When Antibiotics Become a Dilemma: How Swedish Dentists Decide on Prophylaxis for Dental Implants
Dentists worry about antibiotic resistance — but still feel pressured to “play it safe” during implant surgeries. A new qualitative study reveals why.
A Growing Global Problem Meets the Dental Chair
Antibiotic resistance is often described as one of the most urgent health threats of our time. The World Health Organization warns that millions of deaths each year are linked to infections that no longer respond to standard antibiotics. But what does this global crisis look like in everyday clinical practice—particularly in dentistry?
Dental implant surgery is a routine procedure worldwide, and many dentists prescribe prophylactic antibiotics to prevent postoperative infections. Yet, the evidence supporting this practice remains mixed. Some guidelines recommend prophylaxis, while others argue the benefits are too small to justify widespread use.
This tension—between patient safety and antibiotic stewardship—was the focus of a new qualitative study published in BMC Oral Health (2025).
What the Researchers Wanted to Know
The research team from Malmö University, Sweden, set out to explore a deceptively simple question:
How do dentists think about antibiotic prophylaxis when placing dental implants—and what shapes their decisions?
Instead of numbers or charts, the researchers used in-depth interviews with 17 Swedish dentists, including oral surgeons, periodontists, and general practitioners who regularly perform implant surgery. The goal was to capture their reasoning, concerns, and real-world decision-making processes.
How the Study Was Conducted
Semi-structured interviews lasting 13–46 minutes
Participants from public clinics, private clinics, and universities
Dentists with 7–43 years of clinical experience
Data analyzed using qualitative content analysis
The result: three major themes that revealed how dentists navigate the complex decision of whether to prescribe antibiotics.
Key Findings
1. Antibiotic Resistance Feels Real—But Also Abstract
Most dentists acknowledged antibiotic resistance as a serious, society-wide threat. They understood that every single dose contributes to the problem.
But here’s the catch:
The risk feels distant, while the fear of a postoperative infection feels immediate.
Dentists described a psychological tension:
Antibiotic resistance = global, long-term, invisible
Postoperative complications = local, immediate, and highly tangible
This imbalance strongly influences prescribing behavior.
2. Decisions Vary Based on the Procedure, Patient, and Dentist's Experience
The study found wide variability in when dentists choose to prescribe prophylaxis.
Some prescribe antibiotics only when:
Bone grafting or sinus lifting is involved
Patients have systemic health risks
The surgical site is complex
Others rely heavily on:
Their own clinical experience
The quality of their aseptic technique
Shorter surgery times as a reason to skip antibiotics
Meanwhile, a few dentists still prescribe antibiotics routinely for every implant case—believing the preventive benefit outweighs the resistance risk.
This lack of consistency reflects a deeper issue.
3. Dentists Are Frustrated by the Lack of Clear, Evidence-Based Guidelines
Nearly every participant expressed uncertainty about current recommendations.
They described existing guidance as:
“Vague”
“Open to personal interpretation”
“Too inconsistent to rely on”
Because the research evidence is mixed—and sometimes contradictory—dentists feel pressured to rely on personal judgment or mentorship rather than standardized protocols.
Many said they actively try to stay updated, learning from new graduates or recent studies, but feel the field lacks strong scientific consensus.
Why the Findings Matter
This study highlights a critical challenge in dentistry:
How do clinicians balance individual patient safety with global public health responsibilities?
The findings suggest that without stronger, clearer, evidence-based guidelines, dentists will continue to rely on personal experience and risk perception—leading to inconsistent practices and potential overuse of antibiotics.
Given the rising threat of antibiotic resistance, understanding these decision-making patterns is essential for improving stewardship in dentistry.
Conclusion
Swedish dentists are highly aware of antibiotic resistance, yet their day-to-day decisions are shaped more by the real and immediate fear of postoperative complications than by long-term societal risks.
The study underscores the urgent need for:
Stronger research
Clearer guidelines
Consistent clinical protocols
to help dentists balance effective infection prevention with responsible antibiotic use.
Title: Antibiotic prophylaxis in dental implant surgery – A qualitative study on the attitudes and routines of Swedish dentists
Authors: Palwasha Momand, Bengt Götrick, Kristofer Hansson
Journal: BMC Oral Health, 2025
DOI: 10.1186/s12903-025-07064-1