Liver Disease: Dental Implications

• Dental aspects are important to consider in the context of liver disease and its management.

Dental Findings in Liver Disease

• Alcoholic cirrhosis often leads to poor oral hygiene, dental neglect, and dental erosion from gastric reflux.
• Sialosis, or parotid enlargement, can occur.
• Gingival enlargement may be present in liver transplant patients taking ciclosporin.
• Children who need liver transplants might experience delayed tooth eruption and teeth that are discolored or hypoplastic.

Dental Neglect

• Characterized by general neglect, poor oral hygiene, and increased caries.
• Increased inflammation, periodontal disease, and a lack of professional dental care are present.

Dental Management Considerations

• Patients may have an increased bleeding risk.
• There is a risk of poor wound healing and infection.
• Problems metabolizing drugs need to be considered.

Specific Dental Management Steps

• Infection control should be practiced with universal precautions, and staff should be vaccinated against Hepatitis B.
• Liver transplant patients on lifelong immunosuppressants have an increased infection risk, potentially needing antibiotic cover for invasive treatment.
• Elective dental treatment should be avoided until six months after the transplant.

Other Considerations

• The dose of local anesthetics might need to be reduced.
• Articaine can be used instead of Lidocaine.
• NSAIDs should be avoided.
• Patients may not be able to metabolize certain drugs, including tetracycline.

Preventative Dental Management

• Focus is on prevention.
• Oral hygiene instruction should be provided.
• Diet analysis and advice are important.
• Fluoride supplements can be beneficial.
• Alcohol and smoking cessation are recommended.

Summary

• The functions of the liver, main causes and symptoms of liver disease, and dental implications need to be considered.