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Evidence | Guidance & Tools | Stewardship | Continuing Education

Antibiotic Stewardship efforts for dentists aim to improve antibiotic usage, improve patient outcomes, and decrease the spread of infections caused by multidrug-resistant organisms. By prescribing antibiotics only when necessary, dentists may ensure patients receive only antibiotic therapy when indicated. These limited situations include prescribing antibiotic prophylaxis prior to dental procedures when indicated and the treatment of odontogenic infections in certain clinical situations. After making an accurate diagnosis, dentists must ensure they prescribe the right drug, dose, and duration. Dentists can find guidance on antibiotic prescribing, stewardship efforts, adverse events related to antibiotics, penicillin allergies, and continuing education opportunities in the resources outlined below. 

Evidence

• How are dentists prescribing antibiotics?
• Outpatient antibiotic prescribing by general dentists in the United States from 2018 through 2022 (2025)
• Changes in antibiotic prescribing by dentists in the United States, 2012-2019 (2022)

• How and why are antibiotics used prophylactically? 
• Total Joint Replacement
• NEW! AAOS Clinical Practice Guideline Summary - Prevention of Total Hip and Knee Arthroscopy Periprosthetic Joint Infection in Patients Undergoing Dental Procedures (2025)
• Antibiotic Prophylaxis Prior to Dental Procedures After Total Hip and Knee Arthroplasty Does Not Decrease the Risk of Periprosthetic Joint Infection (2024)
• Quantifying the Risk of Prosthetic Joint Infections After Invasive Dental Procedures and the Effect of Antibiotic Prophylaxis (2023)
• Antibiotic Prophylaxis for Prosthetic Joint Patients Undergoing Invasive Dental Procedures: Time for a Rethink? (2022)
• Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures (2022)
• Antibiotic Prophylaxis for Tooth Extractions and Dental Implants, A Narrative Review (2023)
• Antibiotics in Dental Implants: Literature Review (2016)

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Guidance & Tools

What are the risks associated with antibiotics?

• Adverse Drug Events from Antibiotics (CDC)
• What is C. diff (Clostridioides difficile)? (CDC)
• What you need to know about Clostridium difficile? (APIC)?
• Why is C. diff so dangerous? (Sepsis Alliance)?
  
  

What resources are available to address antibiotic use in dentistry for:

Infective Endocarditis?

• Cardiac conditions: Prevention of infective endocarditis. Guidelines from the American Heart Association (ADA).
• Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures (2022)
• Establishing Clarity on the American Heart Association Guidelines (2025)

Patients with Total Joint Replacement?

• AAOS/AAHKS Clinical Practice Guideline (2024): The Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures
• NEW! AAOS Clinical Practice Guidelines Summary (November 1, 2025)
• NEW! Appropriate Use Criteria (AUC) for the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures (Adapted by the American Academy of Orthopaedic Surgeons Board of Directors June 6, 2025)
• PDF
• AUC Criteria and Cases
• JADA Commentary on what dentists need to know about new guidelines for the treatment of patients with prosthetic joints
• NEW! Literature Summary 2025 Antibiotic Prophylaxis Prior to Invasive Dental Procedures in Patients with Total Joint Replacement and Customizable Letter to the Surgeons
  
  

Tooth Pain & Swelling?

• Antibiotics for Dental Pain and Swelling Guideline (ADA, 2019)
• Be Antibiotics Aware - Treating Patients with Dental Pain and Swelling (CDC)
• Chairside Guide for Antibiotics Use for Patients with Tooth Pain and Swelling when Dental Treatment is Immediately Available
• Chairside Guide for Antibiotics Use for Patients with Tooth Pain and Swelling when Dental Treatment is NOT Immediately Available
  
• NEW! CPG for the Temporary Pharmacologic Management of Acute Dental Pain with no Immediate Access to Definitive Dental Treatment 
• Pain management guide for Ages 12 to 65+
• Pain management guide for Ages 0 to less than 12 years old
• NEW! CPG for the Pharmacologic Management of Acute Dental Pain: Postoperative Pain after Simple and Surgical Tooth Extraction(s) in Adolescents, Adults and Older Adults
• Pain management guide for tooth removed - Simple & Surgical for Ages 12 to 65+

Endodontic Procedures?

• Guidance on the Use of Systemic Antibiotics in Endodontics (AAE)
  
  

Pediatric Patients?

• Use of Antibiotic Therapy for Pediatric Dental Patients (AAPD)
• Georgia Pediatric Antibiotic Stewardship: a collaboration of the five children’s hospitals in Georgia to create a statewide antibiogram
  
  

Periodontal Procedures?

• Antibiotic Use for Periodontal Disease Clinical Practice Guideline (ADA)
  
  

Dental Implants?

• Antibiotics in dental implants: A review of Literature
• Antibiotic Prophylaxis for Tooth Extractions and Dental Implants, Narrative Review (2023)
  
  

Oncology Patients?

• Dental Provider’s Oncology Pocket Guide—Prevention and management of oral complications (Head and Neck Radiation Therapy, Chemotherapy, Hematopoietic Stem Cell Transplantation) (NIDCR)
  
  

Patients Reporting Penicillin Allergies? 

• Penicillin allergy reassessment for treatment improvement: A dental office tool to support appropriate penicillin allergy labeling (ADA)
• Penicillin Allergy—What do you need to know? (AAAAI)
• Evaluation and Diagnosis of Penicillin Allergy for Healthcare Professionals
• MARR/ADS
• Penicillin-Allergy Assessment Tool
• Penicillin Allergy Reassessment for Treatment Improvement (PARTI) Tool
• Approach to Patients Reporting Penicillin Allergies (AHRQ) Video
• Penicillin allergy testing encouraged to reduce infection risk in oral surgery patient (AAOMS)

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Stewardship 

Antibiotic Stewardship in Dentistry

• Considerations for responsible antibiotic use in dentistry (ADA)
• “Taking a bite out of “antibiotic prescribing”: The need for antimicrobial stewardship in dentistry (Podcast)
• Improve patient safety by optimizing antibiotic prescribing (CDC Blog)
• Beating antimicrobial resistance takes all of us (JADA Commentary)

Resources and Tools

• Core Elements of Outpatient Antibiotic Stewardship (CDC)
• NEW! Clinician Checklist for Antibiotic Prescribing in Dentistry (CDC)
• NEW! Antibiotic Stewardship Resource Bundles for Dentistry (CDC)
• Antibiotic Use for a Safe Dental Visit (CDC)
• NEW! SOP Template to Incorporate Antibiotic Stewardship Into Your Dental Practice
• NEW! Train the Trainer Toolkit (ADS)
• Antibiotic Stewardship Chart Audit Tool
• Delayed Prescribing Notepad
• Antibiotic Stewardship in the Dental Office (Video)
• Antibiotic Safety at the Dentist (Brochure)
• Educational Resources for Healthcare Professionals (CDC)

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Continuing Education

UPCOMING PROGRAMS 

• January 21 (Wednesday), 2026. NNOHA National Webinar, 4 - 5 pm EDT (1 CE)
  The 411 on Antibiotic Stewardship for Health Centers with Erinne Kennedy, DMD, MPH, MMSc. This educational webinar will be presented by the National Network for Oral Health Access (NNOHA) and is co-sponsored with ADS.
• February 3 (Tuesday), 2026. 4:15 - 5:15 EDT (1 CE), Atlanta, GA. (1 CE)
  Antibiotic Stewardship as a Standard Operating Procedure in Practice with Erinne Kennedy, DMD, MPH, MMSc. Participants must be registered to attend the ADS 2026 Dental Infection Control & Prevention Boot Camp in Atlanta, GA.
• March 3 (Tuesday), 2026 at 7 pm ET. Webinar.
  Antibiotic Stewardship with Erinne Kennedy, DMD, MPH, MMSc. This webinar is sponsored by the Queens Country Dental Society in Queens County, NY.

ON-DEMAND COURSES

• 2025 ADS (formerly OSAP) Free Webinar (1 CE). Antibiotic Prophylaxis: Weighing the Risks and Benefits - Has the Scale Changed? Dr. Matthew Grosso (AAOS) and Dr. Erinne Kennedy (ADS) discuss the new AAOS clinical practice guideline and appropriate use criteria.
• 2025 ADS (Formerly OSAP) Third Annual Dental Antibiotic Stewardship Summit (On-Demand)
• Click HERE for On-Demand recordings offering up to 6.5 hours of CE credit. Note, you must log-in to the ADS website, but membership is not required. Click HERE for instructions to claim self-study CE credit.
• Click HERE for a Blog Summary of the Summit.
• 2025 Antibiotic Stewardship (DACE Online Course)
• Antibiotics Stewardship (ADA Online Course)
• Guideline on Antibiotic Use for the Urgent Management of Dental Pain and Intraoral Swelling (ADA Online Course)
• "SparkNotes" Version of 2024 Dental Antibiotic Stewardship Summit (On-Demand)
• 2024 OSAP Antibiotic Stewardship Summit (On-Demand package of 7 hours CE)
• Antibiotic Considerations in Dentistry (CDC)

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