Oral Health›Health conditions and your mouth

Heart Disease and Your Teeth and Gums

Gum disease and heart disease are linked, but it has not been shown that one causes the other. Here is what is known, when antibiotics before dental treatment are advised, and what to tell your dentist.

Updated September 2026·By the OHA editorial team·8 min read·How we write
Key takeaways
  • Gum disease is linked to heart and blood vessel disease, but it has not been shown to cause it, or that treating gum disease prevents it.
  • Infective endocarditis is a rare but serious heart infection that mouth bacteria can cause. If you are at risk, good daily cleaning and regular check-ups matter most.
  • Advice on antibiotics before dental treatment differs by country. In the UK, NICE does not recommend them routinely. In the US and Australia they are advised for a small group at the highest risk.
  • If you take a blood thinner, tell your dentist before any treatment. Do not stop taking it unless your doctor or another healthcare professional tells you to.
  • Tell your dentist about any heart condition or heart device, and every medicine you take.

If you have a heart condition, your mouth matters in two practical ways: mouth bacteria can, rarely, cause a serious heart infection, and some heart medicines affect bleeding during dental treatment. There is also the question of whether gum disease causes heart disease.

Does gum disease cause heart disease?

Health bodies agree there is a link, but not that one causes the other.

healthdirect Australia says there is growing evidence that poor oral health is linked to heart disease and stroke. The British Heart Foundation (BHF) says gum disease has been linked to a higher risk of heart and blood vessel problems, but that how the two are connected is still not well understood.

The American Heart Association (AHA) has reviewed the evidence twice:

  • Its 2012 statement found that studies support an association between gum disease and atherosclerosis (fatty build-up that narrows the arteries), even after allowing for known shared factors such as smoking, age and diabetes. But it said the studies do not show gum disease causes atherosclerosis, and there was no evidence that gum treatment prevents it.
  • Its updated statement in December 2025 again found an association. It says shared risk factors such as age, smoking and obesity contribute, and that inflammation and gum bacteria entering the blood may help explain it. It concludes that causality has not been established.

A 2022 Cochrane review (a systematic review of trials) asked whether treating gum disease prevents heart and blood vessel disease. It found only two small, unreliable studies and could not draw any conclusions.

In short: there is not yet good evidence that gum disease causes heart disease or that treating it protects your heart. Gum disease is still worth treating for your teeth and gums.

What is infective endocarditis?

The NHS describes endocarditis as inflammation of the inner lining of the heart, usually caused by an infection. It is rare but can be life-threatening. It happens when bacteria or fungi get into the blood and travel to the heart, and the NHS says this can happen through the mouth, for example during a dental procedure. healthdirect and the AHA add that everyday brushing and flossing can also let mouth bacteria into the blood, and healthdirect lists poor oral hygiene and gum disease among the risk factors.

Heart-related risks listed by the NHS include heart valve disease, an artificial heart valve, a pacemaker or implantable cardioverter defibrillator (ICD), some types of congenital heart disease (present from birth), hypertrophic cardiomyopathy (thickened heart muscle), a heart transplant, and having had endocarditis before.

The NHS says symptoms can include a high temperature or feeling shivery, feeling very tired, aches, night sweats, breathlessness and weight loss, often coming on slowly over weeks or months.

Do you need antibiotics before dental treatment?

Taking antibiotics before a procedure to prevent infection is called antibiotic prophylaxis. Once common for people with heart conditions, it is now advised much less often, and advice differs by country.

UK

NICE (the National Institute for Health and Care Excellence) says antibiotic prophylaxis against endocarditis is not recommended routinely for dental procedures. It says people at increased risk should be told why, and how to look after their oral health and spot symptoms. For people at high risk, NICE points dental teams to advice from the Scottish Dental Clinical Effectiveness Programme, endorsed across the UK by the Chief Dental Officers. The NHS says people at higher risk may be advised to speak to a doctor before any dental procedure.

US

The AHA's guidelines, which the ADA (American Dental Association) follows, advise antibiotics only for people at the highest risk: those with an artificial heart valve or valve repair material, previous endocarditis, certain congenital heart conditions, or a heart transplant with valve disease. They apply to procedures that involve handling the gums, working around the tooth roots, or piercing the lining of the mouth. The ADA says the list was narrowed because, for many people, the risks of reactions to antibiotics generally outweigh the benefits, and because of concern about drug-resistant bacteria. If antibiotics are advised for you, the AHA says you may be given a wallet card to show your dentist.

Australia

healthdirect says antibiotics may be recommended before certain dental procedures if you are at risk, and to talk with your doctor and dentist about the risks and benefits. A 2017 Australian Prescriber article said Australian guidelines recommend them for a similar group to the US, plus people with rheumatic heart disease at high risk of endocarditis, whom it describes as Indigenous Australians and people at significant socioeconomic disadvantage. That article is several years old, so check current advice with your dentist or doctor.

Why do the countries differ?

The evidence is thin. A Cochrane review, up to date to 2021, found only one relevant study and concluded it is unclear whether antibiotics before invasive dental treatment prevent endocarditis. The ADA notes that a 2015 UK study linked NICE's 2008 change to a rise in endocarditis cases, but that its authors said the data did not establish cause.

Every body agrees on one thing: if you are at risk, keeping your mouth healthy and seeing a dentist regularly is the most important protection. See how to brush your teeth and cleaning between your teeth.

Blood thinners and dental treatment

Our full guide to blood thinners and dental treatment covers what to expect before and after treatment.

Blood thinners help prevent blood clots. healthdirect explains that they include anticoagulants, such as warfarin, apixaban, rivaroxaban and dabigatran, and antiplatelet medicines, such as aspirin and clopidogrel. The NHS lists bleeding gums among their side effects (see bleeding gums).

  • Tell your dentist. The NHS says to tell your dentist you take an anticoagulant before a procedure such as having a tooth out. healthdirect says to tell your healthcare team when you book.
  • Do not stop it yourself. The NHS says you may not need to stop, but you might need a blood test beforehand to check your blood clots at the right speed, and to stop only on the advice of your GP or another healthcare professional. healthdirect and MedlinePlus (US National Library of Medicine) also say to talk to your doctor before stopping or changing it.
  • Carry your alert card. The NHS says people taking warfarin, apixaban or rivaroxaban are given an anticoagulant alert card to show their doctor or dentist before any procedure.

What should you tell your dentist?

Before any treatment, tell your dentist about any heart condition or device listed above, every medicine you take, and any drug allergies (the AHA asks people to share these). Show any alert card or wallet card you have. If you are at higher risk of endocarditis, the NHS also advises not getting piercings or tattoos without speaking to a doctor first (see oral piercings).

When to see a dentist
  • You have a heart condition that raises your risk of endocarditis: the NHS advises regular dental check-ups. See dental check-ups.
  • You are booking treatment and take a blood thinner, or have a heart condition your dentist does not know about.
Get help urgently
  • Possible heart attack. UK: the NHS says call 999 if you have chest pain that feels tight or squeezing, or that spreads to your arms, neck or jaw. Australia: healthdirect says call triple zero (000) straight away if you think you or someone else may be having a heart attack. US: the National Heart, Lung, and Blood Institute says call 911 even if you are not sure, and not to drive yourself to hospital.
  • Possible endocarditis. The NHS says get help from NHS 111 if you have symptoms, and call 999 for signs of a stroke (face drooping, arm weakness, speech problems, blurred vision or loss of sight), which can be a complication.
  • Bleeding on a blood thinner. healthdirect says call your doctor straight away or go to an emergency department if bleeding does not stop or lasts a long time.

Frequently asked questions

Will treating my gum disease lower my risk of a heart attack?

This has not been shown. A 2022 Cochrane review found no reliable evidence either way, and the AHA's 2025 statement says trials are still needed.

I used to take antibiotics before dental work. Why not now?

Guidelines have narrowed because, the ADA explains, for many people the risks of antibiotics outweigh the benefits. In the UK, NICE does not recommend them routinely. If you are unsure, ask your dentist and doctor.

Should I stop my blood thinner before having a tooth out?

Not on your own. The NHS says you may not need to stop it, and to stop only on the advice of your GP or another healthcare professional. Tell your dentist when you book.

Sources

  1. Endocarditis, NHS, accessed September 2026
  2. Prophylaxis against infective endocarditis: recommendations (CG64), National Institute for Health and Care Excellence, accessed September 2026
  3. Endocarditis, healthdirect Australia, accessed September 2026
  4. Gum disease, healthdirect Australia, accessed September 2026
  5. Infective endocarditis, American Heart Association, accessed September 2026
  6. Top things to know: periodontal disease and atherosclerotic cardiovascular disease, American Heart Association (summary of its 2025 scientific statement), accessed September 2026
  7. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?, American Heart Association scientific statement (Lockhart and others, Circulation, 2012), PubMed, accessed September 2026
  8. Gum disease and heart health: how are they connected?, British Heart Foundation, accessed September 2026
  9. Antibiotic prophylaxis prior to dental procedures, American Dental Association, accessed September 2026
  10. Antibiotic prophylaxis for heart patients, American Dental Association (MouthHealthy), accessed September 2026
  11. Antibiotic prophylaxis for dental procedures, Australian Prescriber (Daly, 2017), accessed September 2026
  12. Treating chronic gum inflammation (periodontitis) to prevent heart and blood vessel (cardiovascular) disease, Cochrane (Ye and others, 2022), accessed September 2026
  13. Antibiotics for the prevention of bacterial endocarditis in dentistry, Cochrane, accessed September 2026
  14. Anticoagulant medicines, NHS, accessed September 2026
  15. Things to consider when taking anticoagulants, NHS, accessed September 2026
  16. Warfarin, NHS, accessed September 2026
  17. Apixaban, NHS, accessed September 2026
  18. Rivaroxaban, NHS, accessed September 2026
  19. Blood thinners, healthdirect Australia, accessed September 2026
  20. Taking warfarin, MedlinePlus (US National Library of Medicine), accessed September 2026
  21. Heart attack, NHS, accessed September 2026
  22. Heart attack, healthdirect Australia, accessed September 2026
  23. Heart attack: symptoms, NIH National Heart, Lung, and Blood Institute, accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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