Current indications for antibiotic prophylaxis for the prevention of infective endocarditis in dentistry: A narrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v15i4.50858

Keywords:

Infective endocarditis, Antibiotic prophylaxis, Dentistry, Bacteremia.

Abstract

Infective endocarditis (IE) is a clinically significant infection that primarily affects the endocardium and heart valves and may progress to severe complications with substantial morbidity and mortality. In dentistry, the oral cavity deserves particular attention because it harbors a diverse microbiota and may contribute to transient bacteremia, especially during invasive procedures or in the presence of persistent oral inflammatory conditions. In individuals with predisposing heart abnormalities, such episodes may contribute to the development of cardiac infection. Over time, antibiotic prophylaxis was widely adopted in dental practice; however, more recent recommendations from the American Heart Association (AHA) and the European Society of Cardiology (ESC) have restricted its indication to patients considered at highest risk, such as those with prosthetic heart valves, previous history of IE, and some cases of congenital heart disease. The present study aimed to discuss, through a narrative literature review, the importance of antibiotic prophylaxis in dental procedures and its relationship with the prevention of infective endocarditis. The gathered evidence suggests that antibiotic prophylaxis tends to provide greater benefit in high-risk patients, whereas oral health maintenance, control of infectious foci, and non-pharmacological preventive measures also play a central role in reducing the occurrence of bacteremia.

References

Almeida Agra Omena, F. de, Almeida Agra Omena, A. de, Abeacy Azevedo de Andrade, J., Anny Azevedo de Andrade, J., Sobreira Bento, L., & Harllen Gonçalves Veríssimo, M. (2022). Endocardite bacteriana e o tratamento endodôntico: Etiologia e processo terapêutico. RECIMA21 - Revista Científica Multidisciplinar, 3(3), e321208. https://doi.org/10.47820/recima21.v3i3.1208

Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Tleyjeh, I. M., Rybak, M. J., Barsic, B., Lockhart, P. B., Gewitz, M. H., Levison, M. E., Bolger, A. F., Steckelberg, J. M., Baltimore, R. S., Fink, A. M., O’Gara, P., Taubert, K. A., & American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. (2015). Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications. Circulation, 132(15), 1435–1486.

Boraks, S. (2011). Medicina bucal: Tratamento clínico-cirúrgico das doenças bucomaxilofaciais. Artes Médicas.

Bumm, C. V., & Folwaczny, M. (2021). Infective endocarditis and oral health: A narrative review. Cardiovascular Diagnosis and Therapy, 11(6), 1223–1235.

Dayer, M. J., Jones, S., Prendergast, B., Baddour, L. M., Lockhart, P. B., & Thornhill, M. H. (2015). Incidence of infective endocarditis in England, 2000–13: A secular trend, interrupted time-series analysis. The Lancet, 385(9974), 1219–1228. https://doi.org/10.1016/S0140-6736(14)62007-9

Del Giudice, C., Cutone, A., Lepanto, M. S., Rosa, L., & Valenti, P. (2021). Infective endocarditis: A focus on oral microbiota. Microorganisms, 9(6), 1218. https://doi.org/10.3390/microorganisms9061218

Fernandes, J. M. B., Vieira, L. T., & Castelhano, M. V. C. (2023). Revisão narrativa enquanto metodologia científica significativa: Reflexões técnico-formativas. REDES – Revista Educacional da Sucesso, 3(1), 1–7.

Habib, G., Lancellotti, P., Antunes, M. J., Bongiorni, M. G., Casalta, J.-P., Del Zotti, F., Dulgheru, R., El Khoury, G., Erba, P. A., Iung, B., Miro, J. M., Mulder, B. J. M., Plonska-Gosciniak, E., Price, S., Roos-Hesselink, J., Snygg-Martin, U., Thuny, F., Tornos Mas, P., Vilacosta, I., & Zamorano, J. L. (2015). 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal, 36(44), 3075–3128. https://doi.org/10.1093/eurheartj/ehv319

Khan, O., Shafi, A. M., Timmis, A., & Thornhill, M. (2016). International guideline changes and the incidence of infective endocarditis. Open Heart, 3(1), e000498. https://doi.org/10.1136/openhrt-2016-000498

Lafaurie, G. I., Noriega, L. A., Torres, C. C., Castillo, D. M., Moscoso, S. B., & Carmona, I. T. (2019). Impact of antibiotic prophylaxis on the incidence, nature, magnitude, and duration of bacteremia associated with dental procedures: A systematic review. The Journal of the American Dental Association, 150(11), 948–959.e4. https://doi.org/10.1016/j.adaj.2019.06.017

Lobo, S., & Bastos, S. B. (2024). Protocolo para uso de antibioticoterapia profilática em condutas odontológicas: Uma revisão de literatura. Research, Society and Development, 13(7), e5013746316. https://doi.org/10.33448/rsd-v13i7.46316

Lopes, H. P., & Siqueira Júnior, J. F. (2020). Endodontia: Biologia e técnica (5ª ed.). Editora Guanabara Koogan.

Mohd Yunus, S. S., Nabil, S., Rashdi, M. F., Nazimi, A. J., Nordin, R., Tan, H. L., Maskon, O., Hassan, H. H. C., Khaithir, T. M. N., Abdul Aziz, A. F., Ng, Y. G., Ismail, R. Y., & Ramli, R. (2023). Perception regarding the NICE guideline on antibiotic prophylaxis against infective endocarditis following dental procedures: A cross-sectional study. Antibiotics, 12(4), 696. https://doi.org/10.3390/antibiotics12040696

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica. Editora da UFSM.

Pereira, J. S., Leutz, A. C. N., Gomes, B. P. F. A., Pelepenko, L. E., & Marciano, M. A. (2024). Does endodontic treatment influence human endocarditis? Systematic review. Hearts, 5(3), 308–328. https://doi.org/10.3390/hearts5030023

Risemberg, R. I. C., Wakin, M., & Shitsuka, R. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica, 7(1), e0171675. https://doi.org/10.52076/eacad-v7i1.675

Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem, 20(2), v–vi.

Rutherford, S. J., Glenny, A.-M., Roberts, G., Hoare, Z., Worthington, H. V., & Furness, S. (2022). Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures. Cochrane Database of Systematic Reviews, (5), CD003813. https://doi.org/10.1002/14651858.CD003813.pub5

Sperotto, F., France, K., Gobbo, M., Bindakhil, M., Pimolbutr, K., Holmes, H., Monteiro, L., Graham, L., Hong, C. H. L., Sollecito, T. P., Lodi, G., Lockhart, P. B., Thornhill, M., Diz Dios, P., Turati, F., & Edefonti, V. (2024). Antibiotic prophylaxis and infective endocarditis incidence following invasive dental procedures: A systematic review and meta-analysis. JAMA Cardiology, 9(7), 599–610. https://doi.org/10.1001/jamacardio.2024.0873

Thabit, A. K., Aljereb, N. M., Khojah, O. M., Shanab, H., & Badahdah, A. (2024). Towards wiser prescribing of antibiotics in dental practice: What pharmacists want dentists to know. Dentistry Journal, 12(11), 345. https://doi.org/10.3390/dj12110345

Thoresen, T., Jordal, S., Lie, S.-A., Wünsche, F., Jacobsen, M. R., & Lund, B. (2022). Infective endocarditis: Association between origin of causing bacteria and findings during oral infection screening. BMC Oral Health, 22, 491. https://doi.org/10.1186/s12903-022-02509-3

Thornhill, M. H. (2024). Endocarditis, invasive dental procedures, and antibiotic prophylaxis. Oral Diseases, 30(3), 1591–1605. https://doi.org/10.1111/odi.14585

Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., Bolger, A., Cabell, C. H., Takahashi, M., Baltimore, R. S., Newburger, J. W., Strom, B. L., Tani, L. Y., Gerber, M., Bonow, R. O., Pallasch, T., Shulman, S. T., Rowley, A. H., Burns, J. C., & Durack, D. T. (2007). Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation, 116(15), 1736–1754.

Published

2026-04-11

Issue

Section

Review Article

How to Cite

Current indications for antibiotic prophylaxis for the prevention of infective endocarditis in dentistry: A narrative review. Research, Society and Development, [S. l.], v. 15, n. 4, p. e2815450858, 2026. DOI: 10.33448/rsd-v15i4.50858. Disponível em: https://rsdjournal.org/rsd/article/view/50858. Acesso em: 18 apr. 2026.