US Study Flags Endodontic Antibiotic Overprescription

A large US practice-based study of endodontic care has identified specific clinical circumstances and dentist characteristics associated with potentially inappropriate antibiotic prescribing, providing evidence for more targeted dental antibiotic stewardship initiatives. Reported by Dental Tribune International on 5 August 2026 and forthcoming in the November 2026 issue of Journal of Dentistry, the study analysed antibiotic prescribing patterns among 153 dentists across 1,723 non-surgical root canal treatments.

The study, conducted through the US National Dental Practice-Based Research Network, involved 104 general dentists and 49 endodontists who enrolled 1,723 patients requiring non-surgical root canal treatment between April and September 2017. Nearly a fifth of patients were prescribed an antibiotic after treatment. Antibiotics were prescribed more often when treated teeth were tender to palpation or showed radiographic evidence of periapical periodontitis, despite neither finding being an indication for systemic antibiotic use according to current guidelines.

Prescribing also varied by dentist characteristics. Clinicians younger than 45 years and those working in large-group or academic settings prescribed antibiotics less frequently, which the authors suggested may reflect more recent training aligned with current guidance. Both the ADA and the American Association of Endodontists (AAE) discourage routine systemic antibiotic use for localised endodontic infections when definitive dental treatment can be provided. A separate analysis of US outpatient prescribing between 2018 and 2022 found that prescribing rates among general dentists had not declined following the ADA’s 2019 guideline update.

The commercial signal is a persistent US dental antibiotic stewardship gap where clinical education, decision support tools and system-level policies emerge as levers. With CPD providers, clinical decision aid vendors and dental practice management platforms increasingly positioned around AMR, expect coordinated response from ADA, AAE, Henry Schein One, Curve Dental and Dentrix through the rest of 2026 and 2027.

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