Dental consultations and antibiotic use in UK General Medical Practice

Objectives: This study aimed to: characterise attendances for dental problems in UK general medical practice 2004-2013; describe the use of antibiotics in such consultations, and identify patient, practice, and appointment characteristics predictive of antibiotic prescription in dental consultations.
Methods: A retrospective cohort study utilising routinely collected primary care data held by the UK Clinical Practice Research Datalink (CPRD). An inclusive sample of all dental consultations between 2004 and 2013 were extracted and cleaned according to CPRD-recommended quality assurance protocols. Multilevel logistic regression analysis was conducted to examine the relationship between patient, practice, and consultation characteristics, and antibiotic prescription.
Results: Between 1^st January 2004 and 31^st December 2013 there were 288,169 consultations for dental problems at 655 general practices. During the study period median annual consultation rates varied between 3.37 and 6.32 consultations per 1000 patient-years. Rates of dental consultations remained relatively static between 2004 and 2008, but decreased between 2008 and 2013. Consultations for dental problems were highest amongst females and adults 20-29 years and an antibiotic was prescribed in 55.0% of consultations. Factors significantly (p<0.05) associated with increased likelihood of antibiotic prescription included: patient middle-age; patients with diabetes mellitus (OR 1.06); previous consultations for tooth-related problems (OR 1.20); consultations in December (OR 1.19), and consultations on a Monday (OR 1.11) or a Friday (OR 1.15). Females (OR 0.93), patients consulting in Scotland (OR 0.75), patients consulting on a weekend (OR 0.11), and patients consulting in January (OR 0.93) all had a significantly (p<0.05) reduced likelihood of being prescribed an antibiotic.
Conclusions: Although rates of attendance for dental problems in general practice were relatively low, consultations commonly result in antibiotic provision. This may contribute to patient morbidity from untreated dental disease, and antimicrobial resistance. Interventions are therefore required to support patients in accessing the most appropriate care when experiencing dental problems.