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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
• 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! 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)
• 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 

• October 16 (Thursday), 2025. Dallas, TX. 5 - 7 p.m. Central Time (2 CEs)
  "Antibiotic Stewardship: Policy, Practice and Processes" with Erinne Kennedy, DMD, MPH, MMSc.
  TAMU College of Dentistry. Brauman-Bell Alpha Omega Lectureship.
• November 7 (Friday), 2025. Webinar. 8:45 a.m. - 12 p.m. EDT (3 CEs)
  Antibiotic Stewardship with Erinne Kennedy, DMD, MPH, MMSc.
  Maine Dental Association Continuing Education
• November 12 (Wednesday), 2025. Webinar. 4 - 5 p.m. EDT (1 CE. Free)
  Antibiotic Prophylaxis: Weighing the Risks and Benefits, Has the Scale Changed? with Matthew Grosso, MD and Erinne Kennedy, DMD, MPH, MMSc.
  Association of Dental Safety
• November 20 (Thursday), 2025. Webinar. 11 - 11:50 a.m. EDT
  Antibiotic Stewardship in Dentistry: Trends, Best Practices and Integration Into the Daily Flow of Dentistry with Marie Fluent, DDS, CDIPC, FACD and Emily McDonald, MD, MPH
  Arizona Department of Health Services. 
  NOTE: This lecture is part of a 4-day webinar series celebrating 2025 U.S. Antibiotic Awareness Week. Each day has 1-3 sessions. Register for each day HERE. 
• November 20 (Thursday), 2025. Webinar. 3 - 4 p.m. EDT
  Beyond the Hospital: Managing Antibiotics in a Shared World (Panel Discussion) with Paul Plummer, DVM, PhD, DACVIM; Erinne Kennedy, DMD, MPH, MMSc and Joscelyn Freimuth, PharmD, MBA, BCSCP
  Tennessee Healthcare-Associated Infections and Antimicrobial Resistance Program.
  NOTE: This lecture is part of a 3-day webinar series celebrating 2025 U.S. Antibiotic Awareness Week. Register for each day HERE.
• January 14, 2026 (Wednesday). Webinar. 2 - 3 p.m. EDT (1 CE)
  Antibiotic Stewardship with Erinne Kennedy, DMD, MPH, MMSc.
  Registration Link to be posted in December 2025.
  
  

ON-DEMAND COURSES

• 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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