Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study

Abstract

BackgroundThe frequency of consulting for dental problems in general medical practice, and antibiotic prescribing associated with these consultations, is poorly described.AimTo describe consultation rates and antibiotic use for dental problems in UK general medical practice, and explore factors associated with antibiotic prescribing for dental conditions.Design and settingA retrospective cohort study using Clinical Practice Research Datalink, a database of general practice patient records in the UK.MethodAll dental consultations between 2004 and 2013 were identified. The main outcome was the prescription of an antibiotic during a dental consultation. Multilevel logistic regression was conducted to examine factors associated with antibiotic prescription.ResultsIn all, 288 169 dental consultations were included in the cohort. The average rate of dental consultations was 6.06 consultations per 1000 patient-years. Rates of dental consultation decreased from 6.84 consultations per 1000 patient-years in 2008, to 4.23 consultations per 1000 patient-years in 2013. Consultation rates were higher among females than males and highest in patients aged 20–29 years. An antibiotic was prescribed in 57.1% of consultations. Significant predictors (P<0.001) of antibiotic prescribing included: patient middle age, male sex, and previous consultations for tooth-related problems. Antibiotics were more likely to be prescribed during consultations in December (odds ratio [OR] 1.18, 95% confidence interval [CI] = 1.13 to 1.24,P<0.001, reference month: June) and on a Monday (OR 1.10, 95% CI = 1.07 to 1.13,P<0.001) or a Friday (OR 1.15, 95% CI = 1.12 to 1.18,P<0.001, reference day: Wednesday).ConclusionConsultation rates for dental problems in UK general practice are relatively low but more than half result in the prescription of an antibiotic. This raises concerns about patient morbidity and contributions to antimicrobial resistance.

<p>Inappropriate Dental Antibiotic Prescriptions: Potential Driver of the Antimicrobial Resistance in Albaha Region, Saudi Arabia</p>

“…3 Many studies have evaluated the prescription trend of dental antibiotics worldwide. [4][5][6][7][8][9] For instance, in the USA, it was found that dental practitioners and dentists prescribed more than 2.9 million antibiotics per year. 5 Moreover, a retrospective study in Croatia showed that antibiotics were prescribed during almost half of the dental emergency visits.…”

“…8 Similarly, in the UK, a retrospective cohort research revealed that dental antibiotics were prescribed during more than half of dental consultations. 9 These findings indicate a negative contribution of medical practitioners toward AMR and paucity of knowledge among the public over-the-counter availability of antibiotics as well as leftover antibiotic usage, which is the hallmark of low-and middle-income countries.…”

Interprofessional working: a spearhead opportunity for dentistry and pharmacy

“…It could possibly even make inroads into addressing recalcitrant oral health inequalities, and contribute to further reductions in the inappropriate prescription of antibiotics in the management of, in particular, dental pain. 4,6 Who knows, such interprofessional working could lead to far-reaching, funded innovations, such as dental and pharmacy teams working together with other healthcare professionals on local screening and vaccination programmes. In anticipation of the validation of the efficacy and cost efficiency of such initiatives, health regulators, educators, commissioners and other funders of dental services should be acting now to put in place arrangements to facilitate and encourage such collaborative working.…”

“…[2][3][4] When pharmacists are consulted they invariably do whatever they can to help such individuals, in particular those in pain. However, oral and dental considerations do not tend to be included in existing programmes of instruction in pharmacy and, in the absence of any working relationship with local dental practices, advice tends to be empirical and based on experience.…”

More health warnings on food are needed to reduce tooth decay, says BMA

“…A study by the Royal College of General Practitioners3 in April 2016 showed that GPs see around 600 000 patients with dental problems each year. One academic study suggested that this costs GPs £26.4m a year 4…”