Abstract
BackgroundNumerous studies of dental antibiotic prescribing show that overprescribing is a worldwide occurrence. The aim of this study was to assess prescribing practices of general dentists in Australia for antibiotics, analgesics and anxiolytics and to determine the extent to which prescribing is in accordance with current guidelines.MethodsA structured questionnaire was sent to 1468 dentists in Victoria and Queensland in July–August 2018. The questionnaire covered demographics, clinical conditions where dentists prescribe antibiotics, non-clinical factors which influence prescribing, and medicines for anxiolysis and pain relief. Responses were scored using a system based on the current Australian therapeutic guidelines. Logistic regression was used to determine the relative importance of independent variables on inappropriate prescribing.ResultsThree hundred eighty-two responses were received. Overall, 55% of overprescribing of antibiotics was detected, with a range of 13–88% on a routine or occasional basis depending on the scenario. Between 16 and 27% of respondents inappropriately preferenced analgesics over anti-inflammatories for dental pain; 46% of those who prescribed anxiolytic medicines did so inappropriately, with varying regimens and choices outside the guidelines. Years of practice was the main demographic factor influencing prescribing, with recent graduates (0–5 years) generally scoring better than their colleagues for antibiotic prescribing (p < 0.05).ConclusionsFuture interventions could be directed towards the appropriate role and use of antibiotics, shortfalls in knowledge and appropriate choices of medicines for pain relief and anxiolysis. Given that the most overprescribing occurred for localised swellings (88%), this area could be focused on in continuing education as well as ensuring it is addressed in undergraduate teaching. Continuing education on the appropriate use of medicines can be targeted at more experienced dentists as well as patients, especially those who expect antibiotics instead of treatment.Trial registrationUniversity of Melbourne Human Ethics Sub-Committee; ID: 1750768.1.
Highlights
Antibiotics are prescribed by dentists both therapeutically and prophylactically for the management of odontogenic infections
Numerous studies of dental antibiotic prescribing show that overprescribing occurs worldwide, where dentists tend to prescribe for unnecessary indications, often without concurrent dental treatment. [2,3,4] A cross-sectional study in Wales showed that 70.6% of antibiotics were prescribed without an operative intervention, [2] and a prospective study in Belgium showed high prescription rates for localised infections such as periapical abscesses, with 54.2% of antibiotics prescribed without
[5] Factors including limited clinical time, fulfilling patients’ expectations, inability to come to a diagnosis and avoiding litigation risk have been documented as non-clinical pressures influencing dental prescribing. [6,7,8] A survey of US endodontists revealed that almost 37% prescribed antibiotics unnecessarily, mostly due to patient expectations. [6]
Summary
Antibiotics are prescribed by dentists both therapeutically and prophylactically for the management of odontogenic infections It is accepted, that active dental treatment is generally the most effective way of treating pain and infection. [1] In Australia, the Therapeutic Guidelines Oral and Dental [1] was established in Numerous studies of dental antibiotic prescribing show that overprescribing occurs worldwide, where dentists tend to prescribe for unnecessary indications, often without concurrent dental treatment. The aim of this study was to assess prescribing practices of general dentists in Australia for antibiotics, analgesics and anxiolytics and to determine the extent to which prescribing is in accordance with current guidelines
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