Summary of Rationale for the Type of Antibiotic and Regimen for Care

A review of the prescribing practices of dentists reveals considerable heterogeneity in prescribing practices, antibiotic regimen choices, and rationale for prescribing. Given the continued concerns with respect to antibiotic resistance, development of evidence-based clinical guidelines and adherence by dental practitioners to biologically indicated antibiotic regimens is critical to public health.³⁵ Studies have suggested that continuous professional development programs on time management could address the overuse of antibiotics in dentistry by eliminating common barriers in oral health practices.³⁶ Specifically, participating general oral health care practitioners thought that the overuse of antibiotics was not related to dentists’ level of knowledge or basic skills but, instead, was a consequence of barriers that arise in daily practice such as a lack of time, inability to inject local anesthetic because of infection, and difficulty accessing a tooth because of swelling, among others.³⁶ In accordance with antimicrobial stewardship initiatives in the U.S. and globally, oral health care professionals must work to educate themselves and the general public about the significance of antibiotic resistance and the importance of restricting the use of antibiotics in the oral health setting. Utilizing the ADA Clinical Practice Guidelines to limit antibiotic prescriptions in immunocompetent adults with pulpitis and pulpal necrosis should be evaluated carefully to determine ideal clinical scenarios.^7,35,37 In summary, the current recommendations suggest that shorter courses of antibiotics are equally as effective as longer courses and antibiotic courses longer than 5 days should be considered the exception rather than the rule to reduce antibiotic resistance.⁷