Many dentists prescribe antibiotics for common procedures, such as tooth removals, “just in case,” hoping to prevent their patients from developing oral bacterial infections.
But prescribing unnecessary antibiotics can put patients at risk. Research shows that 80% of preventive antibiotics prescribed by dentists are unnecessary or inappropriate, because they don’t actually reduce infections.
Overusing antibiotics can push bacteria to evolve in ways that help them survive and spread even when exposed to powerful medications. This phenomenon, known as antimicrobial resistance, contributes to an estimated 5 million deaths around the world every year.
A small new study suggests that educating dentists about these risks may motivate them to prescribe antibiotics more appropriately.
Essential education
The nine dentists in the study attended a three-hour program in 2021 and 2022 about antibiotic stewardship, the practice of prescribing antibiotics more judiciously.
The study focused on periodontists, dentists who specialize in preventing, diagnosing and treating infections of the gums and the bones that support the teeth, because they have high rates of antibiotic prescribing, said Debra Goff, PharmD, first author of the new study and a professor of pharmacy practice at The Ohio State University College of Pharmacy. The researchers also focused on dentists in private practice, who make up 72% of all dentists, rather than hospital-based dentists.
The dentists reduced the number of unnecessary antibiotics for people with joint implants, such as artificial hips or knees, by nearly 90%, from January 2021 to June 2025, according to a study published in May in Open Forum Infectious Diseases. Dentists continued prescribing fewer antibiotics related to artificial joints for at least three years after taking the educational course.
Changing practice
Dentists once routinely prescribed antibiotics before certain procedures to people with artificial joints, Goff said.
Doctors and dentists were afraid that bacteria from the mouth would break loose and enter the bloodstream, where they could cause serious infections in artificial joints. While such infections can be catastrophic, prescribing antibiotics before dental procedures doesn’t necessarily prevent them, according to guidance published in 2024 by the American Academy of Orthopedic Surgeons.
Many dentists aren’t aware of those guidelines or feel unsure about how to follow them, Goff said. There are currently no guidelines for antibiotic use related to dental implant surgery, although the American Dental Association is working on them.
Dentists also commonly prescribed antibiotics for 10 days, a practice that is now viewed as overkill. That’s because every day that patients take antibiotics increases their risk of developing resistant bacteria.
After taking the educational class, dentists in the study prescribed 87% less 10-day antibiotic prescriptions. Dentists increased the number of three-to five-day antibiotics prescriptions by about the same amount.
Prescribing safer medications
Dentists in the study also reduced their use of higher-risk antibiotics. Their prescriptions for a drug called clindamycin, which has a black box warning, fell 85%. Although clindamycin has long been one of the most commonly used dental antibiotics, it’s associated with a high risk of life-threatening infections with Clostridioides difficile, often called C difficile or C diff, a bacterium that releases toxins that can destroy the lining of the intestine.
Although taking any antibiotic can lead to C difficile—which sickens half a million Americans a year and kills nearly 30,000—clindamycin has long been known to pose an especially high risk.
Dentists wrote more than 27 antibiotic prescriptions last year, including 2.3 million for clindamycin, according to data provided exclusively to CIDRAP News by the IQVIA Institute for Human Data Science, an organization based in Parsippany, New Jersey, that provides research and analysis on healthcare data. Clindamycin was the second-most prescribed dental antibiotic.
Dentists also cut their use of fluoroquinolone antibiotics by 31%. This class of antibiotics has been very popular and commonly used, leading many bacteria to become resistant to it. Fluoroquinolones, which include brands such as Ciprofloxacin and Levaquin, can cause serious side effects, including ruptured tendons, nerve damage, confusion or mood changes, heart rhythm problems, blood sugar disturbances and worsening muscle weakness in people with a condition called myasthenia gravis, an autoimmune disease.
Helpful dashboard
The declines in inappropriate prescribing lasted for at least three years, according to the study, which analyzed nearly 12,000 prescriptions for more than 7,300 patients.
One of the ways that researchers helped dentists maintain their new prescribing habits was by giving them links to a secure, personalized dashboard that tracked their prescribing patterns. The dentists reviewed their prescriptions with researchers.
All nine dentists found the dashboard helpful. One told Goff that the dashboard helped catch a problem with his computerized system for issuing prescriptions. Although the dentist thought he had stopped writing 10-day antibiotic prescriptions, his dashboard showed that nothing had changed.
The dentist realized that his electronic system was set up to automatically order prescriptions for 10 days, Goff said. Once he realized the problem, he was able to create a new template for shorter antibiotic prescriptions.
Limitations
The study has an important limitation: It did not include a comparison group that didn’t attend an educational class or use a personalized dashboard, said Elliot Abt, DDS, an adjunct associate professor of oral medicine at the University of Illinois College of Dentistry who co-wrote dental guidelines on antibiotics.
For a future study, researchers could randomly choose 10 dental practices to receive antibiotic stewardship instruction and 10 to continue as usual, Abt said. That would allow researchers to learn if the stewardship course truly led to fewer inappropriate prescriptions.
The periodontists in this study were members of the Seattle Study Club, an international network of more than 7,000 private practice dentists who try to improve their knowledge and skills.
But that doesn’t mean that only study club members would benefit from antibiotic education and dashboard, said Erinne Kennedy, DMD, MPH assistant dean for curriculum and integrated learning at Kansas City University College of Dental Medicine in Missouri.
Goff, who teaches classes in antibiotic stewardship around the country, said she has learned what to say and not to say to dentists.
Rather than telling them what they’re doing wrong, Goff said, she says, “Here are prescribing patterns that most dentists follow. I think we could do better. And let me tell you why.”
