Implanted Medical Devices and Antibiotic Prophylaxis

The following medical conditions require antibiotic prophylaxis for dental procedures where bacteremia could occur such as after manipulation of gingiva or the tooth apex or when oral mucosa is perforated:

  • Vascular grafts (less than 6 months old)
  • Arteriovenous hemodialysis shunts
  • Neurosurgical shunts (dependent on type)
  • Indwelling vascular catheters
  • According to 2015 AAOS-ADA clinical practice guidelines, "for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection."

Antibiotic prophylaxis prior to undergoing dental procedures is NOT required for patients with cardiovascular implantable devices, such as defibrillators or pacemakers.


Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison 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; 116:1736-54.

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. 2015; 146(1): 11-16.

Baddour LM, et al. A summary of the update on cardiovascular implantable electronic device infection and their management. Journal of the American Dental Association 2011; 142(2):159-165.

Berbarie EF, et al. Dental procedures as a risk factor for prosthetic hip or knee inf. Clinical Infectious Disease 2010; 50:8-16.

Friedlander AH. Prevalence of staphylococci in the mouth and presence of streptococci in late infection of knee and hip joint prosthesis: antibiotic prophylaxis, a conundrum. Spec Care Dentistry 2009; 29(6):226-228.

Little JW, Jacobson JJ, Lockhart PB. American Academy of Oral Medicine. The Dental Treatment of Patients with Joint Replacement: A Position Paper from the American Academy of Oral Medicine. Journal of the American Dental Association 2010; 141(6)667-71.