The human body is one unit so you have to help your dentist to record carefully a full medical history for you. Liver problems are of the medical conditions that needs special care in dental clinic. liver diseases has many types but the most common are liver fibrosis as a result of viral infection or parasitic infection (belharizeases in some countries).

Dentist usually give extra care to liver patients because Liver is responsible of producing most of the factors that are essential for blood clotting. So viral hepatitis or any other distructive liver diseases can impair the normal coagulation mechanism and the patient of the uncontrolled liver disease tend to bleed more after surgery or tooth extraction. There is also an crossinfection risk if viral hepatitis(The most common liver problem) is present.

bleeding tendency: The diagnosis should be confirmed by a physician and the severity of liver affection should be taken into consideration by arranging for a coagulation screen tests  before any surgical treatment like extraction. Patients may need vitamin K or freshfrozen plasma to gain enough coagulation and, therefore, should be managed in hospital and the dentist also will concentrate on local methods of reducing post extraction bleeding like stitching or mesh supported dressing.

Drugs & medications: Drugs prescription is really dilemma as liver is responsible for the breakage and excretion of many toxic chemical materials including many drugs. Also there is some drugs that considered liver toxic and can really hurt the liver in compromised patients. so many drugs should be used with caution or avoided completely in severe liver disease. Paracetamol, NSAIDs, sedatives that usually prescribed after extraction or surgery  are the most common. Any drug prescribing should include reference to a drug formulary.  As some drugs even with normal dose can be txic to liver patient because he fails to break and excrete the drug so it accumulate in the body.  It is difficult to estimate the impairment of drug metabolism even with liver function tests so adjusting the doses of drugs can be very hard even for the experienced physician .

Cross viral infection:The most common form of liver disease is the A,B and C viral hepatitis caused by HAV, HBV AND HCV  so the routine precautions for infection control is essential which  means that all patients who needs extraction or any other oral surgery treatment, whether known high risk or not, should be managed in the same strict way to eliminate the risk of transmission of infectious agents like viruses and bacteria.

Before you take the decision you fist have to know what will happen after you extract this tooth:

1-Less chewing capability:

when you extract a tooth (especially molars)  your mastication force is affected badly because you are not only losing the tooth you extracted only but the opposing tooth in the other jaw become nonfunctional because it is biting on air so it can’t chew. also when you chew food the food must fall under pressure to be chewed. The tongue from inside, the check from outside and the upper and lower teeth above and below when you extract a tooth food escape to the empty space.

2- Appearance or Aesthetics:

when you get your tooth pulled and especially if the tooth is in your smile area it gives a really bad looking smile even the teeth after the canines will be apparent from the side profile.

Also extraction of posterior molars will affect you face symmetry and make you look older ??now you are asking  why doc.

Teeth act as a support for your lip and check if you removed one or more molars the check and lip will be depressed which can give a aging look. Also as long as the teeth in place it stabilize the face bone in place once you extract many teeth the face bone may start to shrink which also give a older look.

3-Phonetics or speaking  affected, You even can have a lisp:

Tooth pulling can really affect your phonetics especially if the removed tooth is on the anterior part of the jaws  and it is very challenging to you dentist to restore the normal phonetics even with a good false tooth.

4-Tooth gaps may formed in the extraction side of the jaw:

sometimes the teeth in the same side  rotate or slide in the empty space which may cause teeth gaps which can be very annoying as food get impacted inside it and sometimes cause gingival problems and even caries.

5- the opposing tooth in the other jaw may need to be extracted also:

when a tooth is extracted the opposing tooth in the other jaw start to over erupt or going out from the gums which may cause looseness and sensitivity to clod the looseness may increase with the time till the tooth need removal.

6- Stop pulling save your money :

This may look wear as extraction is usually cheaper than filling and root canal but this is the true PULLING COAST MORE MONEY. I can say that we “the dentists” are rich because of people who like extraction. Once you start to eat after tooth removal you will start to think in making false teeth to fill the space you just will feel bad and start to look for a treatment for the empty space. You go to your dentist and ask him to solve your problem. You will just find that all the options available are really really expensive (implant, bridges or even removable denture)

after all just stop the nonsense and keep your teeth where it should be and don’t start to think about pulling unless your dentist say that there is no other solution if root canal or simple filling treatment can be done in your case do it don’t hesitate.