What are rules on dentists and anticoagulants

[Moonriver]

I am having a wisdom tooth out this week and wondered what rules were on anticoagulants. I usually take mine at night around 7 pm. My appt is at 2.30 pm. following day. I am Dreading it! I get so nervous that I am worried about setting épisode off! Also take beta blockers so they need to be cautious there don’t they with anesthetics?

[BobD Volunteer]

Depends what your dentist has told you to do.. Mine has never wanted me to stop warfarin for extractions but each have therir own protocols. Regarding local anaesthetics always best to ask for non adrenaline if you have AF though these are less effective and may not be suitable for wisdom tooth.

[Moonriver in reply to BobD]

Thanks for your info. Why would non adrenaline not be suitable for wisdom teeth?

[wilsond in reply to Moonriver]

Not quite as effective

[pusillanimous in reply to Moonriver]

Aren't you having a GA, not impacted I presume? if they are fully erupted, don't get in a panic as very often wisdom teeth only have one root, but I'm sure your dentist has discussed with you how many roots yours have and shown you the radiographs, so you are able to see their shape and number.

[Moonriver in reply to BobD]

I did have a root removed at UCL and took 40 mins but don’t know what they used for that. He was drilling away for ages. My new dentist does not seem to know about anticoagulant and asked me to ask my doctor.!

[Jalia in reply to Moonriver]

One is tempted to ask what sort of dentist have you got who knows nothing about anticoagulants ?!

[Moonriver in reply to Jalia]

I have found this the case with other dentists

[Alicant in reply to Jalia]

More likely passing the book to the doctor…

[CDreamer]

Adrenaline helps to stop bleeding so if you have adrenaline free or low adrenaline local anaesthesia and your AF is infrequent and your cardiologist considers you relatively low risk - then it may be advisable to stop anticoagulant at least day before and possibly the day of surgery but you need advice from both your cardiologist about your stroke risk and your dentist on the bleed risk from the extraction. It also depends upon the anticoagulant you are taking? Different times for different DOACs if you are advised to stop. Do your homework, not something you want to leave to chance.

The BDA - British Dentisry Association has guidelines for dentists regarding anticoagulants so there is NO excuse for your dentist’s ignorance and to be honest - not sure I would want any dentist who was not up to date with latest protocols going anywhere near my mouth, especially a wisdom extraction! My dental surgery called in a specialist dental surgeon to do a root canal on me and they prescribed one dose steroid - 5mg prednisone to help stem bleeding.

My husband has to have 4 teeth out Tuesday and was told to not take his Apixaban on the morning of the procedure. I recently had to have reconstruction surgery on my face and my cardiologist was OK with me stopping Apixaban for 5 days, my AF is now very, very infrequent.

You must get clear advice from your medical professionals who know your medical history on this and not rely upon forum members to advise.

Hope all goes well for you, not a pleasant experience but maybe a case of better out than in as oral hygiene is essential to ensure good heart health.

Let us know how you get on.

[JudiHalf]

I had a Molar removed recently and was told not to stop my anti coagulant, Rivaroxoban, I had terrible trouble with bleeding, even with it being stitched, I had to stop the pills for a few days and eventually the bleeding stopped. In future I will stop my anticoagulant the day before!

[OzJames]

i had root canal and was on drugs you mentioned i told the dentist who decided not to give me adrenaline based anaesthetic as it could excite the heart. At the end of the day he gave me about 10 locals over the 1 hours and i could feel the nerves being hit during root canal. He said afterwards that maybe the small amount of adrenaline may have been a better choice to avoid pain.

In your case the local shots maybe ok as its an extraction rather than fishing around the nerves during my root canal Just let them know you have Paroxsysmal AF.

[oscarfox49]

You have to weigh up the relative advantages, mostly for the dentist, in not having blood everywhere in the extraction, and running the risk of having some episode that the anticoagulant is there to prevent.

My dentist gets irked when there is a lot of blood which can make her job longer and more difficult in constantly removing it in the dental siphon thing, but if I had to stop apixaban to go to the dentist I would refuse as I take it to prevent further strokes.

[Silvasava]

I've had a couple of teeth removed, including a wisdom tooth. My dentist told me to stop my Edoxaban the day before. She sutured the incision and I didn't have any pain. I have Afib and DCM no problems at all. I didn't ask about non adrenaline as she seemed perfectly competent and had a list of my medications.Hope you have a painless experience

[Anothernewbie]

I am on apixaban, and when I mentioned extraction to my dentist, she told me to let her take care of that, the practice has anticoagulant plugs they use.

Ask your GP what you should do.

[TracyAdmin Partner]

Hello

Please contact your dentist as soon as you can, explain you are having a tooth extraction and you need to notify them you are taking anticoagulants. the practitioner should provide advice about whether you should continue taking them or halting them based upon the bleed risk, it is their decision to make so you do not have to worry about the best procedure.

Kind regards

TracyAdmin

[Moonriver in reply to TracyAdmin]

I have asked my doctor about it and waiting to hear back. I might cancel whole thing until I feel safe about it. The dentist should know these things. I have never stopped it before on tooth extractions but it’s the fact it is a wisdom tooth that worries me. I had this tooth filled in January and it fell out so had it filled again but did not notice it fell out again till I saw my hygienist and now there is a big hole. The dentist said they used a soft filling because tooth close to gum. I had never heard of soft filling before have you? They sd they cd soft fill it again but cd fail again and best to have tooth out.

[Wishlady]

Hello, I checked with my dentist. I'm on edoxaban. I take it in the morning 7am. I had a tooth out at 10.30 am . Dentist said I didn't have to stop taking it. This is the second tooth I've had out this year. I'm also on beta blockers and had concerns about setting an af episode off. I also insisted no adrenaline in the anesthetic injection. I was totally fine. Good luck .Best wishes

Heather

[Moonriver in reply to Wishlady]

Did you feel much pain without the adrenaline injection?

[Ducky2003]

My dentist said it wasn't a problem to take my Apixaban as normal but my EP told me to stop it the night before. I erred on the side of caution and listened to the EP. My dentist used an anaesthetic called Articaine. It's low adrenaline. I've had adrenaline free before but he's ended up giving me numerous top up jabs, as it's effects are very short lived, so wouldn't have thought it would be great for an extraction.

[LaceyLady]

I stopped mine o think day before

[sapphy]

I am on Dabigatran and Bisoprolol, recently had a tooth out with a new dentist and was worried as previously been referred to a local dental hospital. I spoke at length with the dentist as I wanted to be sure she understood I couldn’t have adrenaline as I have had problems when a dentist didn’t listen to my concerns. I would be taking further advice as others have said to you before you proceed. I did not need to stop the Dabigatran as it was only a single tooth. Good luck as it’s very stressful time.

[Moonriver in reply to sapphy]

Yes very stressful especially when they don’t seem to be clear about things

[sapphy in reply to Moonriver]

Just keep asking the questions until you are happy with what they are planning to do.

[Dudtbin]

my husband had a tooth out last week, he didn’t take his rivaroxaban and the dentist stitched the socket. He was fine. As someone else said wisdom teeth generally only have one root and pop out quite easily if not impacted. All dentists should know to use adrenaline free anaesthetic and either stitch or use a coagulant sponge in the socket!

[Moonriver in reply to Dudtbin]

Put my mind at rest slightly!

[ozziebob]

I don't take any anticoagulation, but my experience of the wisdom tooth extraction itself was as described by Dudtbin above. It came out painlessly with an adrenaline free anaesthetic, and more quickly and easily than I expected. Just needed to bite on a dental pad for 30 mins afterwards to finally stop the trickle of blood.. Let's hope you have a similar positive experience with a dentist who is aware of your situation re AF and anticoagulation as he/she should be. And relax!

[ibuputih]

I am on Edoxaban. Last Friday I had 2 failed implants removed and bone grafting. My dentist said that up to 3 implants are usually ok whilst taking anticoagulants but wouldn’t commit for explants. She suggested for my peace of mind that I checked with my cardiologist. He told me to stop taking Edoxaban 2 days before the procedure. I am glad I did, as it was not straightforward and there has been inevitable seeping through stitches afterwards.

Glad it’s over and I’m looking less like a hamster by the day! Hope all goes well with you.

[Moonriver in reply to ibuputih]

Thanks. I had root out last year and looked like I had done hours in the boxing ring!

[2learn]

Hi, your dentist should know and advise if he can't I'd change my dentist.

[ILF1]

I have had teeth removed using non adrenaline injections and fine on each occasion. I stopped Edoxaban on one of those occasions but not the other. All ok.

I am due to have two implants and 6 crowns done as my teeth are in poor condition. Dentist is doing it with sedation but have been asked to stop Edoxaban 48 hours before then afterwards take as normal. Will also have non adrenaline injections.

Am sure you will be ok. Ask your GP or heart team if you are unsure.

Good luck

[Snowgirl65]

I had to go off Xarelto a day before my tooth extraction a few years ago. It didn't set off a-fib though. In my case, my broken tooth at the back of the mouth -- down to the root -- was causing so much pain I couldn't care less about fear. I just wanted it out!

[Manycrafts]

Yes, I take 5mg Bisoprolol a day and our dentists have full information they request about your medication. I had an extraction in 2018 and within a few seconds of the lidocaine injection I felt vibration/tremors starting and escalating in my chest. I was terrified and thought I was going to have a heart attack or fit. This started to trigger a panic attack but the dentist couldn't tell me the reason for it. I spent 15 minutes walking round the room before it subsided enough and the dentist could remove the tooth. Three years later I broke a tooth and again the same dentist couldn't explain my previous reaction and left me to decide on a root filling or extraction and wanted to use the same anaesthetic again! I never went back nor have been to any dentist since and arranged a telephone appointment with a GP to ask what she thought. She didn't know why it happened either and just suggested I make anyone aware in future. I started doing my own research then and found out that it is well documented that there can be reactions and that they can be severe, even fatal and I'm sure my dentist did know as he seemed cagey. Their receptionist told me that the Lidocaine they use had adrenaline in it. I'm age 77 now and had been to the dentist regularly all my life previously.