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

Trends and patterns of antibiotic using from 2014 to 2018 in stomatology hospitals of China

OBJECTIVE

To analyze trends of antibiotic consumption and expenditure in Chinese stomatology hospitals between 2014 and 2018 with a longitudinal study design, and show the impacts of the comprehensive policy on dental antibiotic use in China.

SUBJECT AND METHODS

Consumption was quantified as the number of daily defined doses (DDDs) and expenditure as the procurement costs, using medical institutions' drug procurement data from the Chinese Monitoring Network for Rational Use of Drugs. Descriptive statistics was employed and the compound annual growth rate (CAGR) was calculated to show the average annual growth rate.

RESULTS

Between 2014 and 2018, overall antibiotic consumption increased from 842.6 thousand DDDs to 1376.7 thousand DDDs (p < 0.001) and expenditure increased from 11.6 million RMB to 20.9 million RMB (p < 0.001), where other β-lactam antibacterials accounted for the largest proportion of total consumption (37.1%-50.1%) and expenditure (52.9%-66.6%), and also increase the largest (CAGR = 18.4%, p < 0.001). The proportion of oral antibiotics was nearly 9 times of parenteral antibiotics in consumption (CAGR = 0.3%, p = 0.023) and only 2 times in expenditure (CAGR = -1.7%, p = 0.112). The non-restricted group accounted for more than 90% of consumption (CAGR = 0.6%, p < 0.001). In 2018, oral first-generation cephalosporins (22.8%), oral imidazole derivatives (22.3%), and oral second-generation cephalosporins (19.2%) were the most frequently used antibiotic classification, while parenteral second-generation cephalosporins were top one (19.8%) for expenditure. At chemical substance levels, the consumption of oral cefradine ranked top one (21.4%) and parenteral cefuroxime accounted for the largest proportion of expenditure (14.5%) in 2018. Oral cefradine, oral metronidazole, and oral cefaclor were the top three frequently consumed antibiotics throughout the five years.

CONCLUSIONS

Despite the potential antibiotic overuse, the comprehensive antibiotic stewardship regulations of China got a satisfactory and better performance in dental practices. More effort is needed to establish more explicit guidelines to improve antibiotic stewardship, such as priority recommending amoxicillin and its derivatives for endodontic infections.

Utilization of Teledentistry in Antimicrobial Prescribing and Diagnosis of Infectious Diseases during COVID-19 Lockdown

OBJECTIVES

 This study aimed to analyze Jordanian dentists' inquiries on oral infections and antimicrobial prescribing using dental professional WhatsApp groups during coronavirus disease lockdown period.

MATERIALS AND METHODS

 Three professional WhatsApp groups of Jordanian dentists were reviewed and analyzed for inquiries posted during the period from January to May 2020. Inquiries were sent from patients to their dentists who posted these inquiries to the professional WhatsApp dental groups for consultation and professional advice. All queries regarding oral infections and antimicrobial prescribing were extracted and analyzed.

RESULTS

 Three WhatsApp professional groups with a total numbers of members of 750 dentists who posted queries about their patients were included in this study. Dentist members posted queries about their patients to these professional WhatsApp groups. There was a total of 32 inquiries regarding oral lesions and 11 consultations regarding prescribing and dental management of medically compromised patients giving a total of 43 consultations. Among which there were 19 inquiries on oral infections and 9 inquiries on antimicrobial prescribing giving a total of 28 consultations. Most common inquiries were on bacterial infections (localized dentoalveolar abscess, pericoronitis, cellulitis, and lymphoid hyperplasia of the tongue), viral herpetic infections, and Candida infections (erythematous and pseudomembranous candidiasis).

CONCLUSIONS

Many dental practitioners cannot distinguish the correct diagnostic features of oral infections particularly viral and fungal infections. Continuing education should be considered to focus on clinical manifestations of various oral infections. Further, educational activities that focus on variations in treatment protocols for various infections should be introduced particularly those that concern indications for antimicrobial prescribing.

Prescription of antibiotics after tooth extraction in adults: a nationwide study in Korea

Objectives

This study aimed to understand the nationwide patterns of antibiotic prescription after tooth extraction in adult patients.

Materials and Methods

This study analyzed dental records from the National Health Insurance Service–National Sample Cohort (NHIS–NSC) database on 503,725 tooth extractions performed in adults (≥19 years) during 2011–2015. Patient sex, age, household income, systemic disease (diabetes mellitus and hypertension), type of dental institution, region of dental institution, year of prescription, and type of tooth extraction procedure were considered. The antibiotic prescription rate and broad-spectrum antibiotic prescription frequency were analyzed using chi-squared tests. Factors affecting the prescription of broad-spectrum antibiotics were evaluated using multivariate logistic regression analysis.

Results

The rate of antibiotic prescription after tooth extraction was 81.85%. Penicillin was most commonly prescribed (45.25%), followed by penicillin with beta-lactamase inhibitors (18.76%), metronidazole (12.29%), and second- to fourth-generation cephalosporins (11.52%). The proportion of broad-spectrum antibiotics used among all prescribed antibiotics was 45.88%.

Conclusion

The findings of this study demonstrate that the rate of antibiotic prescription after tooth extraction is higher in Korea than in other countries. Furthermore, broad-spectrum antibiotics are used more frequently, which may indicate unnecessary drug prescription, an important contributor to antibiotic resistance.

Reduced antibiotic prescription rates following physician-targeted interventions in a dental practice

BACKGROUND

The prescription rate for antibiotics in dental clinics is not declining despite the increase in the antibiotic resistance problem. In this study, we observed the change in antibiotic prescription rates by dentists in a Korean dental hospital for various treatments after conducting interventions targeting dentists.

METHODS

The first intervention was to distribute guidelines. The second intervention was to remove the bundled prescription button containing antibiotics from the Electronic Medical Record system. A total of 22,098 treatment records were divided into 12 main treatment categories, and Chi-square tests and logistic regression analyses were performed.

RESULTS

After the interventions were applied, the overall prescription rate for antibiotics dropped. The antibiotic prescription rate decreased by an odds ratio of 0.774 (95% CI: 0.686-0.873) after intervention 1 and by an odds ratio of 0.574 (95% CI: 0.501-0.658) after intervention 2. The treatments with significantly reduced antibiotic prescription rates were extraction for orthodontic treatment, dental implant surgery, extraction of an impacted tooth and general extraction. These treatments are typically performed in patients without an active infection. The prescription rate did not change for periodontal treatments or endodontic treatments, which are usually performed in patients with an infection. The prescription rate also remained constant for minor operations and other basic treatments.

CONCLUSION

The interventions induced behavioural changes in the dentists and were effective in lowering the antibiotic prescription rates in a dental hospital. In particular, there was a significant reduction in the prescription rates for implant surgery and tooth extraction in the absence of infection.

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.

Trends in antibiotic prescribing by dental practitioners in Germany

PURPOSE

To analyze the structure of antibiotic prescriptions by dentists in Germany during a time-period of four years in relation to medical antibiotic prescriptions.

MATERIALS AND METHODS

We collected nationwide data from all statutory health insurances on dental prescriptions of systemic antibiotics from 2012 to 2015. The annual reports of the "Research Institute for Local Health Care Systems" (WIdO, Berlin) provided the basis for this longitudinal data base analysis. The types of antibiotics, the number of prescriptions and the prescribed 'defined daily doses' (DDD) were analyzed. The results were compared to antibiotic prescriptions of German physicians.

RESULTS

An average of 8.8% per year of all antibiotic prescriptions is issued by dentists. The mostly prescribed antibiotic is amoxicillin. The share of amoxicillin on all dental prescriptions increased from 35.6% in 2012 to 45.8% in 2015 (p < 0.01). About three-quarters of all dentally prescribed DDD can be attributed to amoxicillin and clindamycin. On the part of the physicians the proportion of clindamycin is 18 fold lower than in the dental field.

CONCLUSIONS

Dental and medical antibiotic prescriptions in Germany show statistically significant differences regarding the shares of the prescribed antibiotics. In an international comparison the high proportion of Clindamycin in Germany is noticeable.

Antifungal prescribing pattern and attitude towards the treatment of oral candidiasis among dentists in Jordan

AIM

The aim of this study was to evaluate the attitude of Jordanian dentists towards the treatment of oral candidiasis and their current antifungal prescribing habits, shedding more light on the possible influence of their socio-professional factors on the pattern of prescribing and practice.

METHODS

A structured validated questionnaire was developed and tested; it was then emailed to a random sample of 600 Jordanian dental practitioners during the period of this cross-sectional survey. The questionnaire recorded practitioners' personal details and their attitude and prescribing of antifungal therapy for oral candidiasis. Statistical significance was based on probability values of <0.05 and was measured using the chi-square and Fisher's exact tests. Multiple logistic regression analysis was used to analyse the influence of respondents' socio-professional factors on their attitude towards oral candidiasis.

RESULTS

Of the 423 questionnaires returned, only 330 were included. The attitude of respondents was significantly influenced by their experience [odds ratio (OR) = 0.14; P < 0.001] and workplace (OR = 4.70; P < 0.001). Nystatin was the most commonly prescribed antifungal agent (78.2%), followed by miconazole (62.4%), which was prescribed for topical use. Systemic antifungals were prescribed by 21.2% of respondents, with a significant (P < 0.05) association with the country in which their qualification was obtained.

CONCLUSION

The attitude towards the treatment of oral candidiasis is much better among the least-experienced dentists working in private practice. Nystatin and miconazole are the most popular choices of antifungal agents among Jordanian dentists.

Antibiotic prescription: An oral physician's point of view

Background:

Antibiotics are important in the management and prophylaxis of infections in patients at a risk of experiencing microbial disease. Uses of systemic antibiotics in dentistry are limited since management of acute dental conditions is primarily based upon extraction of teeth or extirpation of the pulp. However, the literature provides evidence of inappropriate prescribing practices by practitioners, due to a number of factors from inadequate knowledge to social factors.

Aim:

The aim was to assess the therapeutic prescription of antibiotics in the dental office.

Materials and Methods:

In the current study, 42 faculty members of two dental colleges in the same vicinity were included. A questionnaire was drafted and sent to the dentists to collect data pertaining to the conditions in which antibiotics were prescribed and most commonly prescribed antibiotic.

Results:

During the study period, 42 faculty members from various departments in the institutes were surveyed, of which 41 questionnaires were completely filled. Amoxicillin was the most commonly prescribed antibiotic followed by other amoxicillin combinations; Metronidazole was most widely prescribed antibiotic for anaerobic infections.

Conclusion:

We have entered an era where cures may be few due to increasing microbial resistance. The biggest force for change will be if all practicing dentists looked at their prescribing and made it more rational.

Antibiotics in dental practice: how justified are we

Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials--prescribing the correct drug, at the standard dosage and appropriate regimen--only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry. This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.

Patient automedication and professional prescription pattern in an urgency service in Brazil

Several studies have indicated an increased resistance of microorganisms resulting from the widespread use of antimicrobial agents. However, few data are available in the dental literature. The aim of this study was to conduct a survey on the patterns of patient usage of antimicrobial prescriptions agents by dentists. A retrospective cross-sectional study was based on the medical records of 223 patients who sought treatment at the Urgency Service, from a Dental School in the South of Brazil, from March 2009 to March 2011. A specific data sheet was used, with questions regarding: patient age and gender; the main complaint; medications used prior to the service; final diagnosis; proposed dental treatment (including prescription medications); and characteristics of the final prescription. Descriptive and inferential statistics were obtained. There was a high frequency of antibiotic use prior to attendance by young patients (Fisher's exact test, p < 0.05). Toothache of endodontic origin was the most frequent patient complaint (72.6%). Endodontic procedures were the measures most frequently adopted to treat the pain (31.2%). The frequency of patient use of antimicrobials prior to the appointment was 14.3%. According to patient records, 83.9% had no systemic drug prescription after receiving urgency treatment. There were few antimicrobial prescriptions after the urgency treatment. The most frequently prescribed agents were amoxicillin, chlorhexidine, and metronidazole. Local measures were more frequently used than systemic approaches to treat urgencies of dental origin. Antimicrobial agents were not frequently prescribed as adjunctives to local administered at the urgency service.

What's the deal with dental records for practicing dentists? Importance in general and forensic dentistry

Dental records are essential for dentist and patient protection, and its maintenance is considered an ethical and legal obligation of the dentist: Ethical, because it satisfies the duty of care that the dentist has toward his patient and legal, as it is an investment for future protection against medico-legal complications. In addition to its legal and ethical role, the dental fraternity in India is slowly waking up to its importance in forensic dentistry. Dentists could play a vital role in assisting forensic investigators in providing information that would help in the identification of perpetrators or victims of crime and natural or manmade disaster situations. This information would be easily available and accessible through well-maintained patient records under dental care.

Antibiotic prescribing practices by dentists: a review

Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.