Antimicrobial Resistance in Dentistry: Patterns, Challenges, and Strategies

Dental clinicians face rising antimicrobial resistance in dentistry, narrowing empiric options and forcing immediate changes to prescribing and prophylaxis decisions.

Recent surveillance and reviews document meaningful increases in nonsusceptibility among Streptococcus spp., Enterococcus faecalis and Porphyromonas gingivalis. Resistance to beta-lactams and macrolides is rising, and metronidazole activity against anaerobic periodontal pathogens is reduced—shifts that directly affect routine odontogenic infections and endodontic therapy and warrant reassessment of empiric selections.

Implementation gaps persist: inconsistent guideline adherence, patient pressure for antibiotics and gaps in clinician education drive unnecessary prophylaxis, extended courses and a preference for broad-spectrum agents. Those drivers erode guideline-based care and point to the need for clarified indications and point-of-care decision rules in outpatient dental settings.

Practical responses center on stewardship. Targeted stewardship programs in dental clinics, focused clinician education and regular audit-and-feedback cycles can preserve narrow-spectrum agents and reduce selection pressure. Where evidence supports benefit, consider non-antibiotic or host-modulating options as adjuncts to reduce antibiotic exposure.

It's also important to revise local protocols to prioritize narrow-spectrum agents when indicated, escalate culture or sampling for refractory infections, and launch small-scale stewardship pilots with measurable endpoints such as prescription rates, guideline adherence and culture positivity. Clinics can begin with standardized indication checklists, brief clinician training sessions and monthly audit cycles—concrete steps to reduce selection pressure this quarter.

Key Takeaways:

• Streptococcus spp., Enterococcus faecalis and Porphyromonas gingivalis show increased nonsusceptibility to beta-lactams, macrolides and metronidazole—directly affecting empiric choice and dosing in odontogenic and endodontic infections.
• General dental practices, endodontists, oral surgeons and patients receiving prophylaxis are most impacted; expect updates to formularies, checklists and workflows in routine care.
• Implement targeted stewardship interventions—reinforce guideline adherence, provide brief focused training and run routine prescribing audits to reduce unnecessary prescriptions and measure impact.