Infective endocarditis (IE) is a life-threatening infection associated with significant morbidity and mortality. Oral surgical procedures represent a major route of bacterial entry, making prevention essential. This narrative review analyzed 34 publications published between 2015 and 2024, including European and international clinical guidelines and recent studies addressing the prevention of infective endocarditis in oral surgery. Recent recommendations introduced an intermediate-risk category, restricted antibiotic prophylaxis to high-risk patients, and removed clindamycin from recommended regimens. Amoxicillin remains the first-line antibiotic, while azithromycin or pristinamycin are preferred alternatives in patients with beta-lactam allergy. Oral implantology and endodontic procedures are no longer systematically contraindicated when performed under strict aseptic conditions, whereas certain invasive procedures remain discouraged in high-risk patients. These updated recommendations emphasize individualized risk assessment and selective antibiotic prophylaxis, aiming to reduce unnecessary prescriptions while maintaining effective prevention. However, challenges related to clinical implementation and international harmonization persist.
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