Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada

Antibiotic Prescribing Knowledge, Awareness, and Attitude of Dental Surgeons Practicing in the Urban Indian Population

BACKGROUND

Studies have reported that dental procedures may serve as a portal of entry for bacteria into the blood circulation, commonly termed as bacteremia which may inhabitate the heart and joints subjected to repair and replacement by prosthesis and may lead to complications in immunocompromised patients. Dental procedure may play a pivotal role in the development of infective endocarditis and infection around the prosthetic joint. Antibiotic use is suggested for all dental procedures requiring gingival manipulation or of the periapical region of teeth or mucosal incision in these patients.

OBJECTIVE

The present study has been conducted to inspect the antibiotic prescribing practices of general dentists among 250 dental practitioners.

METHODS

The study was conducted on 250 dental surgeons practicing in the urban Indian population of various parts of the country. A validated questionnaire was developed by a multidisciplinary dental and medical team and was circulated on the subject of the basic knowledge and awareness about antibiotic prophylaxis in susceptible patients. The data from the participants were collected, collated, and statistically analyzed.

RESULTS

The present study comprised 250 dental surgeons; 178 out of 250 were male, whereas 72 were female. Antibiotic prophylaxis guidelines were followed by 169 practitioners (67.60%), whereas 81 (32.40%) dentists did not follow any guidelines. Out of 169, 67 followed the American Academy of Orthopaedic Surgeons (AAOS) guidelines (39.64%), 58 followed American Heart Association (AHA) guidelines (34.30%), whereas 44 followed general physician's guidelines (26.03%). On screening the underlying conditions for which antibiotic cover was prescribed, it was shown that majority of the dental surgeons did the same for patients with cardiac valve repair or replacement (230; 92%), followed by infective endocarditis (212; 84.80%); organ transplant (212; 84.405); diabetes (189; 75.60%); prosthetic joint replacement (150; 60%); and congenital heart defect (110; 44%).

CONCLUSION

Patients should then be trained to perform meticulous oral hygiene and advised to schedule regular dental checkups to maintain optimal dental health. Dentists should use antibiotic prophylaxis in only conditions associated with a valid scientific basis and should follow the standard protocols recommended by the American Dental Association, AHA, or AAOS.

The 1% of emergency room visits for non-traumatic dental conditions in British Columbia: Misconceptions about the numbers

In Canada, about 1% of all emergency room (ER) visits in a given year are made by patients with a primary diagnosis of a non-traumatic, non-urgent and yet preventable condition, such as tooth decay. This percentage is typically dismissed as irrelevant. Using 2013-2014 British Columbia data on ER use from the Canadian Institute for Health Information, however, we argue that the 1% figure (and its associated cost) has to be considered beyond its percentage value. In 2013-2014 alone, 12 357 non-traumatic dental visits were made to ERs in BC representing 1% of the total number of ER visits at a cost of $154.8 million to the taxpayers (across Canada, all visits to ER cost $1.8 billion/year). But the vast majority of these dental visits are discharged while the oral problem likely persists, hence taxpayer dollars are wasted. The belief that these dental-related ER visits are insignificant within the total cost for the health care system is misleading: treatment is not given, the problem is not resolved, and yet there is a high cost to taxpayers and to the society at large. Public health resources should be reallocated.