Sustained Improvement in Antibiotic Prescribing Among Private Practice Dentists Following Antibiotic Stewardship...

The lack of procedure-specific, evidence-based dental antibiotic guidelines increases unnecessary and inappropriate antibiotic prescribing. The primary objective was to evaluate changes in antibiotic prescribing before and after antibiotic stewardship (AS) education by infectious diseases (ID) AS experts in addition to implementation of self-monitored antibiotic dashboards. A secondary objective was to link antibiotic prescriptions to standardized Current Dental Terminology (CDT) procedure codes.

We conducted a retrospective, multi-practice cohort study among 9 private practice periodontists who completed AS education by ID-AS experts. Antibiotic data, CDT codes, and medical histories were extracted from electronic dental records from 1 January 2021 through 30 June 2025. Individualized dashboards displayed longitudinal antibiotic prescribing and linkage to CDT procedure codes. Outcomes were compared across pre-education, post-education year 1, and post-education year 3 periods.

A total of 11 795 antibiotic prescriptions for 7331 unique patients were identified; 85.6% were therapeutic (≥3 days) and 14.4% were prophylactic. Prophylactic antibiotics for patients with prosthetic joint implants decreased by 89% by post-education year 3 (P < .05). Clindamycin and fluoroquinolone use declined by 85% (P < .001) and 31% (P < .15), respectively. Ten-day antibiotic durations decreased by 87% (P < .001) with a corresponding increase in courses of 3-5 days across multiple CDT procedure categories. Improvements were sustained 3 years after education without ongoing external audit and feedback.

Dentists demonstrated sustained improvements in antibiotic use following ID-AS-led stewardship education and implementation of self-monitored antibiotic dashboards. Linking prescriptions to CDT codes supports future development of evidence-based dental antibiotic guidelines.