Antibiotic Prophylaxis Prior to Dental Procedures
Subject: III. Clinical – I. Patient Care
Department: Clinical
Origination Date: 5/2007
Effective Date: 04/01/2025
Reviewed and/or Revised: 08/2007, 09/01/2017, 07/09/2025
Purpose
To prevent infective endocarditis (IE) or prosthetic joint infections (PJIs) in select high-risk individuals undergoing dental procedures known to cause bacteremia.
Policy & Procedure
I. Purpose
To prevent infective endocarditis (IE) or prosthetic joint infections (PJIs) in select high-risk individuals undergoing dental procedures known to cause bacteremia.
II. General Guidelines as per the AHA 2021 and ADA 2023 guidelines
Antibiotic prophylaxis is not recommended for most patients undergoing dental procedures.
It is only indicated for patients at highest risk of adverse outcomes from infective endocarditis or immunocompromised.
III. Indications for Prophylaxis
Antibiotic prophylaxis is recommended only for patients with the following cardiac conditions before invasive dental procedures (i.e., involving manipulation of gingival tissue, periapical region of teeth, or perforation of oral mucosa, refer to table below)
- Prosthetic cardiac valve or prosthetic material used for valve repair
- History of infective endocarditis
- Congenital heart disease (CHD) as follows:
- Unrepaired cyanotic CHD (including palliative shunts/conduits)
- Completely repaired CHD with prosthetic material during the first 6 months
- Repaired CHD with residual defects at/adjacent to prosthetic site.
- Cardiac transplant recipients who develop valvulopathy
IV. Dental Procedures Requiring vs. Not Requiring Antibiotic Prophylaxis (Cardiac Risk Patients)
| Procedures Requiring Prophylaxis |
Procedures NOT Requiring Prophylaxis |
| Tooth extractions |
Routine anesthetic injections (non-intraligamentary) |
| Periodontal procedures (e.g., surgery, scaling/root planing) |
Dental radiographs |
Dental implant placement
|
Placement/removal of prosthodontic/orthodontic appliances |
Intraligamentary local anesthesia injections
|
Adjustment of orthodontic appliances |
| |
Shedding of deciduous teeth |
| |
Bleeding from trauma to lips/oral mucosa |
V. Prosthetic Joints
- Routine antibiotic prophylaxis is not recommended for patients with prosthetic joints (including hip/knee replacements), regardless of risk factors.
- Temporomandibular Joint replacements (TMJR)- Antibiotic prophylaxis for procedures involving the dentition post- TMJR is unnecessary, providing sufficient time for healing has occurred, with exceptions made only when clinically appropriate (e.g. infected third molars in close proximity to the ramus component with possibility of direct contamination during surgical removal, severely immunocompromised patient and history of previous joint infections)
Adapted from: Appropriate Use Criteria for Management of Patients with Orthopedic Implants Undergoing Dental Procedures. 2016.
VI. Recommended Regimens
Administer 30–60 minutes before the procedure.
| Patient Type |
Agent |
Dose |
Route |
Notes |
| Adults (no allergy) |
Amoxicillin |
2 g |
Oral |
|
| Children (no allergy) |
Amoxicillin |
50 mg/kg |
Oral |
|
| Penicillin-allergic (adults) |
Clindamycin |
600 mg |
Oral |
|
| |
Azithromycin/Clarithromycin |
500 mg |
Oral |
|
| Penicillin-allergic (children) |
Clindamycin |
20 mg/kg |
Oral |
|
| |
Azithromycin/Clarithromycin |
15 mg/kg |
Oral |
|
| If oral meds can't be taken |
Ampicillin, Cefazolin, or Ceftriaxone |
Refer to guidelines |
IV/IM |
Avoid in penicillin-allergic patients due to cross-
reactivity |
If oral meds can't be taken, IV/IM options include ampicillin, cefazolin, or ceftriaxone (except in penicillin-allergic patients due to cross-reactivity risk).
VII. Documentation
- Clearly document the medical indication for prophylaxis in the patient chart.
- Confirm the dose, timing, and route used.
- If in doubt, consult the patient’s cardiologist or medical provider.
VIII. References
- American Heart Association (AHA), 2021 Scientific Statement
- American Dental Association (ADA) Clinical Practice Guidelines, 2023
- Wilson W. et al. "Prevention of Infective Endocarditis." Circulation. 2021
- ADA Council on Scientific Affairs. "Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints." JADA. 2023
- M. Gadd, R.O. Elledge, Dental prophylaxis and alloplastic temporomandibular joint replacement (TMJR): time for a consensus? British Journal of Oral & Maxillofacial Surgery (2025), doi: https:// doi.org/10.1016/j.bjoms.2025.04.001