The role of dentists in controlling hepatocellular carcinoma in Japan (Review)

Abstract

In Japan, the method of treatment for hepatitis is well established due to the high rates of hepatitis C. However, the identification of patients with hepatitis who do not receive appropriate treatment poses a major problem. Some patients with this disease may need to consult with a dentist due to the development of extrahepatic manifestations, such as lichen planus, in the oral cavity. Alternatively, the dentist might discover patients with untreated hepatitis C and hepatitis B during routine dental examination. In such cases, the patient should be referred to a hepatologist for further examinations and treatment. Thus, dentists are required to act as 'gatekeepers of hepatitis'. Furthermore, Japanese dentists need to increase hepatitis B vaccine coverage for infection control. By acting as a 'care coordinator of hepatitis', the dentist will be able to contribute to the eradication of liver cancer in Japan, thereby eliminating the discrimination and prejudice against patients with hepatitis. Dentists need to have a deep understanding of liver disease from the viewpoints of both nosocomial infection control and treatment of oral diseases.

Keywords: dentist; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; lichen planus.

Figure 1

Clinical appearance of oral lichen planus (A, right buccal mucosa; B, left buccal mucosa; C, tongue; and D, lower lip) in patients at Saga University Hospital, Japan. White lace-like (reticular) lesions and erosions were observed on the buccal mucosae (A and B) of a patient with fatty liver and diabetes mellitus. Severe erosions with symptoms of contact pain on the tongue (C) of a patient with HCV-related liver cirrhosis and HCC, and erosion on lower lip (D) of a patient with chronic hepatitis C. HCV, hepatitis C virus; HCC, hepatocellular carcinoma.

Figure 2

The research areas where the examination and treatment of liver disease were recommended by a dentist. Dentists promoted the examination and treatment of hepatitis virus infection among patients who visited the dental clinics in the prefectures (black stars on the map). Each of the three studies was conducted after approval by the Ethics Committee (74,88,89). A study conducted in four prefectures in Japan (Fukuoka prefecture, Yamaguchi prefecture, Shimane prefecture, and Ehime prefecture) and comprising 48 medical institutions reported that the dentist serves the role of a gatekeeper for the treatment of a number of liver diseases.