Antimicrobial Prescribing for General Dental Practitioners
Copyright FGDP(UK) 2014. No part of this publication may be reproduced without permission
Dentists working in primary care prescribe antimicrobials to manage oral and dental infections. The benefits of prescribing antimicrobials are however limited by a number of problems associated with their use eg. side effects, allergic reactions, toxicity and the development of resistant strains of microbes.1
Within the last few decades antimicrobial resistance has become a worldwide problem and constitutes a major threat to public health.2 The indiscriminate prescribing of antimicrobials by health care professionals is targeted as a major factor to be addressed. Dentists working in NHS primary care prescribe nearly 10% of all the oral antimicrobials prescribed in primary care in England.3 There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance.4-7 The use of antimicrobials leads to selection and dominance of resistant micro-organisms; they can also increase the incidence of resistance through the exchange of genetic material, so that resistant genes can spread between bacterial populations.
Dentists should be aware that serious drug interactions can occur with antimicrobial agents when other drugs are taken concomitantly (eg. miconazole/fluconazole and warfarin, erythromycin and simvastatin). Dentists should also be aware that prescribing for the elderly, expectant and nursing mothers, patients that have comorbidities (eg. renal or liver impairment) may require modification. Dentists are advised to always check the BNF or other authoritative sources, such as the Electronic Medicines Compendium.8
Information on any aspect of drug therapy can be obtained from the UK Medicines Information service by phoning your regional Medicines Information (MI) centre; numbers can be found inside the front cover of the British National Formulary. The regional MI centre in the North West (NWMIC) provides a specialist service on drug use in dentistry and can be contacted on 0151 794 8206. For further information about the NWMIC and to access documents related to dentistry, visit www.ukmi.nhs.uk/activities/specialistServices
Antimicrobial prescribing in primary care is only indicated:
- As an adjunct to the management of acute or chronic infection.
- For the definitive management of active infective disease, eg. necrotising ulcerative gingivitis.
- Where definitive treatment has to be delayed due to referral to specialist services. Examples would include: an inability to establish drainage in an uncooperative patient who requires sedation or general anaesthesia for treatment; or a patient who needs to be treated in a hospital environment due to comorbidities.
There is no indication for the prescribing of antimicrobials for acute pulpitis, where definitive treatment of the cause along with analgesics is more appropriate.9,10
1. Finch RG. Adverse reactions to antibiotics. In: Greenwood D, editor. Antimicrobial chemotherapy, 4th ed. Oxford: Oxford University Press; 2000. p. 200-11.
2. House of Lords Select Committee on Science and Technology, Seventh Report. Resistance to antibiotics and other antimicrobial agents. London: HMSO; 1998.
3. Health and Social Care Information Centre. Prescribing by Dentists 2013: England. Available at: http://www.hscic.gov.uk/catalogue/PUB14016/pres-dent-eng-2013-rpt.pdf Accessed: October 2014.
4. Palmer NA, Pealing R, Ireland RS, Martin MV. A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000;189(1):43-6.
5. Palmer NA, Pealing R, Ireland RS, Martin MV. A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000;188(10):554-8.
6. Harte H, Palmer NO, Martin MV. An investigation of therapeutic antibiotic prescribing for children referred for dental general anaesthesia in three community National Health Service trusts. Br Dent J 2005;198(4):227-31,
7. Tulip DE, Palmer NO. A retrospective investigation of the clinical management of patients attending an out of hours dental clinic in Merseyside under the new NHS dental contract. BrDent J 2008;205(12):659-64,
8. The Electronic Medicines Compendium. http://www.medicines.org.uk/emc
9. Brennan MT, Runyon MS, Batts JJ, Fox PC, Kent ML, Cox TL, et al. Odontogenic signs and symptoms as predictors of odontogenic infection: a clinical trial. J Am Dent Assoc 2006;137(1):62-6.
10. Nagle D, Reader A, Beck M, Weaver J. Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90(5):636-40.