Do you need antibiotics before your dental visit?

Key takeaways

• Purpose of antibiotics before a visit: To help prevent infection of the heart lining, valves, or prosthetic joints from bacteria that can enter the bloodstream during dental procedures.
• Who should take antibiotics: Only patients at the highest risk of infection, including those with prosthetic heart valves or valve repair, people with a history of infective endocarditis or other specific heart conditions, heart transplant recipients that develop heart valve disease, or those with severely compromised immune systems.
• Who typically doesn’t need them: Most patients with prosthetic joints or common heart conditions no longer require antibiotics before dental appointments.
• Risks of overuse: For most individuals with common heart conditions, the potential for adverse reactions and antibiotic resistance outweighs the limited benefits.
• Talk with your dentist: Always provide your dentist or physician with a complete medical history and discuss whether antibiotics before dental treatment is right for you.

Understanding antibiotic use in dental care 

Historically, it had been common for most people with heart problems, and for people with prosthetic joint replacements to be prescribed a short course of antibiotics before their dental appointment (antibiotic prophylaxis). This was done to prevent potential infection of the heart lining and valves (infective endocarditis) or artificial joints (e.g., knee, hip) by limiting the spread of bacteria from the mouth into the bloodstream (bacteremia) during dental procedures, even cleanings.

Medical experts have provided guidance over the years on appropriate use of antibiotics for certain patients before bacteremia-causing dental procedures. In recent years, this guidance has been updated.

In 2007, the American Heart Association guidance changed to providing antibiotics only to those patients with cardiac conditions considered at “highest risk” of an adverse outcome from infective endocarditis. In 2015, the American Dental Association (ADA) provided new guidance on when it may be appropriate to consider antibiotic administration prior to dental procedures in patients with replacement joint implants. And, in 2016 the American Academy of Orthopaedic Surgeons (AAOS) also provided appropriate use criteria on when it may be appropriate to consider antibiotic administration prior to dental procedures in patients with replacement joint implants.

Very few cases of infective endocarditis (IE) occur each year as a result of dental procedures. So as a result, only a small number of cases of IE might be prevented with antibiotics before dental care. For most people, antibiotics before dental appointments are not necessary and are now recommended only for individuals at highest risk of serious heart infection.

Antibiotics also carry risks, including upset stomach, rash, diarrhea and allergic reactions. Additionally, the overuse of antibiotics contribute to antibiotic resistance, which reduces their effectiveness over time. Therefore, it is important to use antibiotic prophylaxis only in the right situations and with those people most at risk for infection.

Lastly, research shows that even among the small number of IE cases linked to oral bacteria, most occur during everyday activities like brushing, flossing, or chewing, not during dental appointments.

Heart problems that call for antibiotics before dental procedures

Today, the American Heart Association (AHA) only recommends antibiotics before dental procedures for patients with the highest risk of infection, those who have:

• A prosthetic heart valve or who have had a heart valve repaired with prosthetic material
• A history of endocarditis
• A heart transplant with abnormal heart valve function
• Other congenital heart defects

If you’re not sure about the guidelines for your heart condition, check with your heart specialist. Always tell your dentist about your medical conditions and let them know if you or anyone in your family has allergies to antibiotics or other medications.

Antibiotic prophylaxis and joint surgery

People with joint replacements, such as a hip or a knee replacements, used to be given antibiotics before dental visits. For most patients, this is no longer recommended, though some individuals may still need them.

Antibiotics before dental visits may be appropriate for select patients—primarily those with severely compromised immune systems, such as those with AIDS/HIV, uncontrolled diabetes, active chemotherapy treatment, recent joint infection, or those taking certain medications. The ADA advises that this decision be made in consultation with the patient and orthopedic surgeon, who should recommend the antibiotic regimen and, when appropriate, provide the prescription. 

If you have any questions about whether you need to take antibiotics before dental visits, be sure to discuss with your dentist and consult with your orthopedic surgeon and physician.

Other uses for antibiotics in dentistry

In the past, people who have had a joint replacement, such as a hip or a knee replacement, were often prescribed antibiotic prophylaxis before dental procedures. While this still may be necessary for some individuals, in general, for patients with prosthetic joints, prophylactic antibiotics are not routinely recommended prior to dental procedures to prevent prosthetic joint infection.

The ADA and the AAOS have provided guidance on when it may be appropriate to consider antibiotic administration prior to dental procedures in patients with replacement joint implants. The AAOS guidance advises that most patients with replacement joints are not at risk for infection following dental procedures and do not require antibiotic administration. Prophylactic antibiotic therapy, however, should be considered for certain subsets of patients—primarily those with severely compromised immune systems related to AIDS/HIV, uncontrolled diabetes, chemotherapy, or a recent history of joint infection, along with those taking certain drugs for rheumatoid arthritis or to prevent organ transplant complications. The ADA recommends that prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription. 

If you have any questions about your situation, particularly if you have a significant immunodeficiency or a current or previously infected prosthetic joint, make sure to discuss your situation with your dentist and orthopedic surgeon or physician to determine the need for antibiotic prophylaxis.

Other uses for antibiotics in dentistry

If your dentist detects signs of an acute or chronic infection in your mouth, particularly when accompanied by fever, swelling, or other signs of infection, you may be prescribed antibiotics. Tooth infections occur when bacteria enter a tooth’s root, causing pain, tissue death, and buildup of pus. Called an abscess or abscessed tooth, this kind of infection can spread to other areas of the head and neck. Periodontal disease (also called gum disease) can also lead to gum infections.

Always provide your dentist or physician with a complete medical history and discuss whether antibiotics before dental treatment is right for you. Also, remember that brushing, flossing, eating nutritious food,  and visiting your dentist will help maintain good oral health, and prevent tooth and gum disease.