Advancing Antimicrobial Stewardship in Canadian Dentistry: Early Insights Into a Toolkit to De-implement Overprescribing

Abstract

Introduction and Aims Despite dentistry’s contribution to antibiotic use and antimicrobial resistance, antimicrobial stewardship in Canadian dentistry remains at an early stage. As strategies focused on adherence to evidence-based care have shown limited success in changing prescribing behaviour, the focus has shifted to the de-implementation of low-value care. This study explored dentists’ perspectives on an antibiotic prescribing toolkit and examined how it may support de-implementation. Methods An exploratory qualitative study employed focus groups with 16 dentists who attended toolkit webinars. Dentists who had not downloaded the toolkit were excluded. Discussions were recorded, transcribed, and analysed inductively. Findings were discussed in relation to stewardship and de-implementation research. Results and Discussion The analysis yielded 5 themes—clarifying a key message, reminding and providing a talking point, supporting difficult conversations, legitimising nonprescribing, and moving beyond “preaching to the choir”—that align with de-implementation strategies in dentistry and other health fields, including unlearning, extinction cues, substitution, counterconditioning, and champions. Participants highlighted the need for concomitant interventions, such as audit and feedback, education, software integration, and regulatory and professional engagement, to support de-implementation, consistent with the de-implementation literature. Conclusion The toolkit shows potential to support the de-implementation of unnecessary dental antibiotic prescribing by introducing mechanisms that reduce reliance on low-value antibiotic use. Feedback suggests the toolkit helps shift outdated prescribing habits, manage patient expectations, and legitimise nonprescribing decisions. However, meaningful progress will require multilevel strategies. Future research should evaluate, using quantitative methods, whether the toolkit influences prescribing behaviours longitudinally, as well as whether its integration within broader stewardship interventions supports sustained de-implementation. Clinical Relevance This study identifies strategies to support responsible antibiotic use in dental practice. The findings show how the toolkit may serve as a practice-based resource by offering communication tools, reminders, and substitution strategies that help dentists manage patients without antibiotics, while reducing patient expectations and dentists’ concerns about not prescribing.