Should You Take Preventive Antibiotics Before a Dental Visit?

If you have certain heart conditions, in the past your doctor probably told you to take a course of antibiotics before visiting the dentist. Thanks to guidelines published by the American Heart Association (AHA) in 2008, you now may be able to skip this step.

Many types of dental work — even routine cleanings — can cause bleeding. This allows bacteria from the mouth to enter the bloodstream and travel to other sites in the body. For most people, the immune system disposes of these intruders without a problem. In the presence of certain heart abnormalities, however, bacteria traveling in the blood can gain access to the heart’s inner lining or valves. The resulting infection, known as endocarditis, can cause lasting damage to the heart muscle.

Doctors now believe that the risk for a serious heart infection arising from dental bleeding is much smaller than previously thought. This assessment, coupled with the mounting evidence on the hazards of antibiotic overuse, prompted the AHA to issue a significantly scaled-back recommendation on the use of preventive antibiotics. According to the current guidelines, people with the following heart conditions no longer need to take antibiotics before having dental work:

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 are still advised for people with the following:

An artificial heart valve
A history of infective endocarditis
Certain specific congenital heart defects
A transplanted heart that develops a problem in a heart valve

People with artificial joints may also need to take antibiotics before having dental work. Bacteria from your mouth can potentially travel to the joint, triggering an infection in the prosthesis. The current recommendations state that all patients who have had a total joint replacement in the past two years should take antibiotics preventively. After two years, only certain individuals in high-risk situations need to continue the practice.

People with other health problems, such as cancer, HIV infection, and hemophilia, may also need to take antibiotics before undergoing certain dental procedures. If you have a condition that puts you at greater risk of developing bacterial infection, be sure to tell your dentist, periodontist, and other doctors. Also, if you have taken antibiotics before having dental work in the past, be sure to talk to your doctor about how the guidelines apply to you before seeing your dentist.

Online Medical Reviewer: Weber, Hans-Peter, DMD
Date Last Reviewed: 5/25/2010
Date Last Modified: 5/25/2010

The views represented by this article are that of the author and not of Delta Dental. This article is provided for information only. Please consult with a licensed dentist to discuss the best way for you to improve or maintain your oral health.

In all cases, specific group contract provisions, benefits, limitations and exclusions take precedence over oral health recommendations given here. We recommend that you contact your dental benefits carrier to determine the specific limitations and exclusions for your group.