Objective To analyze the effect of oral anticoagulant drugs on postoperative bleeding and healing in elderly patients undergoing tooth extraction. Methods A total of 40 elderly patients who took oral anticoagulant drugs and underwent tooth extraction at Daxing District Caiyu Town Central Health Center from November 2020 to November 2021 were selected as the study group. Meanwhile, 40 elderly patients who did not take anticoagulant drugs and underwent tooth extraction in our hospital during the same period were selected as the reference group. Both groups received minimally invasive tooth extraction. The bleeding rate, coagulation function indicators, tissue healing, complication rate and appearance satisfaction were compared between the two groups. Results The incidence of bleeding at 30 seconds and 1 hour after operation in the study group was higher than that in the reference group (P<0.05). At 1 hour after operation, the prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) in the study group were higher than those in the reference group, while the platelet count (PLT) was lower than that in the reference group (P<0.05). There was no statistically signiffcant difference in tissue healing rate between the two groups (P>0.05). The incidence of complications in the study group (15.00%) was higher than that in the reference group (5.00%) (P<0.05). There was no statistically signiffcant difference in appearance satisfaction score between the two groups (P>0.05). Conclusion Long-term oral anticoagulant drugs in elderly patients may affect coagulation function, prolong coagulation time, and thereby increase the risk of early postoperative bleeding and complications. Under standardized perioperative management, there is no signiffcant difference in postoperative tissue healing and appearance satisfaction compared with non-medicated patients. Clinically, attention should be paid to patients' medical history of anticoagulant use, and coagulation function monitoring and bleeding intervention should be strengthened to ensure the safety and aesthetic effect of tooth extraction.