Adverse drug reactions in dentistry

Reporting of Adverse Drug Reactions by Dentists and Dental Patients in Albania

BACKGROUND

Procedures on reporting adverse drug reactions (ADRs) in Albania are not yet standardised with the European Union despite continuous legislative changes. The aim of this study was to assess for the first time in Albania the reporting of ADRs by dentists and dental patients and to evaluate the frequency and timing of ADRs.

METHODS

We conducted a questionnaire-based survey for dentists and dental patients in Albania on their knowledge on ADR signalling. Dentists and their patients were randomly reached in private dental clinics. Ninety-five dentists and 640 dental patients from 5 different cities in Albania agreed to participate in the study. Only dentists who were actively working on their dental clinics and who volunteered to participate in the study were considered eligible.

RESULTS

The response rates were 95.0% and 91.4% for dentists and dental patients, respectively. In addition, 7.36% of dentists reported to have been informed on the national ADR signalling through conferences, but when asked about the procedures only 28.6% of them reported to have knowledge on the concrete process. None of the dental patients knew how to report ADRs.

CONCLUSIONS

The findings demonstrate the complete lack of information on ADR signalling in a randomly selected group of 640 dental patients and 95 dentists surveyed. The results of the study are concerning and show that knowledge on ADR signalling should massively increase through public and social media.

Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study

Background: Antibiotics prescribed as infection prophylaxis prior to dental procedures have the potential for serious adverse drug events (ADEs). However, the extent to which guideline concordance and different dental settings are associated with ADEs from antibiotic prophylaxis is unknown. Aim: The purpose was to assess guideline concordance and antibiotic-associated ADEs and whether it differs by VA and non-VA settings. Methods: Retrospective cohort study of antibiotic prophylaxis prescribed to adults with cardiac conditions or prosthetic joints from 2015 to 2017. Multivariable logistic regression models were fit to assess the impact of ADEs, guideline concordance and dental setting. An interaction term of concordance and dental setting evaluated whether the relationship between ADEs and concordance differed by setting. Results: From 2015 to 2017, 61,124 patients with antibiotic prophylaxis were identified with 62 (0.1%) having an ADE. Of those with guideline concordance, 18 (0.09%) had an ADE while 44 (0.1%) of those with a discordant antibiotic had an ADE (unadjusted OR: 0.84, 95% CI: 0.49-1.45). Adjusted analyses showed that guideline concordance was not associated with ADEs (OR: 0.78, 95% CI: 0.25-2.46), and this relationship did not differ by dental setting (Wald χ^2 p-value for interaction = 0.601). Conclusion: Antibiotic-associated ADEs did not differ by setting or guideline concordance.

Dentists' attitudes and prescription practices for analgesics and antibiotics in Kirkuk Governorate, Iraq

The inappropriate use of analgesics and antibiotics is a widespread issue among dentists globally, leading to the risk of over-prescription that could negatively affect patient health and quality of life. This study aimed to assess the prescribing patterns of analgesics and antibiotics by dentists in Kirkuk City, Iraq, focusing on their attitudes, knowledge levels, and practices regarding these medications. A cross-sectional survey was conducted among 280 dentists in Kirkuk City. The dentists were contacted via their work email addresses, and they responded to a survey. Descriptive statistics, including frequency analysis, were employed to evaluate the appropriateness of analgesic and antibiotic prescriptions for different dental conditions. The first-choice analgesic for 44.6% of dentists was mefenamic acid, followed by paracetamol (31.1%). Regarding antibiotic use, 56.8% of dentists in Kirkuk City reported using antibiotics for empirical and direct therapy. Other dentists (43.2%) revealed that they did not have enough information regarding antibiotic group preference in empirical therapy. 106 of the participants (37.85%) recommended the use of broad-spectrum antibiotics in the treatment of bacterial infections. However, most (45%) were unfamiliar with the group preferences in empirical therapy. Dentists in Kirkuk City showed variations in knowledge and awareness regarding using analgesics and antibiotics. This requires further education and training on proper analgesics and antibiotic stewardship guidelines.

Self-reported Knowledge and Practice of Saudi Dental Hygiene Students Towards the use of Chlorhexidine Mouthwash

Aim:

To assess the knowledge and practice of Saudi dental hygiene students regarding the use of mouthwashes in clinical practice.

Background:

Mouthwashes are chemical plaque control agents which are widely used for the prevention of tooth decay, gaining fresh breath, reducing plaque and calculus formation, and reducing gingival inflammation. Chlorhexidine is considered a gold standard mouthwash because of its substantivity action. Thus, it is very important for dental practitioners to understand the knowledge and practices regarding the use of Chlorhexidine mouthwash

Objective:

The primary objective of this study was to find dental hygiene students’ knowledge about chlorhexidine mouthwash and its side effects and also identify their practice toward the use of mouthwashes as plaque inhibiting agents.

Methods:

An online version of a pre-tested and validated questionnaire was used to test the knowledge and practices towards the use of Chlorhexidine mouthwash. Thus, A Cross-sectional questionnaire survey was carried out in Saudi Arabia on dental hygiene students.

Results:

A total of 144 filled questionnaires were obtained out of which 88% were male and 12% were female. After converting the scores into percentages, any score <60% was categorized as a poor score, 60-80% as an average score, and >80% as a good score. Dental hygiene students showed an average knowledge about Chlorhexidine mouthwash with a score of 62.27% and also poor practice with a score of 57.98%.

Conclusion:

The findings of this cross-sectional study demonstrate that most of the Dental hygiene students in Saudi Arabia have got average knowledge and poor practice about the usage of Chlorhexidine mouthwash.

Clinical Significance:

Being the oral health care providers, it is mandatory for dental hygiene students to have adequate knowledge regarding the usage of mouthwashes. With optimum knowledge, they will be able to deliver the right information to the patients thereby ensuring the proper practice of the same.

Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects

Objectives

The aim of this work was to review the current uses of chlorhexidine (CHX) in dentistry based on its mechanism of action, whilst highlighting the most effective protocols that render the highest clinical efficacy whilst limiting adverse drug reactions.

Methods

A literature search was conducted using the key words chlorhexidine, mechanism of action, adverse effects, and dentistry using databases in the University of Toronto library system. The titles and abstracts were read, and relevant articles were selected.

Results

A total of 1100 publications were identified, 100 were investigated, and 67 of them were used. Out of the 67 selected articles, 12 were reviews on CHX; 5 articles focussed on CHX gels; 13 focussed on CHX mouthwashes; 8 focussed on CHX products; 13 discussed adverse effects associated with CHX; 13 focussed on periodontal pathology and treatment; 6 focussed on implant periodontal and dental surgeries; 7 evaluated effects on caries; 6 looked at the mechanisms of action; and 12 focussed on the antibacterial and antimicrobial impact on the oral biome. There were multiple areas of overlap amongst the articles, and results showed that CHX provides different uses, but mainly as an adjunct to various treatments. Mouthwash was the most superior medium when used in short time spans when mechanical prophylaxis was not possible for the prevention of gingivitis and maintenance of oral hygiene. CHX products are often used in periodontics, post–oral surgical procedures, and as a prophylaxis for multiple invasive procedures with minimal adverse effects. Tooth staining was the most negative adverse effect reported by patients.

Conclusions

CHX's antimicrobial properties make it an ideal prophylactic when mechanical debridement is not possible. CHX mouthwash appears to be more effective compared to gels. Concentrations of 0.12% to 0.2% are recommended; any mouthwash with concentrations above 0.2% will unnecessarily increase the unwanted side effects. CHX is useful amongst various areas of dentistry including oral surgery, periodontics, and even general dentistry. For long-term treatments, especially in periodontitis patients (stage I-III) undergoing nonsurgical treatments, CHX chips are recommended. CHX chips are also recommended as an adjunct to implant debridement in patients with peri-implant mucositis and peri-implantitis over CHX mouthwash and gels.