Anticoagulants and dental work

[Pacific]

Help!

I’m having root planing, then 4 extractions, followed a few months later by 4 bone grafts and 4 implants. My periodontist wants me to ask the doctor whether any precautions need to be taken beforehand. I take Dabigatran Bisoprolol, Fleicanide,and an SSRI for anxiety. I haven’t had a cardiology appointment for 2 years and when I rang the medical secretary she said that I had been discharged from their care and was referred back to my GP. Do GP’s have sufficient knowledge about NICE guidelines re dental treatment? I waded through this and other websites, but 4 extractions is not mentioned. I learned by chance that taking SSRI with my meds and having dental treatment increased the bleeding risks.

I had a stroke 4 years ago. I feel fine, but I feel that I’m in a medical wildness here.

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[BobD Volunteer]

I would have thought that your dentist should be aware of the latest quidelines on extraction with anticoagulation. Mine is for sure. At the very worst case scenario it would be stopping anticoags the day before as the modern ones like Dabigatran have very short half lives. Probably re start the next day but do check with him/her.

[Pacific in reply to BobD]

Thank you v much for your speedy response 😊

[Hidden]

The comments we get on this forum suggest that many GP’s are not very knowledgeable but of course, that does not apply to all. Getting the information you need can be difficult because no one seems to take responsibility for making a decision. We are not medically trained therefore we can legitimately fall into that category but we can convey our experiences which may help. Firstly, we are told that if you miss a dose or two the increased risk of stroke is minimal. The information I picked up from NICE which was a while ago, said that a dose of anticoagulant should be stopped before 6 or more extractions. I had a wisdom tooth removed and decided to miss one dose of Apixaban and fortunately had no problems. The only help I can offer is the following extract from NICE. Click on the link below and then click on Dabigatran and then on dental work.

cks.nice.org.uk/anticoagula...

The only other suggestion I have is to contact a Dental Hospital and see if they are able to help....good luck with the treatment.

[Pacific in reply to Hidden]

Thank you! I’ve printed the information and will give it to the dentist.

Bob D is right to state that the periodontist should know this, and especially as he’s an Honorary Clinical Lecturer at the University School of Dentistry. His letter uses the words ‘blood thinners’ rather than anticoagulants. His academic qualifications are impressive, but he’s asked me to ask my doctor to check the protocol for dental treatment.

[Paulbounce]

I also had a problem with a straight forward scale and polish ! My regular hygienist refused to do it because I had a cardiversion a few weeks before. I tried another dentist and they did it no problem.

I`m also on Dabigatran. I took my morning dose, missed the evening one, and booked an early morning appointment the next day so I could resume taking the twice daily dose as normal.

Best,

Paul

[BobD Volunteer in reply to Paulbounce]

Due to 60 odd years of NHS dentistry my gums are pretty poor and I have to have three monthly hygienist visits to try and preserve what few teeth I still have. Never stop warfarin but do sometimes come out looking like Dracula after his lunch.

[Paulbounce]

Heheh Bob. I`m lucky - I look like Dracula BEFORE his lunch !

On a serious note - I think the concern dentist`s have is worrying about bacteria from the gums being released in to the blood stream and reaching the heart. It`s unlikely but could happen I guess.

I checked with my GP when the first dentist said no to a clean. He said it was fine to have done and would give me a `letter of discharge` (after first CV when a-fib free). He still wouldn`t say it was OK to do though.

I think he had his lawyers coat on !

Best,

Paul