Oral Health›Health conditions and your mouth

Blood Thinners and Dental Treatment

If you take warfarin, a newer anticoagulant or an antiplatelet medicine such as aspirin or clopidogrel, most dental treatment can still go ahead. Here is what to tell your dentist, why you should not stop your medicine on your own, and what to do about bleeding afterwards.

Updated September 2026·By the OHA editorial team·8 min read·How we write
Key takeaways
  • Tell your dentist which blood thinner you take, and show your alert card or, for warfarin, your INR record.
  • Do not stop or change your medicine for dental treatment unless your doctor, specialist or dentist tells you to. For most treatment, UK, Australian and US guidance says it is not needed.
  • If you take warfarin, you will usually need an INR blood test shortly before treatment that might cause bleeding.
  • Your dentist can limit bleeding with stitches, packing and by doing a small amount of treatment at a time.
  • For pain afterwards, paracetamol is usually suggested. Avoid ibuprofen and extra aspirin unless a doctor says they are safe for you.

Blood thinners are medicines that help prevent harmful blood clots. healthdirect Australia explains that they come in two main types: anticoagulants, which slow the blood's clotting process, and antiplatelet medicines, which stop small blood cells called platelets from sticking together. The Scottish Dental Clinical Effectiveness Programme (SDCEP), part of NHS Education for Scotland, says these medicines can also make you bleed more easily and for longer, for example after some dental treatment.

See also medicines that affect your mouth and heart disease and oral health.

Which medicines are blood thinners?

healthdirect and SDCEP list warfarin; the newer direct oral anticoagulants (DOACs) apixaban, rivaroxaban, dabigatran and edoxaban; injected anticoagulants such as enoxaparin; and antiplatelet medicines such as aspirin, clopidogrel, prasugrel and ticagrelor. Some people take more than one.

Can you still go to the dentist?

Yes. SDCEP says to keep cleaning your teeth as usual and to keep seeing your dentist and hygienist. Healthy gums mean less need for treatment that causes bleeding. The NHS lists bleeding gums when you brush among the common side effects of apixaban (see bleeding gums).

SDCEP explains that many dental procedures are unlikely to cause bleeding, such as fillings that do not go below the gumline, a scale and polish above the gumline, root canal treatment and denture impressions. Extractions, deep cleaning below the gumline and gum surgery are among the procedures that can.

What to tell your dentist

SDCEP's leaflet for patients asks you to:

  • tell your dentist which blood thinner you take, and if it is warfarin, show your INR record
  • tell them about all other medicines, including ones bought without a prescription and herbal remedies
  • mention kidney, liver or blood conditions, or cancer, which can also make you bleed more (see kidney disease and oral health).

The NHS says people taking warfarin, apixaban, rivaroxaban or edoxaban are given an anticoagulant alert card to show their doctor or dentist before any procedure. healthdirect says to let your healthcare team know when you book.

Should you stop your blood thinner?

Not on your own. The NHS says to stop an anticoagulant only on the advice of your GP or another healthcare professional, and that you may not need to stop it for a dental procedure. The NHS adds that stopping clopidogrel can raise the risk of heart attacks or strokes.

The professional guidance is broadly agreed:

  • UK: SDCEP says in most cases your dentist will carry out treatment as usual and will not ask you to alter your medicine. Its guidance for dentists says aspirin, other antiplatelets and warfarin (with a suitable INR) should not be interrupted for dental treatment, and that people with metal heart valves or coronary stents, or who had a clot in the lungs or a deep vein in the last three months, should not have their medicine interrupted at all.
  • Australia: an article in Australian Prescriber says the extraction of a single tooth or a scale and clean does not need a change in medicine, and that stopping these drugs is often riskier than the bleeding. More extensive surgery needs a risk assessment with your doctor.
  • US: the American Dental Association (ADA) says most people do not need to stop, and that any change should be made on the advice of the patient's physician.
Where the advice differs
  • DOACs: for procedures more likely to bleed, SDCEP says your dentist may ask you to delay or miss the morning dose on the day and will tell you when to restart. A Queen Victoria Hospital NHS Trust leaflet mentions delaying or missing one or two doses before surgery. The ADA says that, for people at higher risk of bleeding, a doctor might consider delaying the dose or a 24 to 48 hour break.
  • Clopidogrel: the NHS says you may need to stop it for a short time before dental work, but only after talking to your doctor or dentist. SDCEP and the ADA say antiplatelets usually do not need to be stopped.

Follow the instructions you are given for your own treatment.

INR checks if you take warfarin

The INR (international normalised ratio) is a blood test that measures how quickly your blood clots (NHS). Before treatment that may cause bleeding:

  • SDCEP says your INR should be checked, ideally no more than 24 hours before, or up to 72 hours before if your INR is usually stable. If it is below 4, treatment can go ahead without changing your warfarin. If it is 4 or above, invasive treatment is delayed or you are referred if it is urgent.
  • The Queen Victoria Hospital trust asks for a test within 48 hours, preferably 24, and also needs it to be below 4.
  • The ADA cites a review allowing an INR of up to 3.0, and a US oral medicine statement saying a simple extraction is safe at 3.5, or 4.0 in some experts' view.

DOACs do not need a blood test before treatment (Queen Victoria Hospital NHS Trust).

What your dentist can do to limit bleeding

SDCEP, the ADA and Australian Prescriber describe:

  • booking treatment early in the day and early in the week
  • treating a small area first and checking the bleeding before carrying on, or spreading treatment over several visits
  • stitches (sutures) and packing the socket with material that helps a clot form
  • firm pressure, and sometimes a tranexamic acid mouthwash, which the Queen Victoria Hospital trust says helps prevent bleeding in the mouth (also ADA)
  • only letting you leave once bleeding has stopped, with written aftercare and a contact number.

Aftercare

SDCEP's advice after treatment such as an extraction:

  • rest while the anaesthetic wears off and the clot forms, usually 2 to 3 hours
  • do not rinse your mouth until the next day, and do not suck hard or disturb the clot
  • avoid hot drinks and hard food for the rest of the day, and chew on the other side
  • from the next day, gently rinse with warm salty water 3 or 4 times a day for 5 days.

Kent Community Health NHS Foundation Trust notes that a little blood mixed with saliva can look like a lot. For general extraction aftercare, see having a tooth out.

Painkillers

  • Paracetamol is the usual choice if you can take it (SDCEP, NHS).
  • Avoid ibuprofen, diclofenac, naproxen and extra aspirin for pain, unless a doctor says they are safe for you. These are non-steroidal anti-inflammatory drugs (NSAIDs), and the NHS says they can affect anticoagulants and raise the chance of bleeding with clopidogrel.
  • Keep taking prescribed aspirin. The advice to avoid aspirin is about taking it for pain. Kent Community Health says if your GP prescribed aspirin for a heart condition, tell your dentist.

If paracetamol is not enough, or you cannot take it, ask your dentist (SDCEP). If you are given antibiotics and take warfarin, the Queen Victoria Hospital trust says you may need an extra INR test, because some antibiotics interact with warfarin.

If the bleeding starts again

  1. Sit quietly and rest (Kent Community Health, Queen Victoria Hospital NHS Trust).
  2. Fold clean damp gauze or a clean handkerchief, place it over the socket and bite or press firmly. SDCEP, healthdirect and Kent Community Health say for 30 minutes; the Queen Victoria Hospital trust says 15 to 20 minutes and to repeat if needed.
  3. If that does not stop it, contact your dentist. SDCEP says to tell whoever you speak to that you take a blood thinner, and which one.
When to see a dentist
  • Bleeding has not stopped after firm pressure. SDCEP says contact your dentist first.
  • You have pain that paracetamol does not control, or you cannot take paracetamol.
  • Your gums bleed more than usual when you brush. The ADA says to contact your doctor if bleeding on a blood thinner does not stop quickly.
Get help urgently
  • Bleeding that will not stop. healthdirect says call your doctor straight away or go to an emergency department if bleeding does not stop or lasts a long time. In the UK, if you cannot reach your dentist, contact NHS 111 (NHS 24 on 111 in Scotland); Kent Community Health says heavy or prolonged bleeding out of hours needs A&E.
  • Signs of serious bleeding elsewhere. The NHS says to call NHS 111 if you take an anticoagulant and have symptoms of bleeding, such as blood in your pee or poo, or coughing or vomiting blood. It lists a sudden bad headache with confusion, slurred speech or difficulty moving the arms or legs as possible signs of bleeding in the brain. For signs of a stroke, such as a drooping face, arm weakness or slurred speech, the NHS says call 999 (or your local emergency number).

Frequently asked questions

Do I need to stop my blood thinner before having a tooth out?

Usually not. SDCEP, the ADA and Australian Prescriber all say most dental treatment goes ahead without stopping. Only change your medicine if your doctor, specialist or dentist tells you to.

Can I take ibuprofen after dental treatment?

Not unless a doctor says it is safe for you. The NHS and SDCEP advise paracetamol instead.

I take warfarin. When should I have my INR checked?

Your dentist will tell you. SDCEP suggests within 24 hours of treatment, or up to 72 hours if your INR is usually stable.

Sources

  1. Anticoagulant or antiplatelet medication and your dental treatment (PDF), Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, March 2022, accessed September 2026
  2. Post-treatment advice for dental patients taking anticoagulant or antiplatelet medication (PDF), Scottish Dental Clinical Effectiveness Programme, March 2022, accessed September 2026
  3. Management of dental patients taking anticoagulants or antiplatelet drugs: quick reference guide (PDF), Scottish Dental Clinical Effectiveness Programme, 2nd edition 2022, accessed September 2026
  4. Updated guidance on treating dental patients taking anticoagulants or antiplatelet drugs, NHS Education for Scotland, accessed September 2026
  5. Important information for dental outpatients taking oral anticoagulant or antiplatelet therapy (PDF), Queen Victoria Hospital NHS Foundation Trust, accessed September 2026
  6. Tooth extraction after care, Kent Community Health NHS Foundation Trust, accessed September 2026
  7. Anticoagulant medicines: considerations, NHS, accessed September 2026
  8. Warfarin, NHS, accessed September 2026
  9. Apixaban, NHS, accessed September 2026
  10. Rivaroxaban, NHS, accessed September 2026
  11. Edoxaban, NHS, accessed September 2026
  12. Symptoms of a stroke, NHS, accessed September 2026
  13. Common questions about clopidogrel, NHS, accessed September 2026
  14. Taking clopidogrel with other medicines and herbal supplements, NHS, accessed September 2026
  15. Blood thinners, healthdirect Australia, accessed September 2026
  16. Bleeding gums and dental bleeding, healthdirect Australia, accessed September 2026
  17. Dentistry concerns for patients taking anticoagulants and antiplatelet drugs, Australian Prescriber 2018;41:116 (NPS MedicineWise), via PubMed Central, accessed September 2026
  18. Oral anticoagulant and antiplatelet medications and dental procedures, American Dental Association, accessed September 2026
  19. Bleeding gums, American Dental Association (MouthHealthy), accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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