Renal & Hepatic
Dental Management of Patients with Liver cirrhosis / hepatic impairment
Assess coagulation before invasive care
Advanced liver disease impairs synthesis of clotting factors and drug metabolism. Check coagulation before surgery.
Emergency vs routine management
If EMERGENCY — what to do
- • Check INR and platelets before surgery; refer to hospital if INR > 2.5 or platelets < 50 × 10⁹/L.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Use local haemostatic measures: oxidised cellulose/collagen packing, sutures, pressure and tranexamic acid 5% mouthwash.Ref: SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- • Limit paracetamol to 2 g/day, avoid NSAIDs; reduce metronidazole dose.Ref: British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
If ROUTINE — what to do
- • Coordinate with the hepatologist; non-surgical routine care can proceed.Ref: Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- • Use the minimum effective LA dose (amides are hepatically metabolised).Ref: British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
Clinical precautions
- • Reduce/avoid hepatically-metabolised drugs (paracetamol dose limits, avoid where advised)
- • Assess coagulation (INR/platelets) before surgery
- • Local haemostatic measures
Information & tests to request
- • INR (if available)
- • Platelet count (x10⁹/L)
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | MODIFY / CAUTION Adjust drug choices for hepatic impairment |
| Supragingival scaling / polish | MODIFY / CAUTION Assess coagulation before invasive care |
| Deep scaling / subgingival RSD (subgingival calculus) | MODIFY / CAUTION Assess coagulation before invasive care |
| Root canal treatment | MODIFY / CAUTION Adjust drug choices for hepatic impairment |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION Assess coagulation before invasive care |
| Surgical / bony extraction | MODIFY / CAUTION Assess coagulation before invasive care |
| Implant placement | MODIFY / CAUTION Assess coagulation before invasive care |
References
- Liver disease — coagulopathy & drug metabolism
- Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023
- SDCEP. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd ed., 2022
- British National Formulary (BNF) — Prescribing in renal impairment, hepatic impairment & drug interactions (current edition)
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.