You might need antibiotics for some dental procedures. Why? Because bacteria fills your mouth!  Staphylococcus, streptococcus, lactobacillus, even Escherichia coli.  These bacteria can wreak havoc if they travel outside of the oral cavity to other areas of the body, especially the heart.

Why Do You Need Dental Prophylaxis?

Infective endocarditis is a serious medical condition that occurs when a bacteria or virus infects the heart tissue.  This results in inflammation and formation of vegetations (clumps of bacteria and/or cell debris) on the heart valves. These vegetations not only weaken ho well the heart valves work but can also break loose to travel to other areas of the body. Complications of endocarditis can be deadly, ranging from heart failure to stroke.

AHA Guidelines for Dental Prophylaxis

With a goal to minimize the chance that bacteria from your mouth gets into the blood after a dental procedure, the American Heart Association released guidelines about antibiotic use. Due to worsening antibiotic resistance, those guidelines only recommend dental prophylaxis for individuals with the highest cardiac risk.

Cardiac Conditions Requiring Prophylaxis for Dental Procedures	Cardiac Conditions NOT Requiring Prophylaxis for Dental Procedures
Cardiac valve disease after a heart transplant	Aortic regurgitation or aortic stenosis
Congenital heart disease – repaired with prosthetic material	Bicuspid aortic valve
Cyanotic congenital heart disease	Mitral regurgitation or mitral stenosis
Heart valve repair using prosthetic material	Mitral valve prolapse
History for endocarditis	Obstructive hypertrophic cardiomyopathy
Prosthetic heart valves	

Guidelines from Other Professional Organizations

The American Dental Association advises against dental prophylaxis for patients who have had joint replacements. Data was insufficient to show a relationship between routine dental procedures and prosthetic joint infections.

For many patients, these policy changes will have a direct impact on their health care.  Many no longer require antibiotics and this is a wonderful thing, at least when it comes to preventing antibiotic resistance. Still, many patients will call their primary care providers looking for antibiotics and not all of those providers will be well versed in the latest recommendations.

Antibiotic Prophylaxis for Invasive Surgery

There may be indications for antibiotic prophylaxis for cases of invasive surgery.  Of note, current guidelines do not recommend prophylaxis for respiratory tract procedures and not at all for bronchoscopy.  They also do not recommend prophylaxis for GU (genitourinary) or GI (gastrointestinal) procedures. In appropriate cases, the surgeon will address the need for antibiotics with their patients during their pre-surgical consultation.