Abstract

Background:Dentistry contributes up to 15% of global antimicrobial prescriptions, yet current prescribing practices are characterized by defensive “just in case” approaches that prioritize perceived safety over evidence based clinical necessity. This pattern contributes significantly to antimicrobial resistance while potentially exposing patients to unnecessary risks.
Objective: This opinion article examines the rationality of contemporary antimicrobial prescribing practices in dentistry and proposes a paradigm shift toward evidence-based decision making through the implementation of “watchful precision” approaches.
Main arguments: The dental profession has developed a culture of fear-based prescribing where antibiotics serve as a psychological safety net rather than a therapeutic tool. This defensive posture results in inappropriate prescribing for conditions that would resolve with proper dental treatment alone, contributing to resistance patterns and delaying definitive care. The hidden costs extend beyond immediate clinical encounters to include economic burden, patient safety risks and long-term sustainability concerns. Proposed solution:The “watchful precision” framework incorporates delayed prescribing strategies, systematic clinical reasoning using the “5Ds” approach [dental treatment, dental condition, drug, dose, duration] and enhanced patient education. This paradigm emphasizes source control through dental intervention over antibiotic reliance and promotes individualized, evidence based therapeutic decisions.
Implementation: Successful transformation requires professional culture change through updated education, interdisciplinary collaboration, technology integration and continuous quality improvement measures. Professional organizations must develop clear guidelines while practitioners embrace antimicrobial stewardship as a core competency.
Conclusion:The dental profession can lead antimicrobial stewardship efforts by abandoning defensive prescribing practices and embracing rational, patient centered approaches that optimize current care while preserving therapeutic options for future generations. This evolution represents both a clinical improvement and a moral imperative for professional responsibility.