Why Antibiotics Are Overused in Dentistry

Broad-spectrum antibiotics are overused in dentistry because many patients mistakenly believe they are allergic to penicillin. But such allergies are rare and should be investigated by a doctor, says Bodil Lund, president of the Tandvårds-Strama network, which supports rational antibiotic therapy in dentistry.

To what extent are antibiotics used in Swedish dentistry?

Dental care accounted for 6.6% of all antibiotic prescriptions in Sweden in 2020. This is lower than international figures, where dental care typically accounts for around 10%. But they are clearly over-prescribed in Sweden as well.

What is the situation ?

An example is the large geographic differences in prescriptions. We don’t have a good explanation for this. Dentists in Skåne, Västmanland and Stockholm prescribe twice as many antibiotics per population compared to Västerbotten. But we have seen a 30% reduction in prescriptions in Swedish dentistry since the start of Tandvårds-Strama in 2007. However, the reduction is very unevenly distributed both geographically and organizationally, public dental care at the group level experiencing a much greater reduction than private healthcare providers. Broad-spectrum antibiotics should also be used less.

What are the most common infections?

Tooth infections are different from other infections in many ways. These are almost always mixed infections caused by as many as 15 different bacteria. The bacteria are of low virulence, which means that they are not very infectious and come from your own oral flora. Understanding this has implications for diagnosis, sampling, culture, resistance determination, and ultimately treatment.

How should this be handled?

Swedish dentists are good at treating acute infections and distinguishing between those that are so severe that the patient needs to be hospitalized. Penicillin works very well on dental infections. However, about 10% of patients tell their dentist that they are allergic to penicillin, even though only about 1% of the population actually is. Allergic patients are given clindamycin, a broad-spectrum antibiotic. I usually urge dentists here to have their patients seen by a doctor.

What is the most important message put forward by Tandvårds-Strama?

Antibiotics should be used when clearly indicated, otherwise not. Treating infections “just to be on the safe side” is a thing of the past.

But are dentists aware of this?

Yes quite. We are about to update our national dental guidelines. Our goal is to carry out a thorough update and to put in place an annual review structure in order to be able to keep the guidelines up to date. We are also working to identify and close key knowledge gaps about how best to use antibiotics in dentistry.