferential statistical analysis was performed, as the study aimed primarily at estimating incidence.

A total of 500 archived blood reports from dental outpatients were reviewed. All participants underwent routine blood investigations prior to dental procedures. The demographic distribution, prevalence of viral markers, and breakdown by gender and age are summarized below.

Table 1 Summary – Age-wise Distribution of Patients
the study population showed a wide age range, with participants distributed fairly evenly across four age groups. The majority of patients (30%) fell within the 31–45 years category, followed by those aged 46–60 years (26%) and the youngest group aged 18–30 years (22%). Patients aged above 60 years also constituted 22% of the study sample. The mean age was calculated to be 42.5 years with a standard deviation of ±12.4 years. This age spread reflects a balanced representation of adult dental patients across both young and older demographics visiting the department for dental care.

Table 2 Summary – Gender Distribution of Patients
Among the 500 dental patients screened, 270 were male and 230 were female, representing 54% and 46% of the sample respectively. The slightly higher representation of male patients is consistent with prior trends observed in dental outpatient visits in tertiary care institutions, where occupational, cultural, or socioeconomic factors may influence gender-based healthcare access patterns. However, the overall distribution remained relatively balanced, allowing for equitable comparison across genders in the subsequent analysis of viral marker prevalence.

Table 3 Summary – Prevalence of Viral Markers among Dental Patients
Routine viral screening of all 500 patients revealed that 3 individuals (0.6%) were positive for Hepatitis B surface antigen (HBsAg), while only 1 patient (0.2%) tested positive for Hepatitis C Virus (HCV). No cases of HIV 1 or 2 were detected in this cohort. These findings indicate a low but non-negligible prevalence of bloodborne viral infections in the dental outpatient population. Even at low incidence levels, the potential risk of transmission during dental procedures reinforces the importance of universal screening and strict adherence to infection control practices.

Table 4 Summary – Distribution of HBsAg and HCV Positivity by Gender
Out of the 3 HBsAg positive cases identified, 2 were male and 1 was female, while the single HCV positive case was found in a male patient. This gender distribution pattern, though based on a small number of positive cases, suggests a slightly higher occurrence of bloodborne infections among male patients in this population. However, due to the limited number of seropositive individuals, no statistically significant inference regarding gender predilection can be drawn from the present data.

Table 1: Age-wise Distribution of Patients (n = 500)

Mean age of participants: 42.5 years ± 12.4 SD

Table 2: Gender Distribution of Patients (n = 500)

Table 3: Prevalence of Viral Markers among Dental Patients

Out of the 500 patients screened, 3 were HBsAg positive, and 1 was HCV positive. No patient tested positive for HIV.

Table 4: Distribution of HBsAg and HCV Positivity by Gender

The majority of HBsAg and HCV positive cases were found in male patients. No statistically significant pattern could be inferred due to the low incidence rate.

The present retrospective analysis of laboratory records revealed a 0.6% prevalence of HBsAg and 0.2% prevalence of HCV among dental outpatients undergoing routine blood screening at a tertiary care dental unit. While these numbers may appear low, they align with findings from other tertiary care settings in India, emphasizing the silent carriage of these viruses even among asymptomatic populations [11]. In a similar screening conducted in a large Indian ophthalmic surgical cohort, the prevalence of HBsAg and HCV was found to be 0.5% and 0.3% respectively, further supporting the value of routine viral marker evaluation before any invasive procedure[12].

Although no HIV-positive cases were found in our sample, the co-prevalence of bloodborne infections in Indian populations has been well-documented. Literature shows that HBV and HCV infections are often underdiagnosed, especially in non-targeted populations such as dental outpatients, unless specifically screened[13]. Dental procedures often involve exposure to saliva and blood, and the risk of transmission to both healthcare providers and subsequent patients is heightened in the absence of preoperative screening and standard precaution protocols[14].

The slightly higher occurrence of positive cases among males in our study is consistent with gender-based trends reported in earlier literature. A seroprevalence study from eastern India observed higher HBV and HCV positivity rates among males, possibly due to a higher prevalence of behavioral and occupational risk factors, including unsafe injections, unregulated dental treatments, and tattooing

practices[15]. However, our limited sample of positive cases did not allow for robust statistical comparisons, and further large-scale studies are necessary to assess gender-linked risk in more detail.

From a public health standpoint, the findings are relevant because even a single seropositive case in a high-turnover dental department poses a potential infection control challenge. Given that HBV and HCV can survive on environmental surfaces for extended periods, dental healthcare workers are considered at moderate to high risk for occupational exposure, particularly in facilities where universal precautions are inconsistently applied[16]. In such contexts, implementing routine viral screening, especially for patients undergoing surgical dental procedures, should be considered a safety imperative rather than an optional diagnostic step.

Recent advancements in point-of-care testing and dried blood spot technology have improved the feasibility of mass screening for hepatitis B and C, making integration into pre-procedural protocols in outpatient departments more practical[17]. The addition of such tests in dental setups could act as an effective barrier against nosocomial transmission, especially in regions with constrained health budgets like Bihar. Moreover, early detection provides an opportunity for linkage to care and management of chronic liver disease, which remains undiagnosed in many rural and semi-urban populations[18].

Comparative epidemiological studies in northern and western India have shown considerable regional variability in hepatitis prevalence, influenced by factors such as literacy level, healthcare access, and vaccination coverage[19]. Unfortunately, the adult HBV vaccination rate in India remains suboptimal, and there is no universal HCV vaccine available, further underscoring the necessity of primary prevention strategies such as screening and barrier precautions in high-risk clinical units like dental departments[20].

This retrospective study highlights the presence of HBsAg (0.6%) and HCV (0.2%) positivity among dental outpatients, emphasizing the importance of reviewing laboratory screening data to inform infection control policies in dental care.Although the observed incidence was low, the findings underscore the importance of incorporating mandatory viral screening protocols in dental settings to enhance infection control and safeguard both patients and healthcare workers. Given the risk of bloodborne transmission during dental procedures, especially in resource-limited regions, implementing universal precautions and routine testing is essential. Early identification also facilitates timely referral and management, contributing to broader public health efforts in controlling chronic viral hepatitis in India.

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