Case: In this article, we present a case report of a patient with limited medical history and without apparent local injury, who developed left hand Group A Streptococcus-induced necrotizing fasciitis after undergoing a prolonged endodontic procedure. Conclusion:In addition to host factors, perhaps, the virulence of the bacteria present in the oropharynx and the expected bacterial load based on the length and complexity of a dental procedure need to be considered when deciding on whether or not to administer prophylactic antibiotics to patients undergoing dental procedures. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B812).