Dental Antibiotic Prescribing Increases Ahead Rest Of NHS

Dental Antibiotic Prescribing Increases Ahead Rest Of NHS

Dentistry has been named as the only part of the NHS to experience an increase in antibiotic prescribing in 2020.

The increase came after years of consecutive annual decline, and was highlighted in an update to a report. released yesterday by the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR).

The FDI World Dental Federation said “The steepest rise occurred when dental practices were closed from March to June 2020 during the first wave of COVID-19, and it has been slow to decline since.” 

Dr Wendy Thompson, Chair of the FDI World Dental Federation’s Antimicrobial Resistance Group said “The COVID-19 pandemic has been unforgiving.”

Dr Thompson warned “But using antibiotics to make up for a lack of access to urgent dental care is a risk to patient safety and should be avoided wherever possible. We need to start treating patients with acute dental pain or infection, not medicating them.”

The British Dental Association said on the BDA News website “We have warned that ongoing difficulties in accessing dental services risk fuelling the parallel health crisis of antibiotic resistance, as new data from the UK Health Security Agency shows a surge in dental prescriptions for antibiotics.” 

BDA News said that although patient volumes fell by more than half un 2020 due to the pandemic, dentistry saw an increase in antibiotic prescriptions of ‘almost a fifth.’

The World Health Organization has predicted that antimicrobial resistance will be the world’s biggest killer by 2050.

The ESPAUR report said the  “Estimated number of deaths attributable to antibiotic-resistant bacteria (based on the antibiotic resistance burden) also increased year-on-year between 2016 and 2019, before declining in 2020 (estimated 2,596 deaths in England in 2019 versus 2,228 in 2020).  

The FDI said “Even in Spring 2021, four out of five people in England still said they had difficulties accessing timely care for their dental problems.”

“Antibiotics are usually only administered for severe infections alongside treatment to drain the infection. Antibiotic-only dental care is rarely in line with guidance. But the restricted access to face-to-face dental appointments last year saw the medicines being prescribed when procedures would usually be a quicker and safer fix.”

In a recent article in the British Dental Journal, Dr Thompson wrote that the  “Restricted access to face-to-face dental appointments resulted in a significant increase in antibiotic prescribing during 2020, which is a problem because it drives the development and spread of infections that are resistant to antibiotics.”

“Using antibiotics to make up for a lack of access to urgent dental care is, therefore, a risk to patient safety and should be avoided wherever possible. Ensuring timely access to appropriate and effective treatment is the best way to provide care for patients with acute dental pain or infection.”

Dr Thompson addressed a universal problem that can occur in dental NHS practice, where time is at a premium.  

She said “The whole healthcare system needs to facilitate guideline-congruent urgent dental care - from the most senior managers to the most junior front-line dental team members.”

“Within the NHS, providing a conducive environment means contracting to incentivise procedures not prescriptions, and managing service provision to ensure inappropriate antibiotic use is minimised (as per the Health and Social Care Act’s code of practice on the prevention and control of infections).”

Professor Ihsane Ben Yahya, President of the FDI said “We need to make a clear and public commitment to tackling antibiotic resistance  and communicate to the general public what appropriate antibiotic use in dentistry is all about and how it impacts them.” 

“And just as importantly, we need to advocate for dentistry to be included within national action plans on antibiotic resistance. And that means developing evidence-based guidelines where they don’t already exist on dental antibiotic use as well as engaging with audits of dental antibiotic use.”

A few weeks ago,  the BDA  signed the World Dental Federation’s pledge to reiterate its commitment to tackling antimicrobial resistance, by preventing dental infections, optimising antibiotic stewardship and raising awareness.

BDA Chair Dr Eddie Crouch said "Antimicrobial resistance poses an even greater threat to human health than COVID.”

“Sadly, the pandemic has wiped out years of progress in bringing down antibiotic use in dentistry. Placeholder prescriptions are now filling deficits in access and time, which the government has chosen not to factor in. Ministers have a responsibility to help dentists turn the page."

The BDA said “We have stressed that the Government must do more to increase access sustainably and ensure patients – particularly urgent cases – have the time for operative interventions to ensure they are not offered antibiotics as a placeholder.”

“The current target-based NHS contract in operation in England has long represented a key barrier to progress.”

A joint statement from the Association of Clinical Oral Microbiologists and College of General Dentistry, supported by the Association of Dental Hospitals, British Dental Association, Healthcare Improvement Scotland, British Association of Oral Surgery, British Society for Antimicrobial Chemotherapy, British & Irish Society for Oral Medicine, Faculty of Dental Surgery of the Royal College of Surgeons of England, Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh, and the Faculty of Dental Surgery of the Royal College of Physicians and Surgeons of Glasgow, reminded patients that “antibiotics do not cure toothache”, and aimed to encourage the dental team to adhere to best practice and only prescribe antibiotics as an adjunct to definitive clinical management of the cause when indicated according to national guidelines.

‘Prudent prescribing of antimicrobials can slow down the development of antimicrobial resistance, and all healthcare prescribers play a vital role. The dental profession has shown its commitment to addressing antimicrobial resistance by significantly reducing the use of antibiotics over the last decade, both in dental practice and a hospital setting. Dental hospitals in the UK and Ireland reduced antibiotic prescriptions by 22% and 30% for therapeutic and prophylactic indications respectively between 2018 and 2020 (prior to the COVID-19 pandemic),” the statement said.

“It has been reported that COVID-19 had a negative effect on the profession’s endeavours in improving antibiotic prescribing patterns. The organisations therefore encourage dental teams in both general practice and hospital settings to re-start auditing their practice of antibiotic prescribing against the recently updated national guidelines, as this will help to reduce the use of antimicrobials and improve patient outcomes.”

“The successful management of acute dental infections requires accurate diagnosis and definitive treatment, and patients who have prompt access to emergency dental services have a much-reduced risk of developing life-threatening sepsis. Dental teams are encouraged to use the following resources to update their knowledge on the latest national recommendations on the use of antimicrobial agents in dentistry, and to audit their practice.”

World Antimicrobial Awareness Week 2021 takes place from 18th November until November 24th.

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