Antibiotics: the patient’s point of view – Dr Svend Ulrich Jensen – principle dentist in Hundested DenmarkFeatured Products Promotional Features
Posted by: Dental Design 4th March 2019
Antibiotic resistance is a compelling global issue. Over the last few decades, growing use has led to growing resistance, leading to warnings that routine procedures are becoming less safe and even deadly, with patients unable to fight off infections.
The campaign to keep antibiotics effective has support from across the entire dental family. A report published by the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) in 2018 outlines the measures taken by the Faculty of General Dental Practice UK (FGDP (UK)) to raise awareness of “the importance of appropriate antimicrobial prescribing in dentistry… and the need for antimicrobial stewardship (AMS) to reduce drug-resistant infections.”[i]ESPAUR’s figures indicate that dental practices dispensed a quarter fewer prescriptions for antibiotics in 2017 compared to 2013, a positive trend that has been praised by the BDA.
A cursory search around on this topic unearths articles that are nearly 15 years old. “Better use of diagnostic services, surveillance and improvements in dental education are required now to lessen the impact of antibiotic resistance in the future” writes one, from 2004.[ii]Certainty most of us would agree that diagnostics and monitoring, as well as education have all improved since then, yet we find ourselves facing the issue of AMS, now with far more urgency. An increased awareness and detection rates for sepsis (“a life-threatening organ dysfunction caused by a dysregulated host response to infection”[iii])means we have seen more stories in the mainstream media about deaths from this condition. Antibiotic treatment as soon after diagnosis as possible is necessary in order for it to be a success and, in some cases, save a patient’s life. But yet again, we can find concerns around this topic going back several years. In 2006, a letter to the BMJ warns of an “alarming increase in dental sepsis”.[iv]
Consistent efforts to keep antibiotic resistance in the spotlight, such as the continued promotion of the FGDP(UK)’s dental AMS toolkit, the quality standards issued by NICE and educational measures such as e-learning modules developed by the British Association of Oral Surgeons suitable for all GDPs,[v]have been supported by the dental media. But what happens when a patient, complaining of a painful abscess, demands antibiotics and says, “that’s what the dentist always gave me in the past and if you won’t let me have any, I’ll go to my GP!”?
An abscess is often the result of decay, and decay remains one of the most preventable chronic diseases worldwide. Poor oral hygiene – ineffective brushing and not cleaning interdentally, as well as consuming sugary foods and drinks are primary causes of decay. Periodontal pocketing can also lead to the formation of an abscess. If a patient presents with an abscess, they must understand that antibiotics willnot and shouldnot be prescribed routinely. Antibiotics are not pain relief. A range of treatments can be recommended – from drainage, to endodontic therapy or extraction – but antibiotics are only required if the infection is severe and needs to be halted from spreading. This is the simple message that patients need to understand. In order to help them get better and for their mouth to feel comfortable again, antibiotics are not always the answer. Pain relief is a different story – over-the-counter medications will ease soreness, or adult patients could try a salt-water rinse. Pain relief is not a substitute for a visit to the dentist though; an abscess will not get better on its own.
So, what is the best thing that dentists, dental hygienists and dental therapists can do in this global battle against controlling infections and changing the culture around antibiotics? Talk prevention, prevention, prevention. It may seem like small steps, but in our practices, by empowering our patients to stay orally healthy, we can contribute to the campaign for AMS. Good, effective cleaning, using high-quality tools, such as the brushes and interdental brushes from the TANDEX range, is the key to avoiding decay, along with regular appointments with the dentist and dental hygienist/therapist. PREVENT GEL™ is also available to support good oral hygiene. A healthy diet, with sugary and highly acidic foods eliminated, or kept in moderation, is fundamental. Good oral health really can help to slow down the development of antibiotic resistance – the message should be as simple as that.
A dental practitioner notprescribing antibiotics will not compromise a patient’s treatment (unless of course they are deemed necessary and the decision to give antibiotics satisfies all the recommendations and guidelines for best practice). This is what we need to tell our patients; that we will to teach them how to prevent decay, in order to avoid infection, and if they are in pain we will diagnose the cause and help them ease the pain accordingly. The fight against antibiotic resistance is defining modern healthcare and in order to win, patients and practitioners must both play their part.
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[i]English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR). Report 2018. Published October 2018 by Public Health England. Link: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/759975/ESPAUR_2018_report.pdf(accessed December 2018).
[v]BOAS. British Association of Oral Surgeons. Antimicrobial Stewardship e-learning Modules. Link: https://www.baos.org.uk/elearning/(accessed December 2018).
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