A BMJ opinion piece that questioned the existing medical advice about
taking a full course of antibiotics to treat infection hit the
headlines recently. Of course, the tabloids relished giving doctors a dressing down about the validity of their health advice, yet again.
The screaming by-lines ‘Current NHS advice is putting patients at risk, according to experts’,
will probably do nothing to help the confusion amongst your dental
patients – so here’s some advice on trying to help make it clear for
your patients, and what you should be doing to prescribe antimicrobials
appropriately in dentistry.
Should you prescribe a full course, when antibiotics are indicated for dental pain?
As dentists, we already tailor antibiotic treatment to individual
patient need: FGDP guidance for most antibiotics prescribed by dentists
gives a guideline of ‘up to five days’, or to ‘review after two to three
days and discontinue if resolved’. The guidance also emphasises that,
alongside, we should always try to remove the cause of the infection if
possible. In dentistry, we are often in a position to do that.
The BMJ article argues that antimicrobial resistance may be more of a threat if a patient has treatment for too long
than if a patient stops taking medication too early. The authors said
there has been no evidence to support the claim that stopping treatment
early might increase the risk of a resistant infection. Their advice is
to treat each patient on an individual basis (which we dentists, of
course, already do) and that messaging to patients on the course of
treatment should be tailored, depending on your clinical judgement.
The FGDP guidance for dentists remains appropriate. For our medical
colleagues, it’s to be hoped that accepted prescribing practice will
always be based on the best available evidence, and that patients
receive clear and consistent messages when prescribed antimicrobials.
First and foremost, they should use them – and safely dispose of any
excess – as directed by the clinician.
Antibiotic resistance is a real and growing problem, and dentistry
Antibiotic resistance: what’s the problem in dentistry?
has its part to play in helping curb the tide of unnecessary
prescribing – studies have estimated up to 10% of all antibiotic
prescriptions in the UK and Western Europe are made by dentists in
Patients sometimes ask for antibiotics, as they mistakenly think this
is a ‘quick fix’ for problems. We know it’s not, and that toothache
diagnosed as an inflammatory condition (for example, acute pulpitis)
can’t be treated effectively with antibiotics. In those circumstances,
clearly it’s a clinical intervention that will solve the problem. It’s important that we don’t give in to inappropriate demands
or allow our clinical judgement to be swayed by anything but what is best for that patient.
How can I make sure I am prescribing antibiotics correctly?
With FGPD and Public Health England, we have developed a toolkit to help you determine whether to prescribe or not
– the fact is that many instances of toothache don’t require
antibiotics and are better actively treated more effectively in other
The toolkit can help you review and optimise your prescribing
practices and offers advice on getting this message across to patients.
For young dentists, we know there is such a fear of being hauled in
front of the regulator, that the temptation to just give a patient what
they want, to avoid complaints, is something to keep an eye on. We have called for adequate training for all dental students and professionals in the diagnosis and treatment of acute dental pain.
We’ve also asked for appropriate state-funded emergency time to allow
dentists to fit in those patients who present unexpectedly with an
infection or pain that needs clinical intervention – factoring this into
commissioning is key to be able to do what we need to do for our
Have faith in yourself
It’s also important that patients listen to the advice of their dentist, so your ability to communicate and hold the trust of your patient will be key to this.
Overcoming misconceptions about treatments, about what drugs are
needed or not, and often, just plain fear, is something that every
general dental practitioner has to face on a daily basis.
But have faith in your skills and expertise – you are the
professional, and if you follow the guidelines, you know you are doing
what is best for your patients
We’re always keen to hear about your experiences and about any
comments or questions that you have on the topic of antibiotics or
antimicrobial resistance, please get in touch.
BDA Health and Science Committee
member, CED Task Force on Antibiotics in Dentistry & member of
Dental Subgroup ESPAUR