Dental treatment with PAF and on Rivaroxaban?

Hi everyone, I added my new medical details (PAF & Rivarixaban) to my dental records and now my dental surgery has said I can't have my regular hygienist appt and dental check up until they have written confirmation that my condition and meds don't require any special precautions. (For instance, they suggested I may need antibiotics before my hygienist descaling work.)

Has anyone else had this request - or had any advice from your cardiologists about special precautions?

Thank you!

37 Replies

  • I have had problems too, dentist won't extract tooth because I am on Rivaroxaban but no mention of needing permission for hygiene work.

  • I'm sorry to hear that - is he sending you to hospital for it? What a pain :(

    My dentist has been putting off my wisdom teeth extractions until 'absolutely necessary'- now I've had this diagnosis I'm guessing he won't do it at all!

  • At first I was told I would have to go to hospital but when I queried it it changed to getting a letter of permission from my GP, only trouble is I have a bit of a phobia about dental treatment anyway and now I'm frightened 😨

  • Oh I'm sorry :( Feel for you...

  • Dentists seem to be very risk adverse these days. Only precaution for AF is adrenaline in local anaesthetic can be a trigger for some, was for me, but there are locals without adrenaline.

    I have a well informed dentist, I have hygiene appointments every 6 months and my main disease is a neuro muscle disease with meds far more problematic than the AF drugs.

    It is even more important have good dental hygiene with heart disease, my gums inflame very easily.

    I have been on and off anticoagulants since 2013 and never had a dentist question or deny me treatment,

    My only concern now would be extraction - but not because of AF or anticoagulants.

    Have the AFA got a recommendation on dental work? Failing that I would contact the Dentist's regulating body and or change your dentist.

  • Thank you! I'm very interested to hear about anaesthetics without adrenaline - that's good to hear... I'll definitely ask for that.

    I didn't see anything on AFA re dental work but I'll look again in case I missed it. Thanks!

    Sorry about the neuro muscle disease :( x

  • I have always had adrenaline free anaesthetics. Just make sure they write it in your notes. I remind my dentist every time to make sure.

    Dentist also wanted pacemaker clinic to write a letter confirming their ok They said they didn't do this but were happy for dentist to call them for guidance.

    Told them I am in rivaroxaban now and have hygienist spot in April. Will post about it then.

  • Thank you! That's very helpful :)

  • PS - it is up to them to write to your GP for confirmation.

  • I've never had any problems with hygienist on warfarin or Pradaxa . Ask for the evidence base to justify their decision

  • Had my usual three month hygienist app yesterday. Been on rivaoxaban three years never had a problem dentist wise. Had lots of dental treatment in that time with no issues whatsoever. No excessive bleeding or anything untoward.

    Dentist knows not to give me anaesthetic containing adrenaline. He is ahighly skilled dentist who I trust completely. He has a full list of my meds which are updated at each visit and is well aware of my arrhythmia and anticoagulant. Guess they are all different. Protecting themselves I guess from litigation.

  • I take Apixaban, Bisoprolol and Flecainide and my PAF is adrenaline sensitive. In the last 3 years I've had descaling every 6 months, one filling and one large, difficult tooth extracted without any problems or cessation of my anticoagulant.

    The only precaution which I insist upon is adrenaline-free injections which my dentist is happy to provide. My cardiologists gave no special instructions for dental work.

    Antibiotics before descaling sounds very strange - did they give a reason? It sounds to me like lawyer-influenced precautions being taken by your practice.

  • You're right! I have no idea... it was the dental practice nurse manager who cancelled my appts and asked me to get written confirmation etc.

    Re the antibiotics, she mentioned heart valves & plaque... but that means nothing to me!

    I think I'll try to talk to the dentist himself. Thanks so much for your advice and experience.

  • I would tell her she is acting outside her competence level. AF is an electrical problem of the heart.

  • Thank you! You sound braver than me! I'm easily intimidated... I need to toughen up I think :)

  • Good for you! This needs to be referred to your dentist. Routine antibiotics every 6 months would worry me unless there was a sound medical reason, identified by my doctor.

  • I did some research on this once, I believe the old thinking was that disturbance of plaque could lead to bugs reaching your heart and settling on valves which leads to serious illness, but nowadays especially with the cutting down of antibiotic use it is not considered essential. Bugs from your gums can cause heart infections at any time which is why good dental hygiene is so important. Sounds like she is overcautious or out of date.

  • Or both?! That's v interesting, thanks Buffafly!

  • Thanks to you all for your replies - that's very reassuring! No one told by dr/EP to be on antibiotics before descaling etc?

    My dentist himself is lovely - I imagine the practice are being over-cautious. Your tips have been very helpful - thank you! xx

  • Antibiotics as routine prophylactics (I.e. to prevent infection) used to be given pre dental treatment for people who had had heart surgery or other problems. The dentist would prescribe a revolting powder to be mixed with water but taken at the surgery in case of a reaction as it was a very strong single dose. The advice changed years ago - I don't remember the last time I had to have it but I still remember the taste! Ugh 😕

  • Interesting! But Ugh! I'm glad that's a thing of the past :)

  • I remember those. Disgusting taste!

  • Yes I took that for years, it went straight through you. Sometimes I did not take it then worried that I would get endocarditis. Such a relief when they stopped using it.

  • That's interesting! Did you used to have that because of AF? Or because of other heart issues? I think I remember they used to insist on antibiotics before treatment for those with heart murmurs - but I guess now the need to cut the overuse of antibiotics is greater!

  • Goodness, my dentist and hygienist aren't so bothered about Rivaroxaban! Antibiotics before descaling? Not suggested to me. They are being ridiculously cautious and should be better informed as you surely aren't their only anticoagulated patient. What other gaps in their knowledge are there one wonders.

    Perhaps an 'Advice for Ignorant Dentists' leaflet could be made available.

  • :D

  • I've been taking Rivaroxaban since last June, and because of a previous tooth problem, have visited the dentist once and the hygienist twice in that period of time, without any major problems. The hygienist did ask me to sit quietly in the waiting room for half an hour after my treatment, so that she could check all was well before my 1 hour drive home, as my gums were 'oozing' a little, but all was ok!

  • Thanks Vanna, that's good to hear!

  • I think we should all learn to be our own expert. I recently attended an eye clinic following the flare-up of an infection and abscess in my tear duct. The consultant recommended that I should have a local anaesthetic injection including adrenalin and that I should take Ibuprofen for the pain. He made no reference to my general notes, only the ophthalmic notes, and I had to explain about AF and why I should not have neither adrenalin nor Ibuprofen. He took my word for it!

  • Wow! Good job you were better informed..!

  • Yes. You have to be knowledgeable about your own condition which is why this group is so good. Except for the adrenaline advice you have been given you need no special treatment at the dentist. They are working on old news.

  • Thank you, Barb- That's v helpful to know.

  • There is no reason whatsoever to take prophylactic antibiotic because of PAF. As far as Rivaroxaban, just inform the dentist/hygienist that you are taking it, no reason to postpone the hygiene appointment. That being said, the dentist can, of course, insist that you folow his recommendations- in which case I would say consult another dentist.

  • Thank you, trtoothdr! Thats v helpful & I really appreciate the reply.

  • Not been asked for this by my surgery and have heavy duty hygienist work no problem

  • Good to know, thanks! (Love the phrase 'heavy duty hygienist work' - me too!)

  • Just thought I'd post an update to say that I managed to see my dentist in person yesterday. And he (unlike the dental nurse/manager) was perfectly happy to take my word that I can have regular dental treatment, rather than requiring written confirmation :)

    Thank you to everyone for your wisdom, experiences and very helpful advice :)

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