An investigation of therapeutic antibiotic prescribing for children referred for dental general anaesthesia in three community national health service trusts

A Preliminary Study of the Treatment Outcomes of Paediatric Dental Patients Referred for General Anaesthesia or Sedation at a Regional Hospital in Trinidad

General anaesthesia and sedation are known to be useful adjuncts in the care of paediatric dental patients. There are several challenges that prevent patients from receiving care.

AIM

To assess the treatment outcomes of paediatric dental patients seen at an emergency facility who were referred for treatment under sedation or general anaesthesia at a regional hospital in Trinidad.

METHODS

Records of patients seen at the Child Dental Health Unit Emergency clinic at the University of The West Indies Dental School from 2012 to 2017 were assessed. The parents of children referred for general anaesthesia or sedation at the regional hospital were then interviewed via telephone.

RESULTS

Most children (53.4%) were younger than 6 years old and the most common reasons for referral were the treatment of multiple carious teeth and behaviour management. Furthermore, 66.1% of cases did not receive treatment and had a mean waiting time of 4.7 years, and 61.7% of referred cases needed emergency care while awaiting general anaesthesia or sedation. Limited access to these services and the high cost of treatment were the main reasons for non-treatment.

CONCLUSION

There is significant need for the timely treatment of paediatric dental patients referred for general anaesthesia or sedation. Improved availability and accessibility of these services could improve patients' quality of life.

A rapid review of variation in the use of dental general anaesthetics in children

Introduction The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue.Aim Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children.Methods Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature.Results From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location.Conclusions This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide.

The use and misuse of antibiotics in dentistry: A scoping review

BACKGROUND

To describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review.

TYPES OF STUDIES REVIEWED

The authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Management's critical appraisal of a survey checklist.

RESULTS

The authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Considering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.

Management of odontogenic infection in paediatric patients: a retrospective clinical study

PURPOSE

To investigate the outpatient and inpatient management of odontogenic infections among paediatric patients attending a university hospital.

METHODS

A retrospective study (2013-2015) was carried out which involved retrieving relevant data from past records (manual/electronic) of paediatric patients (under 18-years-old) who presented with odontogenic infections to the Paediatric Dentistry and Oral and Maxillofacial clinic. Data collected was organised using descriptive statistics with SPSS version 12.0.1.

RESULTS

A total of 153 patients were identified, of which 83.7% were managed as outpatients. Odontogenic infections were more common in females (52.9%) and preschool children (58.2%). The most cases were seen in 2014 and maximum number of cases per month was 12. Common presentations were pain (62.1%), intraoral swelling (37.9%) and spontaneous pus discharge from the tooth and/or surrounding tissues (67.3%) with higher involvement of primary right molars. Dental panoramic tomograph was the most common radiographic investigation done. Outpatients were commonly managed chairside with pulpal opening (46.1%) at the paediatric dental clinic and 7% underwent extraction under general anaesthesia in day-care setting. Inpatients were admitted for 3 days on average and most commonly definitive care was extraction under local/general anaesthesia (68%). There were 22.7% outpatients and 72.0% inpatients who were prescribed antibiotics.

CONCLUSIONS

Overall, treatment and medications prescribed adhered to current guidelines. There was a tendency to solely prescribe antibiotics in 8.6% of outpatients which is contrary to recommendations.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review

There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3–5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

Antibiotic prophylaxis and postoperative complications after tooth extraction and implant placement: A review of the literature

OBJECTIVES

To assess published evidence regarding the use of preoperative antibiotic prophylaxis among children and adults undergoing dental extraction or implant placement.

DATA

Research published between 12/31/97 and 6/30/07 in English.

SOURCES

MEDLINE, PUBMED, EMBASE, EBM Reviews, and Cochrane Central Register for Controlled Trials using the following search terms linked with Boolean AND logic: prophylactic antibiotics, dentistry, tooth, third molar, extraction, implant, endosseous, prophylaxis, prophylactic, infective endocarditis, bacterial, infection, and bacteremia.

STUDY SELECTION

Eight randomized clinical trials and one retrospective study was found involving preoperative use of antibiotics before tooth extraction. Four additional non-randomized intervention studies among patients undergoing implant placement were found. These 13 studies comprised all of the published research found that met our inclusion criteria. Overall, this body of literature was limited and of poor quality. In general, sample sizes were small and provided insufficient statistical power to avoid type II, or false-negative errors. In some studies no comparison group was included and/or it was difficult to determine the extent to which the intervention had actually been implemented.

CONCLUSION

With the recent improvements in the current standards of antibiotic prophylaxis in dentistry, further monitoring of antibiotic use among dental practitioners as well as continuing education for practitioners concerning the public health risks related to the over-prescription of antibiotics are needed.

The effects of a long wait for children's dental general anaesthesia

OBJECTIVES

The purpose of this study was to monitor the effect of an interruption in a service for children who were scheduled to have dental extractions under general anaesthesia (GA). The reasons for offering GA and the treatment given while the service was not available, together with the history of the pain, antibiotic usage and alterations to the number of teeth extracted were recorded.

METHODS

When the GA extraction service stopped, the children who were scheduled to have their teeth extracted were placed on a waiting list. When the service recommenced 6 months later, the children were invited to attend a reassessment. Relevant data were collected at this visit using a proforma.

RESULTS

A total of 321 children had their extractions delayed. Only 249 of these attended for a reassessment. During the waiting period, 102 parents (41.0%) reported that their children required analgesics, 71 (28.5%) stated that their children's sleep was disturbed and 82 (32.9%) recorded problems with eating. One hundred and twenty-three children (49.4%) had received antibiotics, with 49 (19.6%) having been prescribed two or more courses. The majority of treatment plans (85.5%) remained unchanged.

CONCLUSIONS

Many children who had had their extractions delayed suffered further pain and disruption to their life.

The impact of clinical audit on antibiotic prescribing in general dental practice

OBJECTIVE

To reduce the number of antibiotics inappropriately prescribed by general dental practitioners, and to increase overall prescription accuracy.

DESIGN

A prospective clinical audit carried out between September and March of 2002-3 and 2003-4.

SETTING

General dental practices in Eastern England.

SUBJECTS AND METHODS

The pre-audit antibiotic prescribing practices of 212 general dental practitioners were recorded over an initial six week period. On each occasion this included which antibiotic had been chosen, together with its dose, frequency and duration, as well as the clinical condition and reason for which the prescription had been raised. When related to prophylaxis, the patient's medical history was also noted. Following education on contemporary prescribing guidelines, presentations which illustrated the practitioners' previous errors, and the agreement of standards to be achieved, the process was repeated for another six weeks, and the results compared.

RESULTS

In the pre-audit period, 2,951 antibiotic prescriptions were issued, and during the audit this was reduced by 43.6% to 1,665. The majority were for therapeutic reasons, with only 10.5% and 13.6% for medical prophylaxis during the pre-audit and audit periods respectively. Over both periods, amoxicillin and metronidazole were the two most commonly prescribed antimicrobials (63.4% and 21.2% respectively). In the pre-audit period, only 43% of all prescriptions were error free in dose, frequency, and/or duration of use, but this rose significantly to 78% during the audit. Equally, using contemporary published guidelines, out of all the prescriptions made in the pre-audit period, only 29.2% were deemed to be justified, as compared to 48.5% during the audit.

CONCLUSIONS

Clinical audit, in conjunction with education, and prescribing guidelines can favourably change antibiotic prescribing patterns among general dental practitioners.