Antimicrobial Resistance and Antibiotic Prescribing in Dental Practice.

The purpose of this paper is to review the principles of antibiotic prescribing in light of the increasing worldwide problem of antimicrobial resistance and the evidence of inappropriate use of antibiotics in dentistry. Guidance on the management of dental infections and antibiotic prophylaxis based on a review of the scientific evidence will be given to ensure good patient care. Clinical relevance: To discuss the relevance of legislation around antimicrobial prescribing and antimicrobial stewardship for dentists.

An investigation of West Sussex general dental practitioners' awareness, attitudes and adherence to NICE dental recall guidelines.

AIMS: The overall aim of this study was to determine whether general dental practitioners (GDPs) in West Sussex were aware of and followed National Institute for Health and Clinical Excellence (NICE) guidelines on dental recalls. The study also aimed to identify factors in the GDPs' practice of dentistry that could affect their adherence to NICE guidelines and to gain some insight into their views on this topic and how these might affect their adherence. METHODS: A postal questionnaire, which had previously been piloted, and an explanatory letter were sent to a random sample of 195 GDPs representing 50% of the GDPs contracted to the West Sussex Primary Care Trust. Those who did not respond were sent the questionnaire and letter for a second time. The questionnaire consisted of 50 questions that covered awareness of, attitudes towards and adherence to the NICE guidelines on dental recalls, risk factors, and the GDPs' practising profile. Resulting data were entered into a database and, where appropriate, statistically tested with the chi-square test, with the level of statistical probability set at P<0.5. RESULTS: Data were obtained from the 50 questions in the questionnaires. Only key results are presented in this abstract. Ten of the 195 GDPs had either moved away from the area or were orthodontists. The final sample was therefore 185, of whom 117 returned questionnaires, a response rate of 63%. Seventy-three per cent of the respondents had qualified in United Kingdom. Sixty-five per cent were male. The mean age of respondents was 43 years. Seventy-one per cent worked as GDPs within the General Dental Services (GDS) or Personal Dental Services. Concerning NICE recall guidelines, 94% stated that they were aware of them, 61% said they agreed with them, and 64% that they adhered to them. Female GDPs were statistically far more likely to state that they followed NICE guidelines ( P =0.0043). Seventy per cent of GDPs reported that they still recalled their patients at six-month intervals and only 3% that they recalled their patients according to need. Eighty-five per cent reported taking radiographs at two-year intervals and/or according to patient need, and 68% that they gave oral hygiene advice six monthly or at every recall. Risk assessments were reported as being always carried out by 65% of responding GDPs for caries, 83% for periodontal disease, and 81% for oral cancer. Ninety per cent reported that they thought risk factors were relevant when setting the recall interval and 82% thought that six-monthly recalls allowed appropriate screening to take place. CONCLUSIONS: Only 3% of responding GDPs recalled their patients according to patient need, in line with NICE recall guidelines, although the majority of GDPs agreed with the guidelines and stated that they adhered to them; however, this was in contrast to the 70% of GDPs who continued to recall at six-month intervals. The majority of GDPs thought that less frequent recalls would not allow for early caries, periodontal disease and oral malignancy diagnosis, and did not think that access to NHS dentistry would be improved. They also did not believe that excessive NHS money was spent on over-frequent dental examinations. There would appear to be significant obstacles to altering the recall habits of dentists because of the way that dentists practise.

The effect of SARS-CoV-2 on the prescribing of antimicrobials and analgesics by NHS general dental practitioners in England.

Aims To ascertain the effect of SARS-CoV-2 on the utilisation of antibacterial agents and analgesics in primary dental care.Methods Antibacterial agents and analgesics (eg paracetamol, aspirin) prescribed in England by general dental practitioners for the periods April-July 2019 and April-July 2020 were analysed.Results Antibacterial agents prescribed during COVID-19 restrictions in 2020 (799,282) were higher than a similar time period in 2019 (654,332) by 22%. Amoxicillin was used the most (2020 = 65.0%; 2019 = 66.3%) followed by metronidazole (2020 = 30.2%; 2019 = 28.7%). Erythromycin was prescribed at a similar rate, with lincosamides (clindamycin) prescribed more frequently in 2020 (2020 = 0.6%; 2019 = 0.5%). Clarithromycin was prescribed twice more often in 2020 (0.6%) in comparison to 2019 (0.3%). Co-amoxiclav (0.5%) and phenoxymethylpenicillin (0.3%) were prescribed at a similar rate. Analgesics use increased by 84% (2020 = 28,563; 2019 = 15,507). Use of dihydrocodeine tartrate increased (2020 = 40.9%; 2019 = 32.9%), followed by diclofenac sodium (2020 = 24.6%; 2019 = 12.8%). The opposite trend was seen in relation to ibuprofen with use decreasing (2020 = 19.4%; 2019 = 39.8%) while paracetamol use only slightly increasing (2020 = 15.1%; 2019 = 14.6%).Conclusions COVID-19 restrictions on dental care in England resulted in a marked increase in prescribing antibacterial agents and a very marked increase in prescription-only analgesics.

An investigation of the attitudes and fears of vocational dental practitioners in England and wales in 2007.

AIM: The aim of this study was to investigate whether recent changes in the National Health Service (NHS) dental contract may have caused increased anxiety and concern among vocational dental practitioners (VDPs). METHOD: A total of 606 questionnaires, which had previously been piloted, were distributed to VDPs across England and Wales at the end of the vocational training (VT) year in 2007. The questionnaires contained a range of questions about VDPs' attitudes and fears, the influence that they perceived the new dental contract for the General Dental Services of the NHS had on their VT training experience, and their expectations for the future. RESULTS: A 71% response rate was achieved. The results reflected changes in opinion about the dental profession among VDPs between when they applied for university and six years later on their completion of VT. During this period, they reported that their feelings of job security had declined from 93.1% (n=390) to 34.1% (n=145) and financial security from 94.8% (n=405) to 51.5% (n=219). Anxiety about the potential lack of funding in the NHS was felt by 77.6% (n=330). The effect of increasing numbers of dental graduates on employment prospects produced anxiety in 72.5% (n=305) of VDPs. On completion of VT, 19.4% (n=83) of VDPs did not have employment for the following year. CONCLUSION: At present, the future is more uncertain for new dental graduates than in the past. The dental profession needs to become more aware of the pressures that graduates are facing and further research is needed to investigate them and the effects that they are having on the future of dentistry.

Can protein contamination be removed from hand endodontic instruments?

AIM: The aim of this study was to quantify total protein adhering to hand endodontic files and to measure and compare the efficacy of ultrasonic cleaning and washer-disinfectors, with and without presoaking, in protein removal from clinically contaminated endodontic files. METHOD: Total protein contamination of the endodontic files was quantified using an assay reagent colorimetric method. Twelve general dental practitioners were recruited to collect clinically contaminated files. One hundred and fifty clinically contaminated files were allowed to air-dry in sterile plastic containers and a further 60 files were immersed, working end down, in enzymatic detergent immediately following clinical use. Thirty clinically contaminated files were tested for total protein contamination as a positive control. Sixty files were subjected to ultrasonic cleaning and 30 to processing in each of the washer-disinfectors. The presoaked files were divided into two groups of 30 for processing in the washer-disinfectors. A further group of brand-new, unused files were tested for protein contamination as a negative control. RESULTS: Protein was present on 29 of the 30 new files tested. The median total mass of protein recovered from clinically contaminated hand endodontic instruments was 2.046 microg. The most effective method of presterilisation cleaning tested was a presoak in Alkazyme followed by processing in the Miele G7881 washer-disinfector. CONCLUSION: The most effective method of presterilisation cleaning for hand endodontic files is a presoak in Alkazyme, an alkaline enzymatic detergent, followed by processing in a Miele G7881 washer-disinfector. This study provides up-to-date evidence that newer methods of presterilisation cleaning may fail to remove protein from endodontic hand instruments totally. This may have implications for all reusable dental instruments.

Pharmaceutical prescribing for children. Part 6. The management of medical emergencies in children in dental practice.

This paper is the seventh in the series on prescribing medicines for child dental patients. Here, the authors aim to describe the medical emergencies that may occur in children presenting for dental treatment and to provide guidelines on their management, with particular reference to the use of emergency drugs.

Pharmaceutical prescribing for children. Part 3. Antibiotic prescribing for children with odontogenic infections.

This paper is the third in a series on the prescribing of medicines for children by dentists working in primary care. It deals with antibiotics, which may be prescribed for infections arising from teeth, and reviews current best practice.

Pharmaceutical prescribing for children. Part 6. Dental management and prescribing for the immunocompromised child.

This paper is the sixth in a series on the prescribing of medicines for children by dentists working in primary care. It deals with the dental management and prescribing of medicines for the immunocompromised child. It differs from previous papers in the series in that, apart from the prescription of medicaments such as fluoride supplements and chlorhexidine mouthwashes, most medication for this group of children is prescribed by specialists working in secondary care rather than by primary dental care practitioners.

An investigation into Merseyside General Dental Practitioners' interest in primary care research, their views on research and their training needs.

OBJECTIVES: The aims of this investigation were to evaluate the interests of primary care dental practitioners within the Mersey Postgraduate Deanery in research and their views on research, their experience and research training needs. METHOD: A questionnaire was sent to all practitioners in the Mersey Deanery asking for views on dental research, whether they had been involved in any research projects or had any research training, and whether they would be interested in research training and being part of a primary dental care research network. RESULTS: A total of 192 practitioners from the 1120 in the Mersey Deanery expressed an interest in being involved in primary care research. Most believed that primary care research was very important in providing a stronger evidence-base in dentistry and improved quality of dental care. Over 50% of respondents were interested in collaborative research, provided that their income and time could be protected and it was part of the normal working day. Almost 25% had some research experience and a number had undergone research training, ranging from informal training to part of a degree. CONCLUSIONS: A number of GDPs in the Mersey Deanery are interested in primary care research. With appropriate training, support and recognition within the new Personal Dental Services (PDS) contracts, there is a golden opportunity for more primary care dentists to participate in research. This, in time, will add to the evidence base in dentistry and should improve patient care.