The Dental Professional’s Role in the Prevention of Antibiotic Resistance and Adverse Antibiotic Reactions
Course Number: 614
Dentist Education and Patient Counseling for Proper Use of Antibiotic Medications and Discussion of Rationale for Alterations in Prescribing Patterns
Both dentists and patients require education to ensure adherence to current guidelines and optimal principles for proper antibiotic stewardship. When dentists and physicians prescribe antibiotics when they are not indicated, it often reflects personal unfamiliarity with current guidelines and acquiescence to pressure from patients who request antibiotic therapy.85,86 Other factors that may influence inappropriate prescribing patterns include barriers in the health systems, aversion to the uncertainty of a watch-and-wait approach, diagnostic and prognostic uncertainties, and access-to-care issues.85-89 Due to these factors influencing prescribing patterns, education of both dentists and patients is necessary. It has been demonstrated that a systematic education and monitoring program for antibiotic prescription stewardship can significantly reduce antibiotic prescription rates in a dental outpatient setting.3 In one study, the implementation of 1-minute updates, once weekly for 12 weeks was undertaken to influence prescribing patterns for acute dentoalveolar conditions and, in the prescription rate decreased by 72.9% compared to pre-intervention levels.3 Other programs including dental record audit with feedback, prescription writing guidance, and peer comparison have also been shown to be effective in better aligning prescribing habits with current guidance.90-92 This evidence demonstrates that education of practitioners using standardized, evidence-based guidelines, such as the ADA’s Clinical Practice Guidelines, should be instituted to reduce overprescribing and associated increase in antibacterial drug resistance.
In medical outpatient settings, patient education was also an important component of antibiotic stewardship and resulted in significant reductions in antibiotic prescription rates.93 The combination of practitioner and patient education may be critical components to overall success in altering dentist prescribing patterns. Effective patient education measures included educational posters in patient waiting areas stating that “antibiotics are not always the answer” and provider-delivered patient counseling. These combined interventions demonstrated improved outcomes that resulted in decreased numbers of antibiotic prescriptions and decreased duration of antibiotic prescriptions, when they were prescribed.93 Interestingly, certain practitioner characteristics were associated with improved adoption of updated clinical practice guidelines aimed at reducing antibiotic prescriptions. In these cases, practitioners who were specialty trained, female, and younger demonstrated better adherence to updated prescribing guidelines compared to their counterparts who altered prescribing patterns less.94,95 Targeting these demographics and providing resources with which dental healthcare providers can educate patients may be critical to improving inappropriate antibiotic prescribing patterns throughout dentistry.