Clinical
information can be passed to the dental profession quickly. Of course, a sample from an individual patient will also confi rm the most suitable antibiotic for that patient. This information may take a few days, but is essential if the ‘best guess’ antibiotic started initially is not effective. One of the key factors recommended by
SAPG to help improve antimicrobial stew- ardship is auditing clinical practice against guidelines, something Dr Crighton feels is a vital part of prescribing. “Auditing the prescribing patterns of
each dentist in a practice, or the practice as a whole, is an important part of ensuring quality in prescribing,” he said. “This can help produce effective change
in prescribing patterns by allowing dentists to compare their prescribing rate and choice with other dentists in the practice and with regional or national averages.” Within such an audit, dentist should
Scotland are to be commended for increasingly following
this guidance. SDCEP recommends
dentists avoiding antibiotics which
have been associated with a high risk of C diffi cle infection, particularly co-amox- iclav, azithromycin, cephalosporins and clarithromycin. These should not normally be prescribed by a dentist unless instructed by a specialist – something which usually follows microbiological analysis of a pus sample. Although most dentists wouldn’t do this for an abscess, oral microbiolo- gists, such as Professor Andrew Smith of the University of Glasgow, are keen that dentists send pus samples to the microbi- ology laboratory in the same way that soft tissue is routinely sent to the pathology lab. Both attract a fee for the dentist. Getting lots of samples of pus from dentists allows the oral organisms causing dental infections in the general population to be kept under surveillance. If there is a change in the common organisms present that requires a change in the antibiotic prescribing guidance for Scotland, this
look at the number of prescriptions issued, which drugs were prescribed, the quantity and dose of the drug and the clinical indica- tion. After an initial data collection period, the prescribing habits of the practice can be assessed and any need for change identifi ed. But, perhaps the most diffi cult part of antibiotic prescribing can be persuading patients that antibiotics are not required. While many patients may feel they need antibiotics for toothache, most dental pain can be managed by the appropriate use of analgesics and local treatment. Avoiding prescribing and educating patients about when antibiotics are required is important to tackle antimicrobial resistance. Patients and doctors have been through
this already with the use of antibiotics for sore throats having declined markedly and patients now accepting that an antibiotic is not always the best treatment for this condi- tion. Similar education needs to happen in some patients who might wonder why the dentist has not given an antibiotic for their toothache. And, as for those who
are prescribed anti- biotics, Dr Crighton says that dentists must ensure patients follow instructions properly. He said: “Patients are often poor at recalling
instructions given in the dental chair, especially after a stressful procedure or if they are in pain. The most effective way to pass on the important information about the medicine is by giving written as well as verbal instructions.” As dentists use a relatively small range
of medicines, it is possible to have patient information leafl ets prepared in advance. These can also be provided in large type and in a range of languages. A contact telephone number can also be useful as patients can have questions about taking the medication once they have read the ‘Patient Information Leafl et’ included with the dispensed drug. “When antibiotics are prescribed by
a health professional, it is important the patient always takes them as directed. They should not be partially saved for future use or shared with others,” says Dr Crighton. “Everyone has a part to play in reducing
the risk of antibiotic resistance – dentists and their patients are no exception. The longstanding relationship between most dentists and their patients means the dentist can play a key role in providing a better understanding in their patients about antibiotic resistance and the need to reduce antibiotic use as much as is practical. “If we act now, we can preserve these medicines for use long into the future.”
“Everyone has a part to play in reducing the risk of antibiotic resistance”
Dr Jaqueline Sneddon
Scottish Dental magazine 55
Dr Alexander Crighton
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