Frequently Asked Questions (FAQ)


If you are a patient with certain kinds of heart disease or a special heart condition, or you’ve had a joint replaced, taking good care of your teeth and gums is a must-not just for a healthy smile, but also for your overall health.

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Why do I need antibiotics before my dental appointment?

During dental treatment, bleeding sometimes occurs. As a result, bacteria from the mouth can possibly enter the bloodstream and work their way to the heart. This presents a risk for some persons with cardiac abnormalities because the bacteria may cause bacterial endocarditis, a serious inflammation of the heart valves or tissues. Antibiotics reduce this risk.

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What types of heart conditions pose a risk?

Certain heart conditions are more often associated with endocarditis than others. To determine if an existing heart condition poses a risk, your dentist needs complete health information on your medical history form. The form should also include the name and address of your family physician or cardiologist as well as the names and dosages of all medications that you take.

Do any of these apply to you?

  • Heart surgery within past six months
  • Pacemaker
  • Vascular surgery (replaced artery) within past six months
  • Artificial heart valve
  • History of rheumatic fever
  • History of heart murmur (mitral valve prolapse)
  • Previous bacterial endocarditis
  • Systemic pulmonary shunt
  • Congenital heart defect
  • Acquired valvular dysfunction

If you have any of these conditions, if you have been diagnosed with other heart ailments, or if your health status has changed since your last dental visit, tell your dentist.

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Who determines what type of antibiotics I should take?

The American Heart Association routinely publishes guidelines so that physicians and dentists can protect patients who are at risk for developing bacterial endocarditis.
The guidelines, which the American Dental Association helps develop, recommend the use of antibiotics prior to dental treatment, based on the patient’s medical condition and on the treatment to be performed. Your dentist or physician may prescribe antibiotics for dental procedures that would result in bleeding from the gums or mucous membranes in the mouth. Such procedures could include professional teeth cleaning, incision and drainage of infected oral tissue, some types of injections, extractions and some surgeries that involve the maxillary sinus.

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What about a joint replacement?

The bacteria commonly found in the mouth may travel through the bloodstream and settle in your artificial joint. This increases your risk of contracting an infection. Your dentist and your orthopaedic surgeon, working together, will develop an appropriate course of treatment for you.

For the first two years following a total joint placement, antibiotic prophylaxis is recommended for everyone. After two years, only high-risk patients may need to receive antibiotics for high-risk procedures.

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Do any of these high-risk situations apply to you?

  • Rheumatoid arthritis, systemic lupus or other medical conditions that cause you to be Immunocompromised or immunosupressed
  • Immunosupression caused by drug or radiation treatment
  • Malnourishment
  • Hemophilia
  • HIV infections
  • Insulin dependent (Type 1) diabetes
  • Cancer

All patients in these high-risk categories may need antibiotics for all high-risk dental procedures. High-risk dental procedures are those involving bleeding or producing high levels of bacteria in your blood. They include:

  • all dental extractions
  • all periodontal procedures
  • dental implant placement or insertion of teeth that were knocked out some root canal procedures
  • initial placement of orthodontic bands (not brackets)
  • certain specialized local anesthetic injections
  • regular dental cleanings (if bleeding is anticipated)

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How long are antibiotics good for?

Don’t try to stretch the useful life of your medicine. Always check the bottle’s expiration date. Prescriptions that have passed their prime will not help you. Dispose of them promptly. If you are taking antibiotic pills orally, be sure to fill your prescription before your next visit. Carefully follow instructions for the dosage and frequency.