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

Why You Don’t Need to Stop Your Blood Thinners for Most Dental Work

Many people on blood thinners panic when their dentist mentions a cleaning, filling, or extraction. They assume they need to stop their medication first-sometimes even skipping appointments because they’re afraid of bleeding. But here’s the truth: for the vast majority of dental procedures, stopping your blood thinner is more dangerous than keeping it on.

Back in the 1990s, dentists routinely told patients to pause warfarin or other anticoagulants before any dental work. That practice has changed. Today, major medical and dental organizations-including the American Dental Association (ADA), Stanford Health Care, and the Scottish Dental Clinical Effectiveness Programme (SDCEP)-agree: don’t stop your blood thinner unless you’re having major oral surgery. The risk of a stroke, heart attack, or blood clot from stopping your medication far outweighs the small chance of extra bleeding during a routine procedure.

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 clear categories based on how likely they are to cause bleeding:

• Low-risk: Routine checkups, X-rays, teeth cleanings (scaling above the gumline), and making dental impressions. These cause almost no bleeding.
• Low-moderate risk: Fillings, root canals, deep cleanings (scaling and root planing), and placing crowns or bridges. These involve minor gum manipulation but rarely cause serious bleeding.
• Moderate risk: Simple tooth extractions (one to three teeth), gum surgery, or removing a single impacted tooth. These carry a slightly higher chance of bleeding, but still manageable.

Anything beyond that-like multiple extractions, jaw surgery, or complex implant placement-is considered high-risk and may need special planning. But for 9 out of 10 dental visits, you’re in the low or low-moderate risk zone. And for those? No need to change your medication.

What About Your INR Level? (For Warfarin Users)

If you take warfarin (a vitamin K antagonist), your doctor checks your INR-a number that tells how long it takes your blood to clot. The good news? You don’t need to get it perfect. Here’s what’s considered safe:

• Low-risk procedures: INR under 3.5 is fine. Most people on warfarin stay between 2.0 and 3.0 anyway.
• Low-moderate risk: INR under 3.0 is ideal. If you’re at 3.2, it’s still usually okay-just ask your dentist to use extra hemostatic measures.
• Moderate risk: INR under 3.5 is acceptable, especially if your dentist uses gauze, sutures, or a special mouthwash to control bleeding.

If your INR is above 4.0, your dentist should talk to your doctor before proceeding. But even then, stopping warfarin isn’t always the answer. Sometimes, adjusting the dose slightly or delaying the procedure by a few days is safer than stopping cold turkey.

Direct Oral Anticoagulants (DOACs) and Dental Work

More than half of people now on blood thinners take DOACs-drugs like apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), or edoxaban (Savaysa). These are easier to manage than warfarin because they don’t require regular blood tests. But they also don’t have a simple number like INR to guide you.

For DOACs, the rule is simple: skip your morning dose on the day of a moderate-risk procedure. For example, if you take apixaban twice a day and have a tooth pulled at 10 a.m., don’t take your 8 a.m. dose. That gives your body time to clear most of the drug. The same applies to single-dose DOACs taken once daily-skip it on the day of the procedure.

For low-risk or low-moderate procedures? Keep taking your DOAC as usual. There’s no benefit to skipping it, and the risk of clotting goes up if you do.

What to Do If You Bleed After the Procedure

Bleeding after a tooth extraction or cleaning is normal-even if you’re not on blood thinners. But if you’re on anticoagulants, you might notice it lasts a bit longer. Here’s how to handle it:

• Place a clean gauze pad over the area and bite down firmly for 30-45 minutes. Don’t keep checking.
• Don’t rinse, spit, or suck through a straw for 24 hours. That can dislodge the clot.
• Use a cold compress on your cheek if swelling happens.
• If bleeding doesn’t slow after 2 hours, use a tranexamic acid mouthwash. This is a special solution (5%) that helps blood clot. Your dentist can make it for you or prescribe it. Swish 10ml for 1-2 minutes, then spit. Repeat every 2 hours if needed.

Most people stop bleeding within a few hours. If it keeps going past 24 hours, call your dentist. But don’t panic-major bleeding is extremely rare.

Drugs to Avoid While on Blood Thinners

Some common medications can make bleeding worse. Be careful with:

• NSAIDs: Ibuprofen (Advil), naproxen (Aleve), and diclofenac. These interfere with platelets and can increase bleeding. Use acetaminophen (Tylenol) instead for pain.
• Aspirin: Even low-dose aspirin can add to the bleeding risk. Don’t start it unless your doctor says so.
• Some antibiotics: Like clarithromycin or fluconazole. These can affect how your liver breaks down warfarin or DOACs, raising your bleeding risk.
• Herbal supplements: Ginkgo biloba, garlic, fish oil, and ginger can thin your blood too. Tell your dentist about anything you take-even “natural” stuff.

Always check with your dentist or pharmacist before starting any new medication, even over-the-counter ones.

Why You Should Never Stop Blood Thinners Without a Doctor’s Advice

Stopping your blood thinner-even for a few days-can be deadly. Studies show that people who stop warfarin or DOACs before minor dental work have a higher chance of having a stroke or blood clot than they do of bleeding badly from a tooth extraction.

One study from UCSD found that holding anticoagulants for a simple extraction didn’t reduce bleeding but did increase the risk of a clot by 3-5%. Another study showed that people who stopped their medication for dental work had a 1 in 100 chance of having a serious clot within 30 days. That’s far worse than the 1 in 1,000 chance of uncontrolled bleeding from a tooth extraction.

Doctors and dentists now agree: the risk of clotting is much higher than the risk of bleeding for most dental procedures. Your heart or brain doesn’t care about your tooth-it cares about blood flow. Don’t risk a stroke just to make a filling easier.

What Your Dentist Should Do (And What You Should Ask)

A good dentist won’t guess. They’ll ask you:

• What blood thinner are you taking?
• What’s your dose?
• When was your last INR test (if on warfarin)?
• Are you taking any other medications or supplements?
• Do you have kidney or liver problems?

Don’t be shy. Bring a list of your medications. If your dentist doesn’t ask these questions, speak up. You have the right to safe care.

Ask your dentist: “Based on what I’m taking and what you’re doing, do I need to change anything?” If they say yes, ask: “Should I talk to my doctor first?” Most of the time, the answer will be: “No change needed.” And that’s exactly what you want to hear.

Real People, Real Cases

It’s not just older adults on blood thinners anymore. More and more younger people are taking them too:

• A 25-year-old athlete with a blood clot after a long flight.
• A 32-year-old woman with atrial fibrillation diagnosed after her first panic attack.
• A 28-year-old new mom who had a pulmonary embolism after delivery.

These patients aren’t “high-risk” just because they’re young. They’re on anticoagulants for a reason-and they need dental care just like anyone else. The guidelines apply to everyone, no matter their age or why they’re on the medication.

Final Takeaway: Keep Taking Your Medication, Stay Informed

You don’t need to fear dental visits because you’re on blood thinners. The evidence is clear: most dental procedures are safe to do while you’re on anticoagulants. Stopping your medication rarely helps and often hurts.

Here’s what you should do:

1. Keep taking your blood thinner as prescribed.
2. Tell your dentist exactly what you’re on-name, dose, frequency.
3. Ask if your procedure is low-risk. If it is, no changes needed.
4. For extractions or deep cleanings, ask about tranexamic acid mouthwash.
5. Avoid NSAIDs, aspirin, and herbal supplements unless approved.
6. If bleeding lasts more than 24 hours, call your dentist.

Modern dentistry has caught up with modern medicine. You don’t have to choose between your heart and your teeth. With the right information, you can have both.