RA and dentist

I went to the dentist last week and have a broken tooth. The dentist said she could not fill the broken tooth as the adjacent tooth had a crack at root level and needs to be extracted. I would need to go into hospital for the extraction because of the drugs I am on, namely methotrexate,bisopronol, warfarin and folic acid. My INR is2.3. I have had 2 extractions at the same surgery and been on the same drugs. She said the rules have now changed, is this a EU ruling ! I had been told previously that if my INR was below 4 hospitalisation was not necessary. Anyone else had this experience?

4 Replies

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  • No. But it won't have anything at all to do with the EU. It's not clear what she meant by 'the rules' - she might mean the NICE (National Institute for Clinical Excellence) guidelines, which set out medical good practice in the UK. Or she might just mean what dentists are commissioned to do by your local CCG - their contract will specify certain things they do and get paid for, and other things they don't.

    Hope you can get it sorted!

  • I've looked at the NHS Evidence website (https://www.evidence.nhs.uk/Search?q=dental+extraction+warfarin ).

    It looks like it's the Warfarin that is the problem, because of the risk of extra bleeding. These are the latest guidelines I can find there (2007), but guidance is usually reviewed every 4 years or so, so it is likely they have been revised in 2011 and 2015:

    bcshguidelines.com/document...

    It says people can generally have dental extractions at their dentist, except -

    "Patients on oral anticoagulants with co-existing medical problems e.g. liver disease, renal disease, thrombocytopenia or who are taking anti-platelet drugs. Such patients may have an increased risk of bleeding".

    Not sure whether that helps... :)

  • Yes I have a broken tooth that needs filling my dentist will only remove it ha say I have to go to hospital I am not on any medication only pain relief but says my ra is stopping me opening my mouth the dentist is only a short distance from my home and the hospital is miles away I am worried having to go alone and being I'll afterwards

  • I had to come off my drugs - methotrexate and orencia etc a week before I had an extraction and 2 weeks after and had to take antibiotics for the 3 weeks so advised the RA nurse !!!!!!!!!

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