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Antibiotics in endo pain control inaffective
ANTIBIOTIC PROPHYLAXIS IN DENTISTRY: A REVIEW AND PRACTICE RECOMMENDATIONS
Are antibiotics being used appropriately for emergency dental treatment?
British Dental Journal
OCTOBER 13 2001, VOLUME 191, NO. 7, PAGES 391-393
Are antibiotics being used appropriately for emergency dental treatment?
Y. M. Dailey1 and M. V. Martin2
1Lecturer, Department of Clinical Dental Sciences, University of Liverpool, Liverpool L69 3BX;
2Senior Lecturer, Department of Clinical Dental Sciences, University of Liverpool, Liverpool L69 3BX
Correspondence to: Y. M. Dailey
Aim: To investigate the therapeutic prescribing of antibiotics to patients presenting for emergency dental treatment.
Design A prospective clinical study.
Method: Information was collected via a questionnaire concerning the patient's reason for attendance and treatment
undertaken at emergency dental clinics in North and South Cheshire.
Results: Over an 11-week period 1,069 patients attended the five clinics, 1,011 questionnaires were analyzed.
The majority of the attendees had pain (879/1011). 35% (311/879) of these patient had pulpitis and 74% (230/311)
had been issued a prescription for antibiotics, without any active surgical intervention. The principal antibiotic
prescribed for both adult and child patients was amoxicillin.
Conclusion The majority of patients attending the emergency dental clinics had pain, with a large proportion
having localised infections either as pulpitis or localised dental abscess. Three quarters of these patients had
no surgical intervention and were inappropriately prescribed antibiotics.
The General Dental Council states that 'the dentist has a professional responsibility for emergency dental care'.
They recognise the difficulties in defining an emergency but state that a sympathetic response to patients with
pain is expected. If a patient has acute spread of infection, haemorrhage, or trauma, it is the dentist's duty
to make arrangements for the patient to receive advice or treatment in a reasonable time.1
Management of acute dental conditions is primarily based upon extraction of teeth or extirpation of the pulp.
2 The use of antibiotics as an adjunct in the management of orofacial infections is an important treatment option
and when clinically indicated is of therapeutic benefit to the patient.3 However systemic antibiotics should be
used with restraint because of the possibility of allergic reactions, toxicity, side effects and the development
of resistant strains of microbes.4
In 1996 Thomas et al., investigated the prescribing of antibiotics to emergency dental patients by primary
healthcare workers.5 They concluded that both general medical and general dental practitioners had prescribed
antibiotics inappropriately to patients with dental emergencies. Evidence from further studies further suggests
that antibiotics are being prescribed inappropriately within general dental practice.6-9 However these studies
are based upon hypothetical case scenario questionnaires. They are unable to predict the effect that the
dentist-patient relationship may have upon the practitioners' prescribing behaviour. The aims of this study
were to investigate the appropriateness of antibiotic prescribing to patients presenting for emergency dental
treatment.
British Dental Journal 191, 391 - 393 (2001)
Published online: 13 October 2001 | doi:10.1038/sj.bdj.4801190
Subject Category: Therapeutics
Full article...............
References:
1 General Dental Council (Maintaining Standards) November 1997: Providing for dental emergencies and out of hour's care,
paragraph 3.11.
2 Olson A K, MacEdington E, Kulid J C, Weller R N. Update on antibiotics for endodontic practice. Compend Continuing
Educ Dent 1995; 11: 328-332.
3 Pogrel M A. Antibiotics in general practice. Dent Update 1994; 21: 274-270.
4 Mata E, Koren L Z, Morse D R, Sinai I H. Prophylatic use of penicillin V in teeth with necrotic pulps and asymptomatic
periapical radiolucencies. Oral Surg Oral Med Oral Pathol 1985; 60: 201-207.
5 Thomas D W, Satterthwaite J, Absi E G, Lewis M A O, Shepard J P. Antibiotic prescription for acute dental conditions
in the primary care setting. Br Dent J 1996; 181: 401-404.
6 Palmer N A O, Pealing R, Ireland R S, Martin M V. A study of prophylatic antibiotic prescribing in National Health
Service general dental practice in England. Br Dent J 2000; 189: 43-46.
7 Palmer N A O, Pealing R, Ireland R S, Martin M V. A study of therapeutic antibiotic prescribing in National Health
Service general dental practice in England. Br Dent J 2000; 188: 554-558.
8 Palmer N A O, Ireland R, Palmer S. Antibiotic prescribing patterns of a group of general dental practitioners:
results of a pilot study. Prim Dent Care 1998; 4: 137-141.
9 Baker G R, Qualtrough A J E. An investigation into antibiotic prescribing at a dental teaching hospital.
Br Dent J 1987; 162: 303-306.
10 SPSS for Windows Base Version 9.0.0. SPSS Inc, Chicago. 1998
11 Matthews R W, Peak J D, Scully C. The efficacy of management of acute dental pain. Br Dent J 1994; 176: 413-416.
12 Martin M V, Longman L P, Hill J B, Hardy P. Acute dentoalveolar infections: an investigation of the duration of
antibiotic therapy. Br Dent J 1997; 183: 135-137.
13 Lewis M A O, McGowan D A, MacFarlane T W. Short-course high dosage Amoxicillin in the treatment of acute
dentoalveolar abscess. Br Dent J 1986; 161: 299-302.
14 Fazakerley M W, McGowan P, Hardy P, Martin M V. A comparative study of cephadrine, amoxicillin and
phenoxymethylpenicillin in the treatment of acute dentoalveolar infection. Br Dent J 1993; 174: 359-363.
15 Abbott P V. Selective and intelligent use of antibiotics in endodontics. Aust Endo J 2000; 26: 30-39.
16 De Santis G, Harvey K J, Howard D, Mashford M L, Moulds R F. Improving the quality of antibiotic prescription
patterns in general practice. The role of educational intervention. Med J Aust 1994; 160: 502-505.
17 Swann R A, Clark J. Antibiotic policies - relevance to general practitioner prescribing. Family Health Services
Authority, Great Britain. J Antimicrob Chemother 1994; 33: 131-135.
18 Steed M, Gibson J. An audit of antibiotic prescribing in general dental practice. Prim Dent Care 1997; 4: 66-70.
19 Faculty of General Dental Practitioners (UK) Royal College of Surgeons, England. Adult antimicrobial prescribing
in primary dental care for general dental practitioners, 2000.
