Antibiotic and Opioid Stewardship in Dentistry

Medication stewardship refers to efforts by frontline healthcare providers (e.g., hospitals, doctors’ offices, dental offices, etc.) to promote the safe and appropriate use of medications. Stewardship not only ensures that the appropriate drug is prescribed, but also that it is prescribed at the right dose and for the right duration.Antibiotic and opioid stewardship programs are the most common types of stewardship programs. Antibiotics are a powerful tool that have made once deadly infections easily treatable. However, overuse of antibiotics can lead to bacterial resistance, in which bacteria that were once responsive to antibiotic treatment become less susceptible, leading to diseases that are harder to treat, with potentially poorer outcomes. Antibiotic overuse can also lead to other adverse events and health complications like infection with Clostridioides difficile. Similarly, while opioids can be an important tool in the treatment and management of pain, their overprescribing can result in prescription misuse, opioid use disorder, and overdose. Between 1999 and 2018, more than 232,000 individuals in the United States died because of an overdose involving a prescription opioid.

Dentists are high prescribers of antibiotics and opioids, accounting for 10% of opioids and 10% of antibiotic prescriptions4 in the United States. Many of these prescriptions are suspected to be inappropriate or unnecessary, such as antibiotics recommended by other medical doctors for dental infections and procedures, with overlap existing between the highest prescribers of opioids and the highest prescribers of antibiotics. However, antibiotic and opioid stewardship programs are nascent in the dental setting, making this an area with a lot of opportunity to improve prescribing practices. In developing and implementing stewardship programs, there are a number of challenges unique to dentistry that have to be recognized.