Hi Aban !
very good question! nice to have you here
I found this in the internet . it might be helpful:
If a patient suffers severe liver damage, there may be a bleeding risk during surgical procedures (i.e. extractions) due to decreased synthesis of clotting factors, usually produced in the liver. Careful questioning should be undertaken prior to treatment with regard to previous episodes of bleeding following surgery/dental treatment, and any bruising tendencies.
Liaison with patients GMP/gastroenterologist may be necessary before undertaking dental extractions or other surgical procedures. Assessment of full blood count, coagulation screen and liver function tests can be done preoperatively in order to risk assess and decide if surgical treatment is safe. If there is concern over bleeding risk, then the patient should be referred to the local oral surgery or maxillofacial unit.
Care should also be taken when administering LA that is metabolised in the liver – doses should be kept to a minimum. Even two cartridges of LA may trigger signs of CNS toxicity if liver disease is severe.20 In addition, sedative agents and general anaesthetic agents pose a risk of toxicity.
Non-steroidal anti-inflammatory drugs, miconazole, metronidazole, erythromycin and tetracyclines should all be avoided in severe liver damage. Doses of fluconazole and paracetomal should be reduced.20
Many recovering alcohol dependent patients may be on disulfiram (antabuse). It is important to be aware that a psychotic reaction has been reported when disulfiram is given with metronidazole.17 In addition, alcohol-containing substances should be avoided including chlorohexidine mouthwash and benzydamine spray/mouthwash.
