Study shows nearly 20% of dental infection cases use high-risk clindamycin

High-risk antibiotic clindamycin used in nearly 20% of dental infection cases

Nearly one in five patients treated for dental infections are being prescribed clindamycin, a high-risk antibiotic despite clear medical guidelines advising against its use when safer alternatives exist, according to a study published in Open Forum Infectious Diseases. While dental pain is a frequent visitor to emergency departments and urgent care centers, the choice of medication used to bridge the gap until a patient can see a dentist is frequently suboptimal and carries significant health risks.

The study, led by Lisa Dumkow, PharmD, a clinical pharmacist at Trinity Health Grand Rapids in Michigan, analyzed more than 12,000 patients across the Trinity Health Michigan Network treated between January 2020 and August 2025. The findings, reported by CIDRAP, reveal a troubling pattern: while 75% of patients received penicillin-class antibiotics as recommended by the American Dental Association (ADA), nearly 20% were prescribed clindamycin.

This specific antibiotic carries a “black box” warning—the FDA’s most serious alert—due to its link to life-threatening Clostridioides difficile (C. diff) infections. These infections can cause severe diarrhea and destroy the intestinal lining. The stakes are not theoretical; CIDRAP previously reported on the death of 92-year-old Delores Hernandez Owens, who died from a bowel infection following a clindamycin prescription from her dentist.

Penicillin allergy misconceptions drive risky prescribing

A primary driver for the use of clindamycin is the reported allergy to penicillin. However, the study suggests that many clinicians may be overestimating the necessity of this high-risk alternative. Among the patients who received something other than penicillin, 21% had no documented allergy or intolerance at all, and 27% had only a “mild allergy or intolerance.”

The gap between perceived and actual allergy risk is significant. While roughly 10% of Americans have a penicillin allergy listed on their medical records, the CDC reports that less than 1% are actually allergic. Many people outgrow these sensitivities, and the study found that 35% of those treated with clindamycin had only experienced minor reactions, such as a mild rash.

“The majority of patients did not need clindamycin,” Dumkow said. “They could have gotten an alternative antibiotic.”

Dumkow suggests that clinicians can mitigate this risk through better screening. By asking four specific questions—such as whether a patient required medical intervention during a previous reaction—clinicians can determine if a patient’s risk of an actual allergic reaction is less than 1%. If the risk is that low, the study suggests it may be safe to monitor the patient for an hour after a single dose.

Treatment failure rates climb with clindamycin use

Beyond the immediate risk of infection, clindamycin appears to be less effective at managing the oral bacteria responsible for dental pain. The data shows that clindamycin had an 11% risk of treatment failure, the highest among all antibiotics studied. In contrast, the overall treatment failure rate for the group was only 5%.

Common dental antibiotic linked to rare but serious risks

This failure rate is particularly concerning given the efficacy of other options. Research from Kansas suggests that penicillin-class antibiotics are significantly more effective at killing oral bacteria than clindamycin. The discrepancy in success rates highlights a critical gap in how non-dental clinicians—such as those in emergency departments or urgent care—approach dental-related prescriptions.

Antibiotic Category	Risk of Treatment Failure
General Study Average	5%
Clindamycin	11%

The study’s findings are particularly relevant for the nearly 2 million people in the U.S. who seek care for dental pain in non-dental settings annually, according to CDC data. Because these patients are often in urgent care (50%) or emergency departments (40%), they are frequently receiving “Band-Aid” treatments that fail to address the root cause.

The economic barrier to definitive care

While the clinical focus remains on antibiotic selection, a deeper systemic issue complicates the recovery of these patients. Antibiotics are not a cure for a deep-rooted tooth infection; they only manage symptoms until a dentist can perform a procedure like a root canal or extraction. For many, that definitive care is financially out of reach.

The study noted that 38% of participants had no health insurance, and 27% were on Medicaid. Even for those with coverage, dental specialists often do not accept certain insurance plans, and the cost of a root canal and crown can range from $1,500 to $3,500. This creates a cycle where patients return to the emergency room with recurring infections because they cannot afford the only actual cure.

Erinne Kennedy, DDS, MPH, assistant dean at Kansas City College of Dental Medicine, noted that part of the solution involves better coordination between emergency providers and dental professionals. Bridging the gap between an emergency room “Band-Aid” and a specialist’s chair remains the primary hurdle in managing the nation’s dental infection crisis.