Compared with previous recommendations, there are currently relatively few patient subpopulations for whom antibiotic prophylaxis may be indicated prior to certain dental procedures. In patients with prosthetic joint implants, a January 2015 ADA clinical practice guideline , based on a 2014 systematic review states, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” For patients with prosthetic joint replacements, decisions about timing of dental care and any rare use of prophylactic antibiotics should be based on shared decision making among the dentist, orthopedic team, and patient, rather than routine delays or automatic premedication. According to the ADA Chairside Guide , for patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon; in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription. For infective endocarditis prophylaxis, American Heart Association guidelines (updated with a scientific statement in 2021) support premedication for a relatively small subset of patients. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor. Infective endocarditis prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis (see “Patient Selection,” in the main text). For patients with these underlying cardiac conditions, prophylaxis is recommended for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. Recommendations for antibiotic prophylaxis prior to certain dental procedures have existed historically for two groups of patients: those with heart conditions that may predispose them to infective endocarditis; and those who have a prosthetic joint(s) and may be at risk for developing hematogenous infections at the site of the prosthetic. However, compared with prior recommendation statements, there are currently relatively few patient subpopulations for whom antibiotic prophylaxis may be indicated prior to certain dental procedures. In 2014, the ADA Council on Scientific Affairs assembled an expert panel to update and clarify prior clinical recommendations 1, 2 on the prevention of periprosthetic joint infections in people with such implants (e.g., hip or knee replacement) who were undergoing dental procedures. The updated systematic review undertaken in 2014 and published in 2015 found no association between dental procedures and prosthetic joint infections. 3 Based on this evidence review, the 2015 ADA clinical practice guideline states, 3 "In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” According to the ADA Chairside Guide , in cases where antibiotics are deemed necessary, it is most appropriate that the orthopedic surgeon recommend the appropriate antibiotic regimen and, when reasonable, write the prescription. For patients with prosthetic joint replacements, decisions about timing of dental care and any rare use of prophylactic antibiotics should be based on shared decision making among the dentist, orthopedic team, and patient, rather than routine delays or automatic premedication. 4 With input from the ADA, the American Heart Association (AHA) released guidelines for the prevention of infective endocarditis in 2007, 5 which were approved by the CSA as they relate to dentistry in 2008. 6 These guidelines were updated by a 2021 scientific statement by the AHA that recommended no changes to the 2007 guideline recommendations. 7 The AHA continues to recommend infective endocarditis prophylaxis “only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all.” 7 In 2017, the AHA and American College of Cardiology (ACC) published a focused update 8 to their 2014 guidelines on the management of valvular heart disease that also reinforced the previous recommendations. These current guidelines support infective endocarditis premedication for a relatively small subset of patients. This is based on a review of scientific evidence, which showed that the risk of adverse reactions to antibiotics generally outweigh the benefits of prophylaxis for many patients who would have been considered eligible for prophylaxis in previous versions of the guidelines. Concern about the development of drug-resistant bacteria also was a factor. In addition, the data are mixed as to whether prophylactic antibiotics taken before a dental procedure prevent infective endocarditis. The guidelines note that people who are at risk for infective endocarditis are regularly exposed to oral bacteria during basic daily activities such as brushing or flossing. The valvular disease management guidelines 8 recommend that persons at risk of developing bacterial infective endocarditis (see “Patient Selection”) establish and maintain the best possible oral health to reduce potential sources of bacterial seeding. They state, “Optimal oral health is maintained through regular professional dental care and the use of appropriate dental products, such as manual, powered, and ultrasonic toothbrushes; dental floss; and other plaque-removal devices.” Patient Selection The current infective endocarditis/valvular heart disease guidelines 5, 6, 8 state that use of preventive antibiotics before certain dental procedures is reasonable for patients with: prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts; prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords; a history of infective endocarditis; a cardiac transplant a with valve regurgitation due to a structurally abnormal valve; the following congenital (present from birth) heart disease: b unrepaired cyanotic congenital heart disease, including palliative shunts and conduits any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device a According to limited data, infective endocarditis appears to be more common in heart transplant recipients than in the general population; the risk of infective endocarditis is highest in the first 6 months after transplant because of endothelial disruption, high-intensity immunosuppressive therapy, frequent central venous catheter access, and frequent endomyocardial biopsies. 9 b Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of congenital heart disease. Pediatric Patients Congenital heart disease can indicate that prescription of prophylactic antibiotics may be appropriate for children. It is important to note, however, that when antibiotic prophylaxis is called for due to congenital heart concerns, they should only be considered when the patient has: Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits. A congenital heart defect that's been completely repaired with prosthetic material or a device for the first six months after the repair procedure. Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device. Antibiotic prophylaxis is not recommended for any other form of congenital heart disease. Beyond identifying the specific patient population for whom antibiotic prophylaxis is appropriate, special consideration should be given to the antibiotic dose prescribed to children, as it will vary according to the child’s weight. Weight-based regimens for children are outlined in Table 2 of the 2007 American Heart Association guidelines and Table 5 of the 2021 AHA scientific statement . 5-7 As with any medication, check with the primary caregiver to determine whether the child has an allergy to antibiotics or other antibiotic-related concerns before prescribing. Dental Procedures Prophylaxis is recommended for the patients identified in the previous section for all dental procedures that involve manipulation of gingival tissue or the periapical region of the teeth, or perforation of the oral mucosa. 5, 6 Additional Considerations About Infective Endocarditis Antibiotic Prophylaxis (When Indicated) The 2021 AHA scientific statement on prevention of infective endocarditis no longer recommends use of clindamycin as an oral or parenteral alternative to amoxicillin or ampicillin in individuals with allergies to these drugs because clindamycin “may cause more frequent and severe reactions than other antibiotics used for [antibiotic prophylaxis]” (including C. difficile infection). 7 The AHA recommends that in individuals who are allergic to penicillin or ampicillin and who can take oral medication, cephalexin (or other first- or second-generation cephalosporins), azithromycin, clarithromycin, or doxycycline be used as alternatives. 7 In individuals who are penicillin or ampicillin allergic and who cannot take oral medication, the AHA recommends cefazolin or ceftriaxone as alternatives. 7 However, the AHA also recommends that cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillin or ampicillin. 7 The current medication regimens recommended (when indicated) are listed in Table 5 of the 2021 AHA scientific statement . 7 Sometimes, patients forget to premedicate before their appointments. The recommendation is that for patients with an indication for antibiotic prophylaxis, the antibiotic be given before the procedure. This is important because it allows the antibiotic to reach adequate blood levels. However, the guidelines to prevent infective endocarditis 5, 6 state, “If the dosage of antibiotic is inadvertently not administered before the procedure, the dosage may be administered up to 2 hours after the procedure.” If a patient with an indication for prophylaxis who appropriately received antibiotic premedication prior to a dental procedure one day and who is then scheduled the following day for a dental procedure also warranting premedication (e.g., dental prophylaxis), the antibiotic prophylaxis regimen should be repeated prior to the second appointment. Because of the nature of the pharmacokinetics of an antibiotic prophylaxis regimen, a single loading dose is given in order to cover the period of potential bacteremia produced by a single procedure. 9-11 Another concern that dentists have expressed involves patients who require prophylaxis but are already taking antibiotics for another condition. In these cases, the AHA guidelines and 2021 AHA scientific statement for infective endocarditis 5-7 recommend that the dentist select an antibiotic from a different class than the one the patient is already taking. For example, if the patient is taking amoxicillin, the dentist should select azithromycin or clarithromycin for prophylaxis. Other patient groups also may merit special consideration, which is discussed more fully in the AHA guidelines. In 2015, The Lancet published a study out of the United Kingdom that reported a correlation between institution of more limited antibiotic prophylaxis guidelines by the National Institute for Health and Clinical Evidence (NICE) in 2008 and an increase in cases of infective endocarditis. 12 Because of the retrospective and observational nature of the study, the authors acknowledged that their “data do not establish a causal association.” At this time, the ADA recommends that dentists continue to use the AHA/ACC guidelines discussed above. Dental professionals should periodically visit the ADA website for updates on this issue.

With the exception of the AHA/ACC guidelines regarding prevention of infective endocarditis, 5, 6, 8 there is no general guidance or recommendation to provide antibiotics as a prophylactic measure prior to dental procedures except for specific individuals with extenuating circumstances, where the determination and prescription is made by the patient’s surgeon or other treating physician. However, there are a myriad of other conditions that either patients, physicians, or dentists may think that antibiotic prophylaxis prior to dental treatment might be warranted to prevent development of infections at remote locations by bacteria normally associated with the oral flora. The ADA has received queries from members for guidance concerning the evidence for antibiotic prophylaxis in patients who have undergone a variety of surgical interventions. In the following examples, the guidance has been that antibiotic prophylaxis is unwarranted unless the person is predisposed, for some reason, to infection, in which case, it may be appropriate for the treating physician to prescribe the antibiotic. ADA member inquiries have included questions regarding indications such as artificial joint replacement, 2, 13 solid organ transplant, 14 breast augmentation with implants, 14 or penile implant. 15, 16 The National Institute of Dental and Craniofacial Research has recommended that in patients receiving chemotherapy who have a central venous catheter, dental professionals consult the treating oncologist about the need for antibiotic prophylaxis before any dental procedures. 17 Watters W, 3rd, Rethman MP, Hanson NB, et al. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. J Am Acad Orthop Surg 2013;21(3):180-9. Rethman MP, Watters W, 3rd, Abt E, et al. The American Academy of Orthopaedic Surgeons and the American Dental Association clinical practice guideline on the prevention of orthopaedic implant infection in patients undergoing dental procedures. J Bone Joint Surg Am 2013;95(8):745-7. Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2015;146(1):11-16 e8. ADA Council on Scientific Affairs. Shared decision making in oral health care for patients with prosthetic joint replacements: American Dental Association Council on Scientific Affairs position statement. The Journal of the American Dental Association 2026;157(6):667-69. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116(15):1736-54. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc 2008;139 Suppl:3S-24S. Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. Circulation 2021:CIR0000000000000969. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: e1159-e1195. http://circ.ahajournals.org/content/135/25/e1159.full.pdf?download=true . Accessed February 21, 2019. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1990;264(22):2919-22. Pallasch TJ, Slots J. Antibiotic prophylaxis and the medically compromised patient. Periodontol 2000 1996;10:107-38. Hussein H, Brown RS. Risk-benefit assessment for antibiotic prophylaxis in asplenic dental patients. Gen Dent 2016;64(4):62-5. Dayer MJ, Jones S, Prendergast B, et al. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet 2015;385(9974):1219-28. American Dental Association-Appointed Members of the Expert Writing and Voting Panels Contributing to the Development of American Academy of Orthopedic Surgeons Appropriate Use Criteria. American Dental Association guidance for utilizing appropriate use criteria in the management of the care of patients with orthopedic implants undergoing dental procedures. J Am Dent Assoc 2017;148(2):57-59. Stoopler ET, Sia YW, Kuperstein AS. Do patients with solid organ transplants or breast implants require antibiotic prophylaxis before dental treatment? J Can Dent Assoc 2012;78:c5. Holland B, Kohler T. Minimizing Penile Implant Infection: A Literature Review of Patient and Surgical Factors. Curr Urol Rep 2015;16(12):81. Kohler T. Personal communication: Antibiotic prophylaxis prior to dental work for men who have penile implants; 2017. National Institute of Dental and Craniofacial Research. Dental Provider's Oncology Pocket Guide. Department of Health and Human Services 2009 (Archived). https://www.nidcr.nih.gov/sites/default/files/2020-06/oncology-guide-dental-provider.pdf . Accessed December 30, 2025. Professional Resources ADA Council on Scientific Affairs Position Statement: Shared decision making in oral health care for patients with prosthetic joint replacements (JADA) Dental Care & Prosthetic Joint Patients (Infographic PDF) Dental Care & Prosthetic Joint Patients (Infographic PDF) ADA Council on Scientific Affairs, Combating Antibiotic Resistance (JADA) ADA Council on Scientific Affairs, Antibiotic Interference with Oral Contraceptives (JADA) ADA Oral Health Topics: Antibiotic Stewardship Infective Endocarditis: Legal sidebar (PDF) JADA Editorial, Antibiotics: The good, the bad, the ugly Search the ADA Store for products related to antibiotic prophylaxis ADA Library Services Patient Resources JADA "For the Patient" page: What is antibiotic prophylaxis? (June 2016) American Heart Association Prevention of Infective Endocarditis wallet card (English) Prevención de la Endocarditis Infecciosa tarjeta de bosillo (Spanish) Patient Information Sheet: What is infective endocarditis? Hoja de Información del Paciente: ¿Qué es la endocarditis infecciosa? (Spanish) Last Updated: July 15, 2026 Research Services and Scientific Information, ADA Library & Archives. Content on the Oral Health Topics section of ADA.org is for informational purposes only. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.