Combating antibiotic resistance

Factors influencing intraoperative and postoperative complication occurrence: A series of 1135 periodontal and implant-related surgeries

OBJECTIVES

In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator-, procedure-, patient-, and site-associated factors on intraoperative and postoperative complication occurrence.

MATERIAL AND METHODS

A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates. In addition, the severity of each postoperative complication was assessed using a standardized grading system.

RESULTS

A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6, 6.1; p < .001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p = .004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p = .011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p < .001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p = .008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p = .005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p = .039) were associated with higher odds of intraoperative complication occurrence.

CONCLUSIONS

Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk-benefit assessments will become progressively meaningful for patients.

Waking Up to Antibiotic Resistance

Background

Antimicrobial resistance (AMR) has emerged as a global concern, particularly in developing countries where its causes seem to entrench the knowledge, attitude, and practice of healthcare professionals and patients toward the use of antimicrobials.

Methods

This review aims to provide a compendious yet thorough overview of our understanding of antibiotic resistance pertaining to dentistry. Literature provides evidence of inadequate antibiotic prescribing practices by dental professionals. Considering the growing concern about antibiotic prescribing habits and patient's tendencies of improper use, we attempt to address the interventional efforts of dentists and patients in the context to focus on the root causes specifically to prevention of the antimicrobial resistance.

Results

Following the guidelines and flowchart depicted in this article, the members of dental professions will get clear views on the use of antibiotics. This will cause a definite decrease in the growing concern about antibiotic resistance.

Antibiotic Prophylaxis for Prosthetic Joint Patients Undergoing Invasive Dental Procedures: Time for a Rethink?

BACKGROUND

In the United States, it has been common practice to recommend that dentists provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent late periprosthetic joint infections (LPJIs) in patients who have prosthetic arthroplasties despite lack of evidence for a causal relationship between IDP and LPJI and a lack of evidence for AP efficacy.

METHODS

A recent study quantified the IDP incidence over the 15-month period prior to LPJI hospital admissions in the United Kingdom for which dental records were available. A case-crossover analysis compared IDP incidence in the 3 months before LPJI admission with the preceding 12 months. The English population was used because guidelines do not recommend AP and any relationship between IDPs and LPJI should be fully exposed.

RESULTS

No significant positive association was identified between IDPs and LPJI. Indeed, the incidence of IDPs was lower in the 3 months before LPJI hospital admission than that in the preceding 12 months.

CONCLUSION

In the absence of a significant positive association between IDPs and LPJI, there is no rationale to administer AP before IDPs in patients with prosthetic joints, particularly given the cost and inconvenience of AP, the risk of adverse drug reactions, and the potential for unnecessary AP use that promotes antibiotic resistance. These results should reassure orthopedic surgeons and their patients that dental care of patients who have prosthetic joints should focus on maintaining good oral hygiene rather than on recommending AP for IDPs. Moreover, it should also reassure those in other countries where AP is not recommended that such guidance is sufficient.

Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England

Importance

Dentists in the United States are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades, despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of antibiotic prophylaxis efficacy, cost of providing antibiotic prophylaxis, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance.

Objective

To quantify any temporal association between IDP and subsequent LPJI.

Design, Setting, and Participants

This cohort study used a case-crossover and time trend design to examine any potential association between IDP and LPJI. The population of England (55 million) was chosen because antibiotic prophylaxis has never been recommended to prevent LPJI in England, and any association between IDP and LPJI would therefore be fully exposed. All patients admitted to hospitals in England for LPJI from December 25, 2011, through March 31, 2017, and for whom dental records were available were included. Analyses were performed between May 2018 and June 2021.

Exposures

Exposure to IDP.

Main Outcomes and Measures

The main outcome was the incidence of IDP in the 3 months before LPJI hospital admission (case period) compared with the incidence in the 12 months before that (control period).

Results

A total of 9427 LPJI hospital admissions with dental records (mean [SD] patient age, 67.8 [13.1] years) were identified, including 4897 (52.0%) men and 4529 (48.0%) women. Of these, 2385 (25.3%) had hip prosthetic joints, 3168 (33.6%) had knee prosthetic joints, 259 (2.8%) had other prosthetic joints, and 3615 (38.4%) had unknown prosthetic joint types. There was no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the 3 months prior to LPJI (incidence rate ratio, 0.89; 95% CI, 0.82-0.96; P = .002).

Conclusions and Relevance

These findings suggest that there is no rationale to administer antibiotic prophylaxis before IDP in patients with prosthetic joints.

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints

AIMS

With the increasing number of patients with prosthetic joints, recommendations for antibiotic prophylaxis (AP) prior to dental procedures to prevent prosthetic joint infections (PJI) have changed.

METHODS AND RESULTS

This survey evaluated dentists' AP practices for patients with prosthetic joints undergoing dental procedures and their familiarity with the American Dental Association Guidelines (ADA CPG) and American Academy of Orthopaedic Surgeons Appropriate Use Criteria (AAOS AUC). Dentists' attitudes about antibiotic resistance, medical-legal aspects, and adverse effects to using AP were examined. Dentists (n = 574) were familiar (51.2%) with ADA CPG and with the AAOS AUC (25.8%). Familiarity varied according to years since graduation. Female dentists (63.5%) were more likely to be very familiar with the ADA CPG than male dentists (49.5%). Overall, 65.4% of respondents believed that AP is not effective in the prevention of PJI, and 19.4% believed there is enough evidence to support AP. For a healthy patient, 28.9% of dentists would never recommend AP, 44.9% would recommend AP within the first two years since prosthetic joint replacement.

CONCLUSIONS

Dentists' recommendations for the use of AP varied depending on different factors, including health status of the patient, dental procedure, time elapsed since joint surgery, suggesting that adherence to the ADA CPG and AUC is still challenging.

Analysis of essential gene dynamics under antibiotic stress in Streptococcus sanguinis

The paradoxical response of Streptococcus sanguinis to drugs prescribed for dental and clinical practices has complicated treatment guidelines and raised the need for further investigation. We conducted a high throughput study on concomitant transcriptome and proteome dynamics in a time course to assess S. sanguinis behaviour under a sub-inhibitory concentration of ampicillin. Temporal changes at the transcriptome and proteome level were monitored to cover essential genes and proteins over a physiological map of intricate pathways. Our findings revealed that translation was the functional category in S. sanguinis that was most enriched in essential proteins. Moreover, essential proteins in this category demonstrated the greatest conservation across 2774 bacterial proteomes, in comparison to other essential functional categories like cell wall biosynthesis and energy production. In comparison to non-essential proteins, essential proteins were less likely to contain ‘degradation-prone’ amino acids at their N-terminal position, suggesting a longer half-life. Despite the ampicillin-induced stress, the transcriptional up-regulation of amino acid-tRNA synthetases and proteomic elevation of amino acid biosynthesis enzymes favoured the enriched components of essential proteins revealing ‘proteomic signatures’ that can be used to bridge the genotype–phenotype gap of S. sanguinis under ampicillin stress. Furthermore, we identified a significant correlation between the levels of mRNA and protein for essential genes and detected essential protein-enriched pathways differentially regulated through a persistent stress response pattern at late time points. We propose that the current findings will help characterize a bacterial model to study the dynamics of essential genes and proteins under clinically relevant stress conditions.

Antibiotic Prescriptions Associated With Dental-Related Emergency Department Visits

STUDY OBJECTIVE

The frequency of antibiotic prescribing and types of antibiotics prescribed for dental conditions presenting to the emergency department (ED) is not well known. The objective of this study is to quantify how often and which dental diagnoses made in the ED resulted in an antibiotic prescription.

METHODS

From 2011 to 2015, there were an estimated 2.2 million (95% confidence interval [CI] 1.9 to 2.5 million) ED visits per year for dental-related conditions, which accounted for 1.6% (95% CI 1.5% to 1.7%) of ED visits. This is based on an unweighted 2,125 observations from the National Hospital Ambulatory Medical Care Survey in which a dental-related diagnosis was made.

RESULTS

An antibiotic, most often a narrow-spectrum penicillin or clindamycin, was prescribed in 65% (95% CI 61% to 68%) of ED visits with any dental diagnosis. The most common dental diagnoses for all ages were unspecified disorder of the teeth and supporting structures (44%; 95% CI 41% to 48%; International Classification of Diseases, Ninth Revision, Clinical Modification[ICD-9-CM] code 525.9), periapical abscess without sinus (21%; 95% CI 18% to 25%; ICD-9-CM code 522.5), and dental caries (18%; 95% CI 15% to 22%; ICD-9-CM code 521.0). Recommended treatments for these conditions are usually dental procedures rather than antibiotics.

CONCLUSION

The common use of antibiotics for dental conditions in the ED may indicate the need for greater access to both preventive and urgent care from dentists and other related specialists as well as the need for clearer clinical guidance and provider education related to oral infections.

Part 1. Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016

BACKGROUND

Literature has shown dentists tend to overprescribe antibiotics and do not always prescribe in accordance with recommended guidelines. Unnecessary prescribing is one major factor that contributes to the development of antibiotic resistance. The aim of the present study was to assess the antibacterial prescribing patterns of dentists in Australia from 2013 to 2016.

METHODS

Data on dental antibacterial prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) from 2013 to 2016 was accessed and prescribing trends analysed. The prescribing rates were standardized to the dose and population.

RESULTS

There was a slight decrease in the dispensed use of most antibacterials from 2013 to 2016, but there was a significant increase in the dispensed use of amoxicillin/clavulanic acid of 11.2%. Amoxicillin was the most commonly dispensed antibiotic, accounting for approximately 65% of all antibacterials from 2013 to 2016, while phenoxymethylpenicillin accounted for only 1.4% of prescriptions in 2016. There were low but significant quantities of dispensed antibiotic prescriptions that do not fit with current guidelines.

CONCLUSIONS

The data suggest that dentists in Australia are prescribing some antibiotics inappropriately and there is a preference for moderate- to broad-spectrum agents. The current PBS dental schedule is inconsistent with prescribing guidelines and may contribute to inappropriate prescribing.

Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States

BACKGROUND

The purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States.

METHODS

We used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription.

RESULTS

Overall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P = .001).

CONCLUSIONS

Overall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time.

PRACTICAL IMPLICATIONS

From these authors' definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists.

Antibiotic and Analgesic Prescription Patterns among Dentists or Management of Dental Pain and Infection during Endodontic Treatment

OBJECTIVE

The aim of this study was to determine prescription patterns of antibiotics and analgesics among dentists in the management of dental pain and infection for medically healthy patients undergoing endodontic management.

MATERIALS AND METHODS

This descriptive cross-sectional survey was based on a structured questionnaire. The questionnaire collected data on age, gender, years of experience, and the qualifications of dentists. Feedback on prescription patterns for antibiotics and analgesics was collected for a number of clinical scenarios. Participants' choices regarding the type, dose, and duration of antibiotics/analgesics were recorded. Completed questionnaires were analyzed using the Statistical Package for Social Sciences (SPSS; version 24) to determine relationships between prescription patterns, age, gender, and educational qualification.

RESULTS

Of the 227 participants surveyed, 190 (83.7%) did not prescribe antibiotics for patients complaining of severe pain. There were significant associations between age and years of experience and antibiotic prescription for pain management (p = 0.035 and 0.04, respectively). Of the participants, 199 (87.7%) never prescribed antibiotics for reversible pulpitis with normal periapical area; there was a statistical significance in relation to gender (p = 0.044). Amoxicillin 500 mg was prescribed most of the time (51.5%). Diclofenac K (50 mg) was prescribed by 41% of the participants, while 39.2% of the participants very often prescribed ibuprofen (600 mg).

CONCLUSION

Most dentists prescribed analgesics and antibiotics as recommended, but more education on the proper use of these medicines is needed for dentists and patients.

Patterns of drugs prescribed for dental outpatients in Nigeria: findings and implications

OBJECTIVES

There are concerns with inappropriate prescribing of medicines among dentists especially antimicrobials. It is more concerning if this increases resistance rates. This study aimed to address this by assessing patterns of drugs prescribed for outpatients attending a hospital dental clinic in Nigeria. The findings will be used to plan future interventions, particularly around antimicrobial prescribing, where there are concerns.

METHODS AND MATERIALS

Medical records of patients attending the dental clinic of a leading teaching hospital in Nigeria were evaluated. Patients referred for admission, without a prescription, or prescribed medicines without a documented diagnosis were excluded.

RESULTS

Overall, 607 prescriptions were analysed, 314 (51.7%) were for females. Periodontal and gum diseases (414; 68.1%) were the most frequent diagnoses, followed by pulpitis (49; 8.2%), and dentoalveolar abscess (43; 7.1%). A total of 1798 medicines were prescribed for all patients with a mean of 3.0 ± 0.48 medicines per prescription. Antimicrobials (1178; 65.5%) and analgesics (620; 34.5%) were the two drug classes prescribed. Ascorbic acid and vitamin B complex were prescribed for 361 (59.5%) patients. Among antimicrobials, amoxicillin (564; 95.1%) either alone or combined with clavulanic acid was the most frequently prescribed, followed by metronidazole (561; 94.6%). Brand name prescribing was also appreciably higher than WHO recommendations.

CONCLUSION

Polypharmacy, brand name prescriptions, and the frequent prescription of antimicrobials were common practices at the dental clinic of this teaching hospital in Nigeria. We suggest a review of the current standard treatment guidelines in Nigeria to guide dentists on current knowledge- and evidence-based treatment of common oral diseases.

Antibiotic prescribing by general dentists in the United States, 2013

BACKGROUND

Dentists prescribe approximately 10% of outpatient antibiotics, but little is known about dentists' antibiotic prescribing patterns. The authors conducted a study to characterize prescribing by dentists according to antibiotic agent and category, patient demographic characteristics, and geographic region in the United States.

METHODS

The authors identified oral antibiotic prescriptions dispensed during 2013 in the Xponent (QuintilesIMS) database. The authors used the total number of prescriptions and county-level census population denominators to calculate prescribing rates. In addition, the authors analyzed prescribing according to individual agent, drug category, and patient demographic characteristics and the total number of prescriptions calculated for general dentists overall.

RESULTS

Dentists prescribed 24.5 million courses of antibiotics in 2013, a prescribing rate of 77.5 prescriptions per 1,000 people. Penicillins were the most commonly prescribed antibiotic category. Dentists prescribed most antibiotics for adults older than 19 years. The Northeast census region had the highest prescribing rate per 1,000 people. The District of Columbia had the highest prescribing rate of 99.5 per 1,000 people, and Delaware had the lowest prescribing rate of 50.7 per 1,000 people.

CONCLUSIONS

Dentists prescribe large quantities of antibiotics in outpatient settings, and there is considerable geographic variability. Additional study is needed to better understand the reasons for this variability and identify areas of possible intervention and improvement.

PRACTICAL IMPLICATIONS

Continued efforts to combat antibiotic resistance will require all prescribers, including dentists, to examine prescribing behaviors for appropriateness and the effectiveness of guidelines to identify opportunities to optimize antibiotic use.

Activity of the Lichen Usnea steineri and its Major Metabolites against Gram–positive, Multidrug–resistant Bacteria

The antimicrobial activity and possible synergistic effects of extracts and compounds isolated from Usnea steineri were evaluated against four resistant bacterial species. A phytochemical study of the acetone extract of U. steineri resulted in the isolation and characterization of difractaic acid and (+)–usnic acid as the main compounds. The acetone extract showed strong activity (less than 10 μg/mL) against resistant strains of Staphylococcus epidermidis and Enterococcus faecalis, and (+)–usnic acid exhibited strong activity against S. epidermidis (MIC 3.12 μg/mL), S. aureus and S. haemolyticus (MIC 12.5 μg/mL). Combinations of penicillin and tetracycline with (+)–usnic acid did not show any synergistic antimicrobial effects. Difractaic acid was inactive. Our results showed that the acetone extract of U. steineri possesses significant in vitro antimicrobial activity, which is likely related to the presence of (+)–usnic acid.

Bacterial membranes are the target for antimicrobial polysiloxane-methacrylate copolymer

Antibacterial polysiloxane polymers with pending tert-butylamine groups are a novel class of compounds that are compatible with silicone elastomers, but their mechanism of action is not well understood. The research into their action mechanism was conducted on a polysiloxane copolymer grafted with tert-butylaminoethyl methacrylate and covalently attached fluorescein. Fluorometric measurements results suggest that the polymer forms a stable link with bacteria. The results of β-galactosidase enzyme assay with the use of ortho-nitrophenyl-β-galactoside as a substrate show that the polymer has a damaging effect on bacterial membranes. The scanning and transmission electron micrographs of Escherichia coli cells incubated with the polymer prove further that the polymer's site of action is bacterial cell membranes. In order to investigate the polymer interaction with bacterial membranes the fluorescein labelled polymer was incubated with bacterial cells and membranes isolation and identification method was next applied. The E. coli membrane fractions were identified by light scattering, protein content, oxidase NADH activity and N-phenylnaphtylamine fluorescence measurements, as well as electron microscopy. Oxidase NADH and N-phenylnaphtylamine were the inner membrane markers. The bacterial membranes were then tested for the presence of the polymer. The experiments gave evidence that the copolymer binds to the inner bacterial membrane. Further studies, where the copolymer was incubated with isolated mixed (inner and outer) membrane fractions, proved that the copolymer exerts more destructive effect on E. coli outer membrane. The damaging effect on the membranes is concentration dependent.

Isolation and Antimicrobial Resistance ofStaphylococcus aureusIsolates in a Dental Clinic Environment

Objective.

To determine the number ofStaphylococcus aureusisolates collected in a dental clinical environment and to determine their susceptibility to antimicrobial agents commonly used in dentistry.

Setting.

Undergraduate clinic of the Dental School of Piracicaba, University of Campinas, Brazil.

Methods.

Sterile cotton swabs were used to collect the samples from dental-chair push buttons, light handles, 3-in-l syringes, computer “Enter” keys, doorknobs, and X-ray tubes before, during, and after clinical procedures. These samples were spread on brain-heart infusion agar and were incubated at 37°C for 24 hours. The resultingS. aureusisolates were counted and classified using Gram staining and biochemical tests. The counts among the 3 periods and the groups were analyzed by Kruskal-Wallis and Dunn tests (α= 5%). Commercial paper disks containing widely prescribed antimicrobial agents (β-lactams, macrolides, clindamycin, and vancomycin) were used to perform the antimicrobial susceptibility tests.

Results.

An increase in the number of microorganisms was observed during clinical procedures (P< .05). The highest bacterial resistance rates were observed for theβ-lactam group. All isolated strains were sensitive to vancomycin, and 2% of them were resistant to methicillin.

Conclusions.

Clinical procedures increased the number and proportion of antimicrobial-resistantS. aureusisolates dispersed in a dental clinical environment. The present study highlights the need to establish strategies to prevent emergence of drug-resistant bacterial strains in dental settings.

Avaliação do conhecimento de Cirurgiões-Dentistas e acadêmicos de Odontologia na cidade de Aracaju, Sergipe, a respeito da adequada prescrição de antimicrobianos

INTRODUÇÃO: Os antimicrobianos são caracterizados como um dos mais notáveis exemplos do avanço da Medicina moderna. Contudo, a adaptabilidade dos microrganismos propicia resistência a determinados antimicrobianos.OBJETIVO: Apresentar, por meio de pesquisa realizada com alunos do curso de Odontologia e Cirurgiões-Dentistas na cidade de Aracaju-SE, um perfil do conhecimento destes sobre antibioticoterapia, propondo oferecer uma oportunidade de identificar e reconhecer os riscos relacionados à administração incorreta destes fármacos.MATERIAL E MÉTODO: Investigação observacional, transversal, com base em um questionário respondido por 80 alunos do curso de Odontologia e 50 Cirurgiões-Dentistas, escolhidos de forma aleatória, para verificar o conhecimento sobre o tema proposto.RESULTADO: Dentre os entrevistados, aproximadamente 40% eram profissionais e 60% acadêmicos de Odontologia; destes, cerca de 40% relataram que prescrevem utilizando como critério de seleção que o antimicrobiano seja seletivo e bactericida, enquanto que 90% dos entrevistados afirmam prescrever antibiótico somente quando necessário, como forma de evitar a resistência bacteriana.CONCLUSÃO: De acordo com a metodologia empregada, pode-se concluir que os dois grupos mostraram desconhecimento sobre a diferença entre antibioticoterapia, profilaxia antimicrobiana e terapêutica medicamentosa.

Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery

OBJECTIVE

To assess the effect of Symphytum 5CH on the postoperative pain and swelling after placement of a titanium dental implant.

MATERIAL AND METHODS

Data on pain and swelling following pure titanium implants were reviewed. Patients were treated postoperatively with ketoprofen only or ketoprofen and Symphytum 5CH, according to the treating dentist's usual practice. Demographics and baseline characteristics were recorded and compared. Pain and swelling were compared between the two treatment groups using the Wilcoxon rank sum test and ordinal logistic regression, estimating odds ratios and confidence intervals.

RESULTS

100 implants in 57 patients (28 males, 29 females) were treated with ketoprofen alone; 100 implants in 60 patients (14 males, 46 females) with ketoprofen and Symphytum. The group treated with ketoprofen and Symphytum appeared to have a better response in terms of both pain and swelling. Ordinal logistic regression: pain 0.23, 95% CI 0.13-0.41; swelling 0.24, 95% CI 0.13-0.44. Correction for demographics and implant characteristics greatly widened the confidence intervals so that the results were no longer statistically significant (pain: OR = 0.15, 95% CI 0.07-34.56; swelling OR = 0.18, 95% CI 0.07-46.78).

CONCLUSIONS

Adding Symphytum 5CH to conventional analgesia may reduce pain and swelling after minor dental implant surgery. No firm conclusion can be drawn since the results are confounded by baseline differences, principally gender. Further, randomized, studies should be conducted.

Analysis of clinical records of dental patients attending Jordan University Hospital: Documentation of drug prescriptions and local anesthetic injections

OBJECTIVES

THE AIM OF THIS STUDY WAS TO ANALYZE CLINICAL RECORDS OF DENTAL PATIENTS ATTENDING THE DENTAL DEPARTMENT AT THE UNIVERSITY OF JORDAN HOSPITAL: a teaching hospital in Jordan. Analysis aimed at determining whether dental specialists properly documented the drug prescriptions and local anesthetic injections given to their patients.

METHODS

Dental records of the Dental Department at the Jordan University Hospital were reviewed during the period from April 3rd until April 26th 2007 along with the issued prescriptions during that period.

RESULTS

A total of 1000 records were reviewed with a total of 53 prescriptions issued during that period. Thirty records documented the prescription by stating the category of the prescribed drug. Only 13 records stated the generic or the trade names of the prescribed drugs. Of these, 5 records contained the full elements of a prescription. As for local anesthetic injections, the term "LA used" was found in 22 records while the names and quantities of the local anesthetics used were documented in only 13 records. Only 5 records documented the full elements of a local anesthetic injection.

CONCLUSION

The essential data of drug prescriptions and local anesthetic injections were poorly documented by the investigated group of dental specialists. It is recommended that the administration of the hospital and the dental department implement clear and firm guidelines for dental practitioners in particular to do the required documentation procedure.

Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials

PURPOSE

We conducted a synthetic quantitative review of the published clinical trials on the effectiveness of antibiotic prophylaxis in third molar surgery.

MATERIALS AND METHODS

Electronic databases were searched for randomized controlled trials. The primary outcome variables included alveolar osteitis (AO) and surgical wound infection. The extracted data were analyzed using a meta-analytical program with a random-effect model. Number needed to treat (NnT) was calculated.

RESULTS

A total of 2,932 patients randomized in 16 clinical trials reported AO as an outcome. AO occurred in 84 of 1,350 patients in the treatment group, a frequency of 6.2%; and in 228 of 1,582 patients in the control group, a frequency of 14.4%. Systemic antibiotic therapy was effective in reducing the risk of AO (odds ratio [OR], 2.175) with an NnT of 13. A total of 2,396 patients randomized in 12 clinical trials reported wound infection as an outcome. Wound infection occurred in 44 of 1,110 patients in the treatment group, a frequency of 4%; and in 78 of 1,286 patients in the control group, a frequency of 6.1%. Systemic antibiotic therapy was effective in reducing the risk of wound infection (OR, 1.794) with an NnT of 25. Antibiotics reduced the risk of AO and wound infection only when first dose was given before surgery.

CONCLUSIONS

Systemic antibiotics given before the surgery were effective in reducing the frequencies of AO and wound infection after third molar surgery.

Incidence of antibiotic prescribing in dental practice in Norway and its contribution to national consumption

OBJECTIVES

To assess dentistry-based utilization of the 11 antibiotics prescribed by dentists in Norway and its relative contribution to national outpatient consumption and to determine the relationship between numbers of prescriptions and the consumption of these antibiotics.

METHODS

Data on national antibiotic prescriptions by dentists in 2004 and 2005 were used. Consumption of the antibiotics was expressed using WHO defined daily doses (DDDs), DDDs per 1000 inhabitants per day (DIDs) and numbers of prescriptions per 1000 inhabitants (PIDs).

RESULTS

Analysis of 268,834 prescriptions issued by 4765 dentists showed that the dentists' prescriptions contributed 8% of the total national consumption of the 11 antibiotics and 13.5%, 2.8% and 1.2% of the national beta-lactam penicillins, macrolides and lincosamides and tetracyclines utilization, respectively. The dentists' contributions to the national phenoxymethylpenicillin, spiramycin and metronidazole consumptions were considerably higher (> or =13.2%) than for the other prescribed antibiotics (< or =8.6%). There was a strong positive correlation between numbers of DDDs and numbers of prescriptions and between DIDs and numbers of PIDs.

CONCLUSIONS

Reliance of Norwegian dentists on phenoxymethylpenicillin as their first choice suggests a low prevalence of antibiotic resistance among oral bacteria in Norway. Norwegian dentists prefer to prescribe narrow-spectrum antibiotics; their prescribing is conservative and relatively low compared with that of physicians.

Dentistry and endocarditis

Bacterial endocarditis (BE), a rare heart infection caused by a bacteremia, has frequently been blamed on but rarely caused by dental procedures. Viridans group streptococci are found abundantly in the mouth and the gingival sulcus but have been surpassed by staphylococci as the leading cause of BE. Antibiotic prophylaxis has been recommended before dental procedures in patients at risk for BE, but it remains controversial because studies have failed to show that antibiotic prophylaxis is an effective preventive for BE or that dental procedures are an important cause of BE. The risks and costs of antibiotic prophylaxis, including antibiotic resistance, cross-reactions with other drugs, allergy, anaphylaxis, and even death, may exceed the benefits in preventing BE. The rationale for the use of antibiotic prophylaxis to prevent BE allegedly caused by dental procedure bacteremias must be seriously reexamined based on recent evidence, particularly the absolute risk rates for endocarditis after a given dental procedure.