Dental Therapeutic Guideline Adherence in Australia

Objectives: Recent literature has shown dentists tend to overprescribe antibiotics and have poor adherence to recommended guidelines. Unnecessary prescribing contributes to the development of antibiotic resistance, exposes patients to side effects needlessly, and contributes to economic waste. Further, there is limited literature regarding dental prescribing of medicines other than antibiotics. The aim of the present study was to analyse the prescribing trends of all dispensed prescription medicines by dentists in Australia from 2013 to 2016 for adherence to current guidelines.
Methods: Publicly available data on dispensed dental prescriptions from all medicines listed on the Pharmaceutical Benefits Scheme (PBS) from 2013 to 2016 was accessed from the Department of Health, prescribing rates were standardised to dose and population, and prescribing trends were analysed.
Results: There was a slight decrease in the overall quantity of dispensed antibiotic prescriptions. Amoxicillin was the most commonly dispensed antibiotic, accounting for 64.3% of all dispensed antibiotic prescriptions in 2016, and there was a significant increase in the use of amoxicillin/clavulanic acid by 11.2%. There was an overall increase in the standardised use of opioid analgesics and benzodiazepines by 30% and 14.6% respectively. The overall contribution to antifungal prescribing by dentists was very low compared to other prescribers, suggesting a potential overprescribing of antifungals by medical and nurse practitioners.
Conclusions: This study shows that most medicines are being prescribed appropriately, but there is the clear misuse of others such as the preference for moderate to broad spectrum antibacterials. The variation in prescribing from the guidelines indicates a need for interventions to optimise antibiotic stewardship, and the increase in opioid consumption suggests that continuing education is needed regarding the effectiveness of these medications in dental pain, limitations and abuse potential. Further research is needed to investigate dentists’ attitudes towards prescribing and the clinical pressures that influence prescribing decisions.