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Thursday, February 25, 2016
Antibiotic prescribing by dentists has increased: Why?
J Am Dent Assoc. 2016 Feb 4. pii: S0002-8177(15)01213-1. doi: 10.1016/j.adaj.2015.12.014. [Epub ahead of print]
the overall rate of antibiotic prescribing has been declining in
British Columbia, Canada, the authors conducted a study to explain the
increased rate of prescribing by dentists.
authors obtained anonymized, line-listed data on outpatient
prescriptions from 1996 to 2013 from a centralized, population-based
prescription database, including a variable coding prescriber licensing
body. Analyses used Anatomical Therapeutic Classification standard codes
and defined daily dose (DDD) values. The authors normalized prescribing
rates to the population and expressed the rates in DDDs per 1,000
inhabitants per day (DID). The Canadian Dental Association released a
webinar that invited correspondence from dentists about the drivers of
1996 to 2013, overall antibiotic use declined from 18.24 DID to 15.91
DID, and physician prescribing declined 18.2%, from 17.25 DID to 14.11
DID. However, dental prescribing increased 62.2%, from 0.98 DID to 1.59
DID, and its proportionate contribution increased from 6.7% to 11.3% of
antibiotic prescriptions. The rate of prescribing increased the most for
dental patients 60 years or older. Communication from dentists in
Canada and the United States identified the following explanatory
themes: unnecessary prescriptions for periapical abscess and
irreversible pulpitis; increased prescribing associated with dental
implants and their complications; slow adoption of guidelines calling
for less perioperative antibiotic coverage for patients with valvular
heart disease and prosthetic joints; emphasis on cosmetic practices
reducing the surgical skill set of average dentists; underinsurance
practices driving antibiotics to be a substitute for surgery; the aging
population; and more dental registrants per capita.
themes for dental prescribing should be explored further in future
studies; however, themes already identified may guide priorities in
antibiotic stewardship for continuing dental education sessions.
prescribing should be reviewed to make sure that we are compliant with
guidelines. Most practitioners will find opportunities to prescribe less
often and for shorter durations.