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Antibiotics Before Dental Work Checker

Do you need antibiotics before dental work? Answer a few questions about your heart, any joint replacement and your upcoming dental work to see what the American Heart Association and ADA guidelines say, and what to ask your dentist and doctor.

A guideline summary, not a diagnosis or a prescription. Your answers stay on this device.

Question 1 of 4

Do you have any of these heart conditions?

Pick all that apply, or "No heart condition". If you're checking for someone else, answer for them.

For clinicians: AHA 2021 antibiotic regimens (reference table)

For dentists and physicians. Paraphrased from Table 5 of the AHA 2021 scientific statement, for patients in the AHA highest-risk groups having dental work that involves the gingiva, the periapical region or perforation of the oral mucosa. A reference table only, not a dose calculator. Clinical judgment and shared decision-making apply.

Single dose, 30 to 60 minutes before the procedure
SituationAgentAdultsChildren
Can take oral medicineAmoxicillin2 g50 mg/kg
Can't take oral medicineAmpicillin2 g IM or IV50 mg/kg IM or IV
Can't take oral medicineCefazolin or ceftriaxone1 g IM or IV50 mg/kg IM or IV
Penicillin or ampicillin allergy, oralCephalexin (or another 1st- or 2nd-generation oral cephalosporin in equivalent dosing)2 g50 mg/kg
Penicillin or ampicillin allergy, oralAzithromycin or clarithromycin500 mg15 mg/kg
Penicillin or ampicillin allergy, oralDoxycycline100 mgUnder 45 kg: 2.2 mg/kg; over 45 kg: 100 mg
Penicillin or ampicillin allergy, can't take oral medicineCefazolin or ceftriaxone1 g IM or IV50 mg/kg IM or IV
  • Timing: one dose, 30 to 60 minutes before the procedure. If the dose was not given beforehand by mistake, it may be given up to 2 hours after the procedure.
  • The AHA no longer recommends clindamycin for dental prophylaxis: it may cause more frequent and severe reactions, including C. difficile infection.
  • Don't use a cephalosporin after anaphylaxis, angioedema or hives with a penicillin or ampicillin.
  • Use azithromycin or clarithromycin with caution in patients with a known prolonged QTc interval.
  • Patient already on a short course of antibiotics: the AHA prefers a different class from this table, and if possible delaying elective dental work until at least 10 days after the course ends.
  • Several sequential appointments: if possible, wait 10 days after the last dose before the next procedure.

IM: intramuscular. IV: intravenous. Source: AHA 2021 statement, Table 5 and "Other Considerations"; the same values appear in the AAPD reference manual. For prosthetic joints, if antibiotics are judged necessary, the ADA says the orthopedic surgeon should recommend the regimen (ADA).

Who needs antibiotics before dental work?

Only a small group of people with certain heart conditions. The American Heart Association (AHA) suggests antibiotics before some dental work for people at the highest risk of a bad outcome from infective endocarditis, an infection of the heart's lining or valves. Its 2021 list, which the American Dental Association (ADA) follows, covers people with:

  • An artificial heart valve, including one placed through a catheter (such as TAVR)
  • A heart valve repaired with artificial material, such as a ring, clip or chords
  • A heart pump (left ventricular assist device) or an implanted artificial heart
  • A past case of infective endocarditis
  • Certain heart defects present from birth: one that was never fully repaired and lowers oxygen levels (cyanotic), including with a shunt or conduit; one fully repaired with artificial material or a device in the last 6 months; a repair with a leftover defect at or next to the patch or device; or a pulmonary valve or conduit placed by surgery or catheter
  • A heart transplant, if the new heart develops a valve problem

Many common heart conditions are not on the list, including pacemakers and similar devices, heart or other stents, blood vessel grafts (including dialysis grafts) and a hole in the heart that a device has fully closed (after the first 6 months). In 2021 the AHA also reviewed mitral valve prolapse, bicuspid aortic valve, aortic stenosis and rheumatic heart disease, and kept them off.

Do I need antibiotics before dental work after a knee or hip replacement?

Usually not. The ADA's 2015 guideline says antibiotics are generally not recommended before dental work to prevent an artificial joint infection, because the evidence didn't link dental work to joint infections. In 2024 the American Academy of Orthopaedic Surgeons (AAOS) found that, for hips and knees, routine antibiotics may not lower the risk of joint infection.

Your orthopedic surgeon decides the exceptions. In 2016 the AAOS and the ADA published "appropriate use criteria" for special cases. The AAOS published new criteria in 2025, with ADA dentists on its panels. The 2025 criteria rate antibiotics as "may be appropriate" only for dental work on the gums, or that breaks the lining of the mouth, in people with a severely weakened immune system. For higher-risk joints, such as after a joint infection or a redo (revision) surgery, they say there isn't enough data. If you had problems after your joint surgery, the ADA says to talk with your surgeon, who recommends an antibiotic if one is needed.

Timing matters too: the AAOS suggests considering a wait of up to 3 months after a hip or knee replacement before some dental work. Ask your surgeon.

Which dental procedures need antibiotics?

For people on the AHA list: dental work that handles the gums or the area around the tip of a tooth root, or that breaks the lining of the mouth. Pulling teeth, implant surgery and deep cleanings fall into this group. Whether a regular cleaning, a filling, a crown or a root canal counts depends on what your dentist will do, so ask.

The AHA names these as not needing antibiotics, even for people on its list:

  • A numbing shot through healthy, non-infected tissue
  • Dental x-rays
  • Getting dentures, retainers or other removable appliances
  • Getting braces put on, or having braces adjusted
  • A baby tooth falling out
  • Bleeding from an injury to the lips or the inside of the mouth

Why the guidelines changed in 2007 and 2021

Before 2007, many more people took antibiotics before dental visits. In 2007 the AHA narrowed its list, and about 90% fewer patients qualified. Some people kept taking them anyway, most often for mitral valve prolapse, according to a dentist survey cited by the AHA. The AHA's reasons for the change, confirmed in 2021:

  • Mouth bacteria get into the blood far more often from everyday chewing and toothbrushing than from dental visits.
  • Even if antibiotics worked every time, they could prevent only a very small number of cases.
  • Antibiotics carry risks, from allergic reactions to C. difficile infection and antibiotic resistance.
  • A healthy mouth and regular dental care matter more. The AHA suggests checkups twice a year where you can get them.

The 2021 review found no convincing evidence that endocarditis from mouth bacteria became more common or more deadly after 2007, so the list stayed the same, and clindamycin was dropped. The AHA notes that the benefit of these antibiotics has never been proven, so the decision should be shared between you, your dentist and your doctor.

Guidance differs by country. In the UK, NICE says antibiotics are not recommended routinely before dental work. Scottish dental guidance (SDCEP, 2026), which NICE points to, recommends them for people at high risk before extractions and oral surgery, as a shared decision. Outside the US, follow your local guidance.

What if I forgot to take my antibiotic?

Tell your dentist before the work starts. The AHA says a dose missed by mistake may be given up to 2 hours after the procedure. Let your dentist or doctor decide; don't take a dose on your own. Already taking an antibiotic for something else? Say so: the AHA prefers a different type, and if possible, waiting at least 10 days after the course ends for planned dental work.

Don't start, stop or change antibiotics on your own. Before a big job such as a dental implant, ask early. If something goes wrong afterward, the Dental Emergency Checker helps you decide how fast to get care.

How this tool works

The checker matches your answers about your heart, joints, other medical reasons and upcoming dental work to these guideline lists:

Your answerGuideline usedWhat the tool shows
A condition on the AHA 2021 listAHA 2021Recommended before some dental work
A condition not on the lists, or an artificial joint with no special factorsAHA 2021, ADA 2015, AAOS 2024Generally not recommended
Not sure, a special joint factor, or another medical reasonAAOS 2024 and 2025, ADAYour surgeon or doctor decides

With more than one answer, the strongest shows first, each with its source. Each upcoming procedure shows how the AHA groups it (and, for a joint with a weakened immune system, how the 2025 orthopedic criteria rate it).

Limits: it can't see your records, and it doesn't diagnose or prescribe. The AHA doesn't name every procedure, so "ask your dentist" means exactly that. The clinician table copies the AHA's 2021 regimens for reference; it is not a dose calculator. Your answers are never saved. A share link is made only when you click "Copy link", and holds only your answer choices.

Frequently asked questions

Do I need antibiotics before a dental cleaning if I have a heart condition?
Only if your heart condition is on the American Heart Association's highest-risk list, such as an artificial heart valve or a past case of endocarditis, and only if the cleaning works on the gums. Most heart conditions, including pacemakers, stents and mitral valve prolapse, are not on the list. Ask your dentist and cardiologist.
Do I need antibiotics before dental work if I have a pacemaker or a stent?
No, according to the American Heart Association's 2021 statement. It does not suggest antibiotics before dental work for pacemakers, defibrillators and similar devices, or for heart or other stents, because infections of these devices are rare and are mostly caused by other bacteria (staphylococci), not mouth bacteria.
Do I need antibiotics before dental work after a knee or hip replacement?
For most people, no. The ADA's 2015 guideline says antibiotics are generally not recommended before dental work for people with artificial joints, and the American Academy of Orthopaedic Surgeons found in 2024 that routine antibiotics may not lower the risk of a hip or knee infection. Some people, such as those with a severely weakened immune system or a past joint infection, should ask their orthopedic surgeon, who decides.
What if I forgot to take my antibiotic before dental work?
Tell your dentist before the work starts. The American Heart Association says that if the dose was missed before the procedure, it may be given up to 2 hours afterward. Don't take a dose on your own: let your dentist or doctor decide.
Do I need antibiotics before dental work for mitral valve prolapse?
Not according to the American Heart Association. In 2021 it reviewed mitral valve prolapse, bicuspid aortic valve, aortic stenosis and rheumatic heart disease and did not add them to its list. A valve that was replaced, or repaired with artificial material, is on the list.
Why did my dentist stop giving me antibiotics before dental work?
Because the guidelines changed. In 2007 the American Heart Association limited antibiotics to the highest-risk heart conditions, and about 90% fewer people qualified. In 2015 the ADA said antibiotics are generally not recommended for people with joint replacements. If you were told to take them in the past, ask whether that still applies to you.

Sources

  1. American Heart Association. Wilson WR, Gewitz M, Lockhart PB, et al. Circulation 2021;143(20):e963–e978. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. 2021. Table 5 as corrected in Circulation 2022;145(17):e868. Accessed October 26, 2026.
  2. American Dental Association. Antibiotic Prophylaxis Prior to Dental Procedures (Oral Health Topics). last updated July 15, 2026. Accessed October 26, 2026.
  3. American Dental Association (MouthHealthy). Antibiotic Prophylaxis for Heart Patients. Accessed October 26, 2026.
  4. American Dental Association (MouthHealthy). Joint Replacement. Accessed October 26, 2026.
  5. American Dental Association Council on Scientific Affairs. Sollecito TP, Abt E, Lockhart PB, et al. JADA 2015;146(1):11–16.e8. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners. 2015. Accessed October 26, 2026.
  6. American Academy of Orthopaedic Surgeons, with the American Dental Association. Quinn RH, Murray JN, Pezold R, Sevarino KS. J Am Acad Orthop Surg 2017;25(7):e138–e141. Management of Patients with Orthopaedic Implants Undergoing Dental Procedures (appropriate use criteria, 2016). 2017. Accessed October 26, 2026.
  7. American Academy of Orthopaedic Surgeons and American Association of Hip and Knee Surgeons. The Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures: Evidence-Based Clinical Practice Guideline. adopted November 18, 2024. Accessed October 26, 2026.
  8. American Academy of Orthopaedic Surgeons. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Appropriate Use Criteria. adopted June 6, 2025. Accessed October 26, 2026.
  9. American Academy of Pediatric Dentistry. Antibiotic Prophylaxis for Dental Patients at Risk for Infection (Reference Manual of Pediatric Dentistry). latest revision 2022. Accessed October 26, 2026.
  10. National Institute for Health and Care Excellence (NICE), UK. Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures (CG64). 2008, updated 2016. Accessed October 26, 2026.
  11. Scottish Dental Clinical Effectiveness Programme (SDCEP). Infective endocarditis (Drug Prescribing for Dentistry). Accessed October 26, 2026.
  12. Scottish Dental Clinical Effectiveness Programme (SDCEP). Antibiotic Prophylaxis Against Infective Endocarditis: Advice for cardiology and cardiac surgery teams (Implementation Advice, 2nd edition). March 2026. Accessed October 26, 2026.
  13. MedlinePlus, US National Library of Medicine. Endocarditis (Medical Encyclopedia). reviewed November 10, 2024. Accessed October 26, 2026.

Last reviewed by the Dental Health Time editorial team, against the sources above. How we review.

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