All-on-6 if you have a heart condition or take blood thinners
Many people considering All-on-6 take a blood thinner or have a heart condition. Most can still have implants. What changes is the planning around bleeding and, for a few, infection.
Medically reviewed by Dt. Hüseyin Yavuz Özbek, implant surgeon · Updated October 2026UK guidance from the Scottish Dental Clinical Effectiveness Programme helps dentists treat people on anticoagulants and antiplatelets, often without stopping the medicine, using local measures to control bleeding. Patients on warfarin need a recent INR check; some on newer anticoagulants may be told to delay or miss a dose before surgery, but only on clear instructions. NICE says antibiotics to prevent infective endocarditis are not routinely recommended for dental procedures. A 2018 review found implant survival in people with cardiovascular disease similar to or higher than in healthy people.
Why this comes up so often
Most people who need a full arch of new teeth are over 50, and by then blood thinners, blood pressure tablets and heart conditions are common. It is one of the most frequent questions we are asked, and the answer is usually encouraging: heart conditions and blood thinners rarely rule out All-on-6, but they must be planned for.
There are two separate issues. Bleeding is about the medicines that thin your blood. Infection is about a small group of heart conditions where bacteria from the mouth could, rarely, cause infective endocarditis. We take them one at a time.
Which medicines count as blood thinners
| Type | Common examples | What the dentist needs |
|---|---|---|
| Warfarin and similar (vitamin K antagonists) | Warfarin, acenocoumarol | A recent INR result and your usual target range |
| Direct oral anticoagulants (DOACs) | Apixaban, rivaroxaban, edoxaban, dabigatran | The drug, dose and time you take it; kidney function if known |
| Antiplatelets | Aspirin, clopidogrel, ticagrelor, prasugrel | Whether you take one or two, and why (for example a recent stent) |
| Injections | Low molecular weight heparins such as enoxaparin | The reason and the dose schedule |
Tell your dentist about supplements too. Fish oil, ginkgo and some others can affect bleeding slightly, and herbal remedies can interact with warfarin.
What UK guidance says about bleeding
The Scottish Dental Clinical Effectiveness Programme (SDCEP) publishes the guidance most UK dentists follow for patients taking anticoagulants or antiplatelet drugs. It gives dentists a way to assess the bleeding risk of a procedure and plan treatment, with specific recommendations for warfarin, DOACs, heparins and antiplatelets. It also provides printable pre-treatment instruction sheets for patients on DOACs and on warfarin, which shows how routine this planning is.
The overall approach is that many people can have dental treatment without stopping their medicine, because bleeding in the mouth can usually be controlled locally. For more extensive surgery, which All-on-6 is, the dentist may give individual instructions, for example about the timing of a DOAC dose on the day. Those instructions should be specific to you and, where needed, agreed with the doctor who prescribes your medicine.
Never stop or skip a blood thinner on your own. These medicines prevent strokes and clots. The NHS pages for warfarin and apixaban advise carrying your anticoagulant alert card and showing it to your dentist before any dental procedure. Bring it to every appointment.
If you take warfarin
Warfarin's effect varies from day to day, so the dentist needs to know your INR close to the time of surgery. Bring the result of a recent test, your anticoagulant record and the name of the clinic that manages your warfarin. If your INR is higher than expected, surgery may be postponed. If you are travelling for treatment, plan how you will get an INR test near your surgery date; some people use a home testing device and bring the reading.
If you take a DOAC
Apixaban, rivaroxaban, edoxaban and dabigatran wear off faster than warfarin, which makes planning simpler. Depending on the bleeding risk of the surgery, your dentist may ask you to delay or miss one dose, or to take it as usual. Kidney function affects how fast some of these drugs clear, so a recent blood test result is useful. Follow the written instructions you are given exactly.
If you take aspirin, clopidogrel or two antiplatelets
Single antiplatelet medicines are usually continued. Two together (dual antiplatelet therapy), often prescribed for a period after a stent, increase bleeding more, and stopping them early can be dangerous for the stent. Elective implant surgery is often timed after the dual therapy period has finished, but that is a decision for your cardiologist and dentist together.
How bleeding is controlled on the day
- Careful technique and stitches to close the gum around the implants.
- Packs and dressings in extraction sockets.
- Firm pressure with damp gauze, which you continue at home.
- Possibly treating one jaw at a time if both jaws would mean too much surgery in one go. See full-mouth All-on-6.
- Pain relief that does not add to bleeding. Ask which painkillers to use; some anti-inflammatories increase bleeding risk with blood thinners.
Blood pressure and nerves on the day
Long appointments, local anaesthetic and understandable nerves can all push blood pressure up. Your dentist will usually check it before surgery. If it is much higher than normal, elective surgery may be postponed until it is under better control, because high blood pressure makes bleeding harder to control and puts extra strain on the heart.
- Take your usual blood pressure tablets on the morning of surgery unless you have been told otherwise.
- Eat a light breakfast if allowed, and bring water. Low blood sugar and dehydration make people feel faint.
- Tell the team if you feel unwell at any point: chest tightness, palpitations, dizziness or breathlessness. They would much rather pause.
- Ask about sedation if anxiety is a big issue. It can make a long appointment easier, but it needs its own medical assessment.
Pacing the treatment
For some people with heart conditions, the safest plan is a shorter one. Treating one jaw at a time, or removing teeth at one appointment and placing implants at another, spreads the load. It can mean a longer overall timeline, which matters if you are travelling for treatment, so ask early. The stages are explained on how All-on-6 works.
The infection question: infective endocarditis
Infective endocarditis is a rare but serious infection of the heart's inner lining or valves. In the past, many people with heart conditions were given antibiotics before dental treatment to prevent it. NICE guideline CG64 now says antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. For people at high risk, such as those with a replacement heart valve or previous endocarditis, NICE points to SDCEP's implementation advice, endorsed by the UK's Chief Dental Officers.
If your cardiologist has ever told you that you need antibiotics before dental treatment, bring that letter. Keeping your mouth free of infection, before and after implants, is also part of protecting your heart.
What the implant research shows
A 2018 systematic review of older patients and common medical conditions found that, in patients with cardiovascular disease, implant survival may be similar to or even higher than in healthy patients. Heart disease itself does not appear to stop implants integrating. The planning points above are about doing the surgery safely, not about whether implants work.
Recovery on blood thinners
Expect some oozing for the first day or two. Swelling and bruising may be more visible, including on the cheeks and neck, and can take a week or two to fade. Keep your head raised the first night, avoid hot drinks and alcohol early on (see drinks after surgery) and do not rinse vigorously.
- Bleeding that soaks gauze and does not slow after 20 minutes of firm pressure: contact your clinic urgently, or call 999 in the UK if it is heavy.
- Chest pain, breathlessness or symptoms of a stroke: call 999.
Our recovery guide covers the normal pattern of healing.
Bring this to your consultation
- A printed list of all medicines and doses from your GP practice.
- Your latest INR (warfarin) or kidney function result (DOACs), if you have them.
- Letters from your cardiologist about stents, valves, pacemakers or antibiotic advice.
- The date of any heart attack, stroke or heart surgery.
At Precious Dental we review your medicines and heart history before planning All-on-6, and may suggest treating one jaw at a time or asking your doctor for advice before surgery. Why Precious Dental.
Common questions
Do I have to stop my blood thinner for All-on-6?
Not usually, and never on your own. UK dental guidance helps dentists manage most people without stopping anticoagulants or antiplatelets. For extensive surgery, your dentist may give you specific instructions about a dose, agreed with the doctor who prescribes it.
I take warfarin. What do I need?
An INR test shortly before surgery, so the dentist can see how thin your blood is on the day. Bring the result and your anticoagulant record book or app.
Will I need antibiotics because I have a heart valve problem?
NICE says antibiotic prophylaxis against infective endocarditis is not recommended routinely for dental procedures. People at high risk, such as those with certain valve replacements or previous endocarditis, should discuss it with their cardiologist and dentist, following SDCEP's implementation advice.
I had a heart attack or stent recently. Can I have surgery?
Your dentist will usually want to know the date and may wait until your cardiologist is happy for you to have elective surgery. Bring your discharge letter and medicines list.
Is bleeding after All-on-6 worse on blood thinners?
Oozing can last longer, so dentists use stitches, packs and gauze pressure. Heavy bleeding that does not stop with 20 minutes of firm pressure needs urgent help.
Sources
- SDCEP — Management of dental patients taking anticoagulants or antiplatelet drugs
- NICE CG64 — Prophylaxis against infective endocarditis: recommendations
- Schimmel et al. (2018), Clin Oral Implants Res — Effect of advanced age and systemic conditions on implant survival
- NHS — Warfarin
- NHS — Apixaban
Checked October 2026. Where we give our own view as a clinic, we say so.
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