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Concerns

What is the underlying cause of your liver disease?

What type of treatment, if any, are you receiving for your liver disease?

Do you have any increased bleeding tendencies?

Have you been told you cannot take certain medications?

Do you drink any alcoholic beverages?

How severe is your liver disease?

What types of medications are you taking?

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What is the underlying cause of your liver disease?

The most common form of liver disease is hepatitis. This inflammation of the liver may be caused by viral infections or toxic substances, induced by drugs, or secondary to ischemia.

Hepatitis may result in cirrhosis and impaired liver function.

Increased bleeding tendencies and impaired drug metabolism are specific concerns for dental care providers.

What type of treatment, if any, are you receiving for your liver disease?

Treatment for liver disease addresses the underlying cause.

Consequently, most treatments are for viral hepatitis and usually consist of different formulations of interferon, sometimes in combination with ribavirin, or of a single nucleoside reverse transcriptase inhibitor.

Interferon may reduce the absolute neutrophil count.

Do you have any increased bleeding tendencies?

In cases of severe liver destruction, coagulation factors will not be produced, which will impair secondary hemostasis (fibrin production), which may require systemic anticoagulation intervention with fresh frozen plasma. A diminished number of platelets also may be produced, or platelet destruction in the spleen may be increased, resulting in increased bleeding tendencies.

Have you been told you cannot take certain medications?

Two of the major functions of the liver are detoxification of foreign substances and metabolism of drugs. A severely destroyed liver will not be able to perform these functions; this may limit the types of medications the patient can safely take.

Do you drink any alcoholic beverages?

Alcohol, even in small quantities, may cause increased bleeding tendencies in patients with severe liver disease.

How severe is your liver disease?

Combinations of specific laboratory values and clinical signs and symptoms have been proposed to provide prognostic indicators to assess a patient’s degree of liver disease and severity.

The most commonly used methods are the Child-Pugh Score and the Model for End-Stage Liver Disease (MELD) Score.

What types of medications are you taking?

In addition to the medications used to treat the hepatitis, the patient may be taking other medications to treat related conditions, such as hypertension or vitamin deficiencies.

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