Liver & Renal Flashcards
You extract a tooth from a patient and cannot achieve haemostasis, what are the potential medical reasons for your inability to achieve haemostasis?
- inherited/congenital bleeding disorders
- medication induced
- haematological disease (e.g leukaemia)
- liver disease
Why does liver disease have a direct affect on coagulation ability of patients?
Impaired liver function has an impact on the hepatic synthesis of clotting factors and proteins involved in the fibrinolytic system including the VITAMIN K DEPENDENT COAGULATION PROTEINS
In patients with end stage liver disease, what local anaesthetic should be used? Why is this?
Articaine!
- metabolised in the plasma
- stronger anaesthetic so you can avoid blocks and do infiltrations instead (less likely to form haematoma)
In patients with end stage liver disease, what local anaesthetic should be avoided? Why is this?
Lidocaine should be avoided
- it is metabolised in the liver
What drugs should we be careful in prescribing to liver disease patients?
- NSAIDs (increased bleeding risk)
- Paracetamol can be hepatoxic
- Amoxicillin/metronidazole/clindamycin all metabolised in the liver
A patient attends you with a UKELD score of 49 and is awaiting a liver transplant, he has been told to be made dentally fit. Provide a basic treatment plan for this patient:
- Remove any infection
- Consider removing teeth of poor long-term prognosis (this patient will be immunosuppressed for the rest of his life)
- Establish a preventative plan
- Consider the previous dental and social history of this patient; will they be committed to maintain their dentition
In patients receiving organ transplants, being dentally fit is essential. Prevention is a huge part of this, give some examples of how prevention can be incorporated into their treatment:
- OHI
- prescription of fluoride 2800ppm toothpaste
- fluoride mouthwash (225ppm)
