Give me a brief description of the use of antibiotics in dental practice

Antibiotics in dental practice are primarily used for two main purposes: (1) treatment of acute orofacial infections, and (2) prophylaxis to prevent systemic complications in high-risk individuals undergoing invasive dental procedures. For treatment, antibiotics are appropriate when there is clear evidence of bacterial infection that presents with systemic involvement—such as fever, malaise, or lymphadenopathy—or when local control via dental intervention (e.g., drainage, extraction) cannot be achieved immediately. Conditions warranting antibiotic therapy include dental abscesses, cellulitis, acute necrotizing ulcerative gingivitis, and severe periodontitis with systemic symptoms[1]. However, the majority of dental infections can be effectively managed with procedural interventions alone, without antibiotics[1].

Prophylactic use of antibiotics is most clearly indicated for patients at the highest risk of infective endocarditis—such as those with certain cardiac conditions—who are undergoing procedures likely to cause significant manipulation of the gingiva, periapical region, or perforation of the oral mucosa. Evidence suggests prophylactic antibiotics in this group can significantly reduce the incidence of infective endocarditis following procedures like extractions and oral surgery[2]. Despite this, research reveals that the overwhelming majority of antibiotic prophylaxis in dental visits is inconsistent with guideline recommendations, leading to unnecessary exposure and contributing to antimicrobial resistance[3][4]. Prophylactic antibiotics for other conditions, such as prosthetic joint replacements, are generally not supported by scientific evidence and professional guidelines[5][4][6].

The antibiotics most frequently prescribed in dental practice include amoxicillin (often the first-line agent), with clindamycin reserved for patients with penicillin allergy[7][8]. However, studies report significant overprescribing, inappropriate duration, and frequently delayed (post-procedure rather than pre-procedure) administration, which undermines prophylactic benefit and increases risk for resistance and adverse outcomes[7][8][1].

Antibiotic overuse and misuse in dentistry is a recognized problem worldwide, accounting for up to 10–15% of all outpatient antibiotic prescriptions, with estimates suggesting that up to 80% of these may be inappropriate. Contributing factors to this issue include pressure to prescribe, lack of confidence among some clinicians, and variability or reduced awareness of evidence-based guidelines[9][10][1]. Effective antibiotic stewardship—including strict adherence to indications, appropriate drug selection, timing, and duration—is increasingly emphasized as essential for global public health, aiming to limit resistance and protect patients from unnecessary harm[9][10][1].