CDA Essentials 2018 • Volume 5 • Issue 1

28 | 2018 | Issue 1 I ssues and P eople The study, published in JCDA.ca, surveyed roughly half the general dentists in Vancouver and all of the endodontists in British Columbia. Researchers presented dentists with 7 clinical scenarios involving patients with endodontic disease and asked whether they would prescribe an antibiotic, an analgesic, or both (see boxed text for clinical scenarios A–G). A total of 152 dentists (116 general dentists and 36 endodontists) participated in the survey. Survey responses: antibiotics Of the 7 clinical scenarios presented to dentists in the questionnaire, antibiotics were indicated in only one: Scenario G. The decision to prescribe antibiotics for Scenario G is based on the idea that “antibiotics may be used in addition to endodontic treatment in situations where there are signs of systemic involvement where swelling is increasing or where the patient is immunocompromised.” Overall, survey responses revealed a wide range of antibiotic prescribing decisions. For the 6 scenarios where antibiotics would not be indicated, rates of unnecessary prescribing ranged from 5%–88%. For scenario G, where antibiotics are indicated, 76% of survey respondents overall would prescribe antibiotics, which suggests some degree of underprescribing. Survey responses: opioids Similarly, opioids were indicated in only one of the seven clinical scenarios (again, Scenario G) presented to dentists. The decision to prescribe opioids for Scenario G is based on evidence that NSAIDs in large doses are more effective in treating moderate to severe pain, and that “opioids should only have been prescribed where initial non-opioid treatment failed to relieve severe pain.” Dr. Rene Buttar, one of the study’s authors and a practising endodontist in Penticton, British Columbia, explained, “Scenario G describes the patient from Scenario F who is experiencing worsening symptoms and is in extreme pain; it would be reasonable to prescribe opioid analgesics in Scenario G if non-opioid analgesics were used to their maximum potential Antibiotic and Opioid Analgesic Prescribing Decisions of BCDentists As public awareness about the dangers of overprescribing antibiotics and opioids grows, dentists have been identified as potential contributors to these problems. Although not much data exists on the prescribing behaviours of Canadian dentists, some insights from a recent study 1 suggest a significant proportion of dentists in British Columbia prescribe opioids and antibiotics when they are likely not required.