Why wasn’t I told to take antibiotics before my dental treatment?

Dentist chair

I have a heart valve problem. In the past, I’ve been told to take antibiotics before having treatment at the dentist, but this wasn’t the case on my last visit. Why not?

Dr Angela Nobbs says:

Your mouth is home to a large number of different bacteria, which normally don’t cause harm. But sometimes, for example if they get into the bloodstream, the bacteria can become harmful. Oral bacteria known as streptococci can cause unwanted clots on heart valves, leading to a heart condition known as infective endocarditis – an infection of the inner lining of the heart. It’s rare, but is difficult to treat and potentially fatal.

In previous years, people at risk of developing endocarditis, such as those with heart valve problems, were often given antibiotics before dental procedures such as extractions or scaling. The antibiotics were to kill any oral bacteria entering the bloodstream and prevent the formation of infected clots on the heart valves.

Endocarditis is rare, but is difficult to treat and potentially fatal

But there are growing concerns regarding antibiotic safety for patients, and the issue of increasing antibiotic resistance.

In 2008 the National Institute for Health and Care Excellence (NICE) issued new guidance recommending that antibiotics are no longer routinely given to high-risk patients. The decision as to whether or not antibiotics are needed prior to a dental procedure will be based on these recommendations and the dentist’s clinical judgement – the dentist will also seek advice from cardiologists or physicians where necessary.

Regardless of whether or not you receive antibiotics prior to a dental procedure, if you’re at risk of endocarditis you should take extra care to maintain excellent oral hygiene, know the symptoms of endocarditis, and seek medical advice urgently if symptoms develop.

Dr Angela NobbsMeet the expert

Dr Angela Nobbs is Senior Lecturer in Oral Microbiology at the University of Bristol Dental School.



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