Pre-Operative Management
Patients taking low-dose Aspirin (75mg – 300mg daily),
Clopidogrel (Plavix), Dipyridamole (Persantin, Persantin
Retard, Asasantin Retard) or are taking Warfarin are at
greater risk of bleeding after teeth have been removed or
after a biopsy has been performed.
Patients taking low-dose Aspirin, Clopidogrel, Dipyridamole
or are taking Warfarin should not have their medications
stopped or altered prior to dental surgical procedures
unless advised otherwise.
If the patient is on Warfarin, the INR is checked on the day
of extraction or biopsy. If the INR is below 3.5 – 4.0, then
the tooth extraction / biopsy can be done.
Peri-Operative Management
To minimise bleeding after the tooth extraction / biopsy:
the socket can be stuffed with various materials that
assist clotting
the socket is stitched up tightly &
a mouth rinse containing Tranexamic Acid (this
prevents the breakdown of blood clots) can be
prescribed.
Post-Operative Management
Patients should:
look after the initial clot at the operation site by resting
while the local anæsthetic wears off & the clot fully
forms (2 – 3 hours)
avoid rinsing the mouth for 24 hours
not to suck hard or disturb the operation site with the
tongue or any foreign object
avoid hot liquids and hard foods for the rest of the day
avoid chewing on the affected side until it is clear that a
stable clot has formed. Care should then be taken to
avoid dislodging the clot
bleeding continue or restarts, to apply pressure over
the socket using a folded clean handkerchief or gauze
pad. Place the pad over the socket and bite down
firmly for 15 – 20 minutes. If bleeding does not stop,
the Oral Surgeon should be contacted; repacking and
re-stitching of the socket may be required
How Should Post-Operative Pain Be Managed?
Patients should follow the advice of their Anticoagulant
Clinic with regard to the choice of painkillers for short-term
mild to moderate pain.
Generally, Paracetamol is considered the safest simple
painkiller for patients taking Warfarin and it may be taken in
normal doses if pain control is needed and no contra-
indication exists.
Patients should not to take Aspirin, Aspirin-containing
compound preparations or Non-Steroidal Anti-Inflammatory
Drugs e.g. Ibuprofen, which are considered less safe than
Paracetamol in patients taking Warfarin.
Patients requiring a course of antibiotics post-operatively
should be vigilant for any signs of increased bleeding.
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