A Survey of Prescribing Practices by Dentists in Australia

Objectives: Numerous studies of dental antibiotic prescribing show overprescribing worldwide.
The aims of this study are to assess the prescribing practices of general dentists in Australia for antibiotics, anxiolytics and analgesics, to determine the extent to which prescribing is in accordance with current guidelines.
Methods: A structured questionnaire was sent to 1,468 dentists in Victoria and Queensland from July-August 2018, with participants chosen to cover a variety of SES locations, urban and rural practices, overseas-trained and locally-trained dentists, and years of experience. The questionnaire covered demographics, clinical conditions where dentists prescribe antibiotics, non-clinical factors which influence prescribing, and medicines for anxiolysis and pain relief. A scoring system was developed for each question, based on recommendations from the current Australian therapeutic guidelines. Logistic regression analysis was used to determine the relative importance of independent variables on inappropriate prescribing.
Results: 382 responses were received. Significant overprescribing was shown, with an overall result of 55% overprescribing of antibiotics and 13-88% overprescribing by dentists on a routine or occasional basis depending on the clinical scenario. Factors including time pressure, patients’ expectations and the inability to reach a diagnosis were determined as non-clinical pressures that influence prescribing for 68-82% of respondents. Between 16% and 27% of respondents inappropriately preference analgesics instead of anti-inflammatories for dental pain. Of the dentists who prescribed anxiolytic medicines, 46% prescribed anxiolytics inappropriately with varying regimens and choices outside the guidelines. Years of practice was the main demographic factor influencing prescribing, with recent graduates (0-5 years) generally scoring better than their colleagues for antibiotic prescribing (p<0.05, CI:1.96-11.86).
Conclusions: Future interventions must address the appropriate role and use of antibiotics, shortfall in prescribers’ knowledge and appropriate choices of medicines for pain and anxiolysis. Continuing education could potentially be targeted at more experienced dentists as well as patients, especially those who expect antibiotics instead of treatment.