Improving the Quality of Dental Care through Antibiotic Stewardship
DOI:
https://doi.org/10.12775/QS.2026.66.73952Keywords
dental practice, antibiotic prescribingAbstract
Antimicrobial resistance is a major public health threat, and inappropriate antibiotic use remains one of its most preventable drivers. Dentistry contributes a smaller share of antibiotic use than general medicine, but dental prescribing is important because many prescriptions are issued in outpatient, urgent-care or private-practice settings where formal stewardship infrastructure is often limited. This makes dental antibiotic stewardship a practical issue of care quality, not only a pharmacological or microbiological problem. This narrative review analyzes the main causes of inappropriate antibiotic use in dental practice, discusses the consequences for antimicrobial resistance and patient safety, and identifies interventions that may improve prescribing. The review particularly focuses on the tension between definitive dental treatment and the pressure to provide a rapid prescription during consultations for pain, swelling or suspected infection.
References
1. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Aguilar GR, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399(10325):629-655. https://doi.org/10.1016/S0140-6736(21)02724-0
2. World Health Organization. Antimicrobial resistance. Geneva: World Health Organization; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
3. Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recommendations and Reports. 2016;65(6):1-12. https://doi.org/10.15585/mmwr.rr6506a1
4. FDI World Dental Federation. Antibiotic stewardship in dentistry. International Dental Journal. 2020;70(1):9-10. https://doi.org/10.1111/idj.12553
5. Thompson W, Williams D, Pulcini C, Sanderson S, Calfon P, Verma M. The essential role of the dental team in reducing antibiotic resistance. Geneva: FDI World Dental Federation; 2020. https://www.fdiworlddental.org/sites/default/files/2020-11/abr_white_paper_english.pdf
6. Huynh CVT, Gouin KA, Suda KJ, et al. Outpatient antibiotic prescribing by general dentists in the United States from 2018 through 2022. Journal of the American Dental Association. 2025. https://doi.org/10.1016/j.adaj.2024.12.003
7. Stein K, Farmer J, Singhal S, Marra F, Sutherland S, Quiñonez C. The use and misuse of antibiotics in dentistry: a scoping review. Journal of the American Dental Association. 2018;149(10):869-884.e5. https://doi.org/10.1016/j.adaj.2018.05.034
8. Thompson W, Tonkin-Crine S, Pavitt SH, McEachan RRC, Douglas GVA, Aggarwal VR, Sandoe JAT. Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care. Journal of Antimicrobial Chemotherapy. 2019;74(8):2139-2152. https://doi.org/10.1093/jac/dkz152
9. Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. Journal of the American Dental Association. 2019;150(11):906-921.e12. https://doi.org/10.1016/j.adaj.2019.08.020
10. Suda KJ, Calip GS, Zhou J, Rowan S, Gross AE, Hershow RC, et al. Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Network Open. 2019;2(5):e193909. https://doi.org/10.1001/jamanetworkopen.2019.3909
11. Teoh L, Löffler C, Mun M, Agnihotry A, Kaur H, Born K, Thompson W. A systematic review of dental antibiotic stewardship interventions. Community Dentistry and Oral Epidemiology. 2025;53(3):245-255. https://doi.org/10.1111/cdoe.13009
12. Tampi MP, Pilcher L, Urquhart O, Kennedy E, O’Brien KK, Lockhart PB, et al. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: systematic review and meta-analysis. Journal of the American Dental Association. 2019;150(12):e179-e216. https://doi.org/10.1016/j.adaj.2019.09.011
13. Cope AL, Francis NA, Wood F, Chestnutt IG. Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dentistry and Oral Epidemiology. 2016;44(2):145-153. https://doi.org/10.1111/cdoe.12199
14. Durkin MJ, Feng Q, Warren K, Lockhart PB, Thornhill MH, Munshi KD, et al. Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States. Journal of the American Dental Association. 2018;149(5):372-381.e1. https://doi.org/10.1016/j.adaj.2017.11.034
15. Rodríguez-Fernández A, Vázquez-Cancela O, Piñeiro-Lamas M, Herdeiro MT, Figueiras A, Zapata-Cachafeiro M. Magnitude and determinants of inappropriate prescribing of antibiotics in dentistry: a nation-wide study. Antimicrobial Resistance & Infection Control. 2023;12:20. https://doi.org/10.1186/s13756-023-01225-z
16. Teoh L, Marino RJ, Stewart K, McCullough MJ. A survey of prescribing practices by general dentists in Australia. BMC Oral Health. 2019;19:193. https://doi.org/10.1186/s12903-019-0882-6
17. Durkin MJ, Hsueh K, Sallah YH, Feng Q, Jafarzadeh SR, Munshi KD, et al. An evaluation of dental antibiotic prescribing practices in the United States. Journal of the American Dental Association. 2017;148(12):878-886.e1. https://doi.org/10.1016/j.adaj.2017.07.019
18. Lockhart PB, Thornhill MH, Zhao J, Baddour LM, Gilbert GH, McKnight PE, Stephens C, Mougeot JL; National Dental PBRN Collaborative Group. Factors that affect dentists’ use of antibiotic prophylaxis: findings from The National Dental Practice-Based Research Network questionnaire. Journal of the American Dental Association. 2022;153(6):552-562. https://doi.org/10.1016/j.adaj.2021.11.010
19. Ramanathan S, Yan CH, Hubbard C, Calip GS, Sharp LK, Evans CT, et al. Changes in antibiotic prescribing by dentists in the United States, 2012-2019. Infection Control & Hospital Epidemiology. 2023;44(11):1725-1730. https://doi.org/10.1017/ice.2023.151
20. Badrov M, et al. Antibiotics knowledge and prescription patterns among dentists in Croatia, Bosnia and Herzegovina, and Serbia: a cross-sectional survey. Antibiotics. 2024;13(11):1061. https://doi.org/10.3390/antibiotics13111061
21. Contaldo M, Della Vella F, Raimondo E, Minervini G, Buljubasic M, Ogodescu A, et al. Antibiotics in dentistry: a narrative review of the evidence beyond the myth. International Journal of Environmental Research and Public Health. 2023;20(11):6025. https://doi.org/10.3390/ijerph20116025
22. Méndez-Millán JA, León-López M, Martín-González J, Saúco-Márquez JJ, Cabanillas-Balsera D, Segura-Egea JJ. Antibiotic over-prescription by dentists in the treatment of apical periodontitis: a systematic review and meta-analysis. Antibiotics. 2024;13(4):289. https://doi.org/10.3390/antibiotics13040289
23. Ozmen EE, Sahin TN. Antibiotic use in pediatric dental infections: knowledge and awareness levels of dentists. Scientific Reports. 2024;14:24877. https://doi.org/10.1038/s41598-024-77012-6
24. Stenlund S, Huynh J, Pau C, Chuang E, Lishman H, Patrick DM. Dental antibiotic use in British Columbia from 1996 through 2023: are we backsliding? Journal of the American Dental Association. 2025;156(1):37-45.e7. https://doi.org/10.1016/j.adaj.2024.10.001
25. Vázquez-Cancela O, Zapata-Cachafeiro M, Herdeiro MT, Figueiras A, Rodríguez-Fernández A. Dentists’ knowledge, attitudes and perceptions of antibiotic prescribing: a systematic review. Preventive Medicine. 2024;185:108043. https://doi.org/10.1016/j.ypmed.2024.108043
26. Schneider-Smith EG, Suda KJ, Lew D, et al. How decisions are made: antibiotic stewardship in dentistry. Infection Control & Hospital Epidemiology. 2023;44(11):1731-1736. https://doi.org/10.1017/ice.2023.173
27. Carlsen DB, Durkin MJ, Gibson G, Jurasic MM, Patel U, Poggensee L, et al. Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs dentistry. Infection Control & Hospital Epidemiology. 2021;42(12):1422-1430. https://doi.org/10.1017/ice.2021.16
28. Löffler C, Böhmer F. The effect of interventions aiming to optimise the prescription of antibiotics in dental care: a systematic review. PLoS One. 2017;12(11):e0188061. https://doi.org/10.1371/journal.pone.0188061
29. Mendez-Romero J, Rodríguez-Fernández A, Ferreira M, Villasanti U, Aguilar G, Rios-Gonzalez C, Figueiras A. Interventions to improve antibiotic use among dentists: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy. 2025;80(6):1494-1507. https://doi.org/10.1093/jac/dkaf118
30. Goff DA, Mangino JE, Trolli E, Scheetz R, Goff D. Private practice dentists improve antibiotic use after dental antibiotic stewardship education from infectious diseases experts. Open Forum Infectious Diseases. 2022;9(8):ofac361. https://doi.org/10.1093/ofid/ofac361
31. Gross AE, Hanna D, Rowan SA, Bleasdale SC, Suda KJ. Successful implementation of an antibiotic stewardship program in an academic dental practice. Open Forum Infectious Diseases. 2019;6(3):ofz067. https://doi.org/10.1093/ofid/ofz067
32. Thompson W, McEachan RRC, Pavitt SH, Douglas GVA, Aggarwal VR, Sandoe JAT. Co-developing an antibiotic stewardship tool for dentistry. Antibiotics. 2021;10(11):1345. https://doi.org/10.3390/antibiotics10111345
33. Thornhill MH, Dayer MJ, Durkin MJ, Lockhart PB, Baddour LM. Oral antibiotic prescribing by NHS dentists in England 2010-2017. British Dental Journal. 2019;227(12):1044-1050. https://doi.org/10.1038/s41415-019-1002-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Wojciech Warmuz, Natalia Czołpińska, Łukasz Dylewicz, Zuzanna Kata, Jakub Andrzejewicz, Joanna Brzoza, Kinga Bylica, Jakub Rudzki, Ewa Wystalska, Kacper Solarz

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 154
Number of citations: 0