Liver Cirrhosis: Are implants an option?
My patient is a 61 year old male with a history of hypertension. He is currently taking losartan (Cozaar), citalopram (Celexa) and tamsulosin (Flomax). He has no drug allergies. We had met a few months ago and began treatment planning to extract all the maxillary teeth except #4 and place some implants. He just presented yesterday at the wax try in for the denture set up and informed me he was recently diagnosed with cirrhosis of the liver. I have to speak to his medical doctor to get some more information. My question is this patient still a candidate for dental implants? Also, what type of precautions need to be taken in the management in a case like this? How would you proceed? Thanks.
5 Comments on Liver Cirrhosis: Are implants an option?
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Comlan Missih
1/24/2017
The only problem this patient might have during or after surgery is clotting. The liver cirrhosis most likely will affect his/her clotting factors synthesis there his/her ability to prevent bleeding and bruises. From Mayo clinic:
"Bleeding and bleeding disorders. A failing liver isn't able to produce sufficient amounts of clotting factors, which help blood to clot. People with acute liver failure often develop bleeding from the gastrointestinal tract. Bleeding may be difficult to control.
Infections. People with acute liver failure are at an increased risk of developing a variety of infections, particularly in the blood and in the respiratory and urinary tracts."
Dr Bob
1/24/2017
You are wise to consult with the pts MD. This is not a place to proceed with out documentation that you did so. Depends on the damage to the liver that has taken place.
Follow the lead from the MD.
Val Sharma
1/26/2017
Agree with the above comments.
I would also want to know the stage of the cirrhosis and what caused it in the 1st place (alcoholism, infection...) as these will definitely have an impact on my decision making as regards all future management of this patient.
Finally, is he a candidate for transplant as this will also feed into his management.
George
1/26/2017
Placing implants on a patient with cirrhosis will be trouble. There are many factors going against what you will be trying to accomplish. As many have already mentioned, clotting is problem, posted infection, and pain control may be an issue because some pain meds may not be abe to be used. Best to really get specific with the patient's MD. You will need labs such as INR, PTT, and platelet count. Some patient's need a blood transfusion prior to major surgeries. Proceed with caution.
CRS
1/27/2017
Based on the X-rays be sure to remove all those infected teeth see how he heals and coagulates at surgery, prior to placing any implants.This is over the head of a general dentist refer it to an OMS. Personally I would get a medical consultation on the severity and cause of the cirrhosis.Know your limitations may get burned on this one, good luck.
