Canadian dentists prescribe approximately 10% of all antibiotics dispensed nationally, and research suggests that up to 80% of those prescriptions may be unnecessary. As of June 2026, antimicrobial resistance (AMR) is accelerating worldwide, and dental prescribing habits are under increasing scrutiny from Health Canada, the Canadian Dental Association (CDA), and provincial regulatory bodies including the Royal College of Dental Surgeons of Ontario (RCDSO).
Antimicrobial resistance is not a distant public health abstraction. It is a clinical reality that affects patient outcomes in dental practices today. When antibiotics are prescribed unnecessarily — for conditions that would resolve with definitive dental treatment alone — the result is not just wasted medication. It is a measurable contribution to the selection pressure that creates resistant bacterial strains, strains that may later cause treatment-resistant infections in the same patient or in the broader community.
The Scale of Dental Antibiotic Overprescribing in Canada
A study published in the Journal of the Canadian Dental Association examined antibiotic prescribing trends in British Columbia over nearly two decades. The findings were striking: while overall antibiotic prescribing across all medical disciplines in BC declined by 12.8% between 1996 and 2013, dental antibiotic prescribing increased by 62.2% over the same period.
That divergence is significant. While physicians have responded to antimicrobial stewardship campaigns with measurable reductions in unnecessary prescribing, the dental profession has moved in the opposite direction. More recent data suggests the trend has moderated but not reversed.
The most common scenarios where dental antibiotics are overprescribed include:
- Irreversible pulpitis: Pain from an inflamed pulp is treated with antibiotics when the definitive treatment is endodontic therapy or extraction. Antibiotics do not resolve pulpitis.
- Localized dental abscess: A well-circumscribed periapical abscess in an otherwise healthy patient is best managed with incision and drainage or extraction. Antibiotics are indicated only when systemic signs of infection are present — fever, malaise, lymphadenopathy, or fascial space involvement.
- Post-extraction prophylaxis in healthy patients: Routine antibiotic prescriptions following uncomplicated extractions in immunocompetent patients are not supported by current evidence.
- Periodontal conditions: Chronic periodontitis is a bacterial biofilm disease managed through mechanical debridement. Systemic antibiotics are reserved for aggressive or refractory cases, not routine scaling appointments.
Pro Tip: Before writing an antibiotic prescription, apply this three-part test: (1) Is there a systemic sign of infection? (2) Has definitive dental treatment been provided or is it imminent? (3) Is the patient immunocompromised or otherwise at elevated risk? If the answer to all three is no, the prescription is likely unnecessary.
Why Dental Overprescribing Persists
Dental antibiotic overprescribing is not driven by ignorance. Most dentists understand that antibiotics do not treat pulpitis. The drivers are more complex:
- Patient expectations: Patients in pain expect a tangible intervention. A prescription feels like action, even when it is not the appropriate action. Explaining that definitive treatment — not antibiotics — is what will resolve their pain takes more time and communication skill.
- Time pressure: In a busy practice, writing a prescription takes 30 seconds. Performing an emergency pulpotomy or extraction takes 20 to 45 minutes and may require rearranging the schedule. When the day is already overbooked, the prescription becomes a deferral mechanism.
- Medicolegal anxiety: Some dentists prescribe antibiotics as a perceived safety net — "just in case" the infection worsens before the patient returns for definitive treatment. The medicolegal risk of an adverse antibiotic reaction or of contributing to resistance is often underweighted in this calculus.
- Outdated training: Prescribing guidelines have evolved substantially over the past decade. Dentists who graduated before 2015 may have been trained on protocols that are no longer consistent with current evidence, particularly around prophylactic prescribing for joint replacements.
The Joint Replacement Prophylaxis Question
For years, many Canadian dentists routinely prescribed prophylactic antibiotics before dental procedures for patients with prosthetic joints. The rationale was that bacteremia during dental treatment could seed a joint prosthesis and cause a periprosthetic infection.
Current evidence does not support routine antibiotic prophylaxis for dental patients with prosthetic joints. The CDA and international guidelines have moved away from blanket prophylaxis for this population. The risk of a dental-procedure-related joint infection is extremely low, and the risks of unnecessary antibiotic use — allergic reactions, Clostridioides difficile infection, and contribution to antimicrobial resistance — outweigh the theoretical benefit.
Despite this, prescribing patterns in many practices have not caught up with the evidence. Orthopedic surgeons sometimes still send patients to dental appointments with a recommendation for prophylactic antibiotics, creating a communication gap between medical specialties that the dentist must navigate.
Pro Tip: When an orthopedic surgeon requests antibiotic prophylaxis for a dental patient with a joint replacement, have a direct conversation with the surgeon rather than simply complying. Reference the CDA's position and the absence of supporting evidence. In most cases, the surgeon will defer. Document the conversation in the patient record.
What Canadian Regulatory Bodies Are Doing
The Canadian Dental Association participated in World Antimicrobial Resistance Awareness Week in November 2025 under the campaign "Not all Bugs Need Drugs," signalling that AMR stewardship is becoming a professional priority for organized dentistry in Canada.
Health Canada has identified antimicrobial resistance as a national health priority and has funded research into dental prescribing patterns as part of broader AMR surveillance efforts. The Pan-Canadian Action Plan on Antimicrobial Resistance includes dental prescribing within its scope, though enforcement mechanisms remain limited.
At the provincial level, the RCDSO has not yet issued a standalone practice standard on antibiotic stewardship, but its general standards of practice require dentists to provide treatment that reflects current, evidence-based clinical guidelines. Prescribing antibiotics in a manner that contradicts current evidence could, in principle, form the basis of a professional conduct concern.
A qualitative study published in JAC-Antimicrobial Resistance in 2024, which interviewed Canadian dentistry sector leaders and antimicrobial stewardship experts, recommended several systemic interventions:
- Development of a national dental prescription database to track prescribing volumes and patterns
- Integration of antimicrobial stewardship education into dental school curricula and continuing education requirements
- Audit-and-feedback programs modelled on successful medical stewardship initiatives, adapted for the dental practice setting
- Provincial monitoring mechanisms that provide dentists with anonymized benchmarking data comparing their prescribing rates to peers
Practical Steps for Your Practice
Antimicrobial stewardship does not require a complex program. For a dental practice in Ontario, it starts with three concrete actions:
- Audit your prescribing: Review the last three months of antibiotic prescriptions from your practice. Categorize each by indication. Identify how many were prescribed for conditions where definitive dental treatment alone would have been appropriate. This exercise alone often shifts prescribing behaviour.
- Update your patient communication: Prepare a brief explanation — two to three sentences — that you or your team can deliver when a patient expects antibiotics but does not need them. Something like: "The source of your pain is the tooth itself, and antibiotics cannot fix that. What will resolve this is [the specific treatment]. Antibiotics would not help and carry their own risks."
- Review prophylaxis protocols: Ensure your practice's prophylaxis guidelines reflect current CDA and RCDSO positions. Specifically, confirm that routine prosthetic joint prophylaxis is not part of your default protocol unless the patient's physician provides a specific clinical justification.
Frequently Asked Questions
Q: Should dentists in Ontario prescribe antibiotics for dental abscesses?
Antibiotics are not the first-line treatment for a localized dental abscess in an otherwise healthy patient. The standard of care is definitive treatment: incision and drainage, endodontic therapy, or extraction. Antibiotics are indicated when systemic signs of infection are present, such as fever, facial swelling extending beyond the immediate area, or lymphadenopathy. Ontario dentists should follow current evidence-based guidelines from the CDA and RCDSO when making prescribing decisions.
Q: Do dental patients with joint replacements need antibiotics before dental procedures in Canada?
Current evidence does not support routine antibiotic prophylaxis before dental procedures for patients with prosthetic joints. The CDA's position aligns with international consensus that the risk of dental-procedure-related joint infection is extremely low and does not justify the risks associated with unnecessary antibiotic use. If an orthopedic surgeon recommends prophylaxis, dentists should discuss the current evidence with the surgeon and document the decision in the patient record.
Q: What is antimicrobial stewardship in a dental practice?
Antimicrobial stewardship in a dental practice refers to systematic efforts to ensure that antibiotics are prescribed only when clinically indicated, at the correct dose, for the appropriate duration, and with the narrowest effective spectrum. For dental practices in Canada, this includes auditing prescribing patterns, following CDA and RCDSO guidelines, educating patients about when antibiotics are and are not appropriate, and staying current on evolving evidence through continuing education.
EBIKO Dental will continue monitoring regulatory developments in antimicrobial stewardship as they affect dental practices across Canada.