Use and misuse of antimicrobials in pediatric dentistry

Abstract

The prescription of antimicrobials is a common practice in pediatric dentistry for the management of oral infections, trauma, and prophylactic indications. However, inappropriate use and misuse of these agents remain a significant concern, contributing to antimicrobial resistance, adverse drug reactions, and unnecessary exposure in children. The aim of this review was to evaluate the appropriate indications, clinical considerations, and common causes of misuse of antimicrobials in pediatric dental practice, with particular emphasis on antibiotics and analgesics. Children present unique anatomical, physiological, and behavioral characteristics that influence drug selection, dosage, and administration. Antibiotics are indicated primarily in cases of spreading odontogenic infections, facial cellulitis with systemic involvement, specific traumatic injuries, salivary gland infections of bacterial origin, and selected medically compromised conditions requiring prophylaxis. In contrast, antibiotics are not indicated for localized dental conditions such as irreversible pulpitis, necrotic pulps, localized apical abscesses without systemic signs, plaque-induced gingivitis, or viral infections, where definitive dental treatment and local measures are sufficient. Despite clear guidelines, antibiotic overuse in pediatric dentistry is frequently driven by misdiagnosis, time constraints, parental pressure, and insufficient knowledge of evidence-based indications. Such practices increase the risk of antibiotic resistance and may delay definitive dental care. The review also discusses the role of analgesics and anti-inflammatory drugs in pediatric dentistry, emphasizing that pain management should primarily rely on agents such as acetaminophen and ibuprofen rather than antibiotics. In conclusion, antimicrobials play an essential but limited role in pediatric dental care. Judicious prescribing based on accurate diagnosis, clinical severity, and established guidelines is critical to minimize misuse. Increasing practitioner awareness, improving education, and adhering to evidence-based protocols are key strategies to promote rational antimicrobial use and safeguard both individual and public health.