Are Dentist-Prescribed Antibiotics Necessary?

A new study – published in JAMA Network Open – says antibiotics prescribed by dentists as a preemptive strike against infection are unnecessary 81 percent of the time. Dentists are responsible for 10 percent of all antibiotic prescriptions written in the United States. Antibiotics prescribed when not warranted expose patients to the risk of side effects unnecessarily and also contribute to the problem of antibiotic resistance - bacteria evolving to make the drugs ineffective. Antibiotics are recommended as a course of action used to prevent disease prior to some dental procedures for patients with certain types of heart conditions.

The Oregon State University researchers used a national health care claims database to examine nearly 170,000 dentist-written antibiotic prescriptions from 2011 to 2015. The prescriptions involved more than 90,000 patients, 57 percent female, with a median age of 63. Greater than 90 percent of the patients underwent a procedure that possibly warranted taking an antibiotic ahead of time. Less than 21 percent had a cardiac condition that made an antibiotic prescription recommended under medical guidelines. "Preventive antibiotics in these patients gave them risks that outweighed the benefits," says Jessina McGregor, an associate professor in the OSU College of Pharmacy.

The researchers also looked at the prescriptions regionally and found unnecessary prescriptions on a percentage basis to be most prevalent in the West; 11,601 of the 13,735 prescriptions written, or 85 percent, were out of sync with the guidelines. The other regional percentages were 78 percent for the Northeast, 83 percent for the Midwest, and 80 percent for the South. Eighty-two percent of the unnecessary prescriptions were written in urban population centers, 79 percent in rural areas. Among patients who filled prescriptions for unnecessary antibiotics, clindamycin was the most common drug, and joint implants were the most typical reason they were prescribed.

The study was limited to patients with commercial dental insurance and the analysis used a broad definition of high-risk cardiac patients, suggesting the findings may underestimate the unnecessary prescribing of antibiotics. "Dental providers are very thoughtful when they develop care plans for their patients and there are many factors that inform dentists' recommendations, but this study shows that there is an opportunity for dentists to reevaluate if necessary," added Susan Rowan of the Illinois-Chicago College of Dentistry. "I think dental providers should view this study, which is the first to look at preventive antibiotic prescribing for dental procedures, as a powerful call to action, not a rebuke."

Is Ibuprofen, Acetaminophen More Effective Than Opioids In Treating Dental Pain?

It turns out that opioids are not among the most effective or longest lasting options available for relief from acute dental pain, a recent examination of the results from more than 460 published studies has found. Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain, according to research conducted with the School of Dental Medicine at Case Western Reserve University.

The study examining relief of acute pain in dentistry evaluated the safety and efficacy of dozens of pain-relief options. “What we know is that prescribing narcotics should be a last resort,” says Anita Aminoshariae, an associate professor in the dental school’s Department of Endodontics and one of the study’s authors. “Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health. No patient should go home in pain. That means that opioids are sometimes the best option, but certainly should not be the first option. The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events."

The national opioid epidemic is one of many reasons why health-care providers should take note of the findings. The goal of the systematic review was to summarize data using five in-depth studies of the effectiveness of oral-pain medications. The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied. The aim was to create a compendium detailing both the benefits and harms of these medications as a resource for dentists to use in their clinical decision-making. The study also found that opioids or drug combinations that included opioids accounted for the most adverse side effect including drowsiness, respiratory depression, nausea/vomiting and constipation in both children and adults.


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