Dentist Sarah Glover aims to raise awareness for issues around dental antibiotics and COVID-19. She is a member of the charity’s Education Committee and is a highly experienced dental practitioner and teacher. She writes;
“Due to the COVID-19 pandemic, dental practices in the UK were instructed to stop all routine dental care during lock down. Dentists were told that dental emergencies should offer advice, analgesia and antibiotics (AAA). There should be no face to face contact with patients.
Urgent dental centres (UDCs) have been set up to see patients where AAA isn’t sufficient to manage extreme pain or swelling. The UDCs will not see patients face to face until they have had at least one course of antibiotics or more. Antibiotics are often an unsuitable treatment for most dental emergencies, such as reversible pulpits or mobile / broken teeth.
I believe that COVID-19 pandemic responses are leading to over prescription of dental antibiotics. It is also causing the inappropriate prescribing of antibiotics.
What the guidelines say
The Faculty of General Dental Practitioners provide guidelines for antimicrobial prescribing and they state:
‘The majority of uncomplicated infections of dental origin can be successfully treated by the removal of the origin of source of the infection by drainage of the associated abscess, removal of the pulp contents or extraction of the associated tooth.
Antimicrobials are only indicated as an adjunct to definitive treatment where there is an elevated temperature, evidence of systemic spread and local lymph gland involvement.’
What can we do?
Clearly an assessment of the patient is difficult over the phone, or even with a video link when it comes to dental problems. A patient may describe that they have a swelling which results in a prescription for antibiotics. This assumes that the swelling is the result of an abscess and local infection spreading. But what if the swelling is an undiagnosed oral cancer? Then the patient is at risk of delayed referral and treatment. This is a huge concern as some oral cancers can progress rapidly without intervention.
Dentists have lots of experience with cross infection. They have been wearing level 2 PPE as a routine measure before COVID-19. Clearly dentistry involves aerosol generating procedures (AGPs) for routine dental care. But, emergency dental care can be provided without AGPs. Extraction, draining an abscess or referral for suspected oral cancer could all still safely take place.
In my opinion, closing dental practices to providing emergency dental care before any UDCs were available was a step backwards. Dentists had to prescribe antibiotics rather than use local effective treatment. This undermines the work towards reducing over prescribing of antibiotics in the dental sector. In turn, this may contribute to further anti-microbial resistance. This could result in fewer treatment options for sepsis or future pandemics where antibiotics are necessary.”
Sarah Glover
BDS MSC Clinical Dentistry Dip.Rest.Dent RCS Eng