Dentists are licensed healthcare professionals authorized to prescribe medications, including antibiotics, within their scope of practice. This authority focuses on diagnosing and managing bacterial infections in the oral cavity, jaw, and surrounding head and neck structures. Prescribing antibiotics is a deliberate decision, guided by clinical need and established guidelines, not a routine part of every dental procedure. Dentists prescribe these drugs either to treat an active infection or to prevent a potential one.
Treating Active Dental Infections
Antibiotics are prescribed to manage existing bacterial infections that have spread beyond a localized area. This often occurs with an acute dental abscess that shows systemic involvement, meaning the infection is affecting the patient’s overall health. Signs of spread include fever, facial swelling (cellulitis), swollen lymph nodes, or difficulty swallowing or opening the mouth.
In these cases, the antibiotic acts as a supplement to the main dental procedure. The primary treatment for an odontogenic infection must always be surgical intervention, such as draining the abscess, performing a root canal, or extracting the infected tooth. The medication controls bacteria in the surrounding tissues or bloodstream while the dentist eliminates the source. Amoxicillin is often the first-line choice, though options like clindamycin or metronidazole may be used based on severity, location, and resistance potential.
Prescribing Antibiotics for Prevention
A distinct use for antibiotics is prophylaxis, which means taking medication beforehand to prevent a specific infection. This is reserved for patients with underlying medical conditions who are at high risk for serious complications if oral bacteria enter the bloodstream during an invasive dental procedure. The main guidelines focus on preventing infective endocarditis, a severe infection of the heart lining or valves.
Patients with high-risk cardiac conditions—such as those with prosthetic heart valves, a history of infective endocarditis, or certain congenital heart defects—require prophylactic antibiotics before procedures that manipulate the gums or tooth root area. For patients with artificial joints, routine antibiotic pre-medication is generally no longer recommended for total hip or knee replacements. Prophylaxis for joint replacements is considered only for a small number of patients with complex medical factors, often after consulting with the orthopedic surgeon. These preventive regimens require precise timing before the procedure.
When Antibiotics Are Not Necessary
Many common dental issues do not require antibiotics. Simple toothaches, reversible pulpitis (inflammation of the tooth nerve), and localized, well-draining abscesses are typically managed effectively by direct dental treatment alone. The antibiotic cannot fix the underlying structural problem, such as decay or a dead nerve, and relying on medication only delays the necessary physical intervention.
Antibiotics are also ineffective against viral infections or non-bacterial causes of pain, such as inflammation from a dry socket after an extraction. Stewardship guidelines discourage prescribing antibiotics solely to meet a patient’s expectation or for mild, localized swelling where the infection source can be surgically removed. In these cases, the potential side effects, including allergic reactions or stomach upset, outweigh any limited benefit.
Antibiotic Resistance and Stewardship in Dentistry
Dentistry plays a significant role in antibiotic resistance, accounting for an estimated 7% to 10% of all community antibiotic prescriptions. Antibiotic resistance occurs when bacteria evolve the ability to defeat the drugs designed to kill them, making common infections harder to treat. This public health threat makes responsible prescribing, known as antibiotic stewardship, increasingly important.
Stewardship in dentistry means ensuring antibiotics are used only when indicated and are not a substitute for proper procedures. This involves selecting the correct drug, using the lowest effective dose, and prescribing the shortest possible duration of treatment. Dentists prioritize source control—such as drainage or extraction—and reserve antibiotics for cases with clear signs of spreading or systemic infection. Patients contribute by always completing the full prescribed course and never saving or sharing leftover medication.