NHS Dental Prescribing Study Flags Clindamycin, Opioids

A decade-long analysis of NHS primary care dental prescribing in England has found antimicrobial and analgesic prescribing back at pre-pandemic levels, but flagged persistent concerns about clindamycin and dihydrocodeine use. Published in the British Dental Journal on 10 July 2026 and reported on 22 July 2026, the retrospective study covers 2014 to 2023 and highlights the impact of antimicrobial stewardship programmes and COVID-19 disruption on dental prescribing behaviour.

Antimicrobial prescribing by NHS dentists declined considerably across the decade, which the authors attribute to national stewardship initiatives, updated prescribing guidance and rising clinical awareness of antimicrobial resistance. The trend was interrupted during COVID-19 restrictions, when routine care was reduced, remote patient management expanded and antibiotic prescribing rose sharply, but by December 2023 overall antimicrobial prescribing had fallen back to pre-pandemic levels. Amoxicillin remained the most commonly prescribed antibiotic throughout the period, followed by metronidazole. Clindamycin prescribing remained elevated versus pre-pandemic levels, a concern given that UK guidance advises against routine clindamycin use owing to its association with Clostridioides difficile infection.

Analgesic prescribing followed a similar trajectory, declining before the pandemic, rising sharply during restrictions on dental access, and returning close to baseline by the end of 2023. Dihydrocodeine, however, remained higher than pre-pandemic and accounted for more than two-fifths of dental analgesic prescriptions in December 2023. Given the limited role of opioids in acute dental pain and the recognised risks of dihydrocodeine including dependence, nausea and constipation, the authors argue its continued use warrants closer scrutiny. The study calls for continued professional education, regular prescribing audits and adherence to national guidance to sustain stewardship gains.

The commercial signal is a UK dental market where antimicrobial stewardship has moved from initiative to embedded practice, with real behaviour change visible in prescribing data. The clindamycin and dihydrocodeine gaps signal targeted opportunities for stewardship platforms, decision support software and CPD providers. Expect continued NHS focus on audit-driven prescribing behaviour tools as the AMR agenda intensifies through 2026 and 2027.

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