- All health care workers at risk of exposure to patients’ blood and saliva should be immunized against hepatitis B virus (HBV).
- Consult with patient’s physician to determine severity of liver disease and/or use the Child-Pugh Score or MELD Score (see also Calculators below).
- Patients with severe liver disease may develop icterus (jaundice) .
- Be aware of possible hemostatic abnormalities, as well as impaired drug metabolism.
- In patients with severe liver disease and cirrhosis, check laboratory values associated with bleeding prior to dental care.
- Patient wih severe liver disease may also present with oral dysbiosis, which may be associated with progression to liver cirrhosis (see Mohammed H, et al. below).
- Institution of fresh frozen plasma may be necessary before dental care for patients with severe liver disease.
- Prior to performing any surgical procedures, be sure that the patient has not ingested any alcohol.
- Avoid mouth rinses with a high alcohol content.
- Do not use acetaminophen or acetaminophen-containing medications in patients with severe liver disease.
- Check neutrophil count for patients treated with interferon. If the count is below 1,000 cells/mm3, consider antibiotic prophylaxis.
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- Medical Disorders
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- Alaizari NA, et al. Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J. 2016;61(3):282-7.
- Ginès P, et al. Liver Cirrhosis. The Lancet. Published Online September 17, 2021.
- Glick M. Medical considerations for dental care of patients with alcohol-related liver disease. JADA. 1997;128(1):61-70.
- Mohammed H, et al. Oral Dysbiosis in Pancreatic Cancer and Liver Cirrhosis: A Review of the Literature. Biomedicine. 2018;6(4):115
- Shahid I, et al. Real-world challenges for hepatitis C virus medications: a critical overview. Crit Rev Microbiol. 2018;44(2):143-160.
- Autoimmune Hepatitis. National Institute of Diabetes and Digestive and Kidney Diseases.
- Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases.
- Hemochromatosis. National Institute of Diabetes and Digestive and Kidney Diseases.
- Hepatitis. MedlinePlus. U.S. National Librray of Medicine. November 24, 2020.
- Liver Diseases. MedlinePlus. U.S. National Library of Medicine. April 23, 2021.
- Liver Disease. National Institute of Diabetes and Digestive and Kidney Diseases.
- Nonalcoholic Fatty Liver Disease (NAFLD) & NASH. National Institute of Diabetes and Digestive and Kidney Diseases.