Implementation of Clinical Practice Guidelines in Dental Settings

Abstract

This study aimed to determine the knowledge and application of current expert recommendations on antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) both in the United Kingdom and Iran. The study used a 3-part postal questionnaire survey of dentists in the United Kingdom (n=467) and Iran (n=200) covering demographic data, antimicrobial prophylaxis prescribing habits for adults treated under local analgesia, and sources of information about recommended schedules and changes in dentists' prophylaxis regimens. Most UK dentists (87%) reported following the British National Formulary guidelines (BNF) on AP. Seventy-five percent of Iranian dentists follow the guidelines of the American Heart Association (AHA). A significant proportion of practitioners prescribed the correct antibiotic regimens for patients who are nonallergic or allergic to penicillin in the United Kingdom, but in Iran the knowledge of and compliance with the available guidelines regarding antibiotic regimens was poor. Although dentists were familiar with the dental procedures that could place their patients at risk, and more than 80% prescribed prophylaxis for patients with "prosthetic heart valves" and "previous bacterial endocarditis," they also considered AP for patients with medical conditions not known to be at risk. For the UK dentists, the most common source of information on AP is medical and dental journals, whereas for Iranian dentists, academic meetings, colleagues, and textbooks were cited as sources of information on AP. Furthermore, 80% of participants in both countries would like to attend further courses about this topic. Generally, dentists in the United Kingdom were more familiar with the current expert recommendations on AP than dentists in Iran; however, dentists in both countries tended to overprescribe. This could contribute to the problem of antimicrobial resistance. Educational initiatives aimed at implementing updated recommendations and continuous assessment of dental practice might reverse this trend.