Which Oral Procedures Require Prophylaxis?

It is important for primary care providers to be aware of the types of dental procedures that require antibiotic prophylaxis in patients at moderate to high risk for endocarditis. All procedures involving manipulation of gingiva, tooth apex, or perforation of oral mucosa require prophylaxis

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.

Procedures requiring prophylaxis include:

  • Dental Cleaning
  • Tooth extractions
  • Periodontal procedures if bleeding anticipated
  • Scaling and root planing
  • Reimplantation of avulsed teeth
  • Root canal treatment beyond the apex
  • Initial placement of orthodontic bands (not brackets)
  • Intraosseous or intraligamentary injections


The procedures listed above are intended as a guide rather than an exhaustive list. In general, the procedures listed above are ones where some degree of bleeding is expected. Patients who require antibiotic prophylaxis should be educated as to its importance and provided prescribing information to carry with them.

Prophylaxis is NOT recommended for the following procedures that occur above the gumline and are not expected to cause bleeding:

  • Routine fillings
  • Periodontal procedures if bleeding not anticipated
  • Simple root canal treatment
  • Rubber dam placement
  • Suture removal
  • Removable appliance placement
  • Oral impressions
  • Fluoride treatments
  • Oral radiographs
  • Orthodontic appliance adjustment
  • Shedding of primary teeth


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.

Nishamura 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(25): e1159-e1195.

ADA. Oral Health Topics. Antibiotic Prophylaxis Prior to Dental Procedures. www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis