Prescribing patterns in a US dental school from 2010 to 2017.

Abstract

Dental education has an essential role in helping combat the opioid and antibiotic resistance crises. This study evaluates the prescribing practices of clinical instructors, advanced graduate residents, and predoctoral students in an academic dental setting. A retrospective chart review was conducted of electronic dental records from the years 2010 to 2017. The proportions of prescriptions for each drug group was calculated by prescribers' training level and specialty. Descriptive statistics were calculated for the daily opioid Morphine Milligram Equivalent (MME) dose prescribed across years and provider characteristics. Over the 8 years, 65,160 prescriptions were written for 10,374 patients by 625 prescribers. The most commonly prescribed drugs were for fluoride-based medications (30%) and antibiotics (24%). Periodontists had the greatest absolute number of opioid analgesics prescriptions (n=2712); oral maxillofacial surgeons (OMFS) prescribed more opioids than other classes of drug (49%) as a proportion of within-specialty prescriptions. Antibiotics were the most common drugs prescribed by endodontists (46%) and second most common drugs prescribed by periodontists (25%), OMFS (28%), and prosthodontists (21%). From 2010 to 2017, the proportion of prescriptions for antibiotics remained unchanged, while that of fluoride-based drugs increased from 2010 to 2014 and plateaued thereafter. The proportion of prescriptions for opioid analgesics decreased from 18% to 7%. The median daily MME dose across year and provider characteristics stayed constant (<50MME). These results demonstrate encouraging prescription trends for opioid and fluoride-based drugs. Due to the high prevalence of antibiotic prescriptions in academic dental settings, stewardship approaches should be emphasized.