I’m pregnant. Can I still see the dentist?

Yes, and you should. The ADA says preventive, diagnostic and restorative care, including X-rays and numbing, is safe at any point in pregnancy. Hormonal changes can make gums more inflamed, so keep your cleanings. Tell us how far along you are.

I had a joint replaced. Do I need antibiotics before dental work?

Usually not. The ADA’s guideline says antibiotics generally aren’t recommended to protect a replaced joint. Your orthopedic surgeon may recommend one in specific cases, such as a significantly weakened immune system. If your surgery was recent, tell us, and we’ll coordinate timing with your surgeon.

I have a pacemaker. Do I need antibiotics?

No. Pacemakers and defibrillators don’t call for antibiotics before dental work. Tell us you have one so we can plan which instruments to use and keep them away from the device.

I have a congenital heart defect. Do I need antibiotics?

It depends on the defect and how it was repaired. Current guidelines recommend them for unrepaired cyanotic defects and for repaired defects with a leftover leak at or near a patch or device, but not for most other congenital conditions. Your cardiologist will know which applies, and we’ll confirm with them.

I have an artificial heart valve. What do I need to do?

Plan on an antibiotic before most dental procedures. The American Heart Association recommends it for artificial valves, including those placed by catheter, and for valve repairs that used prosthetic material. It’s usually a single dose, typically amoxicillin, taken shortly before your appointment. If you’re allergic to penicillin, there are alternatives.

I’ve had a stroke or heart attack. Is dental work safe?

Usually, with planning. Tell us when it happened and what you take now. After a recent event, we coordinate the timing of non-urgent care with your physician, and we treat urgent problems like pain or infection. Don’t stop a blood thinner for dental work unless the prescribing doctor tells you to.

I take Ozempic or a similar drug. Does that matter?

Mostly if you’re planning sedation. These drugs slow how fast your stomach empties. Current guidance says most people can keep taking them before procedures, with extra planning for people who recently started or raised their dose or have stomach symptoms. Tell us when you schedule.

I take an osteoporosis medication. Can I have a tooth pulled?

Generally, yes. At osteoporosis doses the risk of jawbone healing problems is very low, and the oral surgeons’ association says extractions don’t appear to be off-limits. Tell us the drug and how long you’ve taken it, and don’t stop it on your own.

Medications, Heart Conditions, Pregnancy and Dental Care

Your mouth isn’t separate from the rest of you, and in the 2020s that shows up in the dental chair more than ever. More of our patients take medications that matter for dental work: blood thinners, GLP-1 drugs like Ozempic, bone-strengthening drugs. And several guidelines have changed. Many people who were once told to take antibiotics before every cleaning no longer need to.

Our part is to know the current guidance and coordinate with your doctors. Your part is to tell us what’s going on with your health, every time it changes. That partnership is what keeps dental care safe.

Key takeaways

Bring a current list of your medications to every visit, including injections like Ozempic or Prolia, and supplements.
Routine antibiotics before dental work are now mainly for specific heart conditions, such as an artificial valve or a past heart infection. Most people with joint replacements or pacemakers don’t need them.
Don’t stop a blood thinner for dental work unless the doctor who prescribed it tells you to. For most patients, the ADA says it isn’t necessary.
Dental care, X-rays and numbing are safe at any point in pregnancy, according to the ADA.
If you take a GLP-1 drug and are planning sedation, tell us when you schedule.

Why your health history matters more than it used to

A dental health history used to be a few checkboxes. Now the medications on that list can change how we plan an extraction, whether you need an antibiotic beforehand, how we approach sedation, and even whether an implant makes sense. We review it with you and coordinate with your physicians when a decision needs both of us.

Medications we always ask about

Blood thinners

This includes warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), clopidogrel (Plavix) and daily aspirin. The ADA’s guidance is that for most patients, these don’t need to be stopped for dental work, and that bleeding can usually be controlled at the site with pressure, stitches or agents that help blood clot. Any change to your medication should be made with your physician, and if you have a heart stent, your cardiologist decides. Please don’t stop one on your own.

GLP-1 drugs for diabetes and weight loss

Semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) slow down how fast your stomach empties. That matters mostly for sedation, where an empty stomach is a safety issue. In 2024, five anesthesia, surgical and digestive health societies issued joint guidance: most people can keep taking these drugs before procedures, while people who recently started or increased their dose, or who have stomach symptoms, need extra planning, sometimes including a liquid diet for 24 hours beforehand.

That guidance was written for surgery and endoscopy, not specifically for dental sedation. So if you’re planning sedation with us, tell us you take one when you schedule. Sedation is only for patients healthy enough for it, and this is part of how we decide.

Bone-strengthening drugs

Bisphosphonates such as alendronate (Fosamax) and zoledronic acid (Reclast, Zometa), and denosumab (Prolia, Xgeva), carry a rare risk of a jawbone healing problem called medication-related osteonecrosis of the jaw. At osteoporosis doses the risk is very low: the American Association of Oral and Maxillofacial Surgeons estimates it at 5 in 10,000 or fewer for oral bisphosphonates, and up to 0.3% for denosumab. At the higher doses used for cancer, the risk is higher, generally under 5%.

For people taking these drugs for osteoporosis, the AAOMS says elective procedures like extractions don’t appear to be off-limits. If you’re about to start one for cancer, it recommends getting your dental health in order first when your medical situation allows. Either way, tell us the drug, the dose and how long you’ve taken it, and don’t stop it on your own. Stopping denosumab in particular carries its own risks, so that decision belongs to your prescriber.

Medications that dry your mouth

Hundreds of medicines reduce saliva, including common ones for blood pressure, depression and bladder control. Saliva protects your teeth, so a dry mouth raises your risk of decay. Our guide to habits and bonded dental work covers what helps.

Antibiotics before dental work: who needs them now

The American Heart Association’s 2021 guidance, which the ADA follows, recommends an antibiotic before dental procedures that involve the gums or the area around a tooth’s root only for people at the highest risk of a heart infection called infective endocarditis:

an artificial heart valve, including valves placed by catheter, or prosthetic material used to repair a valve
a past case of infective endocarditis
certain congenital heart conditions: unrepaired cyanotic defects (including shunts and conduits), or repaired defects with a leftover leak at or near a prosthetic patch or device
a heart transplant with a leaking valve

When it’s needed, it’s usually a single dose of an antibiotic, typically amoxicillin, shortly before the appointment. If you’re allergic to penicillin, there are alternatives; clindamycin is no longer recommended for this. Your cardiologist will know whether you’re in one of these groups, and we’ll confirm with them.

Most other heart conditions, including pacemakers and defibrillators, don’t call for antibiotics before dental work. Neither, in general, do joint replacements.

Joint replacements

The ADA’s guideline says that, in general, antibiotics aren’t recommended before dental work to prevent infection in a replaced joint, and the orthopedic surgeons’ 2024 guideline agrees. That guideline also suggests putting off nonurgent invasive dental work for three months after a hip or knee replacement. In 2026, the ADA’s science council said that delay is a clinical opinion rather than an evidence-based recommendation.

In practice, we coordinate with your surgeon. If your immune system is significantly weakened, your surgeon may want you to have an antibiotic, and if your surgery was recent, we’ll agree on timing together.

Pacemakers and defibrillators

No antibiotic is needed. What matters is equipment: the ADA notes that some electrical dental instruments, such as electrosurgery units and certain ultrasonic scalers, have interfered with these devices in lab studies. Tell us you have one so we can choose instruments with that in mind, keep cords away from your chest, and check with your cardiologist if there’s any question.

Pregnancy

The ADA’s guidance is clear: preventive, diagnostic and restorative dental care is safe throughout pregnancy, including X-rays and local anesthetic with epinephrine. Hormonal changes can make gums more inflamed, so cleanings matter more, not less, and urgent problems should be treated, not put off. Tell us how far along you are, and we’ll coordinate with your OB if anything calls for it.

After a heart attack or stroke

Tell us when it happened and what you take now. After a recent heart attack or stroke, we coordinate the timing of non-urgent work with your physician, and we still treat urgent problems like pain or infection. Many people are on blood thinners afterward; as above, don’t stop them for dental work unless the prescribing doctor tells you to.

We follow the guidelines and coordinate with your doctors. We can only do that if we know what you take.

What we do in the office

We keep up with the guidelines on antibiotics, blood thinners, sedation and bone medications, because they change.
We review your health history with you, and ask about anything new since your last visit.
We coordinate with your physicians when a decision needs both of us: your cardiologist, surgeon, OB or prescribing doctor.
We adjust the plan (timing, antibiotics, sedation, the order of treatment) when your health calls for it.

What we need from you

Bring a current medication list to every visit, including injections, inhalers and supplements.
Tell us about new diagnoses, surgeries, hospital stays or a pregnancy.
Don’t stop a medication for dental work unless the doctor who prescribed it says to.
If you’re planning sedation, tell us about GLP-1 drugs and anything else you take when you schedule.

Summary

Dentistry and medicine overlap more than ever. Antibiotics are now mainly for a short list of heart conditions; blood thinners usually stay; pregnancy is no reason to skip care; and newer drugs like GLP-1s and bone medications call for a conversation before certain treatment. We keep up with the guidelines and work with your doctors. You keep us informed. Together, that keeps your care safe.

Where Dentistry and Medicine Overlap: What Your Health History Changes