Vitamin K antagonists are frequently used for the long-term prevention and treatment of thrombosis. Their primary indications include atrial fibrillation, mechanical prosthetic heart valves, deep vein thrombosis, and pulmonary embolism. Managing dental patients on vitamin K antagonists requires careful assessment of the bleeding risk from continuing these medications versus the risk of thromboembolic events that can occur if the therapy is stopped or modified. This chapter offers current recommendations for dental management of patients on vitamin K antagonists, with a focus on local anesthesia and pain control, oral surgical and implant procedures in these patients, and oral surgery in patients receiving combined vitamin K antagonists and antiplatelet therapy.