Antibiotic prophylaxis in dental implant surgery - A qualitative study on the attitudes and routines of Swedish dentists

Antibiotic resistance is a critical global health challenge, necessitating judicious antibiotic use across all medical disciplines, including dentistry. This qualitative study explored the attitudes and decision-making processes of Swedish dentists regarding antibiotic prophylaxis in dental implant surgery. A qualitative inductive research design was used to conduct semi-structured interviews with 17 dentists across Sweden. Purposive and snowball sampling ensured diverse perspectives. Three key themes emerged: Perception of antibiotic resistance, Attitudes on antibiotic prophylaxis, and Need for clear guidelines. Participants demonstrated an awareness of antibiotic resistance as a significant public health concern but often perceived it as abstract compared to the immediate risks of postoperative infection. Their antibiotic prophylaxis practices varied widely, influenced by patient-specific factors, procedural complexity, and personal clinical experience. While some advocated selective use of antibiotic prophylaxis for high-risk cases, others routinely prescribe it to minimize complications, reflecting an ongoing tension between patient safety and antibiotic stewardship. A common frustration among dentists was the lack of evidence-based guidelines, which left decision-making subject to individual interpretation and contributed to practice variability. This underscores the need for standardized protocols that balance effective infection prevention with minimal antibiotic use. This study shows that while dentists recognize the importance of addressing antibiotic resistance, this awareness often feels secondary to the immediate clinical risks of postoperative infections. Practice around antibiotic prophylaxis varies depending on individual clinical judgment, surgical protocol, patient factors, and the absence of clear, evidence-based guidelines. The study highlights the need for evidence-based guidelines that balance patient safety and antibiotic stewardship.