Changes in antibiotic prescribing by dentists in the United States, 2012-2019

Acceptability and usability of Drugs4dent®, a dental medicines decision tool - a pilot study

BACKGROUND

While drugs have a limited role in the management of dental presentations, Australian dentists have high rates of inappropriate prescribing of antibiotics. There is also a lack of relevant drug resources for dentists in Australia. Our team developed Drugs4dent®, a medicines decision support tool, that provides dentists with relevant drug knowledge, assists with appropriate prescribing and provides safety checks to reduce prescribing errors. The aim of this pilot study was to improve Drugs4dent® with focus groups of dentists, and assess the acceptability, usability, and user experience, of Drugs4dent®.

METHODS

Focus groups of ten dentists were established to inform the improvement of Drugs4dent®. Acceptability and usability testing of Drugs4dent® was then undertaken with a further ten dentists using interviews and a survey. The survey was based on the Framework for Acceptability and System Usability Scale. Inductive thematic analysis was undertaken using Nvivo for the focus groups and interviews, and descriptive statistics for analysis of survey results.

RESULTS

Dentists from the focus group and interviews found the content of Drugs4dent® acceptable and useful for dentistry, recognising that similar drug information is currently not available. The majority agreed that Drugs4dent® would improve their ability to prescribe according to guidance. Participants reported Drugs4dent® was intuitive, and information was easy to locate. Most dentists preferred Drugs4dent® integrated with their dental practice software. In the absence of this functionality, they preferred Drugs4dent® as a standalone resource, without needing to input patient data. Drugs4dent® was subsequently commercialised with MIMS Australia, to create the decision support tool: MIMS Drugs4dent®.

CONCLUSIONS

Drugs4dent® is the first dental medicines decision tool in Australia. The high acceptability and usability of the tool, and subsequent commercialisation indicates that MIMS Drugs4dent® has substantial promise for the future, and can transform access to relevant drug information for Australian dentists.

Outpatient antibiotic prescribing by general dentists in the United States from 2018 through 2022

BACKGROUND

Dentists play a role in combatting antimicrobial resistance. This analysis characterizes antibiotic prescribing changes by dentists after the American Dental Association's dental infection treatment guideline was released in 2019.

METHODS

The Xponent (IQVIA) database was used to extract antibiotic prescriptions dispensed from 2018 through 2022. General dentist prescriptions were compared with total outpatient oral antibiotics and summarized by patient and provider characteristics. Census denominators were used to calculate prescribing rates per 1,000 people.

RESULTS

Dentists prescribed 24.65 million antibiotics in 2018 compared with 25.17 million in 2022, resulting in 75.5 prescriptions per 1,000 people for both years. From 2018 through 2022, dentists prescribed 9.8% through 12.1% of all outpatient antibiotics. Females, patients 65 years and older, and patients in the Northeast received the most antibiotic prescriptions.

CONCLUSIONS

Prescribing by general dentists remained stable from 2018 through 2022 despite guideline recommendations to limit antibiotic use for dental infections. Variation by patient and provider characteristics may represent unnecessary antibiotic use.

PRACTICAL IMPLICATIONS

Antibiotic stewardship is needed to optimize prescribing in the dental care setting. The Centers for Disease Control and Prevention's Core Elements of Outpatient Antibiotic Stewardship framework can be adapted for dental stewardship implementation.

Factors associated with antibiotic use patterns in Thailand after COVID-19

The misuse of antibiotics has become a significant problem in Thailand and was particularly exacerbated after the COVID-19 pandemic. Increased access to antibiotics during the pandemic has led to a heightened risk of irrational antibiotic use. This study aimed to analyze the relationships and identify factors associated with antibiotic usage behavior among the Thai population. To examine the factors influencing antibiotic use behavior in Thailand post-COVID-19 and to provide recommendations for targeted interventions. This study utilized secondary data from the 2021 health and welfare survey conducted by the National Statistical Office of Thailand. A total sample of 25,833 individuals was analyzed using multiple logistic regression, adjusting for covariates including demographic factors, health status, and healthcare utilization patterns. The key factors influencing antibiotic use included experiencing illness (adjusted OR: 6.74, 95% CI: 6.11-7.44), sustaining injuries from accidents (adjusted OR: 2.84, 95% CI: 2.19-3.67), receiving dental care (adjusted OR: 1.44, 95% CI: 1.25-1.66), and illness without hospital admission (adjusted OR: 1.60, 95% CI: 1.23-2.10). Additionally, knowledge of antibiotic use was significantly associated with antibiotic use behavior, with those having low knowledge showing higher odds of antibiotic use compared to those with high knowledge (adjusted OR: 2.75, 95% CI: 2.32-3.27). The findings highlight the need for targeted interventions to address inappropriate antibiotic use. The government and relevant agencies should promote health awareness and literacy, develop effective medication, and implement stricter regulations to minimize the adverse effects of antibiotic misuse. Enhanced public education and ensuring access to accurate information from healthcare professionals are essential for mitigating the threat of antimicrobial resistance in Thailand.

Dental antibiotic use in British Columbia from 1996 through 2023: Are we backsliding?

BACKGROUND

Dentists in the United States and Canada have higher rates of prescribing broad-spectrum spectrum antibiotics than dentists in some other Western countries. The authors provide an overview of dental antibiotic prescribing trends from British Columbia, Canada.

METHODS

The data include all prescriptions filed from pharmacies in British Columbia from 1996 through 2023. Dental antibiotic prescribing trends were explored visually and stratified according to patient-related characteristics, type of health service area, type of antibiotic, duration of therapy, and dentist's experience. Interrupted time series regression analysis was conducted to investigate the impact of the COVID-19 pandemic on dental antibiotic prescribing.

RESULTS

Dentistry accounted for an increasing proportion of overall antibiotic consumption in British Columbia. Dental prescriptions increased to a peak rate during the COVID-19 pandemic and remained elevated into 2023. The median duration of prescription converged toward a 7-day supply during the study period.

CONCLUSIONS

The authors documented how a decreasing trend in dental antibiotic prescribing prepandemic has been interrupted by means of continuously high rates after that event.

PRACTICAL IMPLICATIONS

Renewed efforts to ensure appropriateness of dental antibiotic prescribing are needed.

The effect of antibiotic premedication on postoperative complications following dental extractions

OBJECTIVES

We aimed to evaluate the association between antibiotic prophylaxis and adverse outcomes following tooth extraction within the Veterans Affairs Healthcare System.

METHODS

We conducted a retrospective cohort study of patients undergoing dental extractions in 2015-2019. The primary exposure was antibiotic prophylaxis. The primary outcome was post-extraction complication within 7 days (e.g., alveolar osteitis and surgical site infection); the secondary outcome was subsequent medical care relating to a post-extraction oral complication within 7 days. Multivariable logistic regression models assessed the independent effect of antibiotic prophylaxis on each outcome.

RESULTS

Of 385,880 visits with a dental extraction, 122,810 (31.8%) received antibiotic prophylaxis. Overall, 3387 (0.9%) experienced a post-extraction complication and 350 (0.09%) received medical care relating to a post-extraction oral complication within 7 days. In multivariable regression, diabetes was a statistically significant (p = 0.01) effect modifier of the association between antibiotic prophylaxis and post-extraction complication. Among visits for patients without diabetes, antibiotic prophylaxis was significantly associated with an increased odds of post-extraction complication (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.13-1.38), but among visits for patients with diabetes no significant effect was observed (OR = 1.03, 95% CI: 0.92-1.15). Antibiotic prophylaxis was not significantly associated with post-extraction medical care (OR = 1.04; 95% CI: 0.83-1.30).

CONCLUSIONS

In this large retrospective cohort, we observed no significant protective effect of antibiotic prophylaxis on post-extraction complications or subsequent medical care utilization in a setting with low complication rates. These data suggest that use of antibiotic prophylaxis in similar settings may need to be re-evaluated to minimize unnecessary antibiotic use.

Is an Inquisition Warranted in Light of the Widespread Usage of Antibiotics in Dentistry?

The overuse of antibiotics has caused antibiotic-resistant bacteria to develop, making it increasingly difficult to treat infections. The consequences of antibiotic resistance are significant and far-reaching. Antibiotic resistance leads to longer hospital stays, higher healthcare costs, and a decreased ability to undergo surgeries and other medical procedures that rely on antibiotics to prevent infections. This threatens the development of new antibiotics, as pharmaceutical companies are less likely to invest in drugs that may be less effective due to resistance. We need to work together to prevent antibiotic resistance. Healthcare professionals and the general public need to be aware of the dangers of overusing and misusing antibiotics, and we need to impress upon the government that incentives and support be provided to the industry to help develop new antibiotics. We need to take action now to prevent the spread of drug-resistant bacteria and protect public health.

Antibiotic Prescribing Trends in Dentistry during Ten Years' Period-Croatian National Study

Prescribing antibiotics is a regular part of daily dental practice. Antibiotics have a significant but a limited role in general dental practice due to the threat of emergence of antimicrobial resistance (AMR). As such, the aim of this study was to assess prescribing trends in dental antibiotics use from 2014-2023 in Croatia. Data on antibiotic prescribing practices for this study were provided by the Croatian Health Insurance Fund. The analysis included the number of prescriptions, packages, cost, and the World Health Organization's defined daily dose per 1000 inhabitants (DID) per day as an objective utilization for comparison. Over the 10-year period, dentists in Croatia prescribed an annual average of 357,875 antibiotic prescriptions, representing an annual average of 78.7% of all dental prescriptions. The most commonly prescribed antibiotic was the combination of amoxicillin and the beta-lactamase inhibitor clavulanic acid, which made up 58.54% of antibiotics and 46.1% of all dental prescriptions. This was followed by amoxicillin (12.61%), clindamycin (12.58%), and metronidazole (9.96%). The trend showed two discontinuations, the first for the pandemic years, and the second caused by disruption in amoxicillin production. The rise in the use of broad-spectrum antibiotics needs to be addressed and regulated to ensure patients and dentists understand that antibiotics are not a substitute for dental treatment. Dentists should always begin treatment with narrow-spectrum antibiotics regardless of possible exceptional circumstances.

Mapping Worldwide Antibiotic Use in Dental Practices: A Scoping Review

Antibiotic resistance is a critical issue today, necessitating the monitoring of antibiotic usage across various sectors. To determine the defined daily doses (DDDs) of antibiotics prescribed by dentists globally, a comprehensive search was conducted in PubMed, ProQuest, ScienceDirect, Web of Science, Scopus, and EBSCOhost, resulting in the inclusion of 15 documents in this scoping review. The DDD per 1000 inhabitants per day (DID) for oral antibiotics prescribed by dentists for the studied countries was generally below 2.11, with the exception of South Korea, which had a DDD per 1000 patients per day (DPD) of less than 6.97. Most countries, except Croatia and Belgium, demonstrated a decreasing trend in DID before the COVID-19 pandemic, but restrictions during the pandemic led to an increase in these numbers. Penicillin-derived antibiotics were the most commonly prescribed antibiotic among dentists in most countries. This study highlights significant gaps and missing data regarding antibiotics prescribed by dentists worldwide. However, it also indicates that the publication of guidelines, education, and evaluation of antibiotic use can lead to more controlled and appropriate prescriptions among dental professionals.

Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019

OBJECTIVE

The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts.

METHODS

Cross-sectional analysis of 2019 Veterans' Affairs (VA) national electronic health record data. Antibiotics prescribed by dentists were evaluated for appropriateness based on 2 definitions: one derived from current guidelines (consensus-based recommendations) and the other based on relevant clinical literature (nonconsensus). A clustered binomial logistic regression model determined factors associated with discordant prescribing.

RESULTS

In total, 92,224 antibiotic prescriptions (63% amoxicillin; mean supply, 8.0 days) were associated with 88,539 dental visits. Prophylaxis for complications in medically compromised patients was associated with the most (30.9%) antibiotic prescriptions, followed by prevention of postsurgical complications (20.1%) and infective endocarditis (18.0%). At the visit level, 15,476 (17.5%) met the consensus-based definition for appropriate antibiotic usage and 56,946 (64.3%) met the nonconsensus definition.

CONCLUSIONS

More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. Regardless of definition applied, antibiotics prescribed by dentists were commonly unnecessary. Improving prescribing by dentists is critical to reach the national goal to decrease unnecessary antibiotic use.

Barriers and facilitators to guideline concordant dental antibiotic prescribing in the United States: A qualitative study of the National Dental PBRN

OBJECTIVES

While factors contributing to dental antibiotic overprescribing have previously been described, previous work has lacked any theoretical behavior change framework that could guide future intervention development. The purpose of this study was to use an evidence-based conceptual model to identify barriers and facilitators of appropriate antibiotic prescribing by dentists as a guide for future interventions aimed at modifying antibiotic prescribing.

METHODS

Semi-structured interviews were conducted with dentists from the National Dental Practice Based Research Network (PBRN) exploring patient and practice factors perceived to impact antibiotic prescribing. Audio-recorded telephone interviews were transcribed and independently coded by three researchers. Themes were organized around the COM-B model to inform prospective interventions.

RESULTS

73 of 104 dentists (70.1%) were interviewed. Most were general dentists (86.3%), male (65.7%), and white (69.9%). Coding identified three broad targets to support appropriate dental antibiotic prescribing among dentists: (1) increasing visibility and accessibility of guidelines, (2) providing additional guidance on antibiotic prescribing in dental scenarios without clear guidelines, and (3) education and communication skills-building focused on discussing appropriate antibiotic use with patients and physicians.

CONCLUSIONS

The findings from our study are consistent with other studies focusing on antibiotic prescribing behavior in dentists. Understanding facilitators and barriers to dental antibiotic prescribing is necessary to inform targeted interventions to improve appropriate antibiotic prescribing. Future interventions should focus on implementing multimodal strategies to provide the necessary support for dentists to judiciously prescribe antibiotics.

Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study

Background: Antibiotics prescribed as infection prophylaxis prior to dental procedures have the potential for serious adverse drug events (ADEs). However, the extent to which guideline concordance and different dental settings are associated with ADEs from antibiotic prophylaxis is unknown. Aim: The purpose was to assess guideline concordance and antibiotic-associated ADEs and whether it differs by VA and non-VA settings. Methods: Retrospective cohort study of antibiotic prophylaxis prescribed to adults with cardiac conditions or prosthetic joints from 2015 to 2017. Multivariable logistic regression models were fit to assess the impact of ADEs, guideline concordance and dental setting. An interaction term of concordance and dental setting evaluated whether the relationship between ADEs and concordance differed by setting. Results: From 2015 to 2017, 61,124 patients with antibiotic prophylaxis were identified with 62 (0.1%) having an ADE. Of those with guideline concordance, 18 (0.09%) had an ADE while 44 (0.1%) of those with a discordant antibiotic had an ADE (unadjusted OR: 0.84, 95% CI: 0.49-1.45). Adjusted analyses showed that guideline concordance was not associated with ADEs (OR: 0.78, 95% CI: 0.25-2.46), and this relationship did not differ by dental setting (Wald χ^2 p-value for interaction = 0.601). Conclusion: Antibiotic-associated ADEs did not differ by setting or guideline concordance.

The Baker Lab at the OHSU School of Dentistry: leveraging bioinformatics and molecular biology to discover how the bacteria that live in our mouth impact human health and disease

The microorganisms living in the human oral cavity, collectively known as the oral microbiota, play a critical role in not only oral health, but systemic and overall health. The Baker Lab leverages emerging technologies in bioinformatics and molecular biology to answer fundamental questions regarding the ecology, physiology, and pathogenesis of the oral microbiota. We use a microbial 'omics approach, which has included pioneering the use of nanopore sequencing on saliva and oral bacterial RNA. The resulting work discovered novel bacterial species and biosynthetic pathways which impact the ecology of the oral microbiota and its relationship to human disease. This article will briefly define the oral microbiota. It will also summarize how bioinformatics and 'omics-based research have revolutionized oral health research. The article will then provide a broad summary of our past, present and future research and educational programs.