Four national organisations have joined forces to call for antimicrobials to continue to be prescribed in line with national guidance during the coronavirus pandemic.
In an open letter, the Faculty of General Dental Practice (FGDP(UK)), British Dental Association, Public Health England and the Faculty of Dental Surgery of the Royal College of Surgeons of England recognise the difficulties faced by dentists in managing patients through remote assessment and provision of the '3As', but say that the normal principles of prescribing continue to apply.
The letter states that antibiotics "should not be prescribed routinely to all patients as part of a pathway to care" or "to treat conditions that do not respond to antibiotics e.g. pulpitis", and notes that NHS England has asked its regional teams to ensure that the acceptance criteria for Urgent Dental Care centres support this, and align with the guidance set out in its Standard Operating Procedure for Urgent Dental Care, which was published earlier this month.
The FGDP(UK) has included advice on remote prescribing in its collation of Covid-19 guidance and resources of relevance to general dental practice.
The full text of the letter is below:
Prescribing antibiotics for urgent dental care during sustained transmission of COVID 19
We are in unprecedented times dealing with a global pandemic that is affecting the health and economics of our country and impacting personally on all of us.
We recognise the difficulties for the dental profession in managing patients when there is sustained transmission of COVID-19 and the suspension of routine dental care.
The current Standard Operating Procedure1 describes the need to reduce the numbers of patients who are seen face to face. The advice for dentists is to remotely triage patients where possible with Advice, Analgesics and Antibiotics where appropriate.
We recognise the challenges which this presents for clinicians in terms of assessment, diagnosis and management, and the effect which this can have on patient care. We appreciate that you are currently operating in the context of treatment via urgent dental care systems, and NHS England have discussed with the regions the need to ensure that acceptance criteria support the prescribing guidance set out in the SOP and this document.
Appropriate prescribing of antibiotics
This (note/brief/letter) seeks to clarify that even in these challenging times, antibiotics still need to be prescribed appropriately for the patients’ condition and should follow choice, dose and duration of antibiotic recommended in FGDP(UK) or SDCEP guidance.
• SDCEP. Drug prescribing for dentistry
• The dental AMS toolkit also includes patient information leaflets that could be used to provide or reinforce key messages to patients
The General Dental Council’s “expectations of dental professionals” falls within Standard 7.1 of its “Standards for the Dental Team2” which requires that ‘you must provide good quality care based on current evidence and authoritative guidance’. It also recommends that if there is deviation from established practice and guidance, dentists should record the reasons why and be able to justify their decision.
In relation to the prescribing of medications the GDC offers the following guidance3:
• You must make an appropriate assessment of your patient’s condition, prescribe within your competence and keep accurate records.
• You must have an understanding of your patient’s current health and medication, including any relevant medical history, in order to prescribe medicines safely.
• You must only prescribe medicines to meet the identified dental needs of your patients.
• You should only use remote means to prescribe medicines for dental patients if there is no other viable option and it is in their best interests
There is recognition that for many patients, ‘remote means’ are currently the only option for prescribing drugs.
Antibiotics should be prescribed in the following situations:
• if it is considered that the patient has a bacterial infection which requires antibiotics. This would include the treatment of acute apical or periodontal abscess and acute pericoronitis, necrotising ulcerative gingivitis/periodontitis.
• after discussion with the patient about the benefits and risks associated with the treatment options offered
• with advice on what to do if symptoms continue to progress
• with consideration of a follow-up call to the patient after a few days to check how their infection has responded to the antibiotics
Antibiotics should not be prescribed:
• to treat conditions that do not respond to antibiotics e.g. pulpitis
• because of a patient request
• routinely for all patients as part of a pathway to care
With kindest regards,
Sandra White – National Lead for Dental Public Health, Public Health England
Michael Escudier – Dean, Faculty of Dental Surgery, Royal College of Surgeons of England
Ian Mills – Dean, Faculty of General Dental Practice (UK)
Mick Armstrong– PEC Chair, British Dental Association
1NHS E/I COVID-19 guidance and standard operating procedure Urgent dental care systems in the context of coronavirus https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/...
2GDC Standards for the Dental Team: https://standards.gdc-uk.org/pages/principle7/principle7.aspx
3GDC Guidance on prescribing medicines. https://www.gdc-uk.org/docs/default-source/guidancedocuments/guidance-on...