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Letters: Antibiotic use

October 19, 2015

I read, with considerable interest, the article “ADA Supports Responsible Antibiotic Use,” which was published in the June 15 ADA News. The message was generally good. According to, by following an evidence-based approach, there is a resultant decrease in prophylactic antibiotics for most heart conditions and joint replacements. The article further reports on an overall significant yearly mortality (23,000) and morbidity (2 million-plus hospitalizations), as a direct result of antibiotic-caused superinfections. This is a major health problem.

The article also states that, of all providers, dentists prescribe a disproportionate percentage of antibiotics. There is more discussion as to how the ADA will participate at a national consortium and provide expertise on proper use of antibiotics.

Where this article falls short (and the ADA for that matter) is not recognizing that our parent organization has not developed and published specific, useful guidelines on appropriate antibiotic usage. In our literature, there are data from randomized clinical trials and critical reviews that show that antibiotics are largely ineffective in dentistry or that existing data are inconclusive.

Perhaps the most egregious overprescribing is for perceived and existing endodontic problems, particularly when there are adverse signs and symptoms. Surveys show prescribing to be frequent1. Again, clinical trials and critical reviews2, as related to acute apical abscess3, demonstrate that antibiotics are not useful in reducing or preventing symptoms or signs. Specific concerns and recommendations, which are distributed to members of the ADA, have been published recently by the American Association of Endodontists4.

I searched the website for guidelines based on evidence and found nothing useful for practitioners. Why? Why does the ADA suddenly recognize that antibiotic abuse in dentistry is a major problem? Until this happens, with a number of unfortunate deaths and/or hospitalizations resulting in lawsuits, the promiscuous misuse and abuse of antibiotics will continue. Dentistry has the opportunity to become part of the solution and not a major contributor to the problem.

Richard E. Walton, D.M.D.
Iowa City, Iowa



  1. Whitten BH, Gardiner DL, Jeansonne BG, Lemon RR. Current trends in endodontic treatment: report of a national survey. JADA. 1996;127(9):1333-1341.
  2. Fouad AF, Rivera EM, Walton RE. Penicillin as a supplement in resolving the localized acute apical abscess. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(5):590-595.
  3. Canadian Collaboration on Clinical Practice Guidelines in Dentistry (CCCD). Clinical practice guideline on treatment of acute apical abscess (AAA) in adults. Evid Based Dent. 2004;5(1):8.
  4. Endodontics: Colleagues for Excellence—Winter 2012, Use and Abuse of Antibiotics. Available at: Accessed October 12, 2015.