A newbie with worries about dental treatment!

Hi all - my name is Liz and I am quite new to this forum and also to AF so up to now I have been lurking in the background hoovering up all the advice and information. Today I managed to floss half a tooth out, leaving just the other half with its filling - good news is that this tooth has a root canal filling so no pain as no nerves - bad news is, it is going to be difficult to remove and may need to cut my gum and dig around to get it all out, so I now I'm worried about the bleeding in addition to having rising stress levels due to fear of dentists generally. I am not sure whether I need to stop taking the anticoagulant before the extraction and also whether there are any other things I should mention to the dentist? Also - would I be better to get referred to the hospital and get it done there, as this is an option? I take Rivaroxaban 20mg once a day. Also Bisoprolol 2.5mg once a day, Flecainide 50mg twice a day plus Losartan 100mg for blood pressure.

And I should just explain about my journey and why I am so grateful for all the advice on this forum. When I was diagnosed with AF after an echocardiogram (no mention of type - paroxysmal or permanent) and absolutely no advice or information from cardiologist ("atrial fibrillation - nothing to worry about we will just tweak your meds") nor from the GP I saw at the time, and no follow-up for blood tests or checks - just get on with it! It was only when a viral infection triggered a bad PAF episode that took me to A&E, that I was referred to see an EP in Southampton, plus another GP following up from the hospital (you never see the same one twice at our practice) said I should have been back to Cardiology for a check up after 6 months due to the medication I was on being "toxic" - and that comment and mention of "an operation on my heart" sent me straight to the internet where I was lucky enough to find this forum! My appointment with the EP is in early May and I already have a list of questions for him - not at all sure about the ablation route for me - in the past year I have only had five or six episodes, usually at night and of short ( usually no more than a couple of hours) duration apart from the one that took me into A&E last month. I only have the one heart so want to be very sure about my options. I will be returning for advice after I hear what the EP says!!

11 Replies

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  • Hi Liz. Welcome. I am a newbie as well having joined some weeks ago. The information has been invaluable and has helped me immensely. Thus, I try to give back by sharing if and when appropriate.

    Had similar problem in 2016 wherein tooth broke off and had to be extracted. My dentist referred me to a dental surgeon did the procedure in his office. Spoke to his office prior to the procedure about discontinuing meds. I did not have to discontinue the anti-coagulant Xaralto, nor the flecainide, metoprolol, nor bp meds. Like you, pre-surgery, my stress level was through the roof. I thought the anxiety would put me into afib but luckily it didn't. (I too have a lot of anxiety when it comes to any dental work.).

    The actual surgical procedure was all of about two minutes, if that. No sedation just deadening of the gum. I couldn't believe it. I had to ask the surgeon : "you sure you got it all out?" as it was done so quickly. Normal amount of bleeding - no big deal. Had four stitches and was very sore for couple of days but over the counter pain reliever took care of that. Was so pleased with my courage to go ahead with this despite the anxiety, I went back and had major work done. My smile is beautiful. :)))

    Before proceeding, in order to ensure your safety and also to relieve your anxiety, why not call your GP or your dentist and ask about discontinuing any meds? Different dentists may have different criteria.

    All the best.

    👍👍

  • Thank you Phyllie - sounds like you had exactly the same situation as me and same meds more or less too! I will check back with my dentist and doctor - I think I would be happier being referred to a dental surgeon (would be at the hospital) as I am not too confident in my (new) dentist abilities yet!!

    Liz

  • Liz, My dentist wouldn't do the procedure because I was on "heart" medication - mostly flecainide. It had to be done by dental surgeon but could be done in his office where appropriate medical equipment and staff were available should there be a problem. Would be same for you if you had procedure done at hospital which, I think, is wise. Had no problems.

    Good luck,

    Phyll

  • Thanks - I'm sure it will be fine but better to have appropriate medical care nearby if needed I think too.

    Liz

  • Hi, I'm another dentist phobic (anyone know the correct term?) and had root canal treatment in December but there was a problem so my dentist says I must still have an extraction and has booked me for one at the hospital, because I am on Rivaroxaban my surgery won't touch it, apparently after a bad experience with a patient. Other people have had different experiences though so if you do a site search for 'dental work' etc you should find posts. I was terribly proud of myself for going through the root canal 😊!

  • Thanks I think at the moment I'm inclined to get referred to the dental surgeon at the hospital for this extraction although would be ok with my dentist for anything else. Looked up dental phobia also called odontophobia or dentophobia apparently. Isn't google wonderful!!

    Thanks to everyone for responding xx

  • One thing to remember is when you see your dentist ask him for non adrenaline local injection. Not quite as fast acting but shouldn't set of your AF which the other type can.

  • Are you sure you have to have the tooth extracted or could a screw and a crown be put there?

  • I second the remark of BobW about avoiding adrenaline injections. I was also able to negotiate that they avoided the back of my throat because I easily gag -- I have choked more than once in hospital while breathing cold oxygen. Since pain is information but I can often bear the pain if there is purpose, I negotiated as well a hand sign when I felt it, then the dental surgeon squirted in some more anaesthetic just near the important bit.

  • I had to have a tooth removed and my dentist was reluctant so he referred me to the hospital. Felt much safer and comfortable. They were fully up to speed on stopping and restarting Warferin so felt well looked after.

    Also I have an ICD and NICE no longer recommend anti biotics for dental treatment for those with ICDs, pacemakers and heart issues. But since this recommendation the incidents of infections around the leads and of the heart after having dental surgery has risen as has deaths for this category of patients. When I needed 2 crowns I expressed my concern to my dentist and he was happy to give me a prescription, if fact he was Going to suggest it. But he's private so he didn't have to follow the guidelines but use his own judgment.

  • Thanks everyone that's me decided - hospital it is and no adrenaline in the pain killer.

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