Aspirin / Acetylsalicylic Acid

Generic name: Aspirin / Acetylsalicylic acid / ASA

Category: Nonsteroidal anti-inflammatory drug (NSAID), salicylate, analgesic, antipyretic, antiplatelet drug

Common brand names: Aspirin, Bayer Aspirin, Aspirin Protect, Alka-Seltzer. Brand availability and indications vary by country.

This article is for dental education only. Aspirin can relieve pain and fever, but it also irreversibly inhibits platelet function and can increase bleeding risk. In dentistry, aspirin is usually not the first choice for routine postoperative pain control when bleeding is a concern. Patients taking low-dose aspirin for heart or stroke prevention should not stop it without medical or dental guidance.

Aspirin is an older NSAID that can reduce pain, fever, and inflammation. It is also used in low doses for its antiplatelet effect in patients at cardiovascular risk.

In dental pain, aspirin can work as an analgesic, but it is often less preferred than ibuprofen or paracetamol/acetaminophen because aspirin increases bleeding risk and may irritate the stomach.

The most important dental point is to distinguish between aspirin used as a painkiller and low-dose aspirin prescribed for antiplatelet protection. These situations require different clinical thinking.

• Best use: selected pain or fever situations when aspirin is appropriate and bleeding risk is low
• Common dental relevance: antiplatelet therapy, bleeding risk assessment, analgesic counseling
• Main advantage: analgesic, antipyretic, anti-inflammatory, and antiplatelet effects
• Main risks: stomach bleeding, prolonged bleeding, allergy, asthma reaction, tinnitus, overdose toxicity
• Clinical priority: do not advise stopping prescribed aspirin without proper medical/dental assessment

• Educationally important analgesic in dental pharmacology
• Occasional short-term pain or fever relief when no safer alternative is preferred and bleeding risk is low
• Assessment of dental bleeding risk in patients taking low-dose aspirin for cardiovascular prevention
• Planning dental extractions or oral surgery in patients on antiplatelet therapy
• Patient counseling to avoid placing crushed aspirin directly on the gum or tooth, because this can cause chemical burns

Example only: For adult pain or fever, aspirin 325–650 mg orally every 4–6 hours as needed may be used in some labels and settings.

Many adult labels limit total intake to about 4,000 mg per day, but local product information may differ. Low-dose aspirin for antiplatelet therapy is usually much lower and is not the same as analgesic dosing.

Dose and duration must consider age, stomach bleeding risk, anticoagulants, antiplatelet therapy, asthma history, kidney disease, pregnancy, alcohol use, planned dental surgery, and local regulations.

• Known hypersensitivity to aspirin, salicylates, or other NSAIDs
• Previous aspirin- or NSAID-induced asthma, urticaria, angioedema, or severe allergic reaction
• Active stomach ulcer, gastrointestinal bleeding, or serious bleeding disorder
• Use as an analgesic in patients with high bleeding risk unless medically approved
• Children or teenagers with viral illness because of Reye syndrome risk
• Severe liver disease or severe kidney disease without medical approval
• Late pregnancy unless specifically directed by a physician
• Use together with another NSAID unless specifically directed by a clinician

• Bleeding risk: aspirin irreversibly inhibits platelets and may prolong bleeding after dental surgery or extraction.
• Do not stop prescribed aspirin casually: stopping antiplatelet aspirin can increase thrombotic risk in some patients.
• Stomach bleeding: risk rises with older age, ulcer history, alcohol use, corticosteroids, anticoagulants, antiplatelets, or other NSAIDs.
• Aspirin-sensitive asthma: bronchospasm or severe respiratory reaction can occur in susceptible patients.
• Reye syndrome: aspirin should not be used in children or teenagers with viral illness unless specifically directed by a physician.
• Tinnitus and salicylate toxicity: ringing in the ears, dizziness, confusion, vomiting, or rapid breathing may suggest toxicity.
• Pregnancy: analgesic-dose aspirin should be avoided especially in late pregnancy unless medically directed.

In dental care, never treat aspirin simply as “another painkiller.” Ask whether the patient is taking it for heart attack or stroke prevention. If yes, the key question is not only pain control, but also bleeding management and thrombotic safety.

• Anticoagulants: warfarin, DOACs, or heparin may increase bleeding risk.
• Antiplatelet drugs: clopidogrel, prasugrel, ticagrelor, or similar drugs can increase bleeding risk.
• Other NSAIDs: ibuprofen, naproxen, diclofenac, and similar drugs may increase stomach bleeding and adverse-effect risk.
• Corticosteroids: higher risk of gastrointestinal irritation or bleeding.
• SSRIs/SNRIs: may increase gastrointestinal bleeding risk when combined with NSAIDs.
• ACE inhibitors, ARBs, and diuretics: may increase kidney risk, especially in dehydration or older adults.
• Methotrexate: toxicity risk may increase, especially at higher doses or in renal impairment.
• Alcohol: increases the risk of stomach bleeding.

• Stomach pain, heartburn, nausea, or indigestion
• Easy bruising or prolonged bleeding
• Bleeding gums or nosebleeds in susceptible patients
• Dizziness or headache
• Ringing in the ears, especially with higher doses
• Worsening asthma in sensitive patients
• Rash, itching, or allergic reaction
• Rare but serious: stomach bleeding, severe allergic reaction, severe asthma reaction, kidney injury, salicylate toxicity, severe skin reaction

• Do not place aspirin directly on the tooth or gum; it can burn oral tissues.
• Do not combine aspirin with ibuprofen, naproxen, diclofenac, or other NSAIDs unless advised.
• Do not stop low-dose aspirin prescribed for heart or stroke prevention without medical or dental guidance.
• Tell the dentist if you take aspirin daily, even if it is “only a small dose.”
• Avoid alcohol while taking aspirin, especially if stomach bleeding risk exists.
• Seek help for black stools, vomiting blood, severe stomach pain, breathing difficulty, facial swelling, severe rash, or unusual bleeding.
• Contact the dentist if pain worsens, swelling develops, fever appears, or mouth opening becomes limited.

Aspirin is more important in dentistry as a bleeding-risk and medical-history drug than as a routine dental painkiller. For most postoperative dental pain plans, ibuprofen, paracetamol, or their combination is often more practical, while prescribed low-dose aspirin usually requires careful continuation planning rather than casual discontinuation.

• Black stools, bloody stools, vomiting blood, or severe stomach pain
• Uncontrolled bleeding after dental treatment
• Difficulty breathing, wheezing, facial swelling, throat swelling, or collapse after aspirin use
• Severe ringing in the ears, confusion, rapid breathing, repeated vomiting, or suspected overdose
• Severe rash, blistering, or mucosal lesions
• Chest pain, sudden weakness, severe headache, or stroke-like symptoms
• Rapidly spreading dental swelling, fever, trismus, or difficulty swallowing
• Pain that does not improve or becomes worse despite correct use

• Ibuprofen
• Paracetamol / Acetaminophen
• Naproxen
• Diclofenac
• Metamizole / Dipyrone
• Clopidogrel
• Warfarin and direct oral anticoagulants

Aspirin is a salicylate NSAID with analgesic, antipyretic, anti-inflammatory, and antiplatelet effects. In dental pain, it is usually less preferred than ibuprofen or paracetamol because it can increase bleeding and irritate the stomach. Its major dental importance is recognizing patients who take low-dose aspirin for cardiovascular protection and managing dental bleeding risk safely. Never advise a patient to stop prescribed aspirin casually, and never recommend placing aspirin directly on the gum or tooth.