Table 3.101.

Key considerations for dental management in liver failure (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Underlying disease; impaired haemostasis
Appropriate dental care	2	Bleeding tests; preoperative vitamin K; avoid hepatotoxic drugs
Pain and anxiety control
– Local anaesthesia	1	Avoid lidocaine
– Conscious sedation	2	Avoid intravenous benzodiazepine
– General anaesthesia	3/4	Avoid barbiturates, opioids, halothane and suxamethonium
Patient access and positioning
– Access to dental office	0
– Timing of treatment	0
– Patient positioning	0
Treatment modification
– Oral surgery	3	Bleeding tendency; underlying disease
– Implantology	3/5	Avoid in alcoholism
– Conservative/Endodontics	2
– Fixed prosthetics	2
– Removable prosthetics	1
– Non-surgical periodontology	3/5	See oral surgery
– Surgical periodontology	3/5	See oral surgery
Hazardous and contraindicated drugs	2	Avoid aspirin, NSAIDs, erythromycin estolate, tetracyclines and some other antimicrobials (see Table 3.100)

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.