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Antibiotic Prophylaxis | Antibiotics for the Treatment of Dental Infections | Antibiotic Stewardship | Adverse Events | Additional Resources

Antibiotic Stewardship efforts for dentists aim to improve antibiotic usage, improve patient outcomes, and decrease the spread of infections caused by multidrug-resistant organisms. By prescribing antibiotics only when necessary, dentists may ensure patients receive only antibiotic therapy when indicated.  These limited situations include prescribing antibiotic prophylaxis prior to dental procedures when indicated and the treatment of odontogenic infections in certain clinical situations. After making an accurate diagnosis, dentists must ensure they prescribe the right drug, dose, and duration. Dentists can find guidance on antibiotic prescribing, stewardship efforts, adverse events related to antibiotics, penicillin allergies, and toolkits to help with antibiotic stewardship efforts in the resources outlined below. 

Below are key articles, resources, and guidelines that will support clinicians chairside in a prioritized list.

1. How are dentists prescribing antibiotics?
2. How and why are antibiotics used prophylactically?
3. Chairside Guide for Antibiotics Use for Patients with Tooth Pain and Swelling when Dental Treatment is Immediately Available
4. Chairside Guide for Antibiotics Use for Patients with Tooth Pain and Swelling when Dental Treatment is NOT Immediately Available
5. How can we practice antibiotic stewardship in dentistry?
6. How can I practice antibiotic stewardship? (CDC Checklist)
7. What if my patient has a penicillin allergy?
8. How do I assess if my patient's allergy is a true allergy?
9. OSAP Antibiotic/Antimicrobial Resistance Toolkit

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Educational resources, continuing education (CE) and training opportunities, and resources for dental prescribers on antibiotic stewardship are linked below.

Antibiotic Prophylaxis

• American Dental Association (ADA) Chairside Guide: Management of patients with prosthetic joints undergoing dental procedures.
• American Association of Orthopedic Surgeons (AAOS) Appropriate Use Prophylaxis Tool
• JADA: American Dental Association guidance for utilizing appropriate use criteria in the management of the care of patients with orthopedic implants undergoing dental procedures.
• American Association of Orthopedic Surgeons (AAOS) Appropriate Use Criteria for Management of Patients with Orthopedic Implants Undergoing Dental Procedures.
• Antibiotic Prophylaxis: Cardiac conditions: JADA: Prevention of infective endocarditis: Guidelines from the American Heart Association.
• National Institute of Dental and Craniofacial Research: Dental Provider’s Oncology Pocket Guide—Prevention and management of oral complications (Head and Neck Radiation Therapy, Chemotherapy, Hematopoietic Stem Cell Transplantation).
• Antibiotics in dental implants: A review of Literature
• 2022 Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures Article
• Khouja, T., Kennedy, E. & Suda, K.J. Antibiotic Prophylaxis for Tooth Extractions and Dental Implants, A Narrative Review. Curr Infect Dis Rep (2023). 
• Letter to the Surgeons
• Literature Summary 2023 Antibiotic Prophylaxis Prior to Invasive Dental Procedures in Patients with Total Joint Replacement

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Antibiotics for the Treatment of Dental Infections

• ADA: Antibiotics for Dental Pain and Swelling Guideline (2019)
• ADA CE Online Course: Guideline on Antibiotic Use for the Urgent Management of Dental Pain and Intraoral Swelling
• American Academy of Pediatric Dentistry (AAPD); Use of Antibiotic Therapy for Pediatric Dental Patients
• American Association of Endodontists (AAE) Position Statement: Guidance on the Use of Systemic Antibiotics in Endodontics
• CDC: Be Antibiotics Aware - Treating Patients with Dental Pain and Swelling 
• JADA Antibiotic Use for Periodontal Disease Clinical Practice Guideline

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Antibiotic Stewardship 

• Antibiotic Stewardship Chart Audit Tool
• JADA: Considerations for responsible antibiotic use in dentistry
• SIDP Podcast with Katie Suda and Erinne Kennedy: “Taking a bite out of “antibiotic prescribing”: The need for antimicrobial stewardship in dentistry
• CDC Blog: Addressing Antibiotic Resistance in Dentistry: “What can WE do??
• CDC: The Core Elements of Outpatient Antibiotic Stewardship: Clinician Checklist.
• MARR Video: Antibiotic Stewardship in the Dental Office.
• MARR Antibiotic Safety at the Dentist Brochure
• MARR Delayed Prescribing Notepad
• CDC Educational Resources for Healthcare Professionals

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Adverse Events

• CDC: Adverse Drug Events from Antibiotics

Penicillin Allergies

• JADA: Penicillin allergy reassessment for treatment improvement: A dental office tool to support appropriate penicillin allergy labeling
• American Academy of Allergy Asthma & Immunology (AAAAI): Penicillin Allergy—What do you need to know?
• Evaluation and Diagnosis of Penicillin Allergy for Healthcare Professionals
• MARR/OSAP: Penicillin-Allergy Assessment Tool
• MARR/OSAP: Penicillin Allergy Reassessment for Treatment Improvement (PARTI) Tool
• Agency for Healthcare Research and Quality (AHRQ): Approach to Patients Reporting Penicillin Allergies Video
• Oral and Maxillofacial Surgeons, JOMS Study: Penicillin allergy testing encouraged to reduce infection risk in oral surgery patient

Opportunistic Infections (C. Diff) & Antibiotic Resistance

• CDC: What is C. diff (Clostridioides difficile)?
• Association for Professionals in Infection Control and Epidemiology (APIC); What you need to know about Clostridium difficile?
• Sepsis Alliance: Why is C. diff so dangerous?

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Additional Resources

• ADA Brochure: Should you take Antibiotics before your dental treatment? Available for purchase.
• CDC: Antibiotic Use for a Safe Dental Visit
• Society of Infectious Diseases Pharmacists: “Got Old Antibiotics? Dispose of them safely here!”

OSAP Student Membership—As a student, you can join OSAP for FREE! You'll receive a complimentary OSAP membership through graduation. Once you graduate, you will receive an additional one (1) year of Premium membership active from August 1 to July 31. Learn more!

Click on the boxes below to view resources for dental team members, policymakers, and patients receiving dental care.

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