Improvement of dental prescribing practices using education and a prescribing tool: A pilot intervention study.

Characteristics Associated With Opioid and Antibiotic Prescribing by Dentists

Dental prescribing data in Wales have not been studied in detail previously. The analysis of national data available from Health Solutions Wales showed that dental prescribing in Wales accounted for 9% of total antibacterial prescribing in primary care in 2008. Penicillin and metronidazole constituted the bulk of antibiotics prescribed by dentists. Since the publication of National Institute for Health and Clinical Excellence (NICE) guidance (March 2008) on prophylaxis against infective endocarditis, dental prescriptions for amoxicillin 3g sachets and clindamycin capsules have decreased. Dental prescriptions for fluoride preparations increased in number from 2007 to 2008. Dental prescribing of controlled drugs raises no concern. The figure for antibiotic prescribing in Wales is similar to that of England. Nevertheless, the figure seems a little high, indicating potential inappropriate prescribing behaviour among dentists. Antibiotic resistance is a major public health issue and many patients each year die from infections from bacterial strains that are resistant to one or more antibiotics. Inappropriate use of antibiotics is a major cause of antibiotic resistance and every effort should be made to reduce the number of inappropriate antibiotic prescriptions in dental practice.

BackgroundDentists prescribe approximately 10% of antibiotics dispensed in UK community pharmacies. Despite clear clinical guidance, dentists often prescribe antibiotics inappropriately. This cluster-randomised controlled trial used routinely collected National Health Service (NHS) dental prescribing and treatment claim data to compare the impact of individualised audit and feedback (A&F) interventions on dentists’ antibiotic prescribing rates.Methods and FindingsAll 795 antibiotic prescribing NHS general dental practices in Scotland were included. Practices were randomised to the control (practices = 163; dentists = 567) or A&F intervention group (practices = 632; dentists = 1,999). A&F intervention practices were allocated to one of two A&F groups: (1) individualised graphical A&F comprising a line graph plotting an individual dentist’s monthly antibiotic prescribing rate (practices = 316; dentists = 1,001); or (2) individualised graphical A&F plus a written behaviour change message synthesising and reiterating national guidance recommendations for dental antibiotic prescribing (practices = 316; dentists = 998). Intervention practices were also simultaneously randomised to receive A&F: (i) with or without a health board comparator comprising the addition of a line to the graphical A&F plotting the monthly antibiotic prescribing rate of all dentists in the health board; and (ii) delivered at 0 and 6 mo or at 0, 6, and 9 mo, giving a total of eight intervention groups. The primary outcome, measured by the trial statistician who was blinded to allocation, was the total number of antibiotic items dispensed per 100 NHS treatment claims over the 12 mo post-delivery of the baseline A&F. Primary outcome data was available for 152 control practices (dentists = 438) and 609 intervention practices (dentists = 1,550). At baseline, the number of antibiotic items prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. At follow-up, antibiotic prescribing had decreased by 0.4 antibiotic items per 100 NHS treatment claims in control practices and by 1.0 in intervention practices. This represents a significant reduction (-5.7%; 95% CI -10.2% to -1.1%; p = 0.01) in dentists' prescribing rate in the intervention group relative to the control group. Intervention subgroup analyses found a 6.1% reduction in the antibiotic prescribing rate of dentists who had received the written behaviour change message relative to dentists who had not (95% CI -10.4% to -1.9%; p = 0.01). There was no significant between-group difference in the prescribing rate of dentists who received a health board comparator relative to those who did not (-4.3%; 95% CI -8.6% to 0.1%; p = 0.06), nor between dentists who received A&F at 0 and 6 mo relative to those who received A&F at 0, 6, and 9 mo (0.02%; 95% CI -4.2% to 4.2%; p = 0.99). The key limitations relate to the use of routinely collected datasets which did not allow evaluation of any effects on inappropriate prescribing.ConclusionsA&F derived from routinely collected datasets led to a significant reduction in the antibiotic prescribing rate of dentists.Trial RegistrationCurrent Controlled Trials ISRCTN49204710

Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem.Objective This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance. Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis. Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations. Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.

BackgroundData suggest dental antibiotic prescribing is increasing with relatively less documented about prescribing trends in adults and children. Therefore, the aim was to evaluate trends in antibiotic prescribing by US dentists from 2012–2017.MethodsThis was a cross-sectional study of US dental prescribing using IQVIA Longitudinal Prescription Data from 2012 to 2017. Prescribing rates (prescriptions [Rx] per 100,000 dentists), mean days’ supply, and mean quantity dispensed were calculated monthly across eight oral antibiotic groups: amoxicillin, clindamycin, cephalexin, azithromycin, penicillin, doxycycline, fluoroquinolone, and other antibiotics. Descriptive frequencies and multiple linear regressions were performed to obtain trends overall and stratified by adults (≥ 18) and children (< 18).Results220, 325 dentists prescribed 135 million Rx (94.0% in adults). 61.0% were amoxicillin, 14.4% clindamycin, 11.7% penicillin, 4.4% azithromycin, 4.3% cephalexin, 2.0% other antibiotics, 1.4% doxycycline, and 0.7% fluoroquinolones. Prescribing increased by 33 Rx/100,000 dentists (p< 0.0001) each month for all antibiotics. Amoxicillin (p< 0.0001) and clindamycin (p=0.02) prescribing rate increased by 73 and 5 Rx/100,000 dentists, respectively. Prescribing decreased by 8, 12, and 2 Rx/100,000 dentists for cephalexin (p< 0.0001), doxycycline (p< 0.0001), and fluoroquinolones (p=0.008), respectively. Mean days’ supply increased for amoxicillin, penicillin, and clindamycin (p< 0.0001), and decreased for cephalexin (p< 0.0001).Mean quantity dispensed decreased (p< 0.0001) for all groups except azithromycin and doxycycline. Among adults, cephalexin prescribing rates (7 Rx/100,000 dentist; p< 0.0001) and other antibiotics days’ supply (p< 0.0001) decreased. Among children, azithromycin prescribing rates (1 Rx/100,000 dentists, p=0.02), and fluoroquinolone and other antibiotics days’ supply (p< 0.0001) decreased.ConclusionThese findings support dental antibiotic prescribing is increasing, specifically for amoxicillin and clindamycin. Further, trends differed between adults and children. Understanding what is driving these trends is important to target dental antibiotic stewardship efforts.DisclosuresAll Authors: No reported disclosures

Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem. This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance. Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis. Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations. Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.

Preventing medication errors in dental practice: An australian perspective

Introduction:The coronavirus disease 2019 (COVID-19) pandemic and subsequent restrictions on dental services have had a significant impact on the provision of dental care in Australia and around the world.Objectives:To investigate the impact of COVID-19 on medications prescribed by dentists under the Australian Pharmaceutical Benefits Scheme (PBS).Methods:Data on the number of dental prescriptions dispensed for all medications listed on the PBS Dental Schedule, from January 2019 to June 2020, were extracted from publicly available data sets. Analysis of prescription trends was performed for 1) total medications, 2) each major medication class, and 3) individual medications. The number of prescriptions dispensed in each month from January 2020 to June 2020 was compared to the same month in 2019 to determine the relative (percentage) change, and z statistics were used to determine whether changes were statistically significant.Results:There was a significant decrease in dental prescriptions in April 2020 compared to April 2019 (14,785, 18%; P < 0.05). Decreases in prescriptions for antibiotics (10,512, 16%; P < 0.05) and opioid analgesics (3,129, 18%; P < 0.05) were smaller compared to other major medication classes. There was a significant increase in June 2020, compared with June 2019, for prescriptions of amoxicillin with clavulanic acid (4,903, 20%; P < 0.05), tramadol (89, 46%; P < 0.05), and oxycodone (381, 73%; P < 0.05).Conclusion:Dental service restrictions during COVID-19 likely drove an unmet need for routine dental treatment, which had significant implications for public oral health following easing of restrictions. During the initial surge and subsequent lockdown, antibiotics and opioid analgesics may have been used an as alternative to routine operative treatment. Continued professional guidance is required to ensure dental prescribing remains evidence based during the pandemic period.Knowledge Transfer Statement:The COVID-19 pandemic and subsequent restrictions on dental practice have had a profound impact on the provision of dental care in Australia and elsewhere in the world. In this context, population-level medication surveillance is important to identify and respond to changes in prescribing patterns that have arisen due to COVID-19 and restrictions on the provision of dental care. This research is particularly important for governments, regulators, and professional associations to ensure therapeutic guidelines and recommendations during the pandemic period remain relevant and evidence based.

Introduction: Inappropriate use of antibiotics not only drives antibiotic resistance and misuses resources but also increases the risk of potentially fatal reactions and exposes people to unnecessary side effects and unfavorable outcomes ranging from gastrointestinal disturbances to fatal anaphylactic shock. In developed countries, surveys about general dental practitioners’ prescribing habits have raised awareness of the quality of prescriptions of antibiotics. Whilst some surveys have emphasized that dental prescriptions do not follow clinical guidelines, other authors have concluded that there is a lack of scientific information about appropriate and efficient prescription of proper antibiotic. Moreover, changes in the dental pharmacotherapeutic field have been so rapid in recent years that necessitate the constant updating of dental practitioners’ knowledge about new drugs, drug interactions, and useful therapeutic trends is necessary. Methods: We have conducted a descriptive cross-sectional study among dentists and dental trainee in Jazan city. The questionnaire required information about antibiotic prescription habits, knowledge about preventive majors of dental infection, and followed approaches in dental emergencies. Data collected through distribution of online filled questionnaire. The participants filled the questionnaire online then resent it again to the researcher. The distributed questionnaire was in Arabic language to overcome the language barrier. Collected data verified and coded before its entry to Statistical Package for the Social Science (SPSS). Results: Participants were classified into four categories by age: from 20 to 24 years (30.9%), from 25 to 30 years (53.9%), from 31 to 35 years (8.6%) and above 35 years (6.6%). More than half of participants were Dental graduates (56.4%%), (37%) were students and Interns, (6.2%) were with Master/ Diploma and only one of them with PhD (.4%).The majority of participants prescribed antibiotic for acute apical abscess (72.8%), on the other hand, less than half of participants (45.7%) prescribed antibiotics for acute apical abscess without systemic involvement, and nearly two thirds (65.4%) of participants prescribed antibiotic for medically compromised patient after tooth extraction. Conclusion: It is alarming that most dentists do not perform a proper microbial diagnosis before selecting an antibiotic as adjunct periodontal therapy. As a result, they tend to prescribe broad spectrum antibiotics depending on the probability and most likely diagnosis. Also, the misconception of indications for antibiotic prescription and low knowledge about antibiotics assist in the misuse and in proper use of antibiotics.Educational initiatives and continuous refreshment of knowledge may prevent unnecessary prescription in endodontic emergency treatments

Is it time US dentistry ended its opioid dependence?

Oral health in pregnant and lactating women can affect maternal and child health. Dental treatments in this period should not have adverse effects on maternal and child health. This study was conducted to investigate the last-year dental students’ knowledge of the prescription of analgesics and antibiotics for pregnant and lactating mothers in Isfahan city, Iran. Methods: A total of 104 last-year dental students of Khorasgan Islamic Azad University and Isfahan University of Medical Sciences were recruited in this descriptiveanalytical study. They completed a 16-item questionnaire on the prescription of analgesics and antibiotics for pregnant and lactating mothers. Data were analyzed by SPSS (Version 22) statistical software(t-test). Results: The total mean score of students’ knowledge was 9.02±1.91. The highest level of knowledge about the safest analgesic (acetaminophen) was reported for the pregnant patients so that 100% of them had correct information in this regard. Further, the lowest level of knowledge was found for the use of dexamethasone during lactation, as only 10.6% of respondents were able to provide a correct response in this regard. Conclusion: The dental students had average knowledge about the prescription of antibiotics and analgesics for pregnant and lactating patients. To prevent the possible risks for these patients, further information should be provided to dental students.

Trends in antibiotic prescribing by dental practitioners in Germany

Background Antimicrobial prescribing in dentistry contributes to approximately 10% of overall antibiotic prescribing in primary care, which is significant. There is an opportunity to enhance antimicrobial stewardship (AMS) in dentistry practice in Ireland to address this. In order to understand the factors influencing antimicrobial prescribing by dentists, their views and experiences must be explored. Objectives To conduct a mixed methods study to explore general dental practitioner’s views and experiences regarding antimicrobial use and antimicrobial resistance (AMR). Methods An explanatory sequential mixed methods study was conducted. First, a survey exploring dental antimicrobial prescribing and views on antimicrobial prescribing and AMR was emailed to Irish Dental Association members in September 2024. The survey findings were analysed descriptively. The findings helped to refine the topic guide of the subsequent qualitative, semi-structured interviews conducted with general dental practitioners in November/December 2024. The verbatim interview transcripts were analysed by thematic analysis (Braun and Clarke) and then mapped to the Theoretical Domains Framework. Ethics approval was obtained, and all participants provided written informed consent. Results A total of 79 survey responses (62% female) were obtained and 12 interviews (six female) were conducted. The survey found that 45 (57%) dentists referred to the national health service antibiotic prescribing guidelines. Many dentists felt antibiotics are overprescribed in dentistry (61/78, 78.2% agree/strongly agree) and 59 (74.7%) agree/strongly agree that patients often expect to be prescribed an antibiotic. The results found that 41% (32/78) of respondents reported they never calculate a weight-based antibiotic dose for a child. The main domains reported were knowledge, environmental context and resources, memory, attention and decision-making, beliefs about consequences, beliefs about capabilities, social influence and social/professional role. Dentists reported the pressure from patients to prescribe antibiotics and also the lack of time to review and intervene on patients with infection. ‘Just in case’ antibiotic prescribing was noted in the survey and interview findings. Dentists interviewed noted the challenge when making decisions for infections not responding to the initial course of antibiotics and communicating with patients where English is not their first language. Challenges in dental interventions, or antibiotic compliance, in children or those with special needs were also noted as impacting on decisions. Many highlighted the importance of continuing professional development (CPD) and audits to improve antimicrobial prescribing practices. Conclusions This study identified important social and contextual factors in general dental practice which influence the prescribing of antimicrobials. To support the development of AMS in dental practice it is important to engage with dentists to ensure initiatives are tailored to their setting. CPD for dentists, patient education and surveillance of antibiotic prescribing in dental practice are recommended.

To investigate whether clinical audit can improve general dental practitioners' prescribing of antibiotics. An intervention study carried out in general dental practice in the North West of England. Information was collected over an initial six-week period from 175 general dental practitioners on their current antibiotic prescribing practices. The information collected was the antibiotic prescribed including dose, frequency and duration, the clinically presenting signs and conditions, the medical history (if for prophylaxis), and any other reasons for prescribing. This was compared to the practitioners' antibiotic prescribing for a further six-week period following an audit, which included an educational component and the issuing of guidelines. During the initial period practitioners issued 2316 prescriptions for antibiotics. This was reduced by 42.5% to 1330 during the audit. The majority of the antibiotics (81%) for both periods were prescribed for therapeutic reasons. The most commonly prescribed antibiotics were amoxycillin (57.6%), metronidazole (23.8%), penicillin (9.3%), erythromycin (4.8%) and a combination of amoxycillin and metronidazole (1.7%). The antibiotic regimens used by practitioners were significantly changed by the audit (P<0.001) and there was a significant reduction in the number of prescriptions (P<0.05) which did not conform to national guidelines. The results from this investigation support the conclusion that clinical audit, with the issuing of guidelines and an educational component, can change prescribing practices leading to a more rational and appropriate use of antibiotics in general dental practice.

Objective To investigate whether clinical audit can improve general dental practitioners' prescribing of antibiotics. Design An intervention study carried out in general dental practice in the North West of England. Method Information was collected over an initial six-week period from 175 general dental practitioners on their current antibiotic prescribing practices. The information collected was the antibiotic prescribed including dose, frequency and duration, the clinically presenting signs and conditions, the medical history (if for prophylaxis), and any other reasons for prescribing. This was compared to the practitioners' antibiotic prescribing for a further six-week period following an audit, which included an educational component and the issuing of guidelines. Results During the initial period practitioners issued 2316 prescriptions for antibiotics. This was reduced by 42.5% to 1330 during the audit. The majority of the antibiotics (81%) for both periods were prescribed for therapeutic reasons. The most commonly prescribed antibiotics were amoxycillin (57.6%), metronidazole (23.8%), penicillin (9.3%), erythromycin (4.8%) and a combination of amoxycillin and metronidazole (1.7%). The antibiotic regimens used by practitioners were significantly changed by the audit (P < 0.001) and there was a significant reduction in the number of prescriptions (P < 0.05) which did not conform to national guidelines. Conclusions The results from this investigation support the conclusion that clinical audit, with the issuing of guidelines and an educational component, can change prescribing practices leading to a more rational and appropriate use of antibiotics in general dental practice.