What advice should you give about finishing a course of antibiotics for dental infections?
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A BMJ opinion piece that questioned the existing medical advice about taking a full course of antibiotics to treat infection hit the headlines recently. Of course, the tabloids relished giving doctors a dressing down about the validity of their health advice, yet again.
The screaming by-lines ‘Current NHS advice is putting patients at risk, according to experts’, will probably do nothing to help the confusion amongst your dental patients – so here’s some advice on trying to help make it clear for your patients, and what you should be doing to prescribe antimicrobials appropriately in dentistry.
Should you prescribe a full course, when antibiotics are indicated for dental pain?
As dentists, we already tailor antibiotic treatment to individual patient need: FGDP guidance for most antibiotics prescribed by dentists gives a guideline of ‘up to five days’, or to ‘review after two to three days and discontinue if resolved’. The guidance also emphasises that, alongside, we should always try to remove the cause of the infection if possible. In dentistry, we are often in a position to do that.
The BMJ article argues that antimicrobial resistance may be more of a threat if a patient has treatment for too long, than if a patient stops taking medication too early. The authors said there has been no evidence to support the claim that stopping treatment early might increase the risk of a resistant infection. Their advice is to treat each patient on an individual basis (which we dentists, of course, already do) and that messaging to patients on the course of treatment should be tailored, depending on your clinical judgement.
The FGDP guidance for dentists remains appropriate. For our medical colleagues, it’s to be hoped that accepted prescribing practice will always be based on the best available evidence, and that patients receive clear and consistent messages when prescribed antimicrobials. First and foremost, they should use them – and safely dispose of any excess – as directed by the clinician.
Antibiotic resistance: what’s the problem in dentistry?
Antibiotic resistance is a real and growing problem, and dentistry has its part to play in helping curb the tide of unnecessary prescribing – studies have estimated up to 10% of all antibiotic prescriptions in the UK and Western Europe are made by dentists in primary care.
Patients sometimes ask for antibiotics, as they mistakenly think this is a ‘quick fix’ for problems. We know it’s not, and that toothache diagnosed as an inflammatory condition (for example, acute pulpitis) can’t be treated effectively with antibiotics. In those circumstances, clearly it’s a clinical intervention that will solve the problem. It’s important that we don’t give in to inappropriate demands or allow our clinical judgement to be swayed by anything but what is best for that patient.
How can I make sure I am prescribing antibiotics correctly?
With FGPD and Public Health England, we have developed a toolkit to help you determine whether to prescribe or not – the fact is that many instances of toothache don’t require antibiotics and are better actively treated more effectively in other ways.
The toolkit can help you review and optimise your prescribing practices and offers advice on getting this message across to patients.
For young dentists, we know there is such a fear of being hauled in front of the regulator, that the temptation to just give a patient what they want, to avoid complaints, is something to keep an eye on. We have called for adequate training for all dental students and professionals in the diagnosis and treatment of acute dental pain.
We’ve also asked for appropriate state-funded emergency time to allow dentists to fit in those patients who present unexpectedly with an infection or pain that needs clinical intervention – factoring this into commissioning is key to be able to do what we need to do for our patients.
Have faith in yourself
It’s also important that patients listen to the advice of their dentist, so your ability to communicate and hold the trust of your patient will be key to this.
Overcoming misconceptions about treatments, about what drugs are needed or not, and often, just plain fear, is something that every general dental practitioner has to face on a daily basis.
But have faith in your skills and expertise – you are the professional, and if you follow the guidelines, you know you are doing what is best for your patients
We’re always keen to hear about your experiences and about any comments or questions that you have on the topic of antibiotics or antimicrobial resistance, please get in touch.
Susie Sanderson, BDA Health and Science Committee member, CED Task Force on Antibiotics in Dentistry & member of Dental Subgroup ESPAUR