Why the guidelines changed

Dental work releases small amounts of mouth bacteria into the bloodstream. So does brushing. For decades the worry was that those bacteria could seed an infection on a heart valve or an artificial joint, so patients with either were given antibiotics before every visit.

The evidence did not support that for most people. The American Heart Association and the American Dental Association narrowed the recommendations to the patients at genuinely high risk, where the benefit outweighs the harm of frequent antibiotics.

Who still needs premedication

Heart conditions: an artificial heart valve or valve repair with artificial material, a history of infective endocarditis, certain congenital heart conditions, and a heart transplant with valve problems. Mitral valve prolapse and most murmurs no longer qualify.

Joint replacements: the ADA no longer recommends routine antibiotics for most people with artificial joints. Your orthopedic surgeon may still want it in the first months after surgery, or if you have a history of joint infection or a weakened immune system. When your surgeon wants it, I follow their guidance.

What I ask and how we coordinate

If your history puts you in the premedication group, we call your physician or surgeon to confirm, and we make sure you have the prescription before your visit. If it does not, I will tell you why, so you are not taking antibiotics on autopilot from an old instruction.

• Any heart valve surgery, endocarditis, or congenital heart condition
• Any joint replacement, when, and what your surgeon has told you
• Any immune-suppressing condition or medication
• Your full medication list

What to bring to your visit

Your medication list, any card from your cardiologist or surgeon about premedication, and the name of the physician to contact. If you are unsure whether you need it, call us before your appointment and we will sort it out ahead of time rather than in the chair.