Dental Procedures on Blood Thinners: What You Need to Know About Bleeding Risk and Safety

Why You Shouldn’t Stop Your Blood Thinners Before a Dental Visit

Most people on blood thinners panic when their dentist asks about their medication. They assume they need to stop taking it before a cleaning, filling, or extraction. That’s not just outdated advice-it’s dangerous. Stopping anticoagulants like warfarin or DOACs (direct oral anticoagulants) for routine dental work increases your risk of a stroke, heart attack, or blood clot more than it reduces bleeding during the procedure.

The American Dental Association (ADA) has been clear since 2013: for most dental procedures, you should keep taking your blood thinner. This isn’t a guess. It’s based on years of research showing that minor bleeding in the mouth is almost always controllable, while stopping your medication can trigger life-threatening clots. A 2022 review by the ADA found that holding single antithrombotic drugs during dental treatment didn’t lower bleeding risk but did raise the chance of acute thrombotic events by up to 30% in some cases.

How Dental Procedures Are Classified by Bleeding Risk

Not all dental work is the same when it comes to bleeding. Procedures are grouped into three levels: low-risk, low-moderate risk, and moderate risk. Knowing where your procedure falls helps you and your dentist decide what to do.

• Low-risk procedures: Routine checkups, X-rays, teeth cleaning above the gumline, and taking impressions. These involve almost no bleeding. You don’t need to change anything.
• Low-moderate risk procedures: Fillings, root canals, deep cleaning (scaling and root planing), and placing crowns or bridges. These might cause a little bleeding, but it’s usually minor and stops quickly.
• Moderate-risk procedures: Removing one to three teeth, gum surgery, or bone removal around an impacted tooth. These have higher bleeding potential, but even here, stopping your blood thinner isn’t usually needed.

According to the Scottish Dental Clinical Effectiveness Programme (SDCEP), 2023, you can safely have any low or low-moderate risk procedure without pausing your medication. Even for moderate procedures, stopping is only considered in rare cases.

What If You’re on Warfarin? Know Your INR Levels

If you take warfarin (also called a VKA), your doctor likely checks your INR (International Normalized Ratio) regularly. This number tells you how long it takes your blood to clot. For dental work:

• For low-risk procedures: INR under 3.5 is fine. No changes needed.
• For low-moderate risk: INR under 3.0 is safe. Most people fall in this range.
• For moderate risk (like extractions): INR under 3.5 is acceptable if your dentist uses extra hemostatic measures.

If your INR is above these numbers, don’t panic. Talk to your doctor or anticoagulation clinic. They might adjust your dose temporarily-but rarely will they tell you to stop completely. A 2023 study from UCSD Health Care found that only 2% of patients on warfarin needed any adjustment before dental extractions.

What About Newer Blood Thinners Like Apixaban or Rivaroxaban?

Today, about 60% of new prescriptions are for DOACs-drugs like apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and edoxaban (Savaysa). These are easier to manage than warfarin because they don’t need regular blood tests. But people still worry about bleeding.

Here’s the truth: for most dental work, you don’t need to skip a dose. The CHEST 2022 guidelines say you can safely continue DOACs for fillings, cleanings, root canals, and even single tooth extractions. If you’re having multiple extractions or major surgery, your dentist might suggest skipping the morning dose on the day of the procedure. That’s it.

Timing matters. If you skip a dose, schedule your procedure at least 4 hours after your last pill. That way, the drug’s effect is at its lowest, but your protection against clots hasn’t fully worn off.

What Your Dentist Can Do to Control Bleeding

Your dentist isn’t just going to hope the bleeding stops. They have tools and techniques to keep things under control-even if you’re on blood thinners.

• Tranexamic acid mouthwash: A special rinse made in a pharmacy (5% solution) that helps blood clot faster. You swish it for 1-2 minutes, spit, and repeat every 2 hours if needed. It’s safe, effective, and lasts up to 5 days when refrigerated.
• Pressure and sutures: Applying gauze and stitching the area helps reduce bleeding. Dentists often use resorbable stitches that dissolve on their own.
• Avoiding multiple extractions: If you need more than one tooth out, your dentist will space them out over separate visits. Taking out three molars at once? That’s risky even without blood thinners.
• Local hemostatic agents: Gels, sponges, or powders placed directly into the socket help seal the area.

These methods work so well that the American Academy of Oral Medicine says: “Most bleeding from dental procedures is not difficult to control and stop, even in patients who are taking blood thinners.”

Drugs to Avoid Before and After Dental Work

Some medications you might take for pain or inflammation can make bleeding worse when combined with blood thinners. These include:

• NSAIDs: Ibuprofen (Advil), naproxen (Aleve), and similar drugs. They interfere with platelets and increase bleeding risk.
• Aspirin: Even low-dose aspirin for heart protection can add to bleeding risk if you’re also on anticoagulants.
• Certain antibiotics: Like fluoroquinolones (Cipro) or azole antifungals (Diflucan). They can interact with DOACs and raise bleeding risk.

Instead, your dentist will likely recommend acetaminophen (Tylenol) for pain. It doesn’t affect clotting. Always tell your dentist what you’re taking-even over-the-counter supplements like fish oil, ginkgo, or garlic pills. They can thin your blood too.

Real People, Real Scenarios

These aren’t just statistics. Real people are living with blood thinners and getting dental care safely every day:

• A 25-year-old athlete with atrial fibrillation takes apixaban and gets a filling without stopping.
• A 32-year-old woman on rivaroxaban after a pulmonary embolism has a root canal and uses tranexamic acid rinse.
• A 28-year-old postpartum patient with factor V Leiden gets a single tooth extracted with no hold on her medication.

These cases show one thing: modern guidelines work. You don’t need to avoid dental care. You just need to communicate.

What You Should Do Before Your Appointment

Here’s a simple checklist to make your visit safe and smooth:

1. Make a list of all medications you take-including dosages and times.
2. Bring your most recent INR result if you’re on warfarin.
3. Ask your doctor if your blood thinner needs any adjustment. Most of the time, the answer is no.
4. Tell your dentist exactly what you’re on. Don’t assume they know.
5. Ask if they’ll use tranexamic acid rinse. It’s standard in many clinics now.
6. Don’t take NSAIDs or aspirin in the days before your procedure.

And if you’re nervous? That’s normal. But remember: the biggest danger isn’t the bleeding. It’s the clot you might get if you stop your medicine.

What to Do After Your Procedure

After your dental work, follow these steps:

• Keep gauze in place for 30-45 minutes. Bite down gently.
• Don’t spit, rinse, or suck through a straw for 24 hours. That can dislodge clots.
• Use the tranexamic acid rinse if your dentist gave it to you.
• Eat soft foods. Avoid hot, spicy, or crunchy things.
• If bleeding doesn’t stop after 2-3 hours, call your dentist. If it’s severe or you’re swallowing large amounts of blood, go to the ER.

Most people have minimal bleeding that stops within an hour. A little pink saliva is normal. Bright red blood that keeps flowing isn’t.

Why This Matters More Than Ever

More people than ever are on blood thinners. Aging populations, rising rates of atrial fibrillation, and increased awareness of blood clots mean anticoagulant use is growing fast. In Australia, over 1 in 20 adults now take some form of anticoagulant. That’s tens of thousands of people needing dental care.

But many dentists still follow old habits. That’s why it’s up to you to be informed. You’re not just a patient-you’re your own advocate. Bring the guidelines. Ask questions. Push back if your dentist suggests stopping your medication without a clear reason.

The evidence is clear: most dental procedures are safe with blood thinners. You don’t need to delay care. You don’t need to fear the dentist. You just need to know the facts-and share them with your care team.

What’s Next for Blood Thinners and Dentistry?

Research is still evolving. Scientists are working on better tools to predict individual bleeding risk, not just rely on INR numbers. Some clinics are testing point-of-care devices that give instant clotting results during appointments.

For now, the best advice is simple: keep taking your blood thinner unless your doctor says otherwise. Let your dentist know what you’re on. Use the right tools to control bleeding. And don’t let fear keep you from your dental care.