Talking About The ADA And Children Dentistry

In a recent issue of the Journal Of The American Dental Association or ADA it is reported that the majority of dentists working as a children dentist over-prescribe antibiotics to their patients.

The study found a 10%-42% prescribing guideline adherence from the 154 North Carolina dentists surveyed in the way they would treat hypothetical cases.

The Medscape Medical News was told by the corresponding author of the article Jessica Y. Lee, DDS, MPH that she was surprised the figure was that low.

Dr. Lee, a University of North Carolina pediatric dentistry associate professor said antibiotics were prescribed when the guidelines indicated they were not in fact necessary by the dentists.

Her warnings were that there can be severe allergic reactions and one can also develop organisms that makes them develop reistance to antibiotics.

Every year approximately 10% of the antibiotic prescriptions in the U.S. are written by dentists. That 10% translates into somewhere between 200 and 300 million.

The survey was formulated around how respondents would prescribe antibiotics under various scenarios involving patients and whatever their symptoms were.

Of the 154 respondents to the survey 48 were involved in pediatric dentistry while the rest (106) were involved in general dentistry.

The responses were compared by the researchers with guidelines provided by both the ADA and the AAPD whose guidelines were the more specific of the two organizations.

The first hypothetical case involved the right primary second molar with a deep carious lesion. Respondents were asked what would lead them to prescribe antibiotics: local swelling and pain without radiographic proof of pathology, local swelling and pain symptoms with radiographic pathology evidence and facial swelling and pain symptoms also with radiographic pathology evidence.

The professional guidelines of the AAPD say antibiotics should be prescribed by the dentist when there is radiographic pathology evidence or facial swelling with pain or without it.

The bad news is that the correct answer came from only 26% of the respondents. 24% of the general dentists adhered to the guidelines as well as 31% of the pediatric dentists.

The addition of fever to the symptoms resulted in the overall adherence lowering to 12%. Removal of fever and addition of local swelling changed the adherence number to 32%.

Less than 25% of the dentists surveyed reported they would have to see the patient to prescribe antibiotics. Many said they would be willing to prescribe them over the phone which leads to concerns of antibiotic overuse.

The survey also showed that those dentists that see 15 or more children every week would be more likely to hand prescriptions out as would rural dentists. Those who had been through advanced education and training were less likely to hand out prescriptions freely.

Dr. Lee continually emphasizes the need for guideline that are more specific and the professional groups efforts to be certain they are understood by the dentists.

Commenting on the study Paul Casamassimo, DDS, pointed out that the majority of those involved in the study had graduated from the University of North Carolina shedding doubt then that the findings were reflective of all dentists.

Additionally he expressed little surprise saying he had observed similar results in medical physicians surveys.

He additionally expressed he did not regard it as a major concern that many pediatricians are forced into satisfying patients by giving them antibiotics. He also commented his belief that dentists seeing many kids practice a defensive type dentistry.

His final observation was concerning the lack of research regarding antibiotic effectiveness in the dentistry field. This contributes to the typical dentist not seeing the harm in antibiotic overusage.