The short answer
For the large majority of people with a heart condition, the answer today is no. Antibiotic cover before dental treatment — antibiotic prophylaxis (Endokarditisprophylaxe) — is recommended only for a small, precisely defined group at the highest risk of infective endocarditis, an infection of the inner lining of the heart. Having high blood pressure, a stent, a bypass, atrial fibrillation or a pacemaker does not, on its own, put you in that group. The decision is not made by your dentist alone: your cardiologist defines your risk category, and we then apply it to the specific procedure you are having. If you were given this advice fifteen or twenty years ago, it is worth having it checked, because the recommendations have narrowed substantially since then.
Why the rules changed — and why old advice still circulates
Until the mid-2000s, antibiotic cover before dental work was handed out generously. The reasoning felt sound: dental procedures push bacteria into the bloodstream, bacteria in the bloodstream can settle on a damaged heart valve, so block the bacteria and you block the infection.
Two things then changed the picture.
The everyday bacteraemia problem. Researchers found that brushing, flossing and chewing also push oral bacteria into the bloodstream — many times a day, every day. Set against thousands of these everyday episodes a year, the handful caused by dental appointments accounts for only a small share of a person’s total exposure. A single dose of antibiotic covers the appointment. It cannot cover breakfast.
The evidence for benefit stayed thin. No large randomised trial has ever shown that antibiotic cover before dental treatment prevents endocarditis. What exists is indirect reasoning and observational data. Meanwhile the downsides are concrete: allergic reactions, gut side effects and the wider problem of antibiotic resistance.
From 2007 onwards, cardiology societies in the United States and Europe — and with them the German cardiology and dental associations — cut the list of people who should receive prophylaxis down to those with the most to lose if endocarditis occurs. The logic shifted from “prevent every possible case” to “protect the few for whom this infection would be catastrophic”. That is why an older relative may still insist you need a tablet before every filling: the advice was correct once, and has since been superseded.
AND — only if both are yes
Who is in the high-risk group today
German and international cardiology guidance limits prophylaxis to a small number of clearly defined situations. In broad terms, these are:
- people with a prosthetic heart valve (Herzklappenprothese), whether mechanical, biological or implanted via a catheter, and people whose valve was repaired using prosthetic material such as a ring or clip
- people who have already had infective endocarditis once — a previous episode is one of the strongest predictors of another
- people with certain congenital heart defects (angeborene Herzfehler), particularly those that were never corrected and remain cyanotic, those corrected with prosthetic material within roughly the first six months after the operation, and those left with a residual defect next to a patch or prosthesis
- in some guidance, heart transplant recipients who have developed a valve problem in the transplanted heart
This is a summary written for orientation, not a self-assessment tool. Congenital heart disease in particular comes in dozens of forms, and two people with the same diagnostic label can fall on different sides of the line. Your cardiologist’s written assessment is what counts.
Which appointments are affected — and which are not
The second half of the rule is often forgotten: even in the high-risk group, prophylaxis is not tied to every visit. It applies to procedures involving the gum tissue, the region around the root tip, or a breach of the lining of the mouth.
If you are in the high-risk group, tell us what you have been told and let us match it to the appointment. It saves you taking an antibiotic you do not need, and it stops the opposite mistake — a surgical appointment going ahead without cover that should have had it.
How it works in practice in Germany
The card. People at high risk in Germany are usually given an endocarditis prophylaxis card (Endokarditis-Ausweis) through their cardiologist or a heart foundation, stating the risk category and the recommendation. Bring it to every practice you attend. It is the single most useful document you can carry, because it settles the question in five seconds instead of five phone calls.
The prescription. Prophylaxis is a single dose taken shortly before the appointment, not a course of treatment over several days. In most cases it is a penicillin-type antibiotic; alternatives exist for people with a penicillin allergy. The drug, the dose and the timing are set by the prescribing doctor or dentist — never by an internet article, and never by reusing a leftover pack from a previous illness. Tell us about any antibiotic allergy before we write anything.
Who writes it. Either your cardiologist or we can issue the prescription, with the usual statutory prescription charge if you are in the statutory system. What matters is that it is written in advance, so you are not queuing in a pharmacy while your appointment slot runs.
Talking to your cardiologist. Where your situation is unclear, we contact your cardiology practice and ask in writing — a one-line answer from the doctor who knows your valve beats guessing. If you have just moved to Germany and have no cardiologist here yet, bring your discharge letters or operation report from home; we will read them, and your GP (Hausarzt) can arrange a referral (Überweisung). Finding your way through that first round of appointments in a second language is worth having explained once, properly: English-Speaking Dentist in NRW.
What antibiotic prophylaxis does not do
This is where the honest part of the conversation sits, and it is more important than the tablet.
A single dose covers one appointment. It does nothing about the state of your mouth for the other 364 days. If your gums bleed when you brush, bacteria are entering your bloodstream daily from a source that no prophylaxis addresses. For someone with a vulnerable valve, the cumulative everyday exposure from untreated gum inflammation is widely regarded as the more significant issue — which is why cardiology and dental bodies that narrowed the antibiotic indication simultaneously sharpened the advice on oral hygiene and regular dental care.
So the practical priority order for a high-risk patient runs: healthy gums first, regular check-ups second, correct use of prophylaxis third. Not the other way round. If your gums are currently inflamed, that is the thing to deal with: Periodontitis treatment – service page (EN).
Antibiotic cover also does not replace the other precautions heart patients often need. Blood-thinning medication raises entirely separate questions about bleeding — and the one thing you must never do is stop or change a blood thinner on your own initiative. That decision belongs to the doctor who prescribed it. We plan around your medication; we do not ask you to pause it.
When to speak to us, and when to speak to a doctor
As a general rule, no. Coronary stents are not on the list of conditions that call for endocarditis prophylaxis, and this has been the position of cardiology guidance for many years. If you were told otherwise at the time your stent was placed, ask your cardiologist to confirm the current position in writing.
It feels safer, but it is not neutral. Every unnecessary dose carries a risk of allergic reaction and gut side effects, and contributes to resistance in the population. The guidelines narrowed precisely because the balance of harm and benefit did not support routine use. That said, if you are genuinely in the high-risk group, take it — the balance there is different.
Ask your cardiologist directly, or ask your GP to request it from the clinic that treated you. If you had heart surgery abroad, your operation report is usually enough for a German cardiologist to classify you.
It depends on your risk group and on how much bleeding is expected. For a high-risk patient, cleaning below the gum line in inflamed tissue is generally treated as a covered procedure; a light polish of healthy gums may not be. We decide that when we see your gums, not over the phone.
The risk category itself does not change with pregnancy, but the choice of medication and the timing of dental treatment may. In that situation we coordinate with both your cardiologist and your obstetric team before planning anything beyond a check-up.
Antibiotics before dental treatment are now a targeted measure for a small group, not a routine courtesy for anyone with a heart condition. If you have a prosthetic valve, a previous endocarditis or a significant congenital heart defect, the recommendation probably applies — and the card in your wallet is the proof. If you have a stent, a bypass, high blood pressure or an arrhythmia, it probably does not. The decision belongs to your cardiologist; applying it to a given appointment belongs to us. And for everyone here, the bigger and more constant lever is the one nobody prescribes: gums that do not bleed.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
