Antibiotic resistance is among the most prominent health threats worldwide in the recent years. About 10% of antibiotics which are prescribed in dental clinics nowadays are considered unnecessary. Worldwide, evidence has shown that 58%–81% of prophylactic dental antibiotic prescriptions are inconsistent with community/international guidelines. Dentists must acknowledge the indications for dental antibiotics, especially when prescribed prior to dental procedures as prophylaxis.

In the United States, antibiotic prophylaxis became much less common than before as dentists now understand that it has no clear benefit, and  the risk of infection and transient bacteremia from dental procedures is similar to that resulting from daily oral health activities. Moreover, antibiotic prophylaxis could induce adverse drug events such as allergy reactions, Clostridium difficile infection and bacterial resistance. An epidemiology of community-associated CDI study found that dental antibiotic prophylaxis was among the highest indications for antibiotics.

Accordingly, the American Heart Association (AHA) and the American Academy of Orthopaedic Surgeons (AAOS) changed their guidelines regarding dental antibiotic prophylaxis for patients at risk of infective endocarditis or prosthetic joint infections. The new guidelines recommend using antibiotic prophylaxis only for patients with specific heart conditions such as history of infective endocarditis, congenital heart defects, heart transplants associated with cardiac valvulopathy as well as prosthetic cardiac valve repair. Patients in this category are recommended for antibiotic prophylaxis prior to gum surgeries, extractions and implant procedures.

There is further controversy regarding postoperative antibiotic prescription, especially about the dose, duration and potential effect. Most of dentists worldwide prescribe postoperative antibiotics especially with major surgeries such as tooth extraction and implant surgery albeit no clear evidence to support this routine. Postprocedure antibiotics are currently prescribed for extended durations (>7 days) which is also not adherent with the above guidelines. Dentists tend to prescribe antibiotics for patients with poor oral hygiene and uncontrolled comorbidities for the sake of successful dental procedures without recurrent infections.

Antibiotic prophylaxis (oral 2–3gm Amoxicillin preoperatively) were found to reduce the risk of implant failure but it is still unclear if postoperative antibiotics are also beneficial. So clinicians must carefully consider the risks and benefits of antibiotics as the risk of adverse events is high. For example, dentists can modify antibiotics prescription with implant surgery to 1 dose prior to the procedure to decrease overprescribing.