Antibiotic resistance is a worrying issue globally and death rates from previously treatable and emerging infections are on the rise. Primary care dentistry in the United Kingdom accounts for around 10% of all prescriptions. Recent evidence seems to suggest that a significant proportion of these prescriptions may involve inappropriate prescribing of antibiotics. Widespread use of broad spectrum antimicrobials has been responsible for increasing cases of MRSA and diseases associated with Clostridium difficile.
Guidelines on antimicrobial prescribing in dentistry produced by the Faculty of General Dental Practice (UK) and the Scottish Dental Clinical Effectiveness Programme should be the benchmark for all dental practices. Dentists must resist pressure from patients who have become reliant on antibiotic prescriptions from historical patterns of prescribing. Educating patients on the dangers of overusing antimicrobials is crucial if we are to halt the progression of antimicrobial resistance.
When to use Antibiotics
Antibiotics should only be used where local measures are not possible or have failed. Local measures include drainage of pus through incision of soft tissue, tooth extraction or the extirpation of pulpal tissue from the root canal system. In the case of diffuse swellings or spreading infections and cellulitis, antibiotic therapy is indicated. If there is a fever or systemic involvement such as lymph node swelling then antibiotic therapy can be justified. Fever is indicated if temperatures are greater than 38 degrees Centigrade. The availability and use of clinical thermometers therefore is to be encouraged and considered good practice.
Antibiotics should not be used to prevent infections after routine dental surgical procedures. Nor should antibiotics be used in the management of acute pulpitis. Antibiotics should not be used in the prevention of dry sockets during routine non-surgical extraction of teeth. Where patients taken antibiotics six weeks prior to subsequent infection, then alternatives should be prescribed as resistant bacteria may still be present.
Whilst it is all too easy to grab the prescription pad, clinicians need to consider all alternative pathways before prescribing antimicrobials.
