No, aspirin should NOT be stopped before routine dental work
For patients on low-dose aspirin (81 mg daily), continue the medication through routine dental procedures without interruption. The risk of thromboembolic events from stopping aspirin far outweighs the minimal risk of manageable bleeding complications during dental work.
Evidence-Based Rationale
The most recent comprehensive review on antithrombotic management during dental procedures 1 confirms that most dental procedures, including simple cleaning, fillings, and even extractions, pose minimal bleeding risk and antiplatelet therapy should be continued without interruption. This 2025 guidance represents the current standard of care.
Key Supporting Evidence
Multiple high-quality studies demonstrate the safety of continuing aspirin:
- A randomized controlled trial of 80 patients showed that dental extractions can be safely performed without stopping low-dose aspirin, with only one patient requiring additional local hemostatic measures 2
- A meta-analysis of 1,752 patients found that while bleeding risk was slightly higher (relative risk 2.46), the authors explicitly recommend NOT stopping aspirin and instead using local hemostatic measures when needed 3
- A prospective study of 51 patients undergoing minor oral surgery on aspirin 75-100 mg daily reported no excessive postoperative bleeding in all but one case 4
The Critical Risk of Stopping Aspirin
The thromboembolic risk from aspirin interruption is far more dangerous than dental bleeding. Patients on aspirin typically have cardiovascular disease or significant risk factors. Stopping aspirin can precipitate:
- Myocardial infarction
- Stroke
- Death
These catastrophic outcomes far exceed the consequences of minor, easily controlled dental bleeding.
Practical Management Algorithm
For patients on aspirin for secondary prevention (history of MI, stroke, stent):
- Continue aspirin without interruption
- Use local hemostatic measures as needed (pressure, sutures, tranexamic acid mouthwash)
For patients on aspirin for primary prevention only:
- The 2025 review suggests temporary interruption is reasonable 1
- However, given that most primary prevention aspirin use may be guideline-discordant anyway 5, reassess whether aspirin is truly indicated
Local Hemostatic Measures
When bleeding occurs, it is easily managed with:
- Direct pressure with gauze
- Suturing when appropriate
- Tranexamic acid mouthwash 1
- Oxidized cellulose or gelatin sponges
These measures are highly effective and avoid the cardiovascular risks of aspirin interruption.
Common Pitfalls to Avoid
Do not reflexively stop aspirin for dental work - this outdated practice increases patient morbidity and mortality. The evidence from multiple studies 2, 3, 4, 6, 7 consistently shows that continuing aspirin is safer than stopping it.
Do not confuse primary and secondary prevention - while stopping aspirin may be reasonable for primary prevention patients 1, those with established cardiovascular disease should never have aspirin interrupted for routine dental procedures.