The focus of most dental and oral care is clinical intervention. Antibiotics may be used as an essential first line treatment, or alongside clinical care when clinically indicated, but the benefits of prescribing them should always be balanced against their associated risks, including side effects, potential allergy and antibiotic resistance.
To avoid complaints or exposure to criticism from third parties, it's vital to make sure you're aware of current prescribing guidelines, and to record your assessment of patients and your discussions with them around prescribing.
Over the past few years, there has been a major drive to highlight the problem of antibiotic resistance, which is a serious and increasing public health concern. Research by the Faculty of General Dental Practitioners (FGDP) has revealed that in the UK, dentists working in primary care prescribe approximately 10% of all antibiotics, and as such, colleagues are in a prime position to help tackle this problem.
In order to support dentists in appropriate and responsible antibiotic prescribing, a number of resources have recently been developed. These include the Dental Antimicrobial Stewardship Toolkit, which incorporates the current and freely available guidance on prescribing from the FGDP, as well as the Scottish Dental Clinical Effectiveness Programme (SDCEP), the Antibiotic Guardian website, and additional resources such as patient leaflets and posters.
While current guidance is essential to inform and educate dentists about choice, dose and duration of antibiotics, the fundamental issue is often whether an antibiotic is clinically necessary and appropriate.
Antibiotic prescribing in primary dental care can be challenging, and is often influenced by a patient's expectation that antibiotics are needed if they have toothache, or that they can be used as an alternative to clinical intervention. It is important to have the courage of your convictions to politely but firmly decline inappropriate requests and explain your reason for doing so.
Patients' perception of the role of antibiotics in dentistry may also be influenced by misinterpreting information available from many different sources, including social media, and public health campaigns such as Sepsis Awareness.
These challenges are reflected in DDU members' requests for advice and assistance with complaints about not prescribing antibiotics when they were expected and/or requested. Such complaints often highlight the difficulties in communication between dentist and patient when assessing whether antibiotics are indicated.
To avoid these complaints and to help patients understand and appreciate the nature of your decisions, it can be reassuring for them if you explain your assessment and its results as it proceeds.
Despite the fact that the amount of information available can sometimes lead to misunderstandings between patients and clinicians, the increasing availability of patient education resources is a welcome development and can support colleagues in their discussions with patients about whether the prescription of antibiotics is appropriate.
Recording your reasons
It is essential that decisions about whether or not antibiotics are needed are recorded in the patients' notes. This information is important from a patient care perspective, and confirms the advice provided. In addition, in the event of a complaint it provides invaluable evidence to explain and justify the advice given, particularly in cases when this advice appears to be contrary to prescribing guidance.
Complaints about the prescription of antibiotics that go against prescribing guidance can sometimes be difficult to resolve early on, as they can relate to patient safety issues. Such issues include untoward side-effects or reactions to an antibiotic, or when an antibiotic fails to address a patient's symptoms, leading to a worsening of the condition and potential for more serious developments.