In 2019, American health care providers of all specialties wrote a total of 251.1 million antibiotic prescriptions — that’s enough for three-quarters of Americans to receive at least one. That number wouldn’t necessarily a problem if all of the prescriptions were necessary and prescribed within guidelines set by health care associations, but that isn’t always the case. In fact, nearly a quarter of prescriptions are most likely unnecessary, according to a cross-sectional study.

And, unfortunately, dentists are some of the top antibiotic prescribers in the United States.

Why antibiotic stewardship is important

Being thoughtful when prescribing antibiotics is part of a practice called antibiotic stewardship. Antibiotic stewardship is an effort to improve how antibiotics are prescribed and used. The goal is ultimately to treat infections more efficiently and to combat antibiotic resistance.

The most dangerous result of antibiotic overprescription is antibiotic resistance. When germs are exposed to antibiotics but not killed, they evolve and develop resistance to drugs. Those resistant germs cause infections that are difficult, if not impossible, to treat and can increase the mortality rates of once treatable infections.

When antibiotics are prescribed improperly, patients may have to deal with the adverse physical effects of antibiotic treatment for no reason. Common adverse effects include nausea, abdominal pain and vomiting, and they happen in almost 10% of patients. Even more, antibiotics can be a financial burden. Without insurance coverage, the average cost of generic antibiotics is about $43 for a 500mg dosage.

The dentist’s role in overprescription

According to surveys of antibiotic prescriptions in the U.S., dentists write one in 10 antibiotic prescriptions.  In a study done on prescription rates in Australia, England, the U.S. and British Columbia, dentists in the U.S. were found to be the most prolific antibiotic prescribers. American dentists prescribed twice the amount of antibiotics that Australia, the least prolific, did per 1000 population. Studies reveal that almost 81% of antibiotics prescribed by dentists are used against stewardship guidelines.

Antibiotics are a vital tool in dental health, especially when treating patients with comorbidities that can increase the danger of an infection, like heart disease. The American Heart Association recommends that only patients at the highest risk for adverse outcomes from infections should be prescribed antibiotics. They should absolutely be prescribed when necessary. But before you prescribe, take a moment to consider whether antibiotics are necessary.

There isn’t a “one size fits all” approach to managing antibiotic use. The reason antibiotic overprescription is so prevalent is also the reason it’s difficult to change: medical decision-making is incredibly complex. To tackle overprescription in your own practice, you can:

Use the tips above to be antibiotic aware and to inform your colleagues and patients about the importance of antibiotics stewardship.