“Antibiotic Aftershocks,” a three-part special series published in February by Center for Infectious Disease Research & Policy (CIDRAP), investigates “why inappropriate antibiotic prescribing remains common in dentistry.”
The first article in the series examines trends in clindamycin prescribing and antibiotic prescribing overall with a focus on clindamycin’s high risk of complications. “In a sign of progress, dental prescriptions for clindamycin declined 35% from 2020 to 2025, although it remains the second-most common antibiotic prescribed,” the author writes.
Part 2, “Curbing overuse of dental antibiotics proves daunting,” considers potential confusion over prescribing guidelines, whether state boards should mandate continuing education courses on antibiotic prescribing and the challenges of prescribing without a drug monitoring program, such as California’s database for monitoring controlled substance prescriptions. The third article offers suggestions for avoiding inappropriate antibiotics during dental care.
CDA takes antibiotic stewardship seriously. Besides clindamycin’s risks, overuse and inappropriate use of antibiotics are the primary drivers of antibiotic resistance with increasing annual deaths that led the World Health Organization in 2019 to call for urgent action to avoid a crisis, CDA reported.
The dental profession has made important strides in recent years, including publishing updated clinical guidelines and developing C.E. that reinforces appropriate prescribing for dentists. CDA is resharing those resources here.
Clinical practice guideline on antibiotic use: ‘When absolutely needed’
The American Dental Association in 2019 published an evidence-based guideline on antibiotic use for urgent management of pulpal-and periapical-related dental pain and intraoral swelling. CDA published news of the guideline soon after its release.
After conducting a systematic review, the ADA Council on Scientific Affairs and the Center for Evidence-Based Dentistry concluded that antibiotics for target conditions may provide negligible benefits and likely contribute to significant harms. The research panel “recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to dental conditions or when the risk of experiencing progression to systemic involvement is high.”
Antibiotic use and stewardship in the CDA Journal
The CDA Journal in December 2025 published a collection of executive summaries of clinical practice guidelines for dentists. Three of the summaries discuss antibiotic use:
- Antibiotic stewardship and infective endocarditis: Summarizes the American Heart Association’s 2007 “Guideline on Prevention of Infective Endocarditis,” which marked a pivotal change in managing risk of infective endocarditis stemming from dental procedures.
- Antibiotics for pulpal/periapical pain and intraoral swelling: Summarizes the ADA’s 2019 guideline.
- Antibiotic prophylaxis and prosthetic joints: Summarizes the 2013 American Association of Orthopedic Surgeons–ADA guideline recommending that prophylactic antibiotics not be prescribed prior to dental procedures for patients with prosthetic joints.
Dentists can earn individual C.E. credit for each article by reading it and successfully completing an online quiz no later than Dec. 31, 2026.
Also in the CDA Journal, Peter Jacobsen, PhD, DDS, discusses four core elements of antibiotic stewardship in dentistry (2019): commitment; action for policy and practice; tracking and reporting; and education and expertise.
Links to on-demand recordings from the OSAP Antibiotic Stewardship Summit plus additional resources are available on CDA’s website.
Read the CIDRAP series “Antibiotic Aftershocks.”