EC Dental Science

Review Article Volume 25 Issue 1 - 2026

Stewardship in Action: Optimizing Antibiotic Use in Periodontal Practice

Arjun MR1, Nanditha Chandran1, Jilu Abraham1, Paventhan Jolie Coeur2, Kishor Rajkumar3* and Lemi S3

1Reader, Mahe Institute of Dental Sciences and Hospital, Mahé, Pondicherry, India

2Post Graduate, Mahe Institute of Dental Sciences and Hospital, Mahé, Pondicherry, India

3Final Year Student, Mahe Institute of Dental Sciences and Hospital, Mahé, Pondicherry, India

*Corresponding Author: Kishor Rajkumar, Final Year Student, Mahe Institute of Dental Sciences and Hospital, Mahé, Pondicherry, India.
Received: December 20, 2025; Published: January 02, 2025



Antibiotic stewardship has emerged as a critical strategy in addressing the global challenge of antimicrobial resistance. In dentistry, and particularly in periodontics, antibiotics are often prescribed as adjuncts to mechanical debridement and surgical therapy. However, evidence indicates that misuse, overuse, and inappropriate selection of antimicrobial agents contribute to resistance, adverse reactions, and disruption of the oral microbiome. Antibiotic stewardship programs (ASPs) emphasize the rational, evidence-based use of antibiotics through guidelines, surveillance, education, and interdisciplinary collaboration. In periodontics, stewardship focuses on identifying precise clinical indications, limiting empirical prescriptions, favoring local drug delivery when appropriate, and considering host-modulation approaches as alternatives. This article reviews the principles, scope, and implementation of antibiotic stewardship in periodontal practice, highlighting the balance between clinical effectiveness and public health responsibility. Strengthening stewardship in periodontics not only optimizes patient outcomes but also plays a vital role in curbing the spread of antimicrobial resistance.

 Keywords: Antibiotics; Antimicrobial Resistance (AMR); Amoxicillin; Periodontitis; Overdosage; Periodontist

  1. “Global framework for development and stewardship to combat antimicrobial resistance: draft roadmap”. Geneva: World Health Organization (2017).
  2. McGowan JE Jr and Gerding DN. “Does antibiotic restriction prevent resistance?” New Horizons 3 (1996): 370-376.
  3. Gerding DN. “The search for good antimicrobial stewardship”. The Joint Commission Journal on Quality Improvement 8 (2001): 403-404.
  4. “Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries. A practical toolkit”. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO (2019).
  5. File TM Jr., et al. “Antimicrobial stewardship: importance for patient and public health”. Clinical Infectious Diseases 3 (2014): S93-S96.
  6. Uchil RR., et al. “Strategies to combat antimicrobial resistance”. Journal of Clinical and Diagnostic Research 7 (2014): ME01-ME04.
  7. Dixit D., et al. “Compliance with the 4Ds of antimicrobial stewardship practice in a tertiary care centre”. JAC-Antimicrobial Resistance 3 (2021): dlab135.
  8. Mansour O and Al-Kayali R. “Community pharmacistsꞌ role in controlling bacterial antibiotic resistance in Aleppo, Syria”. Iranian Journal of Pharmaceutical Research 4 (2017): 1612-1620.
  9. Guerrini L., et al. “Antibiotics in dentistry: A narrative review of literature and guidelines considering antibiotic resistance”. Open Dentistry Journal 13 (2019): 383-398.
  10. Chung WC., et al. “Outcomes of autotransplanted teeth with complete root formation: a systematic review and meta-analysis”. Journal of Clinical Periodontology 4 (2014): 412-423.
  11. Marthaler TM. “Changes in dental caries 1953-2003”. Caries Research 3 (2004): 173-181.
  12. Zaman SB., et al. “A review on antibiotic resistance: alarm bells are ringing”. Cureus6 (2017): e1403.
  13. Selvarajan R., et al. “Evolution and emergence of antibiotic resistance in given ecosystems: possible strategies for addressing the challenge of antibiotic resistance”. Antibiotics (Basel)1 (2022): 28.
  14. Kapoor A., et al. “Systemic antibiotic therapy in periodontics”. Dental Research Journal (Isfahan)5 (2012): 505-515.
  15. Slots J and Ting M. “Systemic antibiotics in the treatment of periodontal disease”. Periodontology 2000 28 (2002): 106-176.
  16. Ellen RP and McCulloch CA. “Evidence versus empiricism: rational use of systemic antimicrobial agents for treatment of periodontitis”. Periodontology 2000 10 (1996): 29-44.
  17. Slots J and Research, Science and Therapy Committee. “Systemic antibiotics in periodontics”. Journal of Periodontology 11 (2004): 1553-1565.
  18. van Winkelhoff AJ., et al. “Systemic antibiotic therapy in periodontics”. Periodontology 2000 10 (1996): 45-78.
  19. Carranza FA., et al. “Clinical periodontology”. 10th Philadelphia: Jolkovsky DL, Ciancio S. Chemotherapeutic agents.
  20. Hammami C and Nasri W. “Antibiotics in the treatment of periodontitis: a systematic review of the literature”. International Journal of Dentistry (2021): 6846074.
  21. Gasner NS., et al. “Necrotizing periodontal diseases”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2025).
  22. Blair FM and Chapple IL. “Prescribing for periodontal disease”. Primary Dental Journal 4 (2014): 38-43.
  23. Slots J and Research, Science and Therapy Committee. “Systemic antibiotics in periodontics”. Journal of Periodontology 11 (2004): 1553-1565.
  24. Vidović Juras D., et al. “Antibiotic prophylaxis prior to dental procedures”. Dentistry Journal (Basel) 11 (2024): 364.
  25. Chaudhry SB., et al. “Cephalosporins: A focus on side chains and β-lactam cross-reactivity”. Pharmacy (Basel) 3 (2019): 103.
  26. Murray CJL., et al. “Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis”. The Lancet10325 (2022): 629-655.
  27. Chang Y., et al. “Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China”. PLoS One6 (2019): e0214779.
  28. Elgassim MAM., et al. “A rare case of metronidazole overdose causing ventricular fibrillation”. Cureus 5 (2022): e24728.
  29. Nammi J., et al. “Antibiotic misuse: An in-depth examination of its global consequences and public health challenges”. Cureus6 (2025): e85941.
  30. Ranjbar R., et al. “Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis”. Evidence-Based Nursing (2022): ebnurs-2022-103540.
  31. World Bank. “Drug-resistant infections: A threat to our economic future”. Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0 IGO (2017).
  32. Antimicrobial resistance, World Health Organization.
  33. Thompson W., et al. “Tackling antibiotic resistance: why dentistry matters”. International Dental Journal 6 (2021): 450-453.
  34. Costelloe C., et al. “Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis”. British Medical Journal 340 (2010): c2096.
  35. Shah S., et al. “How did COVID-19 impact on dental antibiotic prescribing across England?” British Dental Journal 9 (2020): 601-604.
  36. Cope AL., et al. “Antibiotic prescribing in UK general dental practice: a cross-sectional study”. Community Dentistry and Oral Epidemiology 2 (2016): 145-153.
  37. Suda KJ., et al. “Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015”. JAMA Network Open 5 (2019): e193909.
  38. Rahul Harikumar Lathakumari., et al. “Antibiotics and the gut microbiome: Understanding the impact on human health”. Medicine in Microecology 20 (2024): 100106.
  39. Raymond F., et al. “The initial state of the human gut microbiome determines its reshaping by antibiotics”. ISME Journal 3 (2016): 707-720.
  40. De La Cochetière MF., et al. “Resilience of the dominant human fecal microbiota upon short-course antibiotic challenge”. Journal of Clinical Microbiology 11 (2005): 5588-5592.
  41. Ahmadi H., et al. “Antibiotic therapy in dentistry”. International Journal of Dentistry (2021): 6667624.
  42. Ready D., et al. “Effect of amoxicillin use on oral microbiota in young children”. Antimicrobial Agents and Chemotherapy 8 (2004): 2883-2887.
  43. Antibiotic Stewardship in Dentistry, Unicorn denmart.
  44. Morency-Potvin P., et al. “Antimicrobial stewardship: How the microbiology laboratory can right the ship”. Clinical Microbiology Reviews 1 (2016): 381-407.
  45. Dellit TH., et al. “Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship”. Clinical Infectious Diseases 2 (2007): 159-177.
  46. “Core Elements of Hospital Antibiotic Stewardship Programs”. Atlanta, GA: US Department of Health and Human Services, CDC (2019).
  47. Rohde JM., et al. “Role of the hospitalist in antimicrobial stewardship: a review of work completed and description of a multisite collaborative”. Clinical Therapeutics 6 (2013): 751-757.
  48. Srinivasan A. “Engaging hospitalists in antimicrobial stewardship: the CDC perspective”. Journal of Hospital Medicine 1 (2011): S31-S33.
  49. Manning ML., et al. “Antimicrobial stewardship and infection prevention-leveraging the synergy: A position paper update”. American Journal of Infection Control 4 (2018): 364-368.
  50. Moody J., et al. “Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists”. American Journal of Infection Control 2 (2012): 94-95.
  51. Sanz M., et al. “Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline”. Journal of Clinical Periodontology 22 (2020): 4-60.
  52. “AAE position statement: AAE guidance on the use of systemic antibiotics in endodontics”. Journal of Endodontics 9 (2017): 1409-1413.
  53. Lockhart PB., et al. “Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association”. Journal of the American Dental Association 11 (2019): 906-921.e12.
  54. Antimicrobial Resistance Division (AMR), National Action Plans and Monitoring and Evaluation (NPM), 9789241509763.
  55. National Action Plan and Monitoring and Evaluation, World Health Organization, 9789240061545.
  56. Winkler PC., et al. “Decision-making on systemic antibiotics in the management of periodontitis: A retrospective comparison of two concepts”. Journal of Clinical Periodontology 9 (2024): 1122-1133.
  57. Barca E., et al. “Adjunctive use of antibiotics in periodontal therapy”. Journal of Istanbul University Faculty of Dentistry 3 (2015): 55-62.
  58. Haque MM., et al. “Advances in novel therapeutic approaches for periodontal diseases”. BMC Oral Health1 (2022): 492.
  59. Tania Goutam., et al. “Antibiotic Prescription for Periodontal Therapy: A Survey of Current Trends in Jammu Region”. Journal of Medical Sciences1 (2023): 17-22.
  60. Dhanushka Leuke Bandara. “Systemic antibiotics for periodontal disease prescribe or not to prescribe?” The Saint’s International Dental Journal 5 (2021): 1.

Kishor Rajkumar., et al. “Stewardship in Action: Optimizing Antibiotic Use in Periodontal Practice”. EC Dental Science  25.1 (2026): 01-13.

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