Review Article Pharmaceuticals in Dentistry and the Imperative of Antibiotic Stewardship: A Narrative Review

Author

Dr. Althaaf Khan


Abstract

 Objective: To review the pharmaceutical agents routinely used in dental practice, with emphasis on antibiotics, and to appraise the evidence and strategies for antibiotic stewardship in dentistry, including the South African context.

Methods: A narrative review of peer-reviewed studies, systematic reviews, clinical practice guidelines and policy documents addressing dental pharmacotherapy, antibiotic prescribing, antimicrobial resistance and stewardship.

Results: Dentists prescribe roughly one in ten outpatient antibiotics in several high-income settings, and a large share of dental prescriptions, particularly prophylactic prescriptions, do not align with guidelines. Evidence indicates that systemic antibiotics add little to definitive operative treatment in most pulpal and periapical conditions, whereas they are justified where there is systemic involvement, spreading infection or immunocompromise, and for the narrow group of patients at highest risk of infective endocarditis. South African studies show inconsistent prescribing after tooth extraction and continued antibiotic use for pulpitis, with dentists citing unclear guidelines. Adverse drug reactions, Clostridioides difficile infection and selection for resistance add to the cost of unnecessary prescribing. Effective stewardship combines accurate diagnosis, definitive local treatment, narrow-spectrum short-course therapy, patient communication, audit and feedback, and accessible national guidance. The same principles extend to analgesics, opioids and topical antimicrobial agents.

Conclusion: Dentists are important stewards of antimicrobials. Adopting evidence-based indications, locally relevant guidelines and routine prescribing audit could reduce avoidable antibiotic exposure without compromising patient safety.


Keywords

dental pharmacology; antibiotic stewardship; antimicrobial resistance; antibiotic prophylaxis; dental prescribing; South Africa



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