Do You Need Antibiotics Before the Dentist?

Q: If I have heart valve disease, do I need to take antibiotics before going to the dentist to prevent an infection?

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A: It used to be recommended that people with most types of congenital heart disease receive a dose of antibiotics before having a dental procedure. In the medical world, that’s called antibiotic prophylaxis. In this case, its purpose is to prevent at-risk people from getting infective endocarditis, a bacterial infection of the heart that can lead to heart failure or kidney damage.

The thinking was that people with damaged heart valves were more susceptible to IE, and that bacteria could get into the bloodstream through the gums during an invasive dental procedure.

But in 2007, the American Heart Association issued new guidelines that narrowed the pool of heart patients recommended to take preventive antibiotics before dental procedures.

IE is pretty uncommon, and there aren’t many good studies on it. The research that does exist, though, suggests that the risks of taking antibiotics (such as unpleasant side effects and the threat of antibiotic resistance from overprescribing) outweigh the possible benefits for most people.

It’s more likely that poor oral hygiene is behind many IE infections, rather than dental procedures. After all, we risk releasing germs into the bloodstream through the gums on a daily basis when we brush our teeth and floss. What’s perhaps most important for most people is good regular dental hygiene.

Preventive antibiotics are still recommended before a dental procedure for people most at-risk for IE, though, including patients who:

Have prosthetic cardiac valves, or valves repaired with prosthetic material
Had IE previously
Have cyanotic congenital heart disease or a repaired congenital heart defect with residual shunts or valvular regurgitation
Had a heart transplant with valve regurgitation

They may also be appropriate for people with other reasons for increased risk. Your cardiologist can help you understand your risk and whether you might benefit from preventive antibiotics.

— Cardiologist Brian Griffin, MD

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