The injudicious use of antibiotics is one of the key contributors to the emergence of antibiotic-resistant bacterial strains. It is therefore imperative that antibiotics are prescribed only when they are likely to result in clinical benefit for a patient. Clinical guidelines have been produced to assist dental practitioners in the appropriate use of antimicrobials. Despite these guidelines, there is evidence that antibiotics are still widely used and misused in the management of acute dental conditions. This article explores the barriers that exist with regard to the implementation of antibiotic prescribing guidelines and discusses some of the interventions that aim to optimise antibiotic prescribing in primary dental care.