Table 3.99.

Key considerations for dental management in liver cirrhosis (see text and Liver failure section)

	Management modifications*	Comments/possible complications
Risk assessment	2	Underlying disease; impaired haemostasis; bacterial peritonitis
Appropriate dental care	2	Antibiotic prophylaxis; avoid hepatotoxic drugs
Pain and anxiety control
– Local anaesthesia	1	Avoid lidocaine
– Conscious sedation	2	Avoid intravenous benzodiazepine
– General anaesthesia	3/4	Avoid halothane
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; poor wound healing; liability to peritonitis
– 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 ketoconazole

^*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.