Knowledge-Guided Large Language Model for Automatic Pediatric Dental Record Understanding and Safe Antibiotic Recommendation

Abstract

Accurate interpretation of pediatric dental clinical records and safe antibiotic prescribing remain persistent challenges in dental informatics. Traditional rule-based clinical decision support systems struggle with unstructured dental narratives, incomplete radiographic descriptions, and complex safety constraints. To address these limitations, this study proposes a Knowledge-Guided Large Language Model (KG-LLM) that integrates a pediatric dental knowledge graph, retrieval-augmented generation (RAG), and a multi-stage safety validation pipeline for evidence-grounded antibiotic recommendation. The framework first employs a clinical NER/RE module to extract structured entities and relations from dental notes and radiology reports. Relevant guidelines, drug-safety rules, and analogous historical cases are subsequently retrieved from the knowledge graph and supplied to the LLM for diagnostic summarization and dose-drug-duration prediction. Safety assurance is achieved through a dual-layer validation mechanism combining deterministic rule checking with a learned classifier for detecting allergies, contraindications, and dosing errors. Experiments on 32,000 de-identified pediatric dental visit records demonstrate the effectiveness of the proposed approach. Compared with a domain-adapted Llama-2 clinical baseline, KG-LLM improves record-understanding performance (F1: 0.914 vs. 0.867), drug-dose-duration accuracy (Top-1: 0.782 vs. 0.716), and reduces unsafe antibiotic suggestions by 50%. Additional evaluation across summary quality, recommendation accuracy, and global safety scores further confirms the robustness of the system. Ablation analyses indicate that the knowledge graph, RAG, and safety modules each contribute substantially to clinical reliability and interpretability.