The consistent rate of antibiotic prescriptions by general dentists may underscore the need for stronger measures to prevent overprescription. The study was recently published in the Journal of the American Dental Association.
Furthermore, variations in antibiotic prescribing based on patient sex, age, and location may suggest unnecessary use, the authors wrote.
"Antibiotic stewardship is needed to optimize prescribing in the dental care setting," wrote the authors, led by Dr. Cam-Van T. Huynh, MPH, of the U.S. Centers for Disease Control and Prevention (JADA, March 6, 2025).
As part of the U.S. National Action Plan to combat antimicrobial resistance, the ADA developed guidelines to help dentists prescribe antibiotics more judiciously. Despite the release of these guidelines in 2019, which recommend antibiotics only for infections with systemic involvement, prescription rates by dentists have remained largely unchanged, according to the study.
This cross-sectional study analyzed oral antibiotic prescriptions dispensed by general dentists from 2018 to 2022 using data from the Xponent database, which captures U.S. outpatient prescriptions filled at retail pharmacies and aligns them with wholesale deliveries, they wrote.
Researchers compared general dentists' prescriptions to total outpatient oral antibiotic prescriptions, categorizing them by patient sex, age group, and prescriber location based on U.S. Census Bureau regions. Prescription rates were calculated per 1,000 people using yearly prescription totals and population estimates.
Over four years, the number of prescriptions written by dentists rose slightly. In 2018, general dentists prescribed 24.65 million (9.9%) antibiotic prescriptions, increasing to 25.17 million (10.7%) in 2022. The prescribing rate remained steady at 75.5 antibiotic prescriptions per 1,000 people in both years. During the COVID-19 pandemic, total antibiotic prescriptions dropped by 5.1% compared to 2019. However, the percentage of all outpatient antibiotics prescribed by dentists rose from 9.8% in 2019 to 11.6% in 2020, they wrote.
In both 2018 and 2022, dental antibiotic prescription rates were higher for female patients (~82 prescriptions per 1,000 women) than male patients (~69 prescriptions per 1,000 men). Among patients 65 and older, rates rose from 130.6 per 1,000 people in 2018 to 139.1 per 1,000 in 2022. Geographically, dental prescribers in the Northeast had the highest prescription rates at 84.6 per 1,000 people in 2018 and 85.5 per 1,000 in 2022.
However, the study had limitations. The Xponent database lacks diagnosis or prescription indication data, therefore the appropriateness of antibiotic use could not be evaluated, the authors added.
"Widespread dissemination of the ADA treatment guideline needs to be combined with effective strategies for changing prescribing behavior among dentists," they wrote.
