Antibiotics Before Dental Work for a Heart Condition: Who Still Needs Them
Breath & MouthArticleMany women were once told to take antibiotics before every cleaning because of a heart murmur or valve issue. Since 2007, the American Heart Association has limited this to a short list of highest-risk heart conditions, and its 2021 review kept that list unchanged. Here is who's on it, which dental procedures count, and the antibiotic swap it made.
In this article
Bacteria from the mouth can rarely infect the heart’s lining or valves, called infective endocarditis. For years, many people with heart murmurs or valve issues took antibiotics before dental visits. That changed in 2007.
Who still needs antibiotics?
In 2007 the American Heart Association narrowed the list to four categories at highest risk.1 Its 2021 review, written with the American Dental Association2 and infectious disease experts, found no convincing rise in these infections since then and kept the list the same.1
Per the ADA’s summary, antibiotics before certain dental work are reasonable for people with:2
- An artificial heart valve, including valves placed by catheter, or repair material such as annuloplasty rings
- A past episode of infective endocarditis
- A heart transplant with a leaky, structurally abnormal valve
- Certain congenital heart defects, such as unrepaired cyanotic disease or repairs with leftover leaks near a patch or device
If your condition isn’t on this list, routine antibiotics aren’t recommended.12
Which dental procedures count?
For people on the list, procedures that involve the gums, the area around a tooth’s root, or a cut in the mouth lining.2 Ask your dentist which of your planned procedures qualify.
What changed about the antibiotics?
Amoxicillin remains standard. For penicillin allergy, the AHA no longer recommends clindamycin because it can cause more frequent and severe reactions, including C. difficile infection.2 Alternatives include cephalexin, azithromycin, clarithromycin or doxycycline.2 Cephalosporins like cephalexin shouldn’t be used if you’ve had anaphylaxis, swelling or hives with penicillin.2
What about joint replacements?
That’s a separate question. See our guide to joint replacements and dental antibiotics.
Why oral health matters more than pills
The AHA emphasizes good oral health and regular dental care for everyone.1 Our articles on how often to get cleanings, bleeding gums and extractions on blood thinners can help.
Try: “I have mitral valve prolapse and used to take antibiotics before cleanings. Is my condition on the current high-risk list, or can I stop?”
Is It My Breath? includes a visit script. Use it to bring your heart diagnosis, allergy history and cardiologist’s contact to your dental visit.
This article is for general educational purposes only and is not medical or dental advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Please don't stop or skip antibiotics your cardiologist has prescribed before dental work without talking to them. Fever, chills, night sweats, unusual tiredness or shortness of breath in someone with a heart valve problem needs prompt medical attention. If you think you may be having a medical emergency, call 911 or your local emergency number right away. This article discusses clinical guidance. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Circulation (abstract via PubMed), 2021Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association (opens in a new tab)abcd
- American Dental AssociationAntibiotic Prophylaxis Prior to Dental Procedures (opens in a new tab)abcdefg
Spotted something out of date? Tell us and we’ll check it.
