Antimicrobial Stewardship in Canadian Dental Education: A Qualitative Study of Stakeholder Perspectives on Challenges, Opportunities, and Priority Action Areas

Background: Antimicrobial resistance (AMR) is a major global public health challenge, and dentistry contributes substantially to outpatient antibiotic prescribing. Although antimicrobial stewardship (AMS) is increasingly recognized as an essential component of oral healthcare, strengthening stewardship requires coordinated efforts across dental education, clinical practice, professional regulation, and health policy. The study aimed to explore stakeholder perspectives on AMS education and implementation in Canadian dental education and identify priorities for strengthening stewardship. Methods: This qualitative descriptive study included 45 stakeholders (instructors, students, clinicians, researchers, professional organizations, regulators, and policymakers) from across Canada, who participated in a two-day national stakeholder workshop was held at McGill University, Montreal in October 2025. Participants engaged in structured World Café discussions addressing seven sensitizing constructs related to AMS in dental schools and identified priority action areas for future intervention. The discussions were analyzed using a deductive-inductive thematic analysis. Results: Four overarching themes were identified: (1) fragmented curricula and inconsistent clinical training undermine AMS education; (2) professional identity and ethical decision-making shape antimicrobial prescribing; (3) patient expectations and clinician-patient communication influence prescribing decisions; and (4) system-level barriers limit consistent AMS implementation. Participants identified three priority action areas for intervention co-design: curriculum and guideline development, clinical decision-support tools, and patient education and engagement. Participants emphasized that stewardship extends beyond prescribing knowledge to encompass professional values, faculty development, patient engagement, and coordinated leadership across educational institutions and healthcare systems. Conclusions: Strengthening AMS in Canadian dentistry requires coordinated action across educational, professional, and system level factors. The stakeholder-informed priorities and logic model provide a foundation for future co-development and evaluation of AMS interventions in Canadian dental education and practice.