Addressing Antibiotic Resistance in Dentistry: “What can WE do?”
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Guest Author: Marie T. Fluent, DDS
Educational Consultant for Organization for Safety, Asepsis and Prevention (OSAP)
Antibiotic resistance and antibiotic-associated adverse events are now some of our most serious global health threats (1). As a community of clinicians, educators, researchers, and industry representatives who advocate for safe and infection-free delivery of oral health care, OSAP (Organization for Safety, Asepsis and Prevention) knows these facts to be true:
- Misuse and overuse of antibiotics have contributed to antibiotic resistance (1).
- Every year in the United States, at least 2 million people become infected with antibiotic-resistant bacteria and approximately 23,000 people die as a direct result (1).
- Research and development on new antibiotics has decreased (2).
- Dentists prescribe approximately 10% of outpatient antibiotics (3).
- Studies suggest that 30% to 50 % of prescribed antibiotics are unnecessary or not optimally prescribed (4).
To further compound this problem:
- There are few studies that evaluate the appropriateness of antibiotic prescribing in dentistry.
- Guidelines have been published for antibiotic prophylaxis for prevention of infective endocarditis and prosthetic joint infections (5, 6).
- There are no national guidelines for treatment of specific dental infections.
Until national guidelines are developed and adopted for treatment of dental infections and a formal antibiotic stewardship program exists for dentistry, the question remains: What can dentists and dental teams do to support responsible antibiotic prescribing practices? Fortunately, there is much that can be done! A chart with clinical tips for responsible antibiotic prescribing follows:
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Clinical Tips for Responsible Antibiotic Prescribing in Dentistry* |
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Dos |
Don’ts |
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DO prescribe antibiotics only for a documented diagnosis of an oral bacterial infection |
DON’T prescribe for viral infections, fungal infections or oral ulcerations related to trauma or aphthae |
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DO recognize that antibiotics are not always necessary |
DON’T prescribe in lieu of dental interventions |
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DO prescribe only for patients of record |
DON’T prescribe based on demand or expectations from patients |
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DO prescribe only for bacterial infections you have been trained to treat |
DON’T prescribe based on non-evidence-based historical practices |
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DO review patient’s medical history to assess medical allergies, potential for adverse drug events, and medical conditions that would affect antibiotic selection |
DON’T prescribe based on pressure from another health care provider |
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DO prescribe only when clinical signs and symptoms of bacterial infection suggest systemic spread |
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DO use the most narrow-spectrum antibiotic for the shortest duration possible (after clinical signs and symptoms subside) for otherwise healthy patients |
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DO advise patients to take antibiotics exactly as directed |
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DO ensure antibiotic expertise or references are available during patient visits |
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DO collaborate with referring specialists about prescribing protocols |
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DO provide training to staff members to improve probability of patient adherence |
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DO keep up to date on appropriate management of oral infections (continuing education courses, conferences, accessing dental journals, pharmacology texts) |
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DO revise antibiotic regimens on basis of patient progress and, if needed, culture results |
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DO advise patients that they should NOT take antibiotics prescribed for someone else |
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DO advise patients that they should NOT save antibiotics for future illnesses |
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*Adapted from: Fluent MT, Jacobsen PL, Hicks LA, Considerations for Responsible Antibiotic Use in Dentistry, Journal of the American Dental Association, Vol 147, Issue 8, Aug 2016 |
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Combatting antibiotic resistance is not a one-time event. Continued efforts require a commitment from the entire dental team and that all prescribers evaluate their prescribing behaviors for appropriateness and effectiveness.
Additional resources:
American Dental Association. Oral health topics: antibiotic stewardship.
Centers for Disease Control and Prevention. Get smart: know when antibiotics work.
Organization for Safety, Asepsis and Prevention (OSAP). Antibiotic/antimicrobial resistance tool kit.
References:
- Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013.
- Spellberg B, Powers JH, Brass EP, Miller LG, Edwards JE. Trends in antimicrobial drug development: implications for the future. Clin Infect Dis. 2004;38(9):1279-1286.
- Hicks LA, Bartoces MG, Roberts RM, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015; 60(9):1308-1316.
- Demirjian A, Sanchez GV, Finkelstein JA, et al. CDC Grand Rounds: getting smart about antibiotics. MMWR Morb Mortal Wkly Rep. 2015;64(32):871-873.
- Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association—a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. JADA. 2008;139(1 suppl):3S-24S.
- Sollecito TP, Abt E, Lockhart P, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs. JADA. 2015;146(1):11-16.
Guest Author: Marie T. Fluent, DDS Dr. Fluent is an Educational Consultant for the Organization for Safety, Asepsis and Prevention. Her dental career expands more than 30 years and includes the roles of dental assistant, office manager, dentist (associate and practice owner), infection control coordinator, speaker, author, educator, clinical instructor, and infection control consultant. Dr. Fluent is passionate about infection control and safety and has educated thousands of dental professionals and students through writing, webinars, and lectures. She has written numerous peer-reviewed articles on infection control in the dental setting, OSHA compliance, and responsible antibiotic prescribing.
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