Dentist Sarah Glover talking about dental antibiotics

Dentist Sarah Glover an Education Committee member writes about current dentistry antibiotic use during the COVID-19 pandemic

Colin Garner ANTRUK announcements, Coronavirus COVID-19

Sarah, a member of the charity’s Education Committee and a highly experienced dental practitioner and teacher 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 instructed that dental emergencies should be managed with advice, analgesia and antibiotics (AAA) and 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 the current situation is leading to over prescribing of antibiotics and also  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 be done

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 and antibiotics are then prescribed. This assumes that the swelling has been caused by 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 are highly experienced with cross infection and 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 were expected to prescribe antibiotics instead of local effective treatment to the dental problem. 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 results in fewer treatment options for sepsis or future pandemics where antibiotics are required.”

Sarah Glover

BDS MSC Clinical Dentistry Dip.Rest.Dent RCS Eng