Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study

Abstract

Background Longitudinal studies of dental prescribing in Australia show that dentists make some inappropriate prescribing choices; literature has shown that dentists tend to overprescribe antibiotics and prescribe for incorrect indications. The unnecessary use of antibiotics is a contributing factor towards the development of antibiotic resistance. The aims of the study were to obtain a greater understanding of the perceptions, attitudes and factors that influence dental prescribing for all major relevant drug classes. Method Semi‐structured interviews of 15 purposively sampled dentists practising in Victoria, Australia were conducted from June–September 2018. Two dentists practised in rural areas and the remainder in urban locations. The range of clinical experience varied from 2.5 to 37 years, with a mean of 13 years. The transcripts were analysed thematically. Results Dentists generally preferred amoxicillin as first‐line therapy for odontogenic infections, with some confusion about the spectrum and uses of antibiotics. Overprescribing was evident, mostly due to basing judgement for use of antibiotics on symptoms rather than clinical signs. Other factors, such as time pressure, patient expectations, pressure from assistant staff, concern about online criticism and medico‐legal considerations, influenced prescribing. Of the dentists who prescribed anxiolytics, most did not have a care protocol for their sedated patients. Conclusion A variety of prescribing practices were described, and future interventions should target misconceptions around the appropriate use and choice of antibiotics, resources to address the shortfall in knowledge of therapeutics, patient education and staff training, as well as appropriate care and monitoring of sedated patients.

How did COVID-19 impact on dental antibiotic prescribing across England?

“…Unnecessary dental antibiotic prescribing is a complex behaviour which is influenced by a plethora of clinical and non-clinical factors which affect dentists and patients. 21,22 Early in the COVID-19 pandemic, a selection of potential factors driving the increase in dental antibiotic use were identified in a letter to the British Dental Journal editor-in-chief. 2 Access and other systems/process issues were hypothesised as key, noting in particular that some urgent dental centres had been requiring patients to have tried antibiotics before accepting referral for face-to-face care.…”

Dental opioid prescribing rates after the up-scheduling of codeine in Australia

“…About one in four dentists in Australia (16-27%) would preference the use of analgesics only (paracetamol, paracetamol/ codeine, tramadol or oxycodone) for dental pain, instead of NSAIDs 29 . Australian dentists tend to recommend tramadol if their patient is allergic or finds codeine ineffective 30 , despite both medicines requiring transformation by cytochrome P450 2D6 to the active metabolites. The pharmacogenomic variability of cytochrome P450 2D6 is well established and therefore patients who have inherited two non-functional alleles of this enzyme will likely find both medicines ineffective.…”

“…The pharmacogenomic variability of cytochrome P450 2D6 is well established and therefore patients who have inherited two non-functional alleles of this enzyme will likely find both medicines ineffective. In addition, other non-clinical factors have been identified for prescribing by Australian dentists, such as patient pressure, fear of litigation, and the desire by dentists to make patients feel well managed 30 .…”

A survey of prescribing practices by general dentists in Australia

“…A recent qualitative study on perceptions and reasons for prescribing antibiotics for therapeutic uses revealed that for conditions such as irreversible pulpitis, localised odontogenic infections and alveolar osteitis where antibiotics are not warranted, dentists tended to prescribe antibiotics based on the severity of the patient’s symptoms, rather than clinical signs. [32] The study also revealed that there was a strong desire by dentists to give distressed patients who were in pain the impression that the dentist was doing everything possible to resolve their symptoms so patients would consequently feel that they were well managed, and the prescribing of antibiotics was one such method. [32]…”