Study links face-to-face dentistry restrictions to increased antibiotic prescription

MANCHESTER, UK: Dental guidelines in the UK, as in many countries, are predicated upon the knowledge that dental infections respond better to treatment procedures rather than to antibiotics. Restrictions in providing face-to-face dental services during the pandemic, however, led to increased antibiotic prescription rates. A new study from researchers at the University of Manchester has found that these restrictions, in the words of one of the authors, “caused widespread frustration among dentists who know that procedures rather than prescriptions are generally the safest and quickest fix for toothache”.

The study’s authors analysed National Health Service (NHS) dental antibiotic prescription data in England from both before and during the pandemic and conducted an online survey in 2021 of 159 NHS dentists in England. According to their analysis, there was an increase of 22% in the total number of dental antibiotic prescriptions during the first year of COVID-19 restrictions (April 2020 to March 2021) compared with the immediately preceding 12 months. Antibiotic prescription rates rose fastest (29.1%) in the East of England, whereas London recorded the lowest increase with 12.1%.

Of the dentists surveyed by the researchers, half reported that, during the initial stages of the pandemic from March to June 2020, their referrals of patients to urgent dental centres for hands-on treatment were rejected because the patients had not yet taken antibiotics to treat the issue. More than three-quarters stated that their patients had requested antibiotics more often during the first year of the pandemic than prior to it, and some respondents suggested that this approach to managing dental patients remotely had had a long-lasting effect on patient expectations regarding the potential applications of antibiotics.

“This study highlights that during the pandemic, restricted access to face-to-face dental care was directly linked to much higher antibiotic prescribing than in previous years,” Dr Wendy Thompson, the study’s lead author and a clinical dental researcher at the University of Manchester as well as the chair of the FDI World Dental Federation’s Antimicrobial Resistance (AMR) Working Group, said in a press release.

She continued: “That puts people at increased risk from adverse effects of antibiotics, such as upset stomach, severe allergy and of course the development of antibiotic resistance. As the dental profession contributes around 10% of antibiotic prescribing across NHS primary care, dentists are acutely aware of the need to play their part in tackling resistance by prescribing antibiotics only when strictly necessary and appropriate.”

The study is a timely reminder that dental care contributes to the global public health threat posed by antibiotic resistance. It was published ahead of World Antimicrobial Awareness Week, an initiative run by the World Health Organization from 18 to 24 November that aims to spotlight the global ramifications caused by AMR’s development.

“Understanding the essential need to keep antibiotics working, and their futility for many acute dental conditions, should be fundamental knowledge for everyone involved with planning, managing and delivering dental services,” Dr Thompson added.

The study, titled “Understanding the impact of COVID-19 on dental antibiotic prescribing across England: ‘it was a minefield’”, was published online on 28 October 2022 in the British Dental Journal.


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