Gastrointestinal Disease: Liver Disease

DNHY 341S: Gastrointestinal Disease: Liver Disease

Course Overview

• Subject: Dental Management and Considerations in the Care of Patients with Liver Disease
• Instructor: Professor Jones

Learning Objectives

• Identify diseases of the liver impacting dental treatment.
• Discuss dental treatment modifications in the care of patients with liver disease.
• Discuss common causes of liver impairment:
  • Recognize functions of the liver.
  • Discuss adverse effects of liver dysfunction.
• Effectively manage dental patients presenting with liver disease.

Common Causes of Liver Dysfunction

• Infection: Includes bacterial, viral, and parasitic infections.
• Viruses:
  • Primarily Viral Hepatitis
• Alcoholic Liver Disease: Caused by excessive alcohol consumption.
• Anatomical components of the liver:
  • Right hepatic duct
  • Hepatic portal vein
  • Common hepatic duct
  • Left hepatic duct
  • Gallbladder
  • Spleen
  • Stomach
  • Duodenum (first part of the small intestine)
  • Common bile duct
  • Pancreas

Patient Management Challenges

• Patients with liver disease face high risk during dental treatment due to:
  • Adverse bleeding
  • Altered drug metabolism
  • Infection risk
• Importance of comprehensive health history intake for safe treatment:
  • May require medical referral.
  • Necessitates planning for safe and effective dental treatment.

Understanding Cirrhosis of the Liver

• Definition: Cirrhosis refers to irreversible damage to the liver due to long-term injury leading to fibrosis or scarring.
• Consequences:
  • Jaundice
  • Ascites (accumulation of fluid in the abdomen)
  • Portal hypertension (increased blood pressure in the portal venous system)
  • Liver dysfunction

Differences between Hepatitis and Cirrhosis

• Hepatitis:
  • Inflammation of the liver.
  • Can lead to chronic liver conditions and eventual liver failure.
• Cirrhosis:
  • Result of scarring due to long-term liver inflammation or damage.
  • Can progress to liver cancer or necessitate liver transplantation.

Hepatitis - General Description

• Definition: Hepatitis is inflammation of the liver which can stem from infectious or non-infectious causes.
• Viral Hepatitis: A general term for liver inflammation due to various viruses:
  • Hepatitis A virus (HAV)
  • Hepatitis B virus (HBV)
  • Hepatitis C virus (HCV).
• Noninfectious Hepatitis: Resulting from excessive or prolonged use of drugs and alcohol.

Detailed Viral Hepatitis Overview

Management of Patients with Active Hepatitis

• No elective dental care should be provided.
• Urgent care must be conducted in an isolated setting:
  • Minimize aerosols during procedure.
  • Obtain preoperative prothrombin time and bleeding time if surgery is necessary.
  • Avoid administering drugs metabolized by the liver.
  • Refer patients with acute hepatitis for appropriate medical diagnostics and treatment.

Management of Patients with a History of Hepatitis

• Medical Clearance: Required to ascertain the patient's current state.
• Lab Tests: Check for presence of HBsAg or anti-HCV to evaluate recovery or active disease.

Drug Administration Guidelines

• General Rule: No special drug considerations for cases of recovery from viral hepatitis.
• Drug Metabolism: Consider adjusting dosages for medications metabolized in the liver. Reference to guidelines provided in Table 10.4 is suggested for specific adjustments.

Oral Manifestations and Complications of Liver Disease

• Abnormal Bleeding: A significant complication.- Ensure a complete CBC prior to surgery, including assessment of platelet counts, bleeding time, thrombin time, and prothrombin time.
• Consultation with a physician might be necessary for platelet replacement.

Alcoholic Liver Disease

• Alcohol is toxic to the liver.
• A clear correlation exists between excessive alcohol consumption and liver dysfunction.
• Long-term damage can lead to end-stage liver disease or cirrhosis.
• The earliest indicator of alcoholic liver disease is fatty liver, which is reversible upon cessation of alcohol consumption.

Cirrhosis of the Liver: Implications

• Cirrhosis involves the development of fibrosis, leading to decreased liver function over time.
• Increased risk for complications, including:
  • Infections
  • Bleeding problems due to clotting factor deficiencies
  • Thrombocytopenia (low platelet count)
• Ultimately can result in liver (hepatic) failure.

Dental Management Considerations

• Treatment Planning: Adjustments are necessary as patients with liver disease present unique challenges:
  • Necessary Steps:
  • Conduct comprehensive health assessments.
  • Incorporate laboratory analysis such as CBC, bleeding time, thrombin time, prothrombin time.
  • Engage in consultation with a physician prior to interventions.

Considerations for Patients with Alcoholism

• Increased risk of bleeding tendencies.
• Unpredictable metabolism of certain drugs necessitates caution in administration.
• Risk of infection or transmitting infections.

Treatment Planning Modifications for Cirrhotic Patients

• Patients with cirrhosis show higher levels of plaque, calculus, and gingival inflammation compared to non-cirrhotic patients due to oral neglect.
• It is essential to address and modify oral health behaviors from the onset of treatment.

Oral Complications and Manifestations in Liver Disease

• Presence of a bilateral, painless hypertrophy of the parotid glands is commonly found in cirrhotic patients.
• Alcohol and tobacco use are significant risk factors for oral squamous cell carcinoma; aggressive monitoring of unexplained oral lesions in chronic alcoholics is crucial, especially in the:
  • Lateral border of the tongue
  • Floor of the mouth.

Conclusion

• Effective management of dental patients with liver disease requires a thorough understanding of the implications of liver dysfunction on treatment planning and patient care.

References

• Kerr, A., Miller, C., Rhodus, N., Stoopler, E., & Treister, N. (2024). Little and Falace's dental management of the medically compromised patient (10th ed.). Mosby.
• Policies and Procedures Manual. (2025-26). Eastern Washington Dental Hygiene Student Handbook.