TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background:

Antimicrobial resistance (AMR) represents a major global public health threat, with inappropriate antibiotic use in dentistry contributing significantly to this burden. Despite the availability of evidence-based clinical guidelin es, antibiotic overprescribing remains common in dental practice, driven by a complex interplay of clinical, behavioral, and systemic factors.

Aim:
This study aimed to examine the rational use of antibiotics in dentistry by synthesizing recent international evidence and exploring dentists’ prescribing behaviors through qualitative analysis.

Methods:
A narrative review of literature published between 2021 and 2026 was conducted using PubMed, Scopus, and Web of Science, focusing on therapeutic antibiotic use, prophylactic indications, and antimicrobial stewardship interventions. In parallel, a qualitative focus group study was performed involving ten dentists recruited through purposive sampling to ensure diversity in experience, specialty, and practice setting. Data were collected through a semi-structured discussion, audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

Results:
The literature review confirmed that a substantial proportion of dental antibiotic prescriptions remain inappropriate, with limited clinical benefit in many common dental conditions. The qualitative analysis identified four key themes influencing prescribing behavior: (1) patient expectations and misconceptions, (2) defensive medicine and fear of complications, (3) gaps in guideline adherence and reliance on non-evidence-based knowledge sources, and (4) systemic and regulatory challenges. Participants reported significant pressure from patients, uncertainty in clinical decision-making, and barriers related to diagnostic limitations and healthcare system structures.

Conclusions:
Inappropriate antibiotic prescribing in dentistry is a multifactorial issue extending beyond knowledge deficits to include behavioral and systemic determinants. Effective antimicrobial stewardship in dentistry requires a comprehensive approach combining guideline implementation, behavioral interventions, targeted education, and regulatory reforms. Addressing both clinician and patient-related factors is essential to improving prescribing practices and mitigating the global impact of AMR.

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