Antibiotic Exposure and Dental Health: A Systematic Review

Pediatrics. 2023 Jul 1;152(1):e2023061350. doi: 10.1542/peds.2023-061350.


Context: The use of antibiotics in young children is widespread and may lead to adverse effects on dental health, including staining, developmental defects, and dental caries.

Objective: To systematically review the effects of early childhood antibiotic exposure on dental health.

Data sources: Medline (Ovid/PubMed), Embase (Ovid) and Cochrane databases. Study bias was assessed using the Newcastle-Ottawa Scale.

Study selection: English language articles that reported antibiotic exposure before 8 years of age and 1 or more of the relevant outcomes (dental caries, intrinsic tooth staining, or developmental defects of enamel) were included.

Data extraction: Data on study population, design, type of antibiotic, outcome measurement, and results were extracted from the identified studies.

Results: The initial search yielded 1003 articles of which 34 studies were included. Five of the 18 studies on tetracycline described a dose response relationship between exposure to tetracycline doses of > 20 mg/kg per day and dental staining. Early childhood exposure to doxycycline (at any dose) was not associated with dental staining. There was no clear association between any early childhood antibiotic exposure and dental caries or enamel defects.

Limitations: In all included studies, the main limitations and sources of bias were the lack of comparison groups, inconsistent outcome measures, and lack of adjustment for relevant confounders.

Conclusions: There was no evidence that newer tetracycline formulations (doxycycline and minocycline) at currently recommended dosages led to adverse effects on dental health. Findings regarding antibiotic exposure and developmental defects of enamel or dental caries were inconsistent. Further prospective studies are warranted.

Publication types

  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents* / adverse effects
  • Bias
  • Child
  • Child, Preschool
  • Databases, Factual
  • Dental Caries* / chemically induced
  • Dental Caries* / epidemiology
  • Doxycycline
  • Humans
  • Infant


  • Anti-Bacterial Agents
  • Doxycycline