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

Getting a tooth pulled or a deep cleaning while on blood thinners can feel scary. You’ve probably heard stories about people bleeding for hours after a simple dental visit. But here’s the truth: blood thinners don’t automatically mean you can’t get dental work done. In fact, for most people, stopping them is riskier than keeping them.

Why Stopping Blood Thinners Is Often More Dangerous

For years, dentists would tell patients to stop their blood thinners before any procedure. That’s what doctors used to do. But research over the last decade has flipped that advice completely. Stopping warfarin, apixaban, rivaroxaban, or even aspirin-even for just a few days-can trigger a blood clot. That clot could lead to a stroke, heart attack, or pulmonary embolism. And for many patients, those risks are far greater than the chance of a little extra bleeding during a dental cleaning.

The American Dental Association (ADA) says clearly now: for most dental procedures, you should keep taking your blood thinner. The same goes for guidelines from Stanford, UCSD, and the Scottish Dental Clinical Effectiveness Programme (SDCEP). The data is consistent: minor bleeding from fillings, root canals, or even a single tooth extraction is almost always manageable. But stopping anticoagulants? That’s when things go wrong.

Classifying Dental Procedures by Bleeding Risk

Not all dental work is the same. Bleeding risk is grouped into three levels, and your dentist should use this to decide what to do.

• Low-risk procedures: Routine cleanings, X-rays, exam visits, and simple fillings. No need to adjust your medication. Ever.
• Low-moderate risk: Deep cleanings (scaling and root planing), root canals, crowns, and bridges. Again, no need to stop your blood thinner. Just make sure your INR (if you’re on warfarin) is under 3.5.
• Moderate risk: Removing one to three teeth, gum surgery, or removing a simple bone impaction. Here, you might need a little extra care-but still, stopping your blood thinner is rarely needed.

If your dentist wants to stop your medication for a simple filling or cleaning, ask why. That’s not current practice. The real concern comes with multiple extractions or complex oral surgery. Even then, it’s not automatic.

What If You’re on Warfarin? Know Your INR

If you take warfarin (brand names like Coumadin or Jantoven), your doctor checks your INR regularly. That’s a number that tells how long it takes your blood to clot. For dental work:

• Low-risk: INR under 3.5 is fine.
• Low-moderate risk: INR under 3 is ideal.
• Moderate risk: INR under 3.5 is acceptable, as long as your dentist uses extra hemostatic tools.

If your INR is above these numbers, your dentist won’t proceed without talking to your doctor. But here’s the catch: an INR of 4.5 doesn’t mean you can’t get a filling. It just means your doctor needs to adjust your dose first-maybe lower it slightly, not stop it.

What About Newer Blood Thinners (DOACs)?

About 60% of new prescriptions today are for direct oral anticoagulants (DOACs)-like apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), and edoxaban (Savaysa). These drugs don’t need regular blood tests like warfarin does. That’s convenient. But it also means people often don’t know how they’re affecting their bleeding risk.

The CHEST 2022 guidelines say: for most dental work, you don’t need to stop DOACs. But for moderate-risk procedures-like pulling a few teeth-you can skip your morning dose on the day of the appointment. Just make sure at least 4 hours have passed since your last pill. That’s enough time for the drug’s effect to drop slightly, reducing bleeding risk without leaving you unprotected.

Never stop DOACs for a cleaning, filling, or root canal. The risk of a clot forming is real. And unlike warfarin, you can’t quickly reverse DOACs if something goes wrong.

What About Aspirin or Plavix?

If you’re on aspirin alone, keep taking it. No change needed. Same for clopidogrel (Plavix). If you’re on both (dual antiplatelet therapy), you should keep aspirin but may pause the other one-only if your cardiologist agrees. This is common after stent placement. Stopping both could cause a stent to clot. That’s life-threatening.

Don’t assume your dentist knows your full medication list. Bring a list. Include everything-even over-the-counter stuff. Why? Because NSAIDs like ibuprofen or naproxen can double your bleeding risk when mixed with blood thinners. Even some herbal supplements (like garlic, ginkgo, or fish oil) can interfere.

How Dentists Control Bleeding During Procedures

Dentists aren’t just waiting for bleeding to stop on its own. They use smart, proven techniques:

• Tranexamic acid mouthwash: A 5% solution you swish for 1-2 minutes, then spit. Repeat every 2 hours if needed. It helps clots form faster. This is the gold standard.
• Pressure: Gauze packed tightly over the extraction site for 30-60 minutes. Bite down hard.
• Sutures: Sometimes stitches are placed even on simple extractions to reduce bleeding.
• Avoiding multiple extractions: If you need two or three teeth pulled, don’t do them all at once. Space them out by a week or two. Less trauma = less bleeding.

Your dentist might also use a hemostatic sponge or gel. These aren’t magic-they’re science-backed tools that work well with blood thinners.

What You Should Do Before Your Appointment

Don’t wait until the day of your appointment to figure this out. Here’s your checklist:

1. Know your medication. Write down the name, dose, and how often you take it.
2. Know your INR if you’re on warfarin. Bring your last lab result.
3. Call your doctor. Ask: "Should I keep taking my blood thinner before my dental procedure?" Get their answer in writing if possible.
4. Tell your dentist everything. Even if you think it’s unimportant.
5. Ask your dentist: "What’s my procedure’s bleeding risk? What will you do if I bleed?"

If your dentist says, "We need to stop your blood thinner," ask for a referral to an anticoagulation specialist. Most general dentists aren’t trained to make that call alone.

What to Do After the Procedure

Once you leave the office:

• Keep the gauze in place for at least 30 minutes. Don’t spit or rinse during that time.
• After 30 minutes, gently rinse with cool water or salt water. No vigorous swishing.
• Don’t use straws. The suction can pull out clots.
• Stick to soft foods. Avoid hot, spicy, or crunchy stuff for 24 hours.
• Use ice packs on your cheek if you’re swollen.
• Take acetaminophen (Tylenol) for pain. Avoid ibuprofen or aspirin unless your doctor says it’s okay.

If you see bright red blood soaking through multiple gauze pads after 2 hours-or if you’re swallowing blood repeatedly-call your dentist immediately. That’s not normal.

Special Cases: Younger Patients and Complex Health

More young people are on blood thinners now. A 28-year-old with a pulmonary embolism after pregnancy. A 32-year-old athlete with atrial fibrillation. A 25-year-old with a genetic clotting disorder. These aren’t rare anymore.

If you’re pregnant, have kidney or liver disease, low platelets, or are on multiple blood thinners or anti-inflammatories, your case is more complex. Your dentist should consult your primary doctor or hematologist before proceeding. Don’t assume your dentist knows all the risks. You’re the one who knows your body best.

The Bottom Line

You don’t need to fear dental work because you’re on blood thinners. The real danger isn’t bleeding-it’s stopping your medication unnecessarily. Most dental procedures are safe with your blood thinner running. Dentists have tools to manage bleeding. Doctors know how to adjust doses safely. You just need to be informed.

Talk to your doctor. Talk to your dentist. Bring your meds list. Ask questions. Don’t let fear stop you from getting care you need. Your teeth matter. So does your heart.