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Published: May 7, 2026
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The most common settings in which Americans receive unnecessary antibiotics are not the places most people would guess. Primary care offices and urgent care clinics get most of the attention in the public conversation about overprescribing, but a growing body of evidence points to a quieter and largely unaddressed driver: the dentist’s chair. American dentists wrote 27.3 million antibiotic prescriptions in 2025, and the available data suggest that the great majority of those prescriptions, particularly the ones written before or after dental procedures, are not supported by the evidence.
The data on dental prescribing
Journalist Liz Szabo recently published an illuminating three-part series on dental overprescribing for the Center for Infectious Disease Research and Policy. Her reporting documents that 80 percent of preventive dental antibiotic prescriptions, meaning the ones written to ward off an infection that has not yet occurred, go to patients undergoing procedures for which there is no evidence the antibiotic provides any benefit. This is not a marginal problem at the edges of practice. It is a routine clinical default that has become embedded in how dental care is delivered in the United States.
I had to confront this myself in February. I needed urgent dental work, and the dentist sent me home with a week of amoxicillin to take after the procedure. I did what any epidemiologist would do, which is to go directly to the medical literature and look up whether antibiotics are actually proven to prevent infection or promote healing after the specific procedure I had just had. The answer was no. The literature shows no benefit, but it remains standard practice for many dentists. I did not take the antibiotics, and so far my teeth are fine.
The clindamycin problem
The specific drug choices in dental prescribing make the problem worse. The second most commonly prescribed antibiotic by dentists is clindamycin, which is the same drug identified in the recent Nature Medicine study as the most damaging to the gut microbiome of any antibiotic class examined. Clindamycin also carries a black-box warning, the FDA’s strongest safety caution, for its risk of causing life-threatening C. difficile infections. A drug with that risk profile should be reserved for situations in which it is the right drug for the right organism, prescribed at the right dose for the shortest necessary duration. Instead, it is being handed out routinely, often to patients who do not need any antibiotic at all.
Every unnecessary prescription has a downstream cost
The harms of overprescribing extend well beyond the individual patient. Every unnecessary course of antibiotics accelerates the evolution of bacteria that can evade the drugs we have, and drug-resistant infections already cause an estimated five million deaths worldwide every year. That number is rising as bacteria continue to develop new mechanisms to survive in the presence of antibiotics. When we treat antibiotics as if they were a renewable resource, we shrink the toolbox available to clinicians treating the next sepsis case, the next post-surgical infection, and the next pneumonia. The framing problem here is similar to the one that appears in other parts of public health, where short-term convenience is purchased at the cost of long-term capacity, and the bill comes due years later in the form of harms that fall on people who had nothing to do with the original decision.
Changing prescriber behavior is hard, but it is possible
What clinicians learn during training, even when it is wrong, tends to become the default practice for the rest of their careers. The history of dental opioid prescribing is instructive here. It took a national overdose crisis, widespread state legislation, and mandatory continuing education before dental opioid prescribing meaningfully declined. The same kind of structural intervention is likely going to be needed for antibiotics, because individual conversations with individual dentists will not move the aggregate numbers in the time we have.
There is also a prevention dimension that gets overlooked in this conversation. The single most effective way to reduce antibiotic use is to reduce infections in the first place, and the most reliable way to reduce infections at scale is vaccination. The World Health Organization has estimated that better use of existing vaccines could reduce global antibiotic use by 2.5 billion doses per year. The corollary is also true. As vaccination rates fall under pressure from the contemporary anti-vaccine movement, antibiotic use rises along with the resistance pressure that follows. The same principle applies in child care settings, hospitals, and other congregate environments: preventing the infection in the first place is almost always cheaper, safer, and more effective than treating it after the fact.
Patients have a role here too. The next time a dentist hands you a prescription for amoxicillin or clindamycin before or after a routine procedure, it is reasonable to ask what the evidence is that you actually need it. In a meaningful number of cases, the honest answer is that you do not.
Related FAQs
These related FAQs add context on antibiotic resistance, prevention, and why reducing unnecessary infections matters.
