Are Antibiotics Before Dental Work Really Necessary?

August 9, 2022 5:53 pm Published by


For a long time, people with risk factors for heart conditions were told to take antibiotics before dental work to protect against complications from dental procedures. But is it still necessary to take do so?

The answer is a little complex. While taking antibiotics to prevent, rather than treat, an illness (also called prophylactic or preventive antibiotics) is still recommended in some very specific circumstances, the American Heart Association no longer recommends the practice broadly.

Who Needed Antibiotics Before Dental Work?

Previously, prophylactic antibiotics were recommended for patients who have some type of congenital heart disease or are otherwise at risk of a heart health issue. It was thought that dental procedures could put these patients at increased risk for infective endocarditis, a bacterial infection affecting the heart that can progress to heart failure and also lead to kidney damage. During a dental procedure, bacteria can enter the bloodstream through the gums.

Why Did Only Some People Require Antibiotics?

If this type of endocarditis is a risk associated with dental work, shouldn’t antibiotics have been recommended for anyone undergoing a dental procedure to prevent infective endocarditis?

Well, the condition is actually incredibly rare, affecting only three to 10 people in a population of 100,000. It’s most common in those who have a condition affecting the heart valves, who have had heart valve replacement with an artificial valve, or who have a pacemaker implanted and have lead wires in the heart valves.

It was believed that those who had damaged heart valves or implanted devices affecting the heart valves were at elevated risk of infective endocarditis.

Why Are Prophylactic Antibiotics No Longer Recommended in Most Cases?

The American Heart Association and other health experts regularly review best practices to ensure they’re still medically sound. In 2007, the American Heart Association issued new guidelines related to the use of antibiotics prior to dental procedures.

In its statement, the association indicated that most cases of infective endocarditis were associated with bacteria that enter the gums during normal daily dental activities, such as brushing and flossing, rather than dental work. The side effects of taking prophylactic antibiotics, which can include antibiotic resistance, can outweigh the benefits.

However, the practice is still recommended in certain cases, in particular for patients who:

  • Had a congenital heart defect repaired with residual shunts or valvular regurgitation
  • Had a heart transplant with valve regurgitation
  • Have a replacement heart valve made of prosthetic material
  • Have cyanotic congenital heart disease
  • Previously had infective endocarditis

Still uncertain whether you’ll need to take antibiotics before a dental procedure? Talk to your healthcare provider, who knows your health and health risks better than most people.

If you have any type of cardiovascular condition, have previously undergone a heart health procedure or have any type of cardiovascular implant, talk with your medical team before having dental work done. They’ll be able to provide you with a personalized recommendation on whether you should take prophylactic antibiotics or not.

Since dental issues can be unexpected and require rapid care, it may be a good idea to ask your cardiologist or electrophysiologist at your next appointment about whether you would need antibiotics before a dental visit.

Preparing for a surgical procedure at Magnolia Regional Health Center? The surgical services team is here to answer any questions you have about your procedure.

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This post was written by Magnolia Regional Health Center

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