DENTAL TREATMENT D
ENTAL abscesses tend to lurk within bone around the apices of infected teeth. Tey may be painful, but at
least they’re usually not visible. Yet, for the unlucky few, an abscess can spread, resulting in a facial swelling. Tis can lead to a rapid and spectacular rearrangement of the patient’s classic good looks. Even more serious and alarming complications, such as respiratory embarrassment, are possible. Tat such incidents oſten lead to a complaint or claim is unsurprising, especially in cases where the onset of the swelling follows recent attendance to report symptoms or receive treatment. It is striking how regularly this involves
an allegation that the swelling was caused by the treating dentist’s failure (or refusal) to provide antibiotics. All things being equal, responding to this particular point can be quite straightforward – the use of antibiotics is heavily restricted, with best practice guidelines recommending that first-line management should, if at all possible, be drainage of dental infections. Usually this is achieved by measures such as extraction or endodontics. Antibiotics should only be introduced
where the assessment of the patient reveals, for example, lymph gland involvement or cellulitis. In the absence of these signs, the decision to withhold antibiotics is normally defensible. Arguably, it is this discouragement of reliance on antibiotics by dentists that actually helps to limit the incidence of severe facial swellings.
Honoured in the breach? Yet if dentists reflect on this issue, many will admit (perhaps only to themselves) that they are guilty of departure from these same guidelines. It would be difficult to argue otherwise – published studies have confirmed the high rate of antibiotic prescribing by UK dentists. Te rationales for these decisions are
many and varied. For example, some dentists firmly believe that dry sockets respond to metronidazole. Others will provide antibiotics to palliate an acutely painful abscess, thus allowing the patient to reflect on definitive treatment choices following a good night’s sleep. In the current climate, one is inclined to doubt whether these approaches would completely escape criticism. However, the ice becomes even thinner in other more commonly encountered scenarios. In some cases the provision of antibiotics is simply a capitulation in the face of
18 SUMMONS
concerted patient pressure. Te assertiveness and persistence with which some patients will seek a prescription never fails to astonish. It’s quite easy to empathise – there may well be a degree of reassurance to be derived from holding a prescription. Perhaps there is a genuine misperception that if the pills work, the expense, inconvenience and discomfort of dental treatment can be avoided. However, as the concept of patient autonomy flourishes in healthcare, there may also be a belief that the receipt of antibiotics is a “right”. Not so. Patients are entitled to consider treatment options, together with their
benefits and material risks. Tis ethical doctrine is now enshrined in medical jurisprudence following the seminal ruling in Montgomery v Lanarkshire. However, this is not carte blanche for patients to demand whatever they please – clinicians still cannot be required to offer treatment which is contrary to good practice. In circumstances in which the treatment of dental infections by means of antibiotics is contraindicated, a prescription should not be included in the menu of treatment choices, irrespective of the patient’s wishes. Another potential motivation for writing a prescription is expediency. Adherence to
Doug Hamilton considers the dilemma faced by dentists in deciding when Resistance is
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24