Should Dogs and Cats Receive Antibiotics for Routine Dental Procedures? What a New Systematic Review FoundDental procedures are among the most common surgeries performed in dogs and cats.

By Dr. Steve Mehler

Dental procedures are among the most common surgeries performed in dogs and cats. Yet one question continues to generate debate:

Should pets routinely receive antibiotics before or after a professional dental cleaning or tooth extraction?

For years, many veterinarians have prescribed antibiotics out of concern that bacteria released during a dental procedure could enter the bloodstream and cause serious infections elsewhere in the body.

A new 2026 systematic review published in the Journal of Small Animal Practice examined all of the available evidence to answer that question.

The conclusion?

There is remarkably little evidence that routine antibiotic prophylaxis improves outcomes for most veterinary dental patients. 

Why Are Antibiotics Used During Dental Procedures?

The mouth contains hundreds of bacterial species.

Whenever tartar is removed, periodontal pockets are cleaned, or teeth are extracted, bacteria can temporarily enter the bloodstream—a phenomenon known as transient bacteremia.

This has long raised concerns that these bacteria could seed distant organs and lead to conditions such as:

• Infective endocarditis

• Sepsis

• Other systemic infections

Because of these theoretical risks, antibiotics have often been administered before or after dental procedures.

But does the evidence support this practice?

What Is a Systematic Review?

Unlike a single research study, a systematic review doesn't generate new data.

Instead, it collects and critically evaluates all available published evidence on a specific question.

The authors followed internationally accepted PRISMA guidelines and reviewed studies investigating:

• Infectious complications after dental procedures

• The frequency of bacteremia

• Whether antibiotics reduce those complications

Their goal was to determine whether current recommendations are supported by evidence rather than tradition.

Bacteremia Is Common...

The review found that approximately 47% of dogs and cats develop transient bacteremia at some point during or shortly after a dental procedure.

At first glance, that sounds alarming.

But here's the critical point:

Bacteremia is not the same thing as infection.

In healthy individuals, bacteria entering the bloodstream briefly is often a normal biological event. The immune system rapidly clears these bacteria before they can establish disease.

In fact, transient bacteremia can also occur after:

• Tooth brushing

• Chewing

• Eating

The presence of bacteria in the bloodstream alone does not automatically translate into illness.

Did Bacteremia Lead to Serious Disease?

This is where the review became particularly interesting.

Despite bacteremia occurring in nearly half of patients, the authors found:

• No studies clearly documenting sepsis following routine dental procedures 

• No studies demonstrating infective endocarditis caused by routine dentistry 

• No convincing evidence linking transient bacteremia with clinically important infectious complications 

The certainty of the available evidence was rated very low, largely because so few studies have actually examined meaningful clinical outcomes.

Do Antibiotics Prevent Bacteremia?

Only two randomized controlled trials addressed this question.

One evaluated clindamycin.

Another evaluated penicillin.

Neither study demonstrated a statistically significant reduction in bacteremia compared with untreated controls.

More importantly:

Neither study showed that antibiotics reduced clinically important outcomes such as:

• Endocarditis

• Sepsis

• Local infections

• Mortality

Those studies simply weren't available.

Why the Evidence Is Weak

One of the major strengths of this review is that the authors openly discuss the limitations of the existing literature.

They found:

• Only two randomized clinical trials 

• Small sample sizes

• Short follow-up periods

• Studies measuring bacteremia instead of actual disease

• Virtually no data evaluating post-operative antibiotic use

Because of these limitations, the certainty of evidence was judged to be very low.

In other words:

We still need better research.

What About High-Risk Patients?

This review does not suggest antibiotics should never be used.

Instead, it emphasizes that we currently lack veterinary evidence identifying which patients truly benefit.

In human medicine, prophylactic antibiotics are generally reserved for a very small number of high-risk individuals, such as patients with certain severe cardiac conditions or a history of infective endocarditis.

Whether similar recommendations should apply to dogs and cats remains unknown because the necessary studies simply have not been performed.

Why This Matters

Antibiotics are not harmless.

Every unnecessary prescription carries potential risks, including:

• Gastrointestinal upset

• Allergic reactions

• Disruption of the normal microbiome

• Selection for antimicrobial-resistant bacteria

Antimicrobial resistance is now recognized as one of the greatest challenges facing both human and veterinary medicine.

Responsible antimicrobial stewardship means prescribing antibiotics only when evidence suggests they are likely to provide meaningful benefit.

What Should Pet Owners Take Away?

If your veterinarian recommends not sending your dog or cat home with antibiotics after a routine dental procedure, that decision may actually reflect the latest evidence—not a lower standard of care.

Conversely, if your pet has significant underlying medical conditions, extensive oral infection, or other factors that increase infectious risk, antibiotics may still be appropriate.

The decision should be individualized rather than routine.

The Bottom Line

This systematic review highlights an important reality in veterinary medicine:

We have surprisingly little evidence that routine antibiotic prophylaxis improves outcomes after dental procedures in dogs and cats.

Transient bacteremia appears to be common.

Serious infectious complications appear to be rare.

And current evidence does not demonstrate that routine prophylactic antibiotics reduce those rare complications.

As larger, higher-quality studies become available, recommendations may evolve. Until then, antibiotic use should be guided by careful patient assessment, thoughtful clinical judgment, and antimicrobial stewardship—not simply by tradition.