Do I Need Antibiotics Before Dental Treatment?

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. The AHA’s latest guidelines (April 2007) recommend that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment. Some patients still need antibiotics before dental treatment due to other conditions, such as a joint replacement. Usually, joint replacement patients need antibiotics for the first 2 years after the joint is placed and longer than that only if they are high-risk patients. Ask your physician if you think you might need prophylactic antibiotics before dental treatment. The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

Preventive antibiotics prior to a dental procedure are advised for patients with:

  • artificial heart valves
  • a history of infective endocarditis
  • certain specific, serious congenital (present from birth) heart conditions
  • a cardiac transplant that develops a problem in a heart valve
  • a joint replacement for the first two years after the joint is placed.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of bacteremia and infective endocarditis than taking preventive antibiotics before a dental visit.

For more information, go to