Antibiotics after non-surgical root canals: National Dental Practice-Based Research Network findings

Despite guideline recommendations discouraging routine antibiotic use for localized endodontic infections, antibiotics continue to be prescribed after non-surgical root canal therapy (RCT). This study evaluated antibiotic prescribing patterns among general dentists and endodontists across a range of practice settings in the United States National Dental Practice-Based Research Network.

A total of 153 dentists enrolled 1,723 patients requiring RCT. Dentists collected clinical, radiographic, and demographic data. The primary outcome was whether systemic antibiotics were prescribed after treatment. Generalized estimating equations were used to assess associations between antibiotic prescribing patterns and dentist, patient, and clinical characteristics. A secondary analysis was restricted to teeth with vital pulp and no swelling-clinical situations where antibiotics are not indicated.

Antibiotics were prescribed to 322 (19%) patients. In adjusted models, patients with teeth with tenderness to palpation (OR=1.40; p=.046) or apical periodontitis (OR=1.56; p=.004) were more likely to receive antibiotics. Dentists younger than 45 years (OR=0.47; p=.02), non-Hispanic White (OR=0.40; p=.01), and those affiliated with large group or academic practices (OR=0.25; p=.007) were significantly less likely to prescribe antibiotics. Patients with only a high school education or racial-ethnic minority backgrounds were more frequently prescribed antibiotics (p<.05).

Nearly one in five patients undergoing RCT were prescribed antibiotics, often without clear clinical indications. Prescribing varied by dentist, patient, and clinical characteristics. These findings highlight persistent gaps between guideline-based recommendations and real-world practice, underscoring the need for targeted antibiotic stewardship interventions.