The risks of infection and reduced healing rate associated with immunosuppressive therapy (IST) complicate dental treatment. This review will cover recent literature (2019–2025) on dental IST management, emphasizing significant findings, gaps, and next steps. There remains strong support for pre-therapy dental clearance as it resolves numerous pre-existing infections. Most clinicians prophylactically cover with antibiotics, despite a lack of strong evidence. It is common to continue corticosteroids and DMARDs for minor procedures, with biologics being paused for major surgery. Recommendations tend to come from medicine, not dentistry. Non-invasive care is low risk; with invasive care, risk is manageable with strict protocol adherence. While implant survival is high among those on IST, personalized risk assessments are vital. Significant gaps remain around dental IST, timing of procedures, and newer drug therapy. IST patients with dental needs can be provided care and managed safely with appropriate modifications. There is no standard, evidence-based protocol to guide patients, highlighting the interdisciplinary gaps and needs for dental care with clear, collaborative guidelines.
