Dental work on blood thinners: is it safe?

Yes, most dental work is safe on blood thinners

Cleanings, fillings, root canals and even simple extractions are usually safe if you take blood thinners. The key rule: do not stop or skip your medicine on your own. Your dentist and your prescribing doctor decide together if anything needs to change, and for most routine work, nothing does.

Blood thinners prevent dangerous clots that cause strokes and heart attacks. Stopping them, even for a few days, can raise that risk. For most simple procedures, the risk from stopping is greater than the risk of extra bleeding.

Each person's situation is different. The dose, the reason you take the medicine and the procedure planned all matter. That is why a short call between your dentist and your doctor can be the most useful step you take before a procedure.

What counts as a blood thinner

Blood thinners are medicines that slow clotting. They fall into two groups:

• Anticoagulants, such as warfarin (Coumadin or Jantoven), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa) and edoxaban (Savaysa)
• Antiplatelet medicines, such as aspirin and clopidogrel (Plavix), which keep platelets (tiny blood cells that help clots form) from sticking together

What the research says about stopping them

Guidance from the Scottish Dental Clinical Effectiveness Programme says oral anticoagulants should not be stopped in the majority of patients who need outpatient dental surgery, including extraction. A systematic review of the research reached a similar conclusion. For most patients having a simple, single extraction, the harm from a clot after stopping the medicine clearly outweighs the risk of prolonged bleeding if the medicine continues.

A randomized trial of 117 patients found that extractions could be done safely in a hospital without stopping anticoagulation when the INR was below 4.1. Bleeding was somewhat higher in the group that stayed on the medicine, but the difference was not statistically significant. A survey of dentists in Western Australia found that about one in three would still advise stopping the medicine, even though guidelines say it is unnecessary.

Bleeding after dental work is also local, which means the dentist can see it and treat it right at the spot with gauze, stitches and sponges. A stopped medicine, on the other hand, can cause problems anywhere in the body and cannot be reversed in minutes.

The INR test, in plain words

If you take warfarin, you have blood tests that measure the INR (a number that shows how long your blood takes to clot). Your doctor sets a target range for you. Before an extraction or other bleeding procedure, your dentist or doctor may want a recent INR, often within a few days. Scottish guidelines suggest checking about 72 hours beforehand if your levels are stable.

An NHS patient leaflet says that if your INR is in your target range, which is usually 4 or below, you can keep taking warfarin for most extractions. Newer blood thinners, like apixaban, do not need INR tests. Your dentist may still adjust the timing of your dose. Follow your doctor's instructions exactly.

Newer blood thinners, called direct oral anticoagulants, work differently. They act quickly and leave the body quickly. For some procedures with a higher chance of bleeding, a doctor may suggest skipping a dose around the time of the visit. That is a decision for your doctor, never something to guess.

How dentists control bleeding

Dentists have simple, proven ways to keep bleeding under control:

• Pressing the area firmly with gauze
• Placing a clot-supporting material, such as a collagen sponge, in the socket
• Stitching the gum closed
• Using a tranexamic acid mouthwash, a medicine rinse that helps clots stay in place
• Scheduling treatment early in the day and early in the week, so help is easy to reach if bleeding continues
• Treating one area at a time when you need several teeth removed

What to do at home afterward

After an extraction, bite on gauze for the full time your dentist tells you. Do not rinse hard, spit, use a straw or touch the area for the first day. Eat soft, cool foods. Some oozing the first day is common.

Avoid ibuprofen, naproxen and aspirin for pain unless your doctor says it is OK, since these can add to bleeding. Scottish guidance advises against NSAIDs (a pain-reliever group that includes ibuprofen) for people on warfarin. Ask your doctor what is safe for you.

Rest for the rest of the day. Keep your head slightly raised when lying down, and avoid hard exercise, hot drinks and alcohol for the first 24 hours, since heat and effort can restart bleeding. Keep brushing your other teeth gently, and ask your dentist when to start rinsing with salt water.

Keep your follow-up visit, too. Your dentist wants to check how the area is healing and to remove stitches if you have them.

When to call right away

Call your dentist or doctor if bleeding does not slow after 20 to 30 minutes of firm pressure on clean gauze. Seek urgent medical care if you cannot stop the bleeding, if you feel dizzy or faint, or if you see large clots or heavy bleeding that soaks gauze quickly. Chest pain, trouble breathing, sudden weakness or trouble speaking are 911 emergencies.

Also tell your doctor if a procedure was longer or bigger than planned, or if you were told to skip a dose.

Do not wait to call. Early help is simple, and the sooner you speak up, the easier it is to stop. Keep your dentist's emergency number on your phone before the day of the procedure.

What to tell your dentist, and how KDA helps

Bring a full list of your medicines, the name of the doctor who manages your blood thinner, your most recent INR if you take warfarin, and the reason you take it. Also mention any bleeding problems, easy bruising and any supplements, like fish oil or vitamin E, since some affect bleeding.

At Kendall Dental Associates, our dentists plan treatment around your health and work with your doctor when needed. We are at 8833 SW 107th Ave, Miami, in the Kendall Mall. Call 305-271-1421. Hours are Monday to Friday, 8:00 AM to 5:00 PM, and emergency care is available 24/7. We accept most dental insurances and most Medicare supplemental plans, and financing is available.

Please do not be shy about asking us to talk with your doctor. We can send a letter, take a call, or wait for lab results before we schedule an extraction. A short delay is better than a surprise.

Common questions

This article is general information, not medical advice. Your dentist will confirm what is right for you at your exam. General information checked against: scottishdental.nhs.scot, nature.com, kingstonandrichmond.nhs.uk.