Resources to Support Antibiotic Stewardship in the Dental Office

Provider Commitment Poster and Brochure

Intended Use: To be displayed in a patient-centered location to educate patients on antibiotic stewardship in the dental setting.

Provider commitment posters have been shown to positively impact patient expectations around antibiotic prescribing. These posters can be personalized for your dental office by providing us with your logo. The brochures cover the benefits and risks of antibiotics used in dentistry.

Request a Free Brochure or Poster

Delayed prescribing Notepad

Intended Use: To use as a patient-facing resource to support the recommendations from the 2019 ADA guidelines for management of and distribution in the dental office among patients who would benefit from delayed prescribing.

Delayed prescribing, or watchful waiting, of antibiotics is a practice that can be used by health care providers to reduce unnecessary prescribing. In this practice, dental health professionals advise their patients to fill their prescription only if their symptoms worsen or do not improve after a period of time.

MARR has developed a tool to help dental professionals practice delayed prescribing. This 4” x 6”, 25 page notepad describes how and why the patient should wait to have their antibiotic prescription filled, and addresses pain management.

MARR provides this notepad to dental offices free-of-charge.

Request delayed prescribing notepad

Chairside Guides for Dental Pain and Swelling

Intended Use: To keep in an accessible location in the office and aid dentists in proper antibiotic prescribing for dental pain and swelling.

There are two chairside guides on antibiotic use for dental pain and intra-oral swelling:

• the guide with the purple heading is when dental treatment is immediately available
• the guide with the orange heading is when dental treatment is not immediately available

ADA chairside guide on antibiotic use for dental pain and intra-oral swelling when dental treatment IS immediately available

View full chairside guide PDF for when dental treatment is available

ADA chairside guide on antibiotic use for dental pain and intra-oral swelling when dental treatment IS NOT immediately available

View full chairside guide PDF for when dental treatment is not immediately available

Penicillin Allergy Assessment Tool (PAAT)

Intended Use: To support the dental office in referring appropriate patients for penicillin allergy assessment.

Penicillin Allergy Assessment is an antibiotic stewardship practice that promotes patient safety and informed decision-making for the consideration of optimal antibiotic therapy. This practice calls on healthcare settings, like dentists’ offices, to collaborate with patients and decide whether further evaluation is recommended. The Penicillin Allergy Assessment Tool (PAAT) has been developed by MARR and the Organization for Safety and Asepsis Procedures (OSAP). The tool consists of an algorithm and related indicators for use. To read the accompanying paper describing how the entire dental team can effectively utilize this tool, continue to the Journal of the Michigan Dental Association on this page.

View/ Download PDF of the tool

MARR provides 4" x 6" laminated cards to dental offices free-of-charge.

Request a Laminated PAAT Card

Penicillin Allergy Reassessment Tool (PARTI)

Intended use: As a communicative resource to facilitate mislabeling of penicillin allergies across all healthcare settings, including dental offices and pharmacies.

Mislabeling of penicillin allergies has been associated with increased antimicrobial resistance, adverse effects, length of stay, and health care costs related to the use of broad-spectrum antibiotics.

Dentists can use this tool to implement and enhance antimicrobial stewardship practices in the outpatient setting.

For infective endocarditis prophylaxis, current guidelines support pre-medication in a relatively small subset of patients. Refer to the article Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association by Walter R. Wilson et al Circulation 2021.

In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.

Please refer to the ADA's webpage Antibiotic Prophylaxis Prior to Dental Procedures, for guidelines and more information.

Literature Summary: 2023 Antibiotic Prophylaxis Prior to Invasive Dental Procedures in Patients with Total Joint Replacement

What do Dental Teams need to know about Antibiotic Prophylaxis Prior to Invasive Dental Procedures in Patients with Total Joint Replacement (TJR)?

• Dental procedures pose no greater risk for systemic bacteremia than activities of daily living, such as brushing your teeth or eating.
• The use of antibiotic prophylaxis is not recommended. The use of antibiotic prophylaxis poses unnecessary risk of adverse drug reactions and/or antibiotic resistance.
• Recommendations for antibiotic prophylaxis should be considered individually in each patient, depending on their medical history.

Editable Letter to healthcare provider regarding prophylaxis in patient with prosthetic joint implant

Recent evidence shows that for patients with more than one year post prosthetic device implant, the risk of antibiotic prophylaxis typically outweighs the benefits.This letter is a collaborative form of communication between dentists and their patients’ healthcare providers, used to highlight the latest guidelines on prophylaxis for their patients with total joint replacement.

American Association of Orthopedic Surgeons Appropriate Use Prophylaxis Tool

The American Academy of Orthopaedic Surgeons (AAOS) and American Dental Association (ADA) Council on Scientific Affairs have developed this Appropriate Use Criteria (AUC) to identify the appropriateness of the use of prophylactic antibiotics in the management of patients who have had orthopaedic implants, undergoing dental procedures. Patient information may be input into the tool and resulting recommendations printed out.

AUC Decision Support Tool Online

View / Download AAOS appropriate use criteria PDF

Antibiotic Stewardship

Key Points

• The U.S. Centers for Disease Control and Prevention’s (CDC’s) Division of Oral Health defines antibiotic stewardship as “the effort to measure antibiotic prescribing; to improve antibiotic prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed; to minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics; and to ensure that the right drug, dose, and duration are selected when an antibiotic is needed."
• Antibiotic prophylaxis prior to dental procedures should be reserved for patients at high risk of post-treatment complications.
• According to the CDC, “appropriate antibiotic prescribing means antibiotics are only prescribed when needed, and when needed, the right antibiotic is selected and prescribed at the right dose and for the right duration” and “appropriate antibiotic prescribing should be in accordance with evidence-based national and local clinical practice guidelines, when available.”
• The ADA Center for Evidence-Based Dentistry published a clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling, recommending against use of antibiotics for most of these conditions and instead recommends only the use of dental treatment and, if needed, over-the-counter pain relievers such as acetaminophen and ibuprofen.

ADA’s antibiotic stewardship webpage

Key Topics:

• Antibiotic resistance
• Antibiotics: adverse effects
• C. difficile infection
• Antibiotic prophylaxis
• Antibiotics for therapeutic use

Antibiotic Stewardship in the Dental Office

This 23-minute, case-based, educational video covers current guidelines for use of antibiotics in dental patients. Real-life scenarios are provided, illustrating how the entire dental office can support antibiotic stewardship.

This web page offers the complete collection of tools and resources that were reviewed during the video.

Although this video was developed with students in mind it is appropriate the entire dental office as a collective effort is needed by all to learn, educate, and implement guidelines for proper antibiotic use.

Please consider providing feedback on the video so that we may improve the resources we develop.

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Safe Antibiotic Use for Dental Patients

Videos, resources, and materials for dental patients are available on our Appropriate Antibiotic Use page

1. Penicillin Allergy Assessment and Medical Referral to Promote Antibiotic Stewardship | March 2022
2. Antibiotic Stewardship in Dentistry: Opportunities and Challenges | October 2019
3. Antibiotic Guidelines for Dentistry: Who, When, What, Why, and How to Prescribe | August, 2020
4. Delayed Antibiotic Prescribing: A Simple Strategy to Promote Antibiotic Stewardship | February 2021

Since the 2019 ADA Guidelines advocate for patients with dental infections to discontinue antibiotic treatment 24 hours after resolution of pain and swelling, patients may have leftover antibiotics. Patients should be counseled to:

• Never save antibiotics for future use
• Never share antibiotics with another person
• Never flush antibiotics