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Antibiotics after non-surgical root canals: National Dental Practice-Based Research Network findings
Alan S Law1, Quyen Coro Nguyen2, Ellen Funkhouser3
1Division of Endodontics, Specialty Practices, University of Minnesota, 2200 County Rd. C, West Roseville, MN 55113, MN 55455, USA.
Journal of Dentistry
|July 8, 2026
Summary
Despite guidelines, nearly 20% of patients receive antibiotics after root canal therapy (RCT). Prescribing patterns vary by dentist and patient factors, indicating a need for better antibiotic stewardship in endodontic care.
Area of Science:
- Endodontics
- Infectious Diseases
- Public Health
Background:
- Guidelines discourage routine antibiotic use for localized endodontic infections post-root canal therapy (RCT).
- Antibiotic prescription after RCT remains prevalent despite recommendations against it.
- This study examines antibiotic prescribing patterns in US dental practices.
Purpose of the Study:
- To evaluate antibiotic prescribing patterns among general dentists and endodontists.
- To identify factors associated with antibiotic prescription after non-surgical root canal therapy.
- To assess adherence to guidelines for antibiotic use in endodontics.
Main Methods:
- 1,723 patients undergoing RCT were enrolled across various US practice settings.
- Data collected included clinical, radiographic, and demographic information.
- Generalized estimating equations analyzed associations between prescribing and dentist, patient, and clinical characteristics.
Main Results:
- Antibiotics were prescribed to 19% of patients (322/1723).
- Factors increasing antibiotic likelihood included tenderness to palpation and apical periodontitis.
- Younger dentists, non-Hispanic White dentists, and those in large/academic practices were less likely to prescribe antibiotics.
Conclusions:
- Significant variation exists in antibiotic prescribing after RCT.
- Patient and dentist characteristics influence antibiotic use, often diverging from clinical indications.
- Targeted antibiotic stewardship interventions are needed to align practice with evidence-based guidelines.
