The document outlines best practices for managing dental care in patients with renal and hepatic conditions, emphasizing the importance of consultations, monitoring vital signs, and avoiding nephrotoxic drugs. It includes specific recommendations for patients undergoing dialysis, organ transplantation, and those with liver disorders, highlighting the need for prophylactic antibiotics and careful drug dosing. Furthermore, special attention is required for maintaining oral hygiene and ensuring hemostasis in patients with severe liver disease.

1. MANAGEMENT OF PATIENTS
WITH RENAL AND HEPATIC
CONDITIONS

3. RENAL PROBLEMS
Renal failure
Renal/Other organ transplantation

4. RENAL FAILURE
 History
 Consultation
 Hemodynamics
 Dialysis

5. DENTAL MANAGEMENT
 Time of oral surgery in dialysis patients
 One day after dialysis
 Atrioventricular shunt

6.  Screening for Hepatitis B virus
 Monitor vital signs
 Consider the use of prophylactic antibiotics

7.  Avoid the use of nephrotoxic drugs
 Avoid/ modify drugs that depend on renal metabolism/ excretion
 Look for signs of secondary hyperparathyroidism

8. DENTAL MANAGEMENT OF ORGAN
TRANSPLANT PATIENTS
 Consultation with primary care physician
 Patients on immunosuppressive drugs
 Need for prophylactic antibiotics

9.  Aggressive management of infections
 Monitoring of vital signs
 Avoid the use of nephrotoxic drugs

10.  Use of supplemental steroids
 Screening of Hepatitis B virus
 Index of suspicion for Cyclosporine induced gingival hyperplasia
 Advocate importance of oral hygiene

11. MANAGEMENT OF PATIENTS WITH
HEPATIC DISORDERS
 History
 Causes
 Consultation with primary physician

12.  Avoid/ modify the dose of drugs metabolized/ eliminated by liver
 Carry out platelet count, PT, PTT and bleeding time in patients with severe
liver disease
 Avoid situations in which patient might swallow a large amount of blood
 Ensure adequate hemostasis at the end of the procedure using local
hemostatic measures