Clinical practice advice

Assessing Bleeding Risk

Refer to Section 3 of the full guidance.

The following best practice advice is based on clinical experience and expert opinion.

  • Assess whether the required dental treatment is likely to cause bleeding and, if so, whether it has a low or higher risk of bleeding complications (see Bleeding risks for dental procedures).
  • Ask the patient about their current or planned use of anticoagulants or antiplatelet drugs and other prescribed and non-prescribed medications, when taking or confirming their medical history.
    • The patient should have been advised by their prescriber/dispenser about their anticoagulant or antiplatelet drug(s) and the need to inform their dentist. However, some patients may not know that their medication is an anticoagulant or antiplatelet drug. For a list of anticoagulants and antiplatelet drugs which may be encountered with outpatients in the UK see Anticoagulants and antiplatelet drugs
    • Other medications that can also affect a patient’s bleeding risk are listed in Patient bleeding risk factors - Other medication
    • Be aware that many patients take non-prescribed medications such as aspirin, or other NSAIDs. Patients taking these may have a higher bleeding risk
    • Confirming the details of the patient’s medical history in advance (e.g. by phone or other remote methods) to check for any changes that could impact treatment and require postponement, could reduce wasted appointments and travel
    • If the patient is on time-limited medication, it may be possible to delay dental treatment until they have stopped taking the drug(s)
  • Ask the patient about any medical conditions that they have.
  • Ask about the patient’s bleeding history (e.g. incidences of bleeding requiring retreatment or a hospital visit, prolonged bleeding from other wounds, spontaneous bleeding, easy bruising etc).
    • A patient’s previous experience of bleeding in response to invasive dental or surgical procedures or to trauma may be a useful indicator of the likelihood of bleeding complications from the current dental treatment

Assessing the bleeding risk for a patient taking anticoagulants or antiplatelet drugs involves consideration of both:

  • the likely risk of bleeding associated with the required dental procedure
  • the patient’s individual level of bleeding risk, which can be affected by the drugs that they are taking, in addition to their other medical conditions and medications

While the risk of bleeding complications associated with dental treatment for these patients should always be considered, it should be noted that existing evidence and clinical experience suggest that serious adverse bleeding events are rare.