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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. [ABSTRACT FROM AUTHOR]

The aim of this paper is to highlight a change in guidance relating to possible interactions between antibiotics and oral contraceptives. Until recently, dentists have been advised to warn women taking the combined oral contraceptive pill of the routine need to use additional contraceptive measures while taking courses of broad spectrum antibiotics. Recent guidance relating to this issue has changed and dentists may not be aware of this. This paper reminds dentists of the previous guidelines and related evidence, reviews the pharmacokinetics of hormonal contraception and presents them with the latest evidence-based guidance. This should change their clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate antibiotic prescribing patterns by general dental practitioners (GDPs) in the Greater Glasgow Health Board Area, Scotland.Study Design: A 10% sample of prescriptions were selected at random from 35,545 prescriptions written by GDPs over a 6-month period.Main Outcome Measures: Absolute and relative frequencies were used to describe the different classes of antibiotics used and the variations in prescribing practice.Results: GDPs prescribed a wide range of antibiotics. Seventeen different antibiotics were prescribed with amoxycillin, metronidazole and penicillin V accounting for almost 90% of the prescriptions. In general the antibiotics were prescribed at the British National Formulary (BNF) recommended doses. There were, however, wide variations in the frequencies and durations of the prescriptions for all antibiotics.Conclusions: The present study provides evidence of sub-optimal prescribing of antibiotics by dentists in Scotland, with considerable variation from the recommended frequencies and doses. [ABSTRACT FROM AUTHOR]

Objective: To compare the level of prescribing and types of antibiotics prescribed for dental problems by general medical practitioners and dentists.Design: Secondary analysis of standard consultation data and prescription records from four different settings.Setting: 30 participating general practices in the General Practice Morbidity Database for Wales in 1996.Subjects: 1,185 attendances for tooth-related problems, at 30 participating practices in the General Practice Morbidity Database for Wales in 1996. Standard consultation records from a GDP emergency dental rota, and two weekend emergency dental clinics: one in a health centre, the other in a dental hospital.Results: More than two thirds (68%) of attendances at general medical practices for tooth-related problems resulted in a prescription for antibiotics. In contrast less than a third (28%) of patients seen by a GDP rota, about half (52%) of patients at a weekend emergency clinic in a health centre, and just more than a third (38%) of patients attending the dental hospital clinic received antibiotics. General medical practitioners were also more likely to prescribe broad-spectrum antibiotics than dentists.Conclusion: For acute dental problems general medical practitioners are more likely to prescribe antibiotics than dentists. There also appear to be inter-professional differences in the tendency to prescribe broad spectrum antibiotics. Initiatives to rationalise prescribing for dental conditions may need to target doctors as well as dentists. [ABSTRACT FROM AUTHOR]

Background Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem.Objective This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance.Method Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis.Results Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations.Conclusions Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Usage fees would have several advantages over the banning of non-human use of antibiotic growth promoters. [ABSTRACT FROM AUTHOR]

The article focuses on locally delivered, slow release, non-antibiotic antimicrobial, product PerioChip, which can substantially reduce periodontal pocket depth when used in conjunction with SRP. It releases chlorhexidine for seven to ten days to control plaque bacteria and as chlorhexidine is not an antibiotic, there is no risk of antibiotic resistance developing with repeated use. The new Room Temperature PerioChip enables practice staff to store the product without the need for refrigeration, allowing it to be conveniently to hand during periodontal treatment. It takes less than 30 seconds for a dentist or hygienist to insert, with no specific training or instruments required.

Objective To describe the expectations of walk-in patients seeking emergency dental care out-of-hours. Basic design Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audiorecorded interview transcripts were analysed using the ‘framework’ method of applied qualitative data analysis. Subjects and setting Forty-four walk-in emergency dental patients at a community-based dental clinic and a dental hospital emergency clinic at the weekend. Results In addition to symptom relief, the main desired outcome for emergency dental patients may be informational and psychological — especially reassurance that the problem is not serious, and reduced uncertainty about the cause of the pain. In general, patients' stated expectations for specific treatments (such as antibiotics, or tooth extraction) were not absolute: rather, they implied these expectations were conditional upon the dentist deciding they were necessary. Conclusions Emergency dental services, some of which are still dominantly treatment-focussed, should reflect that many emergency dental attenders want advice and reassurance as much as relief from symptoms. This reinforces the importance of effective and sympathetic dentist-patient communication within emergency or out-of-hours consultations. It also implies that dentists' skills in listening, explaining and reassuring should be captured in any patient satisfaction or outcome measure designed for this patient group. [ABSTRACT FROM AUTHOR]

Objective To compare the level of prescribing and types of antibiotics prescribed for dental problems by general medical practitioners and dentists. Design Secondary analysis of standard consultation data and prescription records from four different settings. Setting 30 participating general practices in the General Practice Morbidity Database for Wales in 1996. Subjects 1,185 attendances for tooth-related problems, at 30 participating practices in the General Practice Morbidity Database for Wales in 1996. Standard consultation records from a GDP emergency dental rota, and two weekend emergency dental clinics: one in a health centre, the other in a dental hospital. Results More than two thirds (68%) of attendances at general medical practices for tooth-related problems resulted in a prescription for antibiotics. In contrast less than a third (28%) of patients seen by a GDP rota, about half (52%) of patients at a weekend emergency clinic in a health centre, and just more than a third (38%) of patients attending the dental hospital clinic received antibiotics. General medical practitioners were also more likely to prescribe broad-spectrum antibiotics than dentists. Conclusion For acute dental problems general medical practitioners are more likely to prescribe antibiotics than dentists. There also appear to be inter-professional differences in the tendency to prescribe broad spectrum antibiotics. Initiatives to rationalise prescribing for dental conditions may need to target doctors as well as dentists. [ABSTRACT FROM AUTHOR]