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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.
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