How justified are dentists in using antibiotics? A review
March 20, 2015
This summary is based on the article published in the International Dental Journal: Antibiotics in dental practice: how justified are we (February 2015)
Sukhvinder S. Oberoi, Chandan Dhingra, Gaurav Sharma, Divesh Sardana
Courtesy of Wiley Publishing, you can access the full-text article for the next 3 months here (PDF)
Context
- Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection.
- Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures.
- The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics.
Purpose of the Review
This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.
Key Messages
- Dentists can make a difference by the judicious use of antimicrobials – prescribing the correct drug, at the standard dosage and appropriate regimen – only when systemic spread of infection is evident.
- The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents.
- There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry.
More often than not we encounter patients who have prescriptions from their physicians or from walk-in clinics for tooth aches without any justification i.e., marked swelling, redness, fever, or any systemic symptoms that justify these prescriptions.
It seems just about every patient has his own supply of “penicillin”. Often we hear the patient say he knew he had an abscess but only had 5 pills or whatever. So he took one every day or two from his supply from last time someone prescribed to him and he didn’t finish the prescription so two days of penicillin would last a week. Now if this doesn’t cause antibiotic resistance, I don’t know what could. I think this article takes aim at dentists but really doesn’t give enough specific information for the reader to be able to discern whether the allegation is correct.