Home News

dentii | News

'Concern' over GPs prescribing 'unnecessary' antibiotics for toothache

Print PDF

Over half of all patients who visited their GP with a dental problem in the last 10 years were not offered a long-term treatment for their pain and were instead prescribed antibiotics, often unnecessarily, new research has found.

In a 10 year retrospective study published in the British Journal of General Practice a team of experts from Cardiff University and Cardiff and Vale University Health Board examined dental consultations in UK general practice and the resultant number of antibiotics prescriptions.

The study found many patients are visiting their GP rather than their dentist, and that over half of these consultations resulted in antibiotic prescribing, which is likely to be unhelpful, and potentially harmful.

"Our study found that many people visit their GP rather than their dentist when experiencing dental problems," said Dr Anwen Cope, a qualified dentist and speciality trainee in Dental Public Health at Cardiff and Vale University Health Board, who completed the research alongside colleagues from the Schools of Dentistry and Medicine at Cardiff University.

"Most dental problems cannot be comprehensively managed by a GP. This places an additional burden on already busy GPs when patients should be visiting a dentist.

"The best treatment for severe toothache remains an operative intervention like an extraction or root canal treatment. These treatments can only be undertaken by a dentist. Therefore, we would always encourage patients to see a dentist, rather than a GP, when experiencing dental problems."

The most alarming finding was the number of unnecessary prescriptions of antibiotics over the last ten years.

The study found over half of patients in the study who consulted their GP with a dental problem were prescribed an antibiotic. This raises serious concerns about the UK's long-term dental health and the potential contribution to antibiotic resistance.

Antibiotic drug resistance, which occurs when bacterial infections no longer respond to antibiotics, is a serious problem, and the use of antibiotics is the single most important factor leading to resistance.

Dr Cope added: "The widespread use of antibiotics in the management of tooth-related complaints in general practice is concerning.

"Despite antibiotics not providing a definitive treatment for dental problems we found over half of consultations for dental problems resulted in prescription of an antibiotic.

"This presents a number of problems. It means patients are not getting a long-term resolution for their dental problem, and they may even remain in pain for longer.

"Prescribing antibiotics also carries a risk of adverse reaction and is likely to increase the number of medical consultations for dental conditions further down the line.

"More worryingly is the potential impact on the rates of antibacterial resistance. Antibiotics save lives, and therefore it's important we use them carefully and only when they are really required.

"Improving antibiotic prescribing for dental problems is an important step in ensuring antibiotics will still be available in the years to come."

This research did not identify the reasons why patients were consulting with a GP rather than a dentist, and it may be that GPs are sometimes treating patients who report being unable to get a timely appointment with a dentist.

Nevertheless, the team hope the study will promote more appropriate consulting for dental problems, and a reduction in antibiotic prescribing by GPs for patients with dental problems.

Dr Cope added: "The messages from our study are simple: GPs should avoid routinely prescribing antibiotics when patients present with dental problems, and more work is needed to identify how patients experiencing dental problems can be best directed to emergency dental services."

 

How bioceramics could help fight gum disease

Print PDF

Severe gum disease known as periodontitis can lead to tooth loss, and treating it remains a challenge. But new approaches involving silicon nitride, a ceramic material used in spinal implants, could be on the way. The surface of silicon nitride has a lethal effect on the bacteria that commonly cause periodontitis. Now scientists, reporting in ACS' journalLangmuir, are examining why this happens. Their findings could help inform future efforts to treat the disease.

About half of American adults have some form of gum disease. It's caused by bacteria that infect the tissue around teeth, resulting in gum inflammation. If the condition progresses, the bacteria can damage the bone that supports the teeth. In addition to tooth loss, periodontitis can increase a person's risk of heart attack or stroke. Options for treatment include scaling and root planing, topical antibiotics and surgery. Giuseppe Pezzotti and colleagues wanted to find a new alternative by studying the reactions of bacteria to antimicrobial silicon nitride.

The researchers investigated how the ceramic material changes the metabolism of Porphyromonas gingivalis - the bacteria species primarily responsible for periodontitis. They found that chemical reactions at the surface cause the bacteria's nucleic acids to degrade and drastically reduce the amounts of certain proteins and fats. While further studies are needed, the results show silicon nitride holds promise as a therapeutic aid for treating severe gum disease.

 

Predicting caries risk at 30-months of age in medical settings

Print PDF

At the 45th Annual Meeting & Exhibition of the American Association for Dental Research, researcher Margherita Fontana, University of Michigan School of Dentistry, Ann Arbor, USA, presented a study titled "Predicting Caries Risk at 30-months of age in Medical Settings." The AADR Annual Meeting was held in conjunction with the 40th Annual Meeting of the Canadian Association for Dental Research.

In this study, researchers aimed to expand partnership with the medical community is a necessary strategy for reducing disparities in dental caries among young children and develop a caries risk tool to identify toddlers at risk of developing caries by age four through medical settings. A psychometrically defensible, 52-item caries risk questionnaire was completed by primary caregivers (PCG), while children received caries examinations using the ICDAS criteria, at baseline (child 12±3 months-of-age), and 18 months after (child 30±3 months-of-age). From three study sites, 1,056 children (out of 1,326 recruited) stratified by race/ethnicity and Medicaid status completed 18-month exams. Caries (dmft; d=ICDAS-3) was assessed and tested for association with each questionnaire item individually using generalized estimating equation models applied to logistic regression.

 
Page 3 of 58