CDC Study Puts Dental Antimicrobial Stewardship in the Spotlight

By on 5:49 AM

A Centers for Disease Control and Prevention (CDC) study published in the Journal of the American Dental Association (JADA) shows that dentists prescribed 24.5 million antibiotic prescriptions in 2013. This equates to 10% of all antibiotic prescriptions in the outpatient setting.

The study found dentists usually prescribe within recommended guidelines. However, they sometimes prescribe antibiotics not indicated for dental conditions, such as fluoroquinolones and others used to treat urinary tract infections. CDC notes that additional study is needed to better understand the reasons for the variability and identify areas of possible intervention and improvement.

As the study author's state, "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."

In a blog, CDC identifies the following dos and dont's for responsible antibiotic prescribing practices in dentistry.

  • prescribe antibiotics only for a documented diagnosis of an oral bacterial infection
  • recognize that antibiotics are not always necessary
  • prescribe only for patients of record
  • prescribe only for bacterial infections you have been trained to treat
  • review patient’s medical history to assess medical allergies, potential for adverse drug events, and medical conditions that would affect antibiotic selection
  • prescribe only when clinical signs and symptoms of bacterial infection suggest systemic spread
  • use the most narrow-spectrum antibiotic for the shortest duration possible (after clinical signs and symptoms subside) for otherwise healthy patients
  • advise patients to take antibiotics exactly as directed
  • ensure antibiotic expertise or references are available during patient visits
  • collaborate with referring specialists about prescribing protocols
  • provide training to staff members to improve probability of patient adherence
  • keep up to date on appropriate management of oral infections (continuing education courses, conferences, accessing dental journals, pharmacology texts) 
  • revise antibiotic regimens on basis of patient progress and, if needed, culture results 
  • advise patients that they should NOT take antibiotics prescribed for someone else
  • advise patients that they should NOT save antibiotics for future illnesses

  • prescribe for viral infections, fungal infections or oral ulcerations related to trauma or aphthae
  • prescribe in lieu of dental interventions
  • prescribe based on demand or expectations from patients
  • prescribe based on non-evidence-based historical practices
  • prescribe based on pressure from another health care provider

Over the course of the past few years, a major emphasis has been placed on antimicrobial stewardship program development and maintenance. As publication of the study's results and blog indicate, CDC is bringing attention to the importance of dental antimicrobial stewardship.

Dental offices and oral surgery centers in need of assistance with development of AMS programs or other infection prevention and control initiatives are encouraged to contact Infection Control Consulting Services (ICCS). The ICCS team of consultants serve all healthcare facility types, including dentists, ambulatory surgery centers and outpatient care facilities.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.