ADA Statement Puts Scaling and Root Planing Ahead of Antibiotics for Periodontitis

Edited by Hygienetown staff

Scaling and root planing remains the first treatment for chronic periodontitis, and definitive local care should come before systemic antibiotics across a range of conditions, the ADA Council on Scientific Affairs said in a clinical practice statement published online Aug. 7 in the Journal of the American Dental Association.

The statement highlights existing ADA guidance recommending scaling and root planing as the initial treatment for chronic periodontitis. It notes that adjunctive systemic doxycycline at a subantimicrobial dose may produce a small additional clinical attachment gain in select moderate to severe cases.

For localized oral conditions in immunocompetent adults, including symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute or chronic apical abscesses, ADA guidance calls for pulpotomy, pulpectomy, root canal treatment, incision and drainage, or extraction. Antibiotics should be reserved for cases with systemic involvement or signs of spreading infection.

The council framed the guidance against a prescribing pattern that has not moved. Prescribing by dentists remained essentially unchanged from 2012 to 2022 even as prescribing by medical clinicians declined, and dentists have accounted for roughly 10% of all outpatient antibiotic prescriptions in recent years.

The council wrote that the profession needs to move from a precautionary just-in-case approach to an evidence-based when absolutely needed model, calling stewardship a public health priority as resistant pathogens spread.

Dentists have historically prescribed antibiotics to manage diagnostic uncertainty or patient expectations, the statement said. Systemic antibiotics can substantially reduce gut microbiome diversity, creating conditions that favor Clostridioides difficile. C. difficile infection can range from mild diarrhea to fatal pseudomembranous colitis and intestinal perforation, and the council said that risk outweighs the unproven benefit of precautionary prescribing for dental pain or localized infection.

Drawing on Centers for Disease Control and Prevention core principles, the council listed stewardship strategies including verifying patient history and risk factors, prioritizing definitive dental treatment, limiting antibiotic use, optimizing selection and duration, standardizing prescribing practices, and communicating risks to patients.

The statement is the second article published under Association Reports, a new JADA feature. The council said the ADA is extending stewardship work through living guidelines on antibiotics for implants and extractions, with the first implant recommendation expected this winter.

Sources:
Journal of the American Dental Association, “Antibiotic stewardship: balancing patient care and public health: American Dental Association Council on Scientific Affairs Clinical Practice Statement,” published online Aug. 7, 2026: doi.org/10.1016/j.adaj.2026.07.013
ADA News, “ADA council highlights need for evidence-based antibiotic prescribing,” Aug. 12, 2026: adanews.ada.org/2026/august/evidence-based-antibiotic-prescribing