Bleeding risks for dental procedures

The table below is intended to be a guide only and because of the wide variation in invasiveness of some treatments, such as those involving flap raising procedures, there will be some overlap between the categories. Bleeding risk assessment for a patient’s dental treatment is likely to require further judgement on an individual case basis taking into consideration the extent and invasiveness of the procedure. 

a Local anaesthesia should be delivered using an aspirating syringe and should include a vasoconstrictor, unless contraindicated. Note that other methods of local anaesthetic delivery are preferred over regional nerve blocks, whether the patient is taking an anticoagulant or not.

b There is no evidence to suggest that an inferior dental block performed on an anticoagulated patient poses a significant risk of bleeding. However, for patients taking warfarin, if there are any indications that the patient has an unstable INR (see Warfarin or another Vitamin K antagonist), or other signs of excessive anticoagulation, an INR should be requested before the procedure to ensure <4 before proceeding.

c Although a BPE can result in some bleeding from gingival margins, this is considered extremely unlikely to lead to complications.

d Simple extractions refers to those that are expected to be straightforward without surgical complications.

e Complex extractions refers to those that may be likely to have surgical complications.

f Consideration should be given to the extent and invasiveness of the individual procedure. Some may be less invasive and could be treated as low risk.

The management of patients taking anticoagulants or antiplatelet drugs whose dental treatment involves procedures that are unlikely to cause bleeding should be straightforward and these patients can be treated according to standard practice, with care taken to avoid causing bleeding (see Managing Bleeding Risk).

More careful consideration should be given to patients who require procedures likely to result in bleeding (see Managing Bleeding Risk and Treatment Recommendations).

Dental procedures that are likely to result in bleeding are further categorised into:

  • those with a low risk of post-operative bleeding complications
  • those that are judged to be more invasive and potentially carry a relatively higher risk of bleeding complications

'Bleeding complications' means prolonged or excessive bleeding or bleeding not controlled by initial haemostatic measures.

Note that the use of the term ‘higher risk’ is not intended to suggest that these are high risk dental treatments. Furthermore, a dental procedure categorised as low or higher risk is still likely to be considered a relatively minor bleeding risk in the wider context of medical surgical procedures.