Liver Disease - Oral Health Care Considerations

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.

Medical Complexity Status - Liver Disease#

See Medical Complexity Status for more information.