Have NICE guidelines for tooth extraction changed?

[Bagrat]

cks.nice.org.uk/topics/anti...

As my dentist gave me a choice of root canal and crown or extraction of a premolar this morning, I chose extraction and started researching.

Last time I had one I was told to take apixaban as normal and that was a molar. I ignored dentist and omitted morning dose and he said he was pleased I did!

Read the above today (scroll down to dental) and it says omit dose before.

Have mentioned I don't want adrenaline in local anaesthetic as it a different dentist in practice that does extractions.

[BobD Volunteer]

It does not apear that anything has changed as far as I can see. Most dental work is low risk and needs no stoppage. I have always found that it is usually up to the individual dentist to be honest. I'm on warfarin and my dentist doen't ask for stoppage.

[Bagrat in reply to BobD]

Thanks Bob. It was this bit under minor procedures which says no need to interrupt anticoagulation but adds this

"In general, these procedures can be performed 12–24 hours after the last dose of apixaban is taken.

It may be practical to have the intervention scheduled 18–24 hours after the last dose of apixaban is taken, then restart apixaban 6 hours later. This means that one dose of apixaban may be missed."

I'm not concerned by this just thought "uninterrupted" a bit misleading.

[stoneyrosed in reply to Bagrat]

I had a molar extraction a few weeks ago, the dentist told me to miss the morning dose of Edoxaban. Everything was fine.

[Bagrat in reply to stoneyrosed]

Thank you.

[Sixtychick in reply to BobD]

I was a dental nurse many years ago and all the practices I worked in then, asked people on Warfarin to stop it for 48 hours. The new anti- coagulants were not around then ,so not sure what the advice is on those.I’ve not had any teeth out sinceI’ve been on Edixaban.

[Buffafly]

I was told to take my medication as usual but that didn’t end well. I would skip at least one dose.

[Bagrat in reply to Buffafly]

Exactly!

[2learn]

Might be worth checking whether you need antibiotics for extraction. Mouth bacteria is apparently worse sort for heart

[Bagrat in reply to 2learn]

Thank you. I think they've for the most part, stopped prophylactic antibiotics these days. My husband used to have 3gm sachet of amoxil even pre hygienist, then it all stopped

[2learn in reply to Bagrat]

I have been advised and given antibiotics by consultants and dentist important if any blood involved

[Crumble2]

I ask for no adrenaline at the dentist too. But I went out of rhythm with the second covid jab and it was reported a couple of weeks later that there were others who did the same because of adrenaline. I’ve not looked into it as I had a different vaccine for the 3rd.

[Bagrat in reply to Crumble2]

Ive had 2 astra zeneca then pfizer then moderna no probs with any.

[ILowe]

Several years ago I had jaw surgery, in outpatients. A three root molar with root canals and crown had totally collapsed. The dead canal roots had grown bone links to the jaw. The surgeon had to slit the gum so that he could cut at the base of each root.

I gave him a printed copy of this article: SURGICAL MANAGEMENT OF THE PRIMARY CARE DENTAL PATIENT ON WARFARIN. app.dundee.ac.uk/tuith/Stat...

"The consensus from reviews on the management of dental patients taking warfarin is that patients requiring dental surgical procedures in primary care and who have an

International Normalised Ratio (INR) below 4.0 should continue warfarin therapy without dose adjustment."

The surgeon simply required a venous blood test result on the same day as the surgery. I think I had an INR of 3.4 and he was happy. In turn, I told him I gagged easily and might have problems with bronchitis. He said that was easy and he said he would not freeze the back of the mouth though this might mean I had to accept some pain. We agreed a hand signal for when the pain was too much.

After the op I never once had to cope with even minor bleeding.

Since an INR up to 4.0 is acceptable, even for jaw surgery, probably all the other anticoagulants are also acceptable.

[Bagrat in reply to ILowe]

Yes re warfarin as my husband is on it and has had several extractions. Dentist last extraction I had said he was happy Idomitted a dose of apixaban ( it's twice daily) and to omit evening dose as well.

[ILowe in reply to Bagrat]

Fair enough about the dentist being happy to miss a dose of apixaban. But is the cardiologist happy? I treasure the protection provided by anticoagulants and find reasons to maintain them.

[Bagrat in reply to ILowe]

I do but 24 hours out of 365 days is not an issue for me and have never bothered a cardiologist in the past.