80% of antibiotics prescribed by dentists are unnecessary, study finds

  • Dentists prescribe 26.6 million of the 266 million courses of antibiotics dispensed each year
  • But a new study, the first to analyze national dentistry prescribing, finds that figure is too high

Dentists prescribe 10 percent of all antibiotics in the US – one of the highest rates of any medical specialism.

In other words, they prescribe 26.6 million of the 266 million courses of antibiotics dispensed each year.

But according to a new study, 80 percent of those (roughly 21.3 million prescriptions) are unnecessary, mostly in the Western US. 

The study by Chicago researchers, published in JAMA Network Open today, is the first attempt to gauge nationally how and where dentists are prescribing these drugs, to pinpoint where we could cut down. 

A new study looks at where and to whom dentists are prescribing antibiotics

A new study looks at where and to whom dentists are prescribing antibiotics

‘Use of preventive antibiotics in these patients opens them up to the risks associated with antibiotic use – increasing bacterial resistance and infections, for example – when the evidence used to develop the guidelines suggests that the risks outweigh the benefits in most patients,’ said Katie Suda, the corresponding author on the study. 

The more antibiotics we take, the faster we will all become resistant to the life-saving drugs. 

Despite global efforts to curb antibiotic use, little has changed in the last few decades, but few studies have dug into why. 

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One obvious area to target was the practice of prescribing antibiotics before a dental visit – known as antibiotic prophylaxis – for people with high risk of infection from prosthetic joints or heart conditions.

But research has suggested it may not be necessary or effective, so new US dentistry rules published in 2007, and tightened again in 2013, said only people with the highest risk should get pre-appointment pills. 

According to the new research led by Suda, associate professor at the University of Illinois, Chicago, College of Pharmacy, not everyone is up to date on that guideline change. 

Her team looked at 168,420 dental visits, and their prescriptions, compared to the national average of who should, proportionally, be prescribed antibiotics.  

They found that 81 percent of prescriptions did not align with the national guidelines and were provided for patients without high-risk cardiac conditions.

Most unnecessary prescriptions were made to people in the Western US, to women, to people with joint replacements, and to people with tooth implants. 

The most commonly used antibiotics was clindamycin, which gave Dr Suda pause, because that is the antibiotic most commonly associated with C. difficile infections, by attacking the lining of the intestines. 

‘Until recently, little attention has been paid to the use of antibiotics in dentistry,’ Emily S. Spivak, MD, of the University of Utah School of Medicine, who was not involved in the study, wrote in a commentary for JAMA. 

Dr Spivak added: ‘This is an interesting finding, suggesting that possibly a “worried well” phenomenon may be driving prescribing.’    

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Susan Rowan, executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry, who worked with Suda on the research, said:

‘I think dental providers should view this study, which is the first to look at preventive antibiotic prescribing for dental procedures and provide this type of actionable information, as a powerful call to action, not a rebuke.’ 



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