NHS Dental Prescribing Study Flags Clindamycin and Opioid Concerns

A decade-long analysis of NHS primary care dental prescribing in England reveals that while overall antimicrobial and analgesic rates have returned to pre-pandemic levels, specific concerns remain regarding the use of clindamycin and dihydrocodeine. Published in the British Dental Journal, the study highlights the long-term impact of antimicrobial stewardship initiatives and the temporary disruption caused by COVID-19. These findings are critical for the dental sector as they underscore the ongoing challenge of antimicrobial resistance and the need for stricter adherence to national prescribing guidelines.

The retrospective study, covering the period from 2014 to 2023, found that antimicrobial prescribing by NHS dentists generally declined over the decade. This downward trend is attributed to national stewardship programmes, updated clinical guidance, and an increased awareness of antimicrobial resistance among practitioners. Although the COVID-19 pandemic caused a temporary spike in antibiotic use due to restricted routine care and an increase in remote patient management, prescribing levels successfully returned to their pre-pandemic baseline by December 2023.

Despite the overall decline, the study identified persistent issues with clindamycin, which remains at elevated levels compared to the pre-pandemic era. This is a significant concern for the industry because UK guidance advises against routine clindamycin use due to its strong association with Clostridioides difficile infections. Amoxicillin continues to be the most frequently prescribed antibiotic in dental settings, followed by metronidazole, but the continued reliance on clindamycin suggests a gap in the implementation of stewardship protocols.

Analgesic prescribing followed a similar pattern of fluctuation, but the data regarding dihydrocodeine is particularly troubling for dental health experts. By December 2023, dihydrocodeine accounted for more than two-fifths of all dental analgesic prescriptions, remaining higher than pre-pandemic levels despite its limited role in treating acute dental pain. The study's authors emphasize the risks of opioid dependence, nausea, and constipation, calling for regular prescribing audits and better professional education to align dental practices with national safety standards.

For the commercial dental market, these findings signal a shift toward embedded antimicrobial stewardship and a demand for tools that support clinical decision-making. There are clear opportunities for developers of stewardship platforms, audit-driven software, and providers of continuing professional development (CPD) to address the gaps in clindamycin and dihydrocodeine prescribing. As the antimicrobial resistance agenda intensifies through 2026 and 2027, the NHS is expected to focus more heavily on behavior-modifying tools and rigorous prescribing audits.