A survey of 154 dentists in North Carolina (48 pediatrics, 109 general) suggests that a large number of the professionals are over-prescribing antibiotics to children.
The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) have issued specific guidelines on the prescription of antibiotics. However, the survey found that dentists were adhering to them only in 10% to 42% of the (hypothetical) scenarios the researchers sent to them.
The researchers sketched the following scenario: A patient is suffering from a deep carious lesion (a severe, abnormal decay) on the mandibular right primary second molar (a tooth that fulfils the function of grinding). In which of the following circumstances would you prescribe an antibiotic? 1: pain and local swelling with no radio-graphic evidence of pathology (or ‘x-ray evidence of disease’); 2: pain and local swelling with radio graphic evidence…or 3: pain and facial swelling with radio-graphic evidence.
According to AAP guidelines, dentists must prescribe antibiotics for a condition of facial swelling – with or without pain, a condition suggesting radio-graphic evidence of pathology, or a variant of the three symptoms mentioned above. Only 26% of the respondents gave the correct answer. Thirty one percent pediatric dentists and 24% of the general dentists adhered to the guidelines.
“What can go wrong is that we can develop antibiotic-resistant organisms, and people can have an allergic reaction that can be pretty severe”, says Dr Lee, associate professor of pediatric dentistry at the University of North Carolina in Chapel Hill.
Paul S. Casamassimo, American Academy of Pediatric Dentistry Spokesperson, says that most of the dentists surveyed are from one institution – the University of North Carolina – hence the findings may not apply to all dentists.
(The survey is reported in the January issue of the ‘Journal of the American Dental Association’.)