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.