US study examines endodontic prescribing patterns

Dental Tribune International

Wed. 5. August 2026

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MINNEAPOLIS, US: Despite recommendations to limit systemic antibiotic use for localised endodontic infections, prescribing in endodontic care remains an important antibiotic stewardship concern. Efforts to improve prescribing practices require an understanding of the factors that influence clinicians’ decisions. A US practice-based study has examined the circumstances and dentist characteristics associated with potentially inappropriate antibiotic use, providing evidence that may inform targeted stewardship measures.

The study was conducted through the US National Dental Practice-Based Research Network and involved 104 general dentists and 49 endodontists. Between April and September 2017, the participating clinicians enrolled 1,723 patients requiring non-surgical root canal treatment. Overall, nearly a fifth 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. The authors noted that these findings are not, by themselves, indications for antibiotic use according to current guidelines. They suggested that the pattern may indicate a gap in understanding of the distinction between inflammatory signs and infection requiring systemic antibiotic treatment.

Prescribing also differed according to dentist characteristics. Clinicians younger than 45 years, non-Hispanic white dentists, and practitioners working in large-group or academic settings prescribed antibiotics less frequently. The authors suggested that lower prescribing among younger clinicians may reflect more recent training aligned with current guidance and that practitioners working in large-group or academic settings may have greater exposure to evidence-based protocols.

The authors stated that the findings raise concern about a continuing gap between guideline-based recommendations and clinical practice, but they cautioned that the 2017 data may not fully reflect current practice. However, a separate analysis of US outpatient prescribing between 2018 and 2022 found that prescribing rates among general dentists had not declined after the American Dental Association (ADA) issued its 2019 guideline on antibiotic use for the urgent management of pain and intra-oral swelling associated with pulpal and periapical conditions.

Guidance from the ADA and the American Association of Endodontists discourages routine systemic antibiotic use for localised endodontic infections when definitive dental treatment can be provided. The ADA guideline, which applies to immunocompetent adults, supports antibiotic use in cases involving systemic signs, and the American Association of Endodontists similarly recommends limiting adjunctive antibiotics to selected clinical situations, including infections with systemic involvement.

In the current study, the researchers noted that the observed variation according to dentist age and practice setting is consistent with broader evidence that recent training and institutional culture influence prescribing decisions. They concluded that continuing education, clearer clinical decision aids and possible system-level policies are needed to reinforce appropriate antibiotic use. They said that the findings may inform initiatives aimed at reducing unnecessary prescribing and support communication with patients about evidence-based care.

The study, titled “Antibiotics after non-surgical root canals: National Dental Practice-Based Research Network findings”, was published in the November 2026 issue of the Journal of Dentistry.

Topics:

Tags:

American Association of Endodontists American Dental Association Antibiotic overprescription Antibiotic stewardship Endodontics Root canal treatment

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