CDA Essentials 2018 • Volume 5 • Issue 1

25 Issue 1 | 2018 | I ssues and P eople To better understand the prescribing decisions made by Canadian dentists, CDA conducted a survey in 2017, in collaboration with researchers from the University of Toronto and the University of British Columbia. 3 The researchers asked dentists about their prescribing decisions for various clinical scenarios to determine whether dentists are prescribing antibiotics unnecessarily and, if so, in what situations. The survey report, based on responses from over 1000 dentists from across the country, reveals that the majority of dentists follow the best available evidence and clinical guidelines in their antibiotic prescribing decisions. But the results also revealed several areas of concern, including: ◗� Dentists prescribing prophylactic antibiotics for patients with total joint replacement There is no evidence to support the use of antibiotics for prevention of prosthetic joint infection for dental procedures. Prescribing antibiotics for patients with total joint replacement is not recommended, according to the joint consensus statement on this issue from CDA, the Canadian Orthopedic Association, and the Association of Medical Microbiology and Infectious Disease. 4 One-third of survey respondents reported that they would never prescribe antibiotics for patients with total joint replacement. But over half reported sometimes prescribing antibiotics of patients with total joint replacement and 9% of dentist always prescribe for these patients. ◗� General overuse of amoxicillin and underuse of penicillin V prescribing in dentistry For patients with no known allergies to penicillin, survey respondents reported that their primary choice of antibiotic was amoxicillin (77%), followed by penicillin V (19%). The survey report notes that overuse of amoxicillin, a broad-spectrum antibiotic, may contribute to the emergence of resistance in pathogenic bacteria and an increased risk of C. difficile infection. A better alternative to amoxicillin is penicillin V, say the survey report authors. It has a narrower spectrum of activity, is currently underused in dentistry and is the treatment of choice for most dental infections. 5 ◗� Variation in prescribing practices for antibiotic prophylaxis in the context of dental implant placement Among survey respondents who perform dental implant placements, 64% always prescribe prophylactic antibiotics, 15% sometimes prescribe and 20% never prescribe. Although evidence to support the effectiveness of prophylactic antibiotics in reducing dental implant failure is inconsistent, dentists should use their clinical judgment in identifying patients who are at higher risk for developing infection and are therefore more likely to benefit from prophylactic antibiotics. 5 The study authors also note that “…never prescribing antibiotics for dental implant placement may suggest underprescribing for high-risk patients.” 3 When antibiotics are clinically indicated, the length of the antibiotic regimen may also contribute to the problem of overprescribing. Close to 60% of survey respondents who prescribe antibiotics for dental implant placement use a single preoperative dose, followed by a postoperative course. However, a Cochrane review 6 found there was no evidence to support postoperative antibiotics for dental implant placement—although a single, preoperative does of antibiotics appears to be beneficial for preventing postoperative infections. ◗� Discrepancies among dentists about which medical conditions require antibiotic prophylaxis for the prevention of infective endocarditis Overuse of antibiotics is responsible for the serious and growing global threat of antibiotic resistance and the emergence of superbugs and incurable infections. 1 As antibiotic prescribers, dentists may be contributors to the problem, although there isn’t much data on their prescribing habits. By some estimates, dentists prescribe roughly 10% of all antibiotics. 2