Beyond antibiotic prophylaxis: A scoping review of infective endocarditis prevention in the device era

Infective endocarditis (IE) remains a severe condition associated with significant morbidity and mortality. Dental procedures involving manipulation of gingival tissue or the periapical region may cause transient bacteremia, making prevention strategies at the dental-medical interface clinically important. Current guidance emphasizes selective antibiotic prophylaxis (AP) for patients at the highest cardiac risk while prioritizing long-term oral health maintenance. This scoping review synthesizes contemporary evidence (2021-2025) and major international guidelines to clarify the relationship between invasive dental procedures (IDPs) and IE, identify patients who may benefit from AP, and outline practical prevention strategies in dental practice. A PRISMA-ScR-guided scoping review was conducted using PubMed/MEDLINE, Web of Science, and EMBASE (January 2021-October 2025), with citation tracking of key guidelines, including those from the American Heart Association (2021), European Society of Cardiology (2023), and National Institute for Health and Care Excellence. Thirty-four studies met the eligibility criteria and were included in the final evidence synthesis. The evidence base comprised international guidelines, systematic reviews, observational studies, registry analyses, and narrative reviews relevant to IE prevention and dental management. AHA and ESC recommend antibiotic prophylaxis for patients with high-risk cardiac conditions undergoing IDPs, defined as procedures involving gingival or periapical manipulation or mucosal perforation. NICE guidance does not recommend routine prophylaxis but supports individualized decision-making and informed consent. Contemporary data indicate the strongest short-term association between IDPs and IE following tooth extractions and oral surgical procedures in high-risk patients. In these groups, AP has been associated with reduced IE incidence, with estimated numbers needed to prevent one case of approximately 244 for all IDPs, 143 for extractions, and 71 for oral surgery. Evolving epidemiology underscores the need for accurate cardiac risk stratification. Prevention should focus on identifying high-risk patients, maintaining oral health, communicating procedural risks, and applying selective AP when indicated, although evidence remains largely observational.