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Volume3 Issue1
CDA
at
W
ork
which facilitatesdatacollectiononprescribingpatterns
of healthcareprofessionals, highlights adisturbing
trend in that province. From1996-2013, overall useof
antibioticsdeclined,withan18.2%decline inphysician
prescribing; however, dentists increased their rate
of antibioticprescribingby62.2% in the same time
period. Thismeans that theproportional contribution
of antibioticprescriptionsbydentists rose from6.7% to
11.3%.
5
What isnot known ishowmanyprescriptions
are issuedbynon-dentists (e.g., primarycareor ER
physicians) for dental problems.
Basedonanecdotal evidenceanddiscussionswith
pharmacists, it ismy sense that someantibiotic
prescriptions arebeingunnecessarily issuedby
dentists. For example, prophylacticantibiotics arenot
indicated inpatientswhohaveundergonea routine
extractionof impacted teeth,withanartificial joint and
nocomorbidity, orwithdental painprior to (or instead
of) a surgical intervention.
InMarch2015, CDAattendeda roundtablediscussion
onantimicrobial resistancehostedbyHealthCanada,
andweanticipateacontinuationof thesediscussions
in thecomingyear. Clearly, antibiotic stewardship is a
critical issue thatwemustmonitor andaddress as a
profession inCanadaand internationally.
a
References
1.HaasDA,EpsteinJB,EggertFM.Antimicrobialresistance:dentistry’srole.JCanDentAssoc.
1998;64(7):496-502.
2.GlennyA,SimpsonT.TheCCCDguidelines(Clinicalpracticeguidelinesonemergencyman-
agementofacuteapicalperiodontitisandacuteapicalabcess).EvidBasedDent.2004;5:7-11.
Available:www.nature.com/ebd/journal/v5/n1/full/6400233a.html[accessed2016Jan6]
3.WilsonW,TaubertKA,GewitzM,LockhartPB,BaddourLM,LevisonMetal.Preventionof
infectiveendocarditis:guidelines fromtheAmericanHeartAssociation:aguideline fromthe
AmericanHeartAssociationRheumaticFever,Endocarditis,andKawasakiDiseaseCommittee,
CouncilonCardiovascularDisease intheYoung,andtheCouncilonClinicalCardiology,Council
onCardiovascularSurgeryandAnesthesia,andtheQualityofCareandOutcomesResearch Inter-
disciplinaryWorkingGroup.Circulation.2007;116(15):1736-54[accessed2016Jan6].Available:
circ.ahajournals.org/content/116/15/1736.long
4.BritishDentalAssociation.BDAAMR indentistrysummit,10November2015,ConsensusReport
[accessed2016Jan6].Available:bda.org/news-centre/press-releases/Documents/BDA%20
AMR%20in%20dentistry%20summit%20consensus%20report.pdf
5.PatrickDM,MarraF,GeorgeD,ChongM,O’KeefeJ,Blondel-HillE. Whataccounts fora large
increase inantibioticprescribingbydentists?Postersessionat IDWeek,October2015,SanDiego,
CA.Abstract156.
AntibioticProphylaxisand
InfectionControl
TheCDAPosition Statement onPrevention
of Infective Endocarditis states that “only
those at greatest risk of developing infective
endocarditis…should receive short-term
preventive antibiotics before common, routine
dental andmedical procedures.” Read the full
CDAPosition Statement at:
TheCDAPosition Statement onDental
Patientswith Total Joint Replacement states
that “routine antibioticprophylaxis is not
indicated for dental patientswith total joint
replacements, nor for patientswithorthopedic
pins, plates and screws.” Read the full CDA
Position Statement at:
T
owatch an interviewwithDr. DavidPatrick,
associateprofessor in theUniversityof British
Columbia School of Population andPublic
Health, discussinghis researchwhich showed
an increase in antibioticprescribing rates by
dentists inB.C., see:
Prophylactic antibiotics are not indicated in patientswhohave
undergone a routine extraction of impacted teeth, withanartificial joint
andno comorbidity, orwithdental pain prior to (or instead of) a
surgical intervention.
