According to the American Academy of Implant Dentistry, 500 000 dental implants are placed each year by generalist and specialist dentists.1 National antibiotic prophylaxis guidelines for dental implant surgeries do not exist. A survey of generalist and specialist dentist members of The National Dental Practice-Based Research Network identified that antibiotic prophylaxis decision-making is most influenced by official guidelines or advice from a physician or medical specialist.2 This editorial provides insights from an infectious disease pharmacist and physician, and specialist dentists on antibiotic prophylaxis for dental implant surgery.Together, we conducted the first US study evaluating antibiotic use among private practice dentists.3 In our study and subsequently in ongoing outreach education to over 3000 private practice dentists, many different prophylactic and post-procedure antibiotic regimens are used in dental implant surgery. Observations include the following regimens:If patients are allergic to penicillin, 85% of dentists use clindamycin that is prescribed similarly to above regimens.Our study and the ongoing dental lectures do not provide information on the types or numbers of dental implants, if placed immediately or delayed, if bone grafting was done, or if the patient was medically compromised; however, we are perplexed at the variety of regimens and the self-identified clinical success rates of 98%. These success rates beg the question of whether any post-procedure antibiotics are necessary, and if so, when? The dental literature provides no definitive answers. When dentists are asked how they determine post-procedure antibiotic durations for dental implants, most state durations recommended while in training or from a dental implant expert. In the era of escalating antibiotic resistance, we implore dentists to look at the risk vs perceived benefit for any post-procedure antibiotics for implant surgery.More than 2.8 million antimicrobial-resistant infections occur annually in the US.4 This translates to one antibiotic resistant infection every 11 seconds and one death every 15 minutes. There are ∼223 900 Clostridium difficile (C. difficile) cases and 12 800 US deaths related to antibiotics, annually.4 US dentists are the highest prescribers of clindamycin, with the highest risk of a C. difficile infection (CDI).5 We do not recommend clindamycin for any dental procedures due to the high risk of CDI as per the 2021 American Heart Association infective endocarditis (IE) guidelines.6When a patient acquires an antibiotic-resistant infection or CDI, they do not come to a dental office; they go to an emergency room. Over our 30-plus years of infectious disease experience at a large academic medical center, we see patients with infections resistant to all available antibiotics; many of whom may never return to their prior quality of life or die. Sadly, even previously healthy patients receiving an unnecessary antibiotic may present to the emergency room with toxic megacolon from a CDI and can die. A single 600-mg dose of clindamycin can result in CDI and death.7 No healthcare systems have mechanisms to inform dentists when their patient experiences an antibiotic adverse event leading to a clinic visit, hospital admission, or death; thus, dentists rarely see the harm from antibiotics. Dentists prescribing 3–14 days of antibiotics post-procedure believe antibiotics provide benefit (ie, prevent an implant infection and potential implant failure) but with little associated risk. There is always a risk of harm from necessary and/or unnecessary antibiotics so preserve them for when absolutely necessary.Evidence-based medical literature repeatedly shows shorter courses of antibiotics decrease the risk of resistance by 4% per day8 and the risk of CDI by 9% per day,9 and result in fewer adverse effects by 3% over 10 days.10 CDI is more than just “a little diarrhea.” The clinical manifestations of CDI are devastating, with an estimated 30-day mortality ranging from 5% to 7%. Patients with CDI report physical, psychological, and economic consequences.11 Many stop working as a result; others report depression, feeling suicidal, extreme weight loss over a month, as well as social stigma associated with a disease that is poorly understood by the public. Many are fearful of a CDI recurrence, which is common if exposed to another antibiotic. We recommend dental practice “medical intake forms” ask patients not only about surgical procedures, but if they have ever had a CDI. If yes, and antibiotics are indicated for the dental procedure, doxycycline may be a better option. It seems to be protective against CDI12 and is recommended in the dental prophylaxis guideline for prevention of IE, now instead of clindamycin.6 Fear of a lawsuit should not drive antibiotic prescriptions, but shared decision-making is recommended for patients when guidance is lacking.The field of infectious diseases is rife with dogma that drives historical practices including the traditional 7, 10, and 14 days of antibiotic durations. Escalating rates of antibiotic resistance led clinicians to question these prolonged durations. Could shorter courses be used without clinical failure? There are now over 120 randomized trials mostly in systemically ill hospitalized patients for infections such as pneumonia, bloodstream infection, and urinary tract infection, which establish that short-course regimens are as effective as longer ones.13 ID experts and hospital-based antibiotic stewardship programs provide ongoing education to physicians to change antibiotic prescribing habits to align with these shorter and efficacious courses.Two editorials by Dr. Rutkowski in the Journal of Oral Implantology address antibiotic prophylaxis for dental implant surgery.14,15 The author asks: “What is the proper antibiotic prophylaxis regimen for dental implant placement?” We agree that dentists are obligated to provide the best evidence-based care without putting the patient at risk. Multiple major operative procedural studies show antibiotics beyond a single preoperative dose may be without benefit. Unnecessary antibiotics increase the risk of adverse reactions, contribute to escalating antibiotic resistance, and increased healthcare costs. What makes dental implant surgery “more risky” than placement of a prosthetic hip, open-heart surgery, or neurosurgery, where additional postoperative antibiotics are not prescribed after leaving the operating room? When antibiotics are used without evidence, it is a risk and potential detriment to patient care. We (DAG, JEM) see the harm in the consequences of antibiotic resistance and CDI in hospitalized patients. The dogma on post-procedure antibiotics for dental implants needs to be re-questioned based on a lack of evidence.