Educational antimicrobial stewardship interventions in dental schools: A scoping review

Abstract

Antimicrobial resistance (AMR) is increasing at an alarming rate, with dentists contributing to over 10% of global antibiotic use. Antimicrobial stewardship (AMS) interventions help reduce AMR, but dental education often lacks focus on such initiatives. Our study aims to systematically map existing evidence on AMS initiatives in dental education, identify knowledge gaps, and inform future research. A scoping review was conducted by searching six databases (Web of Science, Medline, Embase, Scopus, ERIC, and CINAHL) using key terms surrounding AMS and dental education on May 9, 2025. Inclusion criteria targeted studies focusing on interventions promoting AMS in dental schools. Exclusion criteria removed commentaries, book chapters, letters, editorials, opinion pieces, and conference abstracts. No restrictions were placed on publication year, setting, or language. Two reviewers independently screened articles and extracted data. Descriptive and qualitative content analysis were employed to synthesize the studies’ characteristics, participant populations, and intervention approaches. From 523 records screened, 18 articles were included. These studies highlighted a variety of AMS interventions, all differing in their approaches to facilitate learning. The content taught formed seven categories, spanning teachings directly related to AMR and material building a background knowledge, including infectiology and pharmacology. A total of 12 categories were developed from the learning strategies present in initiatives. This included both traditional techniques, as seen in lectures, and non-conventional modalities, such as games and roleplay. Findings will inform the development of future interventions in dental school settings, collectively contributing to the fight against the growing AMR crisis.

Keywords

antimicrobial stewardship antimicrobial resistance dental education dental school

Introduction

Antimicrobial resistance (AMR) has become a critical public health concern by reducing the sensitivity of microbes to current medication (Prestinaci et al., 2015). Driven by the overuse and misuse of antimicrobials, AMR contributed to 4.95 million deaths in 2019 and directly caused 1.27 million (Centers for Disease Control and Prevention, 2015). This issue will only continue to grow in the coming decades, predicted to result in 10 million deaths annually by 2050 (Tagliabue and Rappuoli, 2018).

A 2024 United Nations General Assembly on AMR saw an international commitment to reduce AMR-associated deaths by 10% by 2030 (World Health Organization, 2024). The World Health Organization (WHO), one party in this agreement, previously set five objectives in its 2015 global action plan on AMR (World Health Organization, 2015). While these objectives encompass a wide range of global industries, one specifically targets communication, education, and training, across health-related sectors.

Dentists account for over a tenth of global antibiotic use, with a large proportion considered unnecessary or inappropriate (Cope et al., 2015; Suda et al., 2019; Thompson et al., 2020). These patterns reflect gaps in dentists’ knowledge and understanding of antimicrobial stewardship (AMS). Since prescribing habits are shaped by early professional training, dental schools play a critical role in ensuring proper antibiotic use (Moura et al., 2014).

Despite this, studies consistently report poor AMS teaching for students (Holz et al., 2020). In the United States, for instance, more than 80% of students reported being unfamiliar with the term ‘antimicrobial stewardship’ and 71% indicated that further initiatives would be beneficial (Al-Khatib and Almohammad, 2022; Holz et al., 2020). These findings reveal that future dentists are entering practice underprepared, underscoring the need for stronger AMS interventions within dental education.

Interventions from other professional contexts highlight the potential for school-level programs in equipping students newly entering practice with proper prescription practices. In medical schools, a range of interventions with various learning strategies, such as didactic modules, web-based courses, case studies, and games, have been implemented (Augie et al., 2021).

While reviews have synthesized AMS programs in medical schools, to our knowledge, none have evaluated initiatives in dental schools. To date, interventions in dentistry have been examined primarily in general dentistry, summarized in three systematic reviews (Löffler and Böhmer, 2017; Mendez-Romero et al., 2025; Teoh et al., 2025). Reviewing clinical guidelines and hosting educational sessions are frequently carried out, and newer initiatives, such as clinic monitoring systems continue to emerge. These reviews focus exclusively on practicing dentists; leaving dental schools largely unexplored.

Given this gap, this review aimed to investigate what AMS initiatives currently exist to teach a range of groups within a dental school context. The concept of AMS interventions was synthesized with respect to their content, form, and effectiveness. With the threat of AMR only continuing to grow, our findings aim to inform the development of future AMS educational interventions to target this issue.

Method

We conducted a scoping review, which was driven by the fact that the literature on AMS interventions in dental education is diverse, rapidly evolving, and lacks a comprehensive synthesis. This review was conducted under the guidance of the Methodology for JBI Scoping Reviews and no protocol was previously published (Peters et al., 2015). Reporting of the study was completed in accordance with the PRISMA-ScR checklist (see Supplemental File 1) (Tricco et al., 2018).

Information sources and search

A search of the databases Web of Science, Medline (OVID), Embase (OVID), Scopus, ERIC (ProQuest), and CINAHL (EBSCO) was conducted on May 9, 2025. The search strategy was developed in collaboration with a librarian specialized in dentistry at McGill University. Search terms followed the central concepts of AMS and dental school, but were tailored to each database’s conventions and most relevant terms (Table 1). Forward and backward citation searches, identifying papers citing and cited by included studies, respectively, were also employed for relevant articles. A separate search of grey literature was not included in this review’s search strategy.

Table 1.

Complete search strategy employed.

Database	Search terms	Results
Web of Science	Antimicrobial stewardship: (antimicrobial* OR antibiotic) NEAR/2 (stewardship OR resistance* OR program* OR prescri* OR use* OR usage*) in topic	249
Web of Science	Dental school: (dental* OR dentistry* OR oral) NEAR/2 (educat OR school* OR college* OR universit* OR student* OR professor* OR fellow* OR resident* OR undergraduate* OR postgraduate* OR graduate* OR train*) in topic	249
Medline	Antimicrobial stewardship:	216
	1. MeSH: Antimicrobial stewardship (exp, all subheadings) OR drug resistance, microbial (exp, all subheadings)
	2. Terms: (antimicrobial* OR antibiotic) ADJ2 (stewardship OR resistance* OR program* OR prescri* OR use* OR usage*) in.ti,ab,kf.
	Dental school:
	1. MeSH: Schools, dental (exp, all subheadings) OR education, dental (exp, all subheadings) OR students, dental (exp, all subheadings)
	2. Terms: (dental* OR dentistry* OR oral) ADJ2 (educat OR school* OR college* OR universit* OR student* OR professor* OR fellow* OR resident* OR undergraduate* OR postgraduate* OR graduate* OR train*) in.ti,ab,kf.
Embase	Antimicrobial stewardship:	334
	1. SH: Antibiotic resistance (exp, all subheadings) OR antimicrobial stewardship (exp, all subheadings)
	2. Terms: (antimicrobial* OR antibiotic) ADJ2 (stewardship OR resistance* OR program* OR prescri* OR use* OR usage*) in.ti,ab,kf.
	Dental school:
	1. SH: dental education (exp, all subheadings) OR dental student (exp, all subheadings)
	2. Terms: (dental* OR dentistry* OR oral) ADJ2 (educat OR school* OR college* OR universit* OR student* OR professor* OR fellow* OR resident* OR undergraduate* OR postgraduate* OR graduate* OR train*) in.ti,ab,kf.
Scopus	Antimicrobial stewardship: (antimicrobial* OR antibiotic) W/2 (stewardship OR resistance* OR program* OR prescri* OR use* OR usage*) in article title, abstract, keywords	364
Scopus	Dental school: (dental* OR dentistry* OR oral) W/2 (educat OR school* OR college* OR universit* OR student* OR professor* OR fellow* OR resident* OR undergraduate* OR postgraduate* OR graduate* OR train*) in article title, abstract, keywords	364
Eric	Antimicrobial stewardship: (antimicrobial* OR antibiotic) N2 (stewardship OR resistance* OR program* OR prescri* OR use* OR usage*) in TX all text	0
	Dental school:
	1. Thesaurus: Dental schools
	2. Terms: (dental* OR dentistry* OR oral) N2 (educat OR school* OR college* OR universit* OR student* OR professor* OR fellow* OR resident* OR undergraduate* OR postgraduate* OR graduate* OR train*) in TX all text
CINAHL	Antimicrobial stewardship:	92
	1. SH: Drug resistance, Microbial+ (exp) OR antimicrobial stewardship
	2. Terms: (antimicrobial* OR antibiotic) N2 (stewardship OR resistance* OR program* OR prescri* OR use* OR usage*) in XB title and abstract
	Dental school:
	1. SH: Students, dental OR schools, dental OR education, dental
	2. Terms: (dental* OR dentistry* OR oral) N2 (educat OR school* OR college* OR universit* OR student* OR professor* OR fellow* OR resident* OR undergraduate* OR postgraduate* OR graduate* OR train*) in XB title and abstract

Eligibility criteria and selection

Inclusion criteria included the following: a focus on AMS intervention, a dental school setting, and a study type of empirical sources and reviews with an explicit reporting of methods. Exclusion criteria consisted of commentaries, book chapters, letters, editorials, opinion pieces, and conference abstracts. No restrictions were placed on the study publication date, geographical location, or language.

Search results were screened using the Covidence platform. Two reviewers independently screened the titles and abstracts, followed by full-text articles. Conflicts were resolved through discussion among the two reviewers. Senior team members with extensive review experience were consulted for any cases with ambiguity.

Data extraction and synthesis

Two reviewers independently completed and combined data extraction in Covidence. The extraction process was adapted from the Template for Intervention Description and Replication (TIDieR) Checklist to effectively describe interventions (Hoffmann et al., 2014). More specifically, the following categories were extracted: study title, study start and end dates, country, study design, potential conflicts of interest, intervention name and aim, intervention description, participant information (sample size, age, gender, and role), and intervention results.

Data from extracted studies were synthesized in Microsoft Excel. Descriptive synthesis was employed on publication years, countries, study designs, participant characteristics, providers, locations, delivery modes, durations, and frequencies. Qualitative content analysis was employed for intervention aims, content, learning strategies, and results. The grouping of interventions was carried out collaboratively between two reviewers, with continual refinement of themes. Data synthesis was also conducted in conjunction with the wider research team, with four team-wide meetings held in this iterative process.

Translation methods

Included articles not written in English were translated by a fluent team member and the platform DeepL Translate (Isbej et al., 2024).

Results

The search yielded a total of 523 records after the removal of duplicates. Following the addition of three studies from forward and backward citation searching, screening yielded a total of 18 articles for inclusion (see Figure 1 and Supplemental File 2 for more details).

Figure 1.

PRISMA diagram.

Study characteristics

Included studies were published between 2012 and 2025. Half of the papers were published after 2020, with most occurring in 2024 (22.2%) and 2022 (16.7%). Publications emerged from 13 countries, with multiple from the United Kingdom (n = 4), India (n = 3), Saudi Arabia (n = 2), and Egypt (n = 2). One study assessed educational interventions on an international level, spanning Austria, Italy and the United Kingdom (Berr et al., 2012).

Pre-post single group was the most commonly employed study design, accounting for 11 included studies (61.1%). Four studies (22.2%) employed a cross-sectional design, while retrospective analysis, nonrandomized study, and randomized controlled trial were used in one study each (5.6%).

Participants

Six studies (33.3%) did not report their participant sample size. Among the remaining 12, sample sizes ranged from 31 to 1164 participants, but nine studies included fewer than 100 participants.

Participant categories of dental students, faculty, interns (classified as individuals practicing clinically under supervision), and practicing dentists, were formed based on the populations of included studies. A total of 38.9% of studies included more than one type of role in their interventions. Student participants were present in 77.8% of interventions, with second-year students being the most represented and first-year students the least. Four studies (22.2%) included students from multiple academic years. Interns, practicing dentists, and faculty were each featured in 16.7% of the studies, while patient participation was only reported in one study (5.6%).

A total of 55.6% of studies did not report the age or gender of intervention participants. Among the eight studies reporting, participants were primarily in their early twenties, and all but one had more female than male participants (Alqadi et al., 2024).

Aim

The aims of interventions were classified into four categories: raising awareness toward AMS, building participants’ knowledge, improving antimicrobial prescription accuracy, and providing a positive learning experience where students feel satisfied. All studies covered at least one aim, with 61.1% citing multiple. Half of the articles included an aim of improving prescription accuracy, 44.4% for improving knowledge, 33.3% for raising awareness towards antimicrobial usage, and 11.1% for fostering a positive experience.

Content

While all included studies contributed to AMS, the specific content covered by interventions varied considerably. The subjects taught were distinguished in seven categories: antimicrobial prescription, AMR, AMS, indication for antimicrobial use, infectiology, pharmacology, and alternative treatment options (Table 2). All interventions addressed a range of two to five of these topics.

Table 2.

Overview of content.

Content	Meaning
Antimicrobial prescription	Instruction on proper prescription of antimicrobials, including current guidelines and trends.
Antimicrobial resistance (AMR)	Instruction on the causes, impacts, and processes of microbes building resistance to antimicrobial drugs.
Antimicrobial stewardship (AMS)	Instruction on the responsible use of antimicrobials.
Infectiology	Instruction on the infectious nature of microbes, including bacteriology and microbiology.
Indication for antimicrobial use	Instruction on indication for antimicrobial prescription based on patient factors, such as allergies and symptoms.
Alternative treatment options	Instruction on potential treatment options that can replace the need for antimicrobials.
Pharmacology	Instruction on the uses, impacts, and mechanisms of antimicrobial drugs.

Antimicrobial prescriptions represented the most commonly taught content, included across 83.3% of studies. Interventions focused on a variety of subtopics, including relevant clinical guidelines, prescription patterns, patient records and referrals, considerations during chemotherapy, and polypharmacy.

A total of 61.1% and 50.0% reported directly teaching AMR and AMS content, respectively. AMR-related content typically covered the causes of the resistance, its consequences, and resistance mechanisms. AMS-focused learning honed in on current policy and strategies to reduce AMR.

Patient-driven indications for antimicrobial use appeared in 44.4% of interventions. This topic encompassed antimicrobial prescribing in conjunction with specific patient characteristics and medical histories, such as prophylaxis and allergies.

Infectiology and pharmacology were addressed less frequently, appearing in only 16.7% of interventions each. Infectiology spanned several relevant fields, including microbiology, bacteriology, and infection control measures. Pharmacology delved into the effects and mechanisms of antimicrobial drugs, as pertinent to clinicians.

Alternative treatment options represented the least covered content (11.1%). This focus centered on equipping participants with knowledge of non-antimicrobial options, such as dental procedures.

Learning strategies

All but one study (Tamboli et al., 2016) reported their intervention’s specific learning strategies. Strategies were summarized into 12 distinct modalities: lectures, case studies, interactive activities, reviews of clinical guidelines, reflective practices, reminders, feedback, in-course evaluations, web applications, tutorials, mentoring for participants, and mentoring by participants (Table 3). Notably, 88.9% of interventions were multimodal, with an average of 3.5 learning strategies across specifying studies.

Table 3.

Overview of learning strategies.

Learning strategy	Meaning
Lectures	Strategy where content is delivered in a formal talk.
Interactive activities	Strategy where participants engage in a learning activity with a focus on interaction.
Case studies	Strategy where learning stems from a sample scenario focusing on antimicrobial prescription.
Reviews of clinical guidelines	Strategy where proper clinical guidelines are communicated to participants.
Feedback	Strategy where participants receive feedback on their antimicrobial prescribing.
Reflective practices	Strategy where participants engage in self-reflection in regard to their prescribing accuracy.
Mentoring for participants	Strategy where participants receive guidance and mentoring from an expert.
Tutorials	Strategy where participants learn in small groups.
Mentoring by participants	Strategy where participants take on a mentoring role, teaching others about AMS.
Reminders	Strategy where posters or emails summarizing content are frequently communicated to participants.
In-course evaluations	Strategy where assessments are included in the intervention.
Web applications	Strategy where participants actively engage in an interactive online platform.

Teaching through lectures was the most common modality, present in two-thirds of studies. Lectures took several forms, including online—synchronous or asynchronous—and face-to-face delivery. This form of learning was almost always employed in conjunction with other strategies, notably case studies or interactive activities.

Interactive activities were included in 44.4% of studies. Most activities took the form of discussions, including weekly team meetings to review prescribing practices and seminars focusing on participants’ questions (Alqadi et al., 2024; Isbej et al., 2024). Another study hosted a laboratory session, aiming to increase participants’ AMR understanding through a practical lens (Veses et al., 2020). Roleplay was employed in one study, where participants worked in a small group setting to educate the public on AMR (Badran et al., 2022).

Present in 38.9% of interventions, case studies took several forms, including both clinical scenarios and patient-delivered vignettes. This varying approach targeted both improving participant problem-solving skills and contextualizing the life-changing impact AMR can cause.

Presenting clinical guidelines was reported in one third of interventions. Guidelines were communicated in a variety of ways, including delivery through oral presentations and loading onto clinical computers. Guidelines reviewed included the Essential Drug List of Nepal, the Scottish Dental Clinical Effectiveness Programme, and the American Dental Association guidelines (Alqadi et al., 2024; Rauniar et al., 2012; Roganović et al., 2024).

Feedback as a learning modality was present in 27.8% of studies. This took the form of expert-to-participant feedback provided in the moment or presenting clinical audit results.

Reflective practices were defined as any activity requiring self-reflection. This modality was present in 11.1% of interventions and focused on justifying prescribing decisions in patient records or pharmacist assessments (Chopra et al., 2014; Okihata et al., 2023).

Interventions offering mentoring to participants were described in three studies (16.7%). This modality took multiple forms, including supervisors verifying prescriptions and supervised learning. In a similar vein, tutorials were present in three studies.

A flipped learning model, where intervention participants mentored others, was employed in 16.7% of studies. In one peer education intervention, a small team of student ambassadors developed and hosted an activity to teach their fellow students about AMR (Veses et al., 2020). Two additional studies focused on participants engaging in patient education and developing educational materials (Badran et al., 2022; Farghaly et al., 2021).

Reminders took the form of posters or emails, present in 16.7% of studies. Posters were displayed in clinical and classroom settings, while emails were sent on a weekly basis. The Centers for Disease Control and Prevention’s Core educational tip sheet, Seven Ways Dentists Can Act Against Antibiotic Resistance (Centers for Disease Control and Prevention, nd), were displayed as posters in two studies (Alqadi et al., 2024; Gross et al., 2019).

Mandatory in-course evaluations were employed in 16.7% of studies. Assessments tested participants’ understanding of content, including post-lecture quizzes and post-intervention essays. Further, participants were prompted to carry out their own AMR-related research in 11.1% of studies, independently conducting literature searches on antimicrobial-related subjects.

Web applications were used in two studies (11.1%), taking the form of a virtual game and a guideline-based study tool. The game-based application prompted participants to manage a virtual patient (Berr et al., 2012), whereas the web-based study tool helped participants navigate antimicrobial-related clinical scenarios (Roganović et al., 2024).

Intervention characteristics

In the 16 studies reporting on their initiative’s providers, experts both within and outside of dentistry delivered AMS interventions. A total of 55.6% of interventions included teaching by an individual with expertise in dentistry, 61.1% included teaching by an individual with expertise in another field, and one-third employed both dental and non-dental experts. Within non-dental providers, fields of expertise spanned across pharmacy, medicine, engineering, and computer science. Dental students acted as the providers of the intervention in two studies (11.1%) and an external resource was employed in one (5.6%).

Regarding the delivery of interventions, the 16 reporting studies (88.9%) included 11 employing a face-to-face approach, 10 delivering content online, and five using a blended approach. Intervention settings were additionally identified as having clinical and non-clinical components, with the former representing dental school-run outpatient clinics and the latter representing classroom, laboratory, or asynchronous environments. Initiatives including clinical components comprised 44.4% of studies and initiatives including non-clinical components amounted to 88.9% of interventions. One third incorporated both non-clinical and clinical approaches.

The durations of intervention varied significantly among studies. A total of 16.7% and 11.1% of studies ran interventions lasting under one day and one to seven days, respectively. Interventions lasting between one week to one month, and over one month each accounted for 22.2% of initiatives. All but two studies (88.9%) reported on the frequency of the intervention’s delivery. A total of 61.1% employed a continuous approach, with content delivered over multiple instances. One third of interventions involved a punctual approach, without regular content delivery.

Outcome

Outcomes were grouped into six categories: participants’ learner satisfaction, change in knowledge, attitude, practice, prescription accuracy and rates, as well as retention. A total of 61.1% of studies included a knowledge assessment, measuring participants’ understanding of content through surveys. 10 of the 11 studies assessing knowledge saw an overall improvement following their intervention (Aboalshamat et al., 2019).

One third of studies assessed participants’ satisfaction, collected both anecdotally and through surveys. This category found predominantly positive results, including a self-perceived improvement in prescribing and enjoyment of an application-based approach.

A change in participants’ prescription accuracy or prescription rates was assessed in 27.8% of studies. Authors typically measured both the adherence of participants’ prescriptions to guidelines and trends in antimicrobial prescribing rates over time. Findings saw overall improvement, defined as increased accuracy and lowered prescribing rates, across all studies, barring one paper, which found high prescription variance for acute dentoalveolar conditions in a post-intervention audit (Gross et al., 2019).

Typically assessed alongside knowledge via surveys, participants’ attitudes and practices were investigated in 22.2% and 11.1% of studies, respectively. Measurement of evolving attitudes highlighted more recognition of the AMR crisis; however irregular and self-use of antimicrobials were not improved (Mate et al., 2021). Changes in practice included the improvement of participants’ own antimicrobial usage and their prescribing practices to patients (Mate et al., 2021).

Long-term retention of knowledge or prescription rates was investigated in four studies, with assessment occurring two months, six months, two years, and five years after baseline testing. Mixed results were found, with two studies seeing long-term improvement in knowledge (Badran et al., 2022; Okihata et al., 2023), but another identifying regression in improved prescription rates (Rauniar et al., 2012).

Discussion

To our knowledge, this project represents the first scoping review on dental school-based AMS interventions. Findings show a high level of diversity among interventions, including a range of aims, content, learning strategies, and delivery methods. Even with this variation, nearly all interventions reported success at improving participants’ AMS.

There were several characteristics linked with positive learning experiences and outcomes. Most studies employed a combination of passive and active learning strategies, but in assessment, participants often focused on active modalities. One intervention paired self-directed lectures with an interactive session to address questions and case studies (Isbej et al., 2024). Students were drawn towards the active learning component in qualitative reflections, praising the opportunity to apply their knowledge. A second study engaging participants in non-conventional active learning activities, including roleplay, developing questionnaires, and conducting research, shared similar findings (Badran et al., 2022). Overall satisfaction was high at 82.1%, with participants favouring practical and collaborative modalities over writing and research-based ones (Badran et al., 2022). The application of contemporary active learning approaches represents a potential path forward for interventions, encompassing teaching modalities such as virtual patient simulations and games (Lin et al., 2023; Salari and Amini, 2026). In this review, no included studies directly explored their interventions through educational frameworks, especially the pedagogical theories of behaviourism and constructivism (Moss et al., 2023; Teixeira and Arriel, 2024). While neither theory is considered better, participants’ overall preference for active learning leans more towards a learner-centered building upon one’s understanding, generally associated with constructivism (Mahbub and Beedle, 2025). Literature on constructivism emphasizes the importance of participants inquiring, imagining, hypothesizing, and interacting, drawing parallels with several learning modalities identified in this review, including learner-directed case studies and roleplay (Specioza and Hilary, 2023). While these approaches were only employed in a minority of included interventions, they represent promising paths forward in AMS education. Future research should place more consideration on pedagogical theories in the development and analysis of AMS interventions.

A multimodal approach to learning has been linked to increased student satisfaction, self-sufficiency in knowledge application, and effectiveness of curriculum delivery (King and Fricker, 2002). The multimodal nature of this review’s included interventions was similarly associated with positive outcomes. This was seen in an intervention combining videos, discussions, and quizzes to build participants’ understanding of AMR (Cooper et al., 2022). While discussing their satisfaction, participants specifically appreciated the multimodal approach. Another study comparing AMS initiatives across 15 dental schools reached a similar conclusion quantitatively (Constant et al., 2025). Through assessing AMS content, students taught in schools with multiple learning strategies were significantly more likely to hold a high level of knowledge. Paired with the finding that the one included non-multimodal study reported no difference between intervention and non-intervention groups (Aboalshamat et al., 2019), the benefit of multiple learning strategies is reinforced, representing a promising approach for future AMS initiatives.

Given the recency of included studies, there was a high proportion of online interventions. The benefits of in-person education are typically associated with increased comprehension and social interaction, while downsides surround the low level of flexibility (Kumari et al., 2021). Outcomes of included studies did not indicate a clear preference for either setting, but several more specific considerations emerged. One study discussed a downside of Internet-based learning, citing that students may have skipped through sections of their online lectures and searched for answers in their corresponding knowledge tests (Aboalshamat et al., 2019). Another initiative, an Internet-based study tool, found contrasting perspectives (Roganović et al., 2024). In assessing students’ satisfaction, elements such as the accessibility and practicality of the web application were specifically praised. While both benefits and concerns exist, it will be necessary to account for these considerations to develop effective interventions as education continues to be modernized.

This review illustrates several strengths across initiatives; however, it is critical to still strive for improvement. One included study compared the curriculum of multiple healthcare disciplines (Castro-Sánchez et al., 2016). Dental schools had an average of 8.5 hours of AMS intervention, the lowest among all groups and notably less than in medical, pharmacy, nursing, and veterinary schools. With dentists playing such a significant role in antimicrobial prescribing, this disparity emphasizes the importance of proper AMS education in dental training (Peyre and Eliav, 2025).

Despite this need, several barriers to implementing AMS education continue to prevail. The need for patient education in conjunction with provider stewardship is vital. Without a public awareness about the role of antimicrobials and impact of AMR, patient demand can continue to place pressure on dental providers, contributing to unnecessary prescriptions (Noor et al., 2025). Although our review investigated AMS interventions on a global scale, it is necessary to also consider policy-specific barriers to stewardship. Low- and middle-income countries often have lower policy enforcement, staff support, and infrastructure to support long-term and effective AMS interventions (Noor et al., 2025). As both country-specific research and interventions continue to emerge, it is critical to consider and adapt to the political and healthcare contexts of these regions. Lastly, a reliance on solely guidelines represents a critical barrier to achieving sustainable change. Guidelines can be ambiguous and inaccessible, contributing to dental providers overprescribing antimicrobials (Noor et al., 2025). Even with suitable guidelines, risk-averse behaviour can be at the crux of unnecessary prescribing, further emphasizing the need for educational interventions targeting participants’ attitudes and prescribing habits (Martine et al., 2024).

On a larger scale, targeting AMR goes beyond enforcing prescription guidelines and even changing provider behaviours, requiring involvement from a multitude of sectors. Known as the One Health approach, the WHO emphasizes the need for action across human, animal, plant, and environmental components of AMR (World Health Organization, 2024). This requires intervention from political, healthcare, agricultural, and pharmaceutical industries (World Health Organization, 2015). While this review focuses on AMS in the context of dental education, practice and policy implications must reach far wider to address the AMR crisis as a whole.

While our review focused on strong methodology, there are limitations to consider. The risk of missing relevant studies was minimized through searching six databases and collaborating with a specialized librarian, however, this limitation is still present. The inclusion of grey literature was outside of this review’s scope, but represents an area where potentially pertinent sources may have been missed. Within included studies, the level of detail reported varied significantly. There was a lack of specificity surrounding several intervention characteristics, and as such, our synthesis should be interpreted with this limitation in mind. We encourage future research to prioritize more thorough reporting of their intervention methodology, such as through the TIDieR framework (Hoffmann et al., 2014). Our scoping review did not include an analysis of the quality and effectiveness of included studies. Although outside of the scope of this review, this represents an area for further investigation with significant potential to shape the modalities of future AMS interventions.

Conclusion

This review highlighted the wide scope of interventions promoting AMS in dental schools globally. It is hoped that the findings of this study will inform future initiatives, contributing to more engaging and effective education. AMR cannot be fought without actively promoting AMS, underscoring the importance of meaningfully reaching the next generation of dental practitioners and those instructing them.

Supplemental material

Supplemental Material - Educational antimicrobial stewardship interventions in dental schools: A scoping review

Supplemental Material for Educational antimicrobial stewardship interventions in dental schools: A scoping review by Madison Dick, Annie Mao, Belinda Nicolau and Quan Nha Hong in Community Dental Health.

Supplemental material

Supplemental Material - Educational antimicrobial stewardship interventions in dental schools: A scoping review

Footnotes

Acknowledgements

We would like to thank McGill University librarian Jingjing Li for her assistance in developing our search strategy.

ORCID iDs

Madison Dick

Annie Mao

Belinda Nicolau

Quan Nha Hong

Ethical considerations

Ethical approval was not required for this scoping review.

Author contributions

Madison Dick: Formal Analysis (equal), Investigation (lead), Writing – Original Draft Preparation (equal), Writing – Review & Editing (equal). Annie Mao: Formal Analysis (equal), Investigation (supporting), Writing – Original Draft Preparation (equal), Writing – Review & Editing (equal). Belinda Nicolau: Conceptualization (equal), Funding Acquisition (lead), Methodology (equal), Supervision (equal), Writing – Review & Editing (equal). Quan Nha Hong: Conceptualization (equal), Methodology (equal), Supervision (equal), Writing – Review & Editing (equal).

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Canadian Institutes of Health Research (grant number 481511).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All data relevant to this scoping review is shared within the manuscript and supplementary files.

Supplemental material

Supplemental material for this article is available online.

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