Antimicrobial Resistance and Stewardship in Dentistry: An Umbrella Review of Systematic Reviews

Introduction: Antimicrobial resistance (AMR) is a major global health challenge, with dentistry contributing 7–10% of antibiotic prescriptions worldwide. Inappropriate prescribing, rising resistance in oral pathogens, and limited stewardship interventions underscore the need for consolidated evidence. To synthesize evidence from systematic reviews and meta-analyses on AMR and stewardship in dentistry, and to critically appraise their methodological quality using a measurement tool to assess systematic Reviews 2 (AMSTAR-2). Materials and Methods: An umbrella review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 and Joanna Briggs Institute methodology. PubMed, Scopus, Embase, Web of Science, and Cochrane Library were searched for systematic reviews and meta-analyses published between January 2020 and March 2025. Eligible reviews reported on AMR prevalence, prescribing practices, prophylaxis, stewardship interventions, or oral microbiota resistance. Methodological quality was assessed using AMSTAR-2. A narrative synthesis was performed due to heterogeneity. Results: Thirteen systematic reviews and meta-analyses were included. Key themes identified were the following: (1) antibiotic prophylaxis—single-dose preoperative prophylaxis reduced implant failures, while prolonged regimens showed no added benefit; (2) prescribing patterns and misuse—high rates of inappropriate prescribing and self-medication were reported, especially in low- and middle-income countries; (3) AMR in oral pathogens—widespread resistance to penicillin, amoxicillin, metronidazole, and clindamycin was observed, with oral biofilms harboring diverse resistance genes; and (4) stewardship interventions—audit and feedback with education were most effective, while guideline dissemination alone was insufficient. Methodological quality varied, with several reviews rated as critically low due to a lack of protocol registration and limited bias assessment. Conclusion: Dentistry contributes significantly to the AMR burden through inappropriate prescribing and pathogen resistance. Evidence supports single-dose prophylaxis and active stewardship strategies. Dentistry must be integrated into national and global AMR action plans to strengthen antimicrobial stewardship and safeguard antibiotic effectiveness.