NHS dental prescribing: What a decade of data reveals

Dental Tribune International

Wed. 22. July 2026

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LONDON, England: A ten-year analysis of National Health Service (NHS) dental prescribing in England suggests that antimicrobial and analgesic prescribing, which increased during COVID-19 restrictions, has largely returned to pre-pandemic levels. However, persistent prescribing of certain drugs highlights the need for continued antimicrobial stewardship, prescribing audits and professional education to support safe, evidence-based dental care.

The retrospective analysis of NHS data examined antimicrobial and analgesic prescribing by NHS primary care dentists between 2014 and 2023. The study assessed long-term prescribing trends, the impact of COVID-19 restrictions and whether prescribing had returned to pre-pandemic levels.

Overall, antimicrobial prescribing declined considerably over the decade. The authors suggest that this may reflect the influence of antimicrobial stewardship initiatives, national prescribing guidance and increased awareness of antimicrobial resistance. A recent systematic review of dental antibiotic stewardship interventions found that audit and personalised feedback, combined with individualised behaviour change messages, are effective in reducing inappropriate antibiotic prescribing in dental practice, whereas evidence for in-person education was uncertain and guideline dissemination alone was ineffective.

This overall downward trend was interrupted during the COVID-19 pandemic, when restrictions on routine dental care led to increased remote management of patients and a temporary rise in antibiotic prescribing. By December 2023, overall antimicrobial prescribing had fallen back to levels comparable with those recorded before the pandemic.

Amoxicillin remained the most commonly prescribed antibiotic throughout the study, followed by metronidazole. While prescribing of most antibiotics reduced after the pandemic, clindamycin remained above pre-pandemic levels. The authors highlight this as a concern because UK guidance recommends avoiding routine clindamycin use owing to its association with Clostridioides difficile infection and the availability of safer alternatives for most dental infections.

Analgesic prescribing showed a similar pattern: rates declined before the pandemic, increased sharply during restrictions on access to dental care and then returned close to baseline by the end of 2023. Despite this overall recovery, prescribing of dihydrocodeine remained higher than before the pandemic and accounted for more than two-fifths of dental analgesic prescriptions in December 2023. Given the limited role of opioids in managing acute dental pain and the recognised risks of dihydrocodeine, including dependence, nausea and constipation, the authors suggest that its continued use warrants closer scrutiny.

The findings suggest that national antimicrobial stewardship programmes have contributed to sustained reductions in prescribing, although pandemic-related disruptions temporarily reversed this progress. The study concludes that continued professional education, regular prescribing audits and adherence to national guidance are needed to further reduce inappropriate antimicrobial and opioid prescribing. The authors emphasise that particular attention should be paid to limiting clindamycin and dihydrocodeine use. They argue that doing so would improve patient safety and support wider efforts to tackle antimicrobial resistance.

The article, titled “Ten-year trends in antimicrobial and analgesic prescribing by NHS dentists in England: A retrospective analysis study”, was published on 10 July 2026 in the British Dental Journal.