Liver Disease Pre-Extraction — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementLiver Disease Pre-ExtractionORE Part 1

A patient with end-stage liver disease and suspected hepatocellular carcinoma presents with a dental abscess requiring extraction. The patient is not taking anticoagulant or antiplatelet medication. Which investigation is most important to obtain, alongside medical liaison, before planning the extraction?

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Correct answer: B — PT/INR and platelet count

The correct answer is B. Advanced liver disease may impair haemostasis through reduced hepatic production of coagulation factors and thrombocytopenia/platelet dysfunction, so PT/INR and platelet count are the most directly relevant tests before extraction. SDCEP also advises liaison with the patient’s GP or specialist to establish the severity of liver disease and its likely effect on procedural bleeding risk. These tests must be interpreted clinically; they do not by themselves create an automatic threshold for treatment or transfusion. Bilirubin and transaminases describe hepatic injury or excretory function but do not directly assess procedural haemostatic risk. Chest assessment, glycaemic testing and hepatitis B serology may be relevant in particular clinical contexts, but none is the priority investigation for extraction-related bleeding risk in this stem.

Reference: Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, section 3.2.2 and Table 2, 2022. https://www.sdcep.org.uk/media/efmfgy44/sdcep-anticoagulants-guidance.pdf