ADA highlights dentistry’s role in antibiotic stewardship, calls for practical support in national action plan

As federal officials develop the next National Action Plan on Combating Antibiotic-Resistant Bacteria, the ADA is emphasizing both dentistry’s role in outpatient antibiotic prescribing and the profession’s responsibility to be a strong steward of appropriate antibiotic use. 

The Association submitted comments May 29 to the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria and the Federal Inter-Agency Combating Antibiotic-Resistant Bacteria Task Force, which are gathering input as they develop the next five-year national action plan. 

In its letter, the ADA said the updated plan should recognize dentistry as a “distinct and important” element of outpatient antibiotic stewardship, noting that the Centers for Disease Control and Prevention reported that general dentists prescribe more than 10% of outpatient antibiotics. 

ADA President-elect Thomas Paumier, D.D.S., said dentistry has an important role to play in addressing antibiotic resistance. 

“As a profession, and individually, we have a responsibility to be better antibiotic stewards,” Dr. Paumier said. “Primum non nocere. First, do no harm. Recognizing that antibiotic use is not benign is the first step to meeting that standard. Let’s be the leaders in healthcare by addressing this looming crisis now, before it’s too late.” 

The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, or PACCARB, advises the Department of Health and Human Services on national efforts to address antibiotic resistance. The federal interagency task force develops, implements and updates the National Action Plan on Combating Antibiotic-Resistant Bacteria. 

The ADA’s comments emphasized that stewardship efforts in dentistry should account for how dental care is delivered in the United States. 

“Most dental care is delivered in community-based practices, including small and solo practices, rather than large hospital systems with dedicated antimicrobial stewardship infrastructure,” the Association wrote. “Federal strategies should account for that operational reality by prioritizing education, clinical decision support, patient-facing resources and quality improvement tools that are feasible in dental practice.” 

The Association highlighted its 2019 evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. The guideline recommends against antibiotics for most dental pain and intraoral swelling associated with pulpal and periapical infections and instead emphasizes definitive, conservative dental treatment when appropriate. 

The ADA also stressed the importance of preserving dentists’ clinical judgment in stewardship policies. 

“The National Action Plan should also recognize the distinction between inappropriate antibiotic use and appropriate prescribing for patients who meet evidence-based criteria,” the letter reads. “Stewardship policies should preserve clinical judgment and avoid blunt measures that could discourage appropriate prescribing for high-risk patients.” 

Among its recommendations, the ADA called on federal agencies to identify dentistry as a priority outpatient stewardship partner, support implementation of evidence-based dental prescribing guidance, strengthen referral pathways to definitive dental treatment, develop practical stewardship tools for community-based practices and encourage voluntary, data-informed quality improvement efforts. 

The ADA said evidence shows that dental stewardship interventions can improve prescribing when they are designed specifically for dental practice settings. The Association cited research finding that stewardship education combined with audit and feedback helped private practice dentists reduce antibiotic duration and decrease clindamycin use. 

“The ADA stands ready to serve as a resource to PACCARB, the Department of Health and Human Services (HHS), CDC and other federal partners as they strengthen the nation’s response to antibiotic resistance,” the letter said. 

According to the Federal Register notice, the June 16 meeting will inform the next five-year iteration of the National Action Plan, which will cover 2026-2031.