Dental treatment

I need to have two teeth extracted, but the dentist is unwilling because I am taking xeralto - 20mg daily, he says it is dangerous it is such s strong drug and there is no antidote as there is with warfarin etc.,

He told me to either change the medication or find out a solution from my doctor which I did. My GP, said he cannot change the meds, only a cardiologist can, who I don’t see until middle of November. He called someone on the phone (I assumed it was a cardiologist) and was told that if I stop the xeralto for 48 hours prior to treatment then all should be well. I told my dentist this, but he is still very reluctant and wants me to speak to the cardiologist (easier said than done) and also have an INR test done the same day as the extractions. I have 2 very infected teeth/roots (not abscesses apparently) which are uncomfortable, so don’t want to wait until my cardio appointment in a month’s time.

47 Replies

  • Oh Dear jeanette

    Your dentist wants you to have an INR test done and you take rivaroxaban?

    That will tell him diddley squat, rivaroxaban has no effect on INR whatsoever, so your dentist will learn nothing.

    I would ask your dentist to contact his professional body and ask their advice, as he/she is obviously not aware of how these drugs work, stopping 48 hours before will almost certainly be enough, they do major surgery on people who stop 48 hours before, so a tooth extraction is not likely to be a problem.

    Be well


  • Ian, I live in Spain, but the dentist is German (speaks excellent English) and the practice generally has a good reputation locally. It just all seems such a mission to try and sort this out as the system is out of whack with the NHS I think. Not sure whether to find a different dentist, although I have already had a 3D X-ray to determine the extent of my gum disease with a view to implants, which was €100, don’t really want to start all over again. The X-ray was how he discovered the infected teeth in the first place. 😟

  • It's a common practice to stop blood thinners 2 days before a procedure. I'm having an endoscopy procedure on Wednesday of this week. And I was told to stop xeralto two days before the procedure. You need to find a new dentist!

  • I had an endoscopy last week and was told to not take my rivaroxaban only on the day of the procedure.

  • you can download the guidance for dentists from the NHS site- I think you can have 2 teeth out easily. I had one out without stopping Apixaban and had no bleeding and the root was hard to get out,

    You may have to change dentists but try taking in the guidance to show him

  • How do I find the guidance please Rosy, is there a link?

  • This is the link- just scroll through and click on dentistry links it takes you to somewhere that spells out how many teeth are low risk procedures etc

  • Thanks Rosy x

  • I don’t think he will accept that Rosy, it is different to xeralto, which he insists is a very serious anti coagulant with no antidote for heavy bleeding should it occur.

  • Most of the new ACs don't have antidotes but have short half lives which make it safe for dental work. Maybe get referred to hospital as they won't be worried. Best wishes

  • Not sure how that works in Spain, but thanks so much for your help Rosy x

  • Hello Jeanette :-) I understand now NOACS (DOACS) are more widely prescribed, dentist are developing a strategy for their use during dental treatment which involves taking into account when the dose is administered rather than withholding it altogether.

    See the quote and link to an article in the British Medical Journal dated Feb this year..

    [quote ''In conclusion, it is possible to safely conduct dentoalveolar procedures for patients prescribed concurrent DOACs. In order to minimise post-operative bleeding and complication, it is important to consider the time the DOAC is usually ingested and when the procedure is planned. Dental surgeons should aim to undertake the procedure when peak DOAC concentrations have subsided ie, 5–6 hours post last dose. Current SDCEP guidance suggests achieving this by delaying the morning dose of a DOAC for procedures with a high risk of bleeding. We endorse this recommendation as it avoids having to treat patients in the late afternoon when there is limited time to manage persistent bleeding. Careful consideration should also be given to when the DOAC is re-commenced. We suggest waiting a minimum of four to six hours after the procedure and that haemostasis should be secure. We would also advise that local measures to promote haemostasis, ie, haemostatic packing and soft tissue suturing, are used in every case. Patients at high risk of bleeding, should be considered for referral to specialist units for their procedures. Further clinical experience and controlled cohort studies will determine the optimum peri-procedural strategy for managing this growing cohort of patients''].

  • I recently had a wisdom tooth removed and did not stop taking my apixaban. I had not read the above guidance but did adjust my timings so that I was at the bottom of the cycle when the tooth was removed. Just common sense!

  • Hi. I think your dentist needs to check guidance as mine did before I had (just the one) tooth extracted recently. I take exactly the same med as you (Xarelto) every evening with dinner - I was advised that as long as the extraction took place in the afternoon then I didn't even have to stop taking it! Extraction was entirely successful with no excessive bleeding and it healed up really quickly.

    There are more knowledgeable people on this forum who can explain how Xarelto works but honestly it was no problem for me or my dentist. Also I think others have reported an improvement in AF following removal of infected teeth.

    One option that was open to me was to have my tooth extracted in local hospital where my dentist sends patients who need sedation and where they have more knowledge of dealing with this sort of thing - maybe your doctor or dentist could refer you?

    Hope you are able to resolve this soon xx

  • I think I would change my dentist, he should be finding solutions for you, not putting barriers in front of you!

    And how on earth is changing the meds to Wafarin supposed to help? Ooooh... he’s made me angry and I haven’t even met him.

    Hope to get sorted very, very soon.....ouch!

  • He wants me to change to something like aspirin really 🙄

  • Even more of an idiot then!

  • That's worse!

  • The dentist needs extra training

  • You need a new dentist, this is basic stuff he really should know😕 Hope it gets sorted soon, toothache is awful .

  • Ask your dentist to refer you to a hospital dentist, they will either take you or tell him what to do.

  • I live in Spain, they have different methods here.

  • I had the same problem, my dentist said I had to be sent to hospital to have the tooth out (waiting list 12 months). So I braved root canal treatment ....

  • Because he was nervous of excessive bleeding? Surely there is the potential for a fair amount of bleeding with root canal treatment?

  • I didn't have any. She said there had been an incident where someone had to go to hospital after an extraction because of bleeding so the surgery policy was not to do extractions for people taking NOACs unless they brought a letter of consent from their GP.

  • Tooth infections can affect the heart and should be dealt with asap.

    My advice would be urgently to seek a dentist who knows his/her job and is up to date with modern medicines. Your dentist is in the anticoagulant Dark Ages, doesn't understand NOAC's - and he is willing to risk your health on aspirin?!

    I take Apixaban and didn't need to stop for a large tooth extraction.

  • I agree. Tooth infections can affect the heart. It once spread and I had endocarditis, which attacked the Mitral Valve which meant it needed replacing + six weeks in hospital for intravenous. I now threaten dentists with this prospect if they act slowly. It did no good in UK, so I went private in Tunisia where dentists are affordable, and some are extremely up to date.

    Another time my dentist put me on antibiotics, and sent me quickly to a specialist because the technical part was difficult. He took me short notice because of the infection, treated me as urgent, insisted on a good scan to locate the problem exactly, then operated, all within the 10 days of the antibiotic. OK, Warfarin is not the same. But he did NOT stop it! Just wanted a low INR on the day (less than 4). He simply used techniques to minimise bleeding.

    Frankly, the fuss is about a minor problem. Any bleeding will be obvious, and is easily treated with for instance a hot probe which burns/seals. I know from experience!!

    All this to say, you need to act fast. With tooth infections you have little margin: days not weeks.

  • Hello,

    I too take 20 mg do Rivaroxaban daily and when I had invasive dental treatment by an hygienist she required a letter from my GP. The letter explained how the drug worked and precautions to take according to the guidelines given above.

    However, my dentist has carried out extractions without such a letter as she was aware of the procedures to be followed. Your dentist has obviously not kept up to date with current practice and this is not acceptable for a health care professional. Suggest you change dentists if that is possible in your area.

    Best wishes Pam

  • I was prescribed Pradaxa just a little over 3 years ago by my EP, and have had no side effects. I had to have an extraction earlier this year of a back tooth. There did seem to be a little more blood than I'd expected, but really the main trouble was the discomfort, because of where it was. Don't forget if you're going to have a tooth pulled, there's going to be blood. Dave

  • I am on apixaban and recently had a tooth extracted. Not problem at all, my dentist put a "sponge" in the cavity, it dissolves naturally, which deals with the bleeding, I bled very little. You can have it done at a hospital if you are in the UK.

  • Send your dentist a link to this thread?

  • Hi Jeanette

    I am on Rivaroxaban and had a tooth out about three weeks ago. I didn't stop taking the medication and during the night it started bleeding quite a lot. I returned to the dentist at 9am the following morning to have it repacked and restitched and stopped taking the Rivaroxaban for three days whilst it healed. My dentist also said it was a good idea to not take the medication for that length of time. As you can see I lived to tell the tale!

    I really didn't have any problems and healed nicely.

    Good luck!


  • Thanks Gloria x

  • Gloria, in Every pack of rivaroxaban that you have, is there a card that you have to fill in to say that you are taking this, giving details of your doctor and also a contact name and telephone number?

  • Yes there is. I keep one in my mobile phone and another in my purse.

  • How about changing dentists to someone who either knows about drugs or at least investigates properly. Mine knows all about all the anticoagulants.

  • Whereabouts in Spain do you live Jeanette? We lived in Spain for a short while and still have property there so go quite regularly and I have alsways found the healthcare generally in advance of U.K. but that was Southern Spain.

  • We are in Denia, northern Costa Blanca. The healthcare here is excellent, but all dentists are private, (mine is German as are many here, also Dutch) and I don’t have any knowledge about hospital referrals in this case

  • Yes that was my experience of dentists in Spain as well. My local one in Spain was also German and somewhat out of date.

    Of course most dentists in UK are also private nowadays but there are dental departments in the large regional hospitals.

    What a nightmare for you, persist though as you do need urgent treatment.

  • I totally understand his postion

    Its true there is no antidote to rivaroxban

    So if rivaroxban apparently does not effect the INR and one should not have it measured

    Then whats the point of taking a drug that does not stop strokes according to the health practitioner s

    The whole point of taking it is too meant to stop blood from clotting isnt it

    So i totaly agree with the dentist patients need to be safe


  • From what I understand from other peoples’ experience and knowledge, it is not a blood thinner but an anti coagulant, and this has no effect on the INR as such. However as an anti coagulant it is very effective for the prevention of strokes...complicated differentiation for us non medical people to get our heads around I think.

  • @Jeanette49 My dentist discovered I had a root infection at a routine examination a couple of weeks ago. Had root canal treatment last week (painless). Since then I have felt so much better, and AF episodes much reduced in intensity and duration, and the blood pressure crashes I had been experiencing have stopped. Dentist also worried about extractions when patient on Xarelto. He had an elderly patient who needed several extractions eventually done in hospital, and patient was readmitted to hospital 5 times with bleeds.

  • I also have to have two teeth out, and are taking xeralto, my dentist has said that I should leave off the tablets for 3 days. As I had such a bad reaction when I had implants in my gums, I am going to leave them off for 4 days. If I start to bleed badly again I shall go straight to A and E. Hospitals are geared to deal with it, apparently. My appointment is in 2 weeks!!

  • Had the teeth out 3 hours ago, back teeth one each side. Had to scrape out the infection, pack with sponges to help control the bleeding, and stitched up. So far all ok, still bleeding a little and quite sore. Couldn’t have the anaesthetic with adrenaline, so it wore off quite quickly, a bit of a juggling act, topping up etc, but managed ok, stitches out in 2 weeks. Relieved it is done!

    Good luck with your extractions Jeanie.

  • Thanks Jeanette, that's encouraging! Good luck with the healing. I am going to go into hibernation as I shall look such a sight with no teeth left up top, until the new teeth are fitted! How they can advertise new teeth 'in a day' I don't know. My treatment started in July, and I shall be lucky if I have them by Christmas! Hopefully the dentist will be able to add teeth to my denture, until all my fittings are done. I would not have gone for implants if I had known all the trouble I was going to have! Just hope my AF doesn't occur at the same time. I think stress can trigger it, as I am also moving into a retirement apartment, stress is highly likely!

  • Yes indeed, my heart was bouncing all over the place during the treatment. Won’t you get the teeth at the same time? Is the denture a plate or one that fixes to the implant? I have six crowns at the top front which are getting loose, one hanging on by a thread! We have discussed implants as I don’t fancy a plate, but I have severe periodontitis with marked bone loss. It can be done apparently, but because I don’t have enough bone, they would need to put artificial bone in my sinus cavities which would take months to adhere! All sounds very daunting, and painful! 😖

  • I still have my original denture, with holes in it for the titanium screws. The new teeth will be screwed on, then there will be a bridge between each so I will not have any plastic denture, just teeth as normal. They will have to be cleaned very thoroughly to prevent gum disease. There is another type where you can get each section off to clean them, but I thought that might be difficult to do, and it would have a small plastic coating on the gum. I thought it would have been easy, to put the new teeth in straight away, but it seems I have to have a fitting first. The whole thing will cost around £ 11,000 ! I know people do have problems with bone loss, it depends on what you decide to do. .I have had to wait 3 months for the titanium to fuse with the bone. I have put up with dentures since I was 11 years old so am very fed up with them!

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