Private Practice Dentists Improve Antibiotic Use After Dental Antibiotic Stewardship Education From Infectious Diseases Experts

Abstract Background Private practice dentists represent 72% of United States dentists. We conducted a prospective cohort study of private practice dentists comparing antibiotic use before and after dental antibiotic stewardship education by infectious diseases (ID) antibiotic stewardship experts. Methods Study phases were as follows: phase 1 (preeducation), 3 months of retrospective antibiotic data and a presurvey assessed baseline antibiotic knowledge; phase 2 (education), dentists attended 3 evening Zoom sessions; phase 3, (posteducation/interventions), 3 months of prospective audits with weekly feedback; phase 4, postsurvey and recommendations to reach more dentists. Results Fifteen dentists participated. Ten had practiced >20 years. Presurvey, 14 were unfamiliar with dental stewardship. The number of antibiotic prescriptions pre/post decreased from 2124 to 1816 (P < .00001), whereas procedures increased from 8526 to 9063. Overall, appropriate use (prophylaxis and treatment) increased from 19% pre to 87.9% post (P < .0001). Appropriate prophylaxis was 46.6% pre and 76.7% post (P < .0001). Joint implant prophylaxis decreased from 164 pre to 78 post (P < .0001). Appropriate treatment antibiotics pre/post improved 5-fold from 15% to 90.2% (P = .0001). Antibiotic duration pre/post decreased from 7.7 days (standard deviation [SD], 2.2 days) to 5.1 days (SD, 1.6 days) (P < .0001). Clindamycin use decreased 90% from 183 pre to 18 post (P < .0001). Postsurvey responses recommended making antibiotic stewardship a required annual continuing education. Study participants invited ID antibiotic stewardship experts to teach an additional 2125 dentists via dental study clubs. Conclusions After learning dental antibiotic stewardship from ID antibiotic stewardship experts, dentists rapidly optimized antibiotic prescribing. Private practice dental study clubs are expanding dental antibiotic stewardship training to additional dentists, hygienists, and patients across the United States.

[1]  M. Janal,et al.  Dental implant failure rates in patients with self-reported allergy to penicillin. , 2022, Clinical implant dentistry and related research.

[2]  C. Evans,et al.  Antibiotic prophylaxis prescriptions prior to dental visits in the Veterans’ Health Administration (VHA), 2015–2019 , 2022, Infection control and hospital epidemiology.

[3]  C. Engh,et al.  Editorial: The 2021 Hip Society Members Meeting and 2022 Awards. , 2022, The Journal of arthroplasty.

[4]  J. Becktor,et al.  Effect of antibiotic prophylaxis in dental implant surgery: A multicenter placebo‐controlled double‐blinded randomized clinical trial , 2022, Clinical implant dentistry and related research.

[5]  M. Bradburn,et al.  Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England , 2022, JAMA network open.

[6]  J. López‐López,et al.  Systemic Antibiotic Prophylaxis to Reduce Early Implant Failure: A Systematic Review and Meta-Analysis , 2021, Antibiotics.

[7]  D. Couper,et al.  Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association , 2021, Circulation.

[8]  R. Centor,et al.  Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians , 2021, Annals of Internal Medicine.

[9]  Jessina C. McGregor,et al.  Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs (VA) dentistry , 2021, Infection Control & Hospital Epidemiology.

[10]  C. Evans,et al.  Postextraction infection and antibiotic prescribing among veterans receiving dental extractions , 2021, Infection Control & Hospital Epidemiology.

[11]  Juan Carlos Bernabeu-Mira,et al.  Prescription of Antibiotic Prophylaxis for Dental Implant Surgery in Healthy Patients: A Systematic Review of Survey-Based Studies , 2021, Frontiers in Pharmacology.

[12]  T. Johnson,et al.  Adjunctive systemic antimicrobials for the non-surgical treatment of periodontitis. , 2020, The Cochrane database of systematic reviews.

[13]  Jessina C. McGregor,et al.  Serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the United States , 2020, Infection Control & Hospital Epidemiology.

[14]  R. McEachan,et al.  Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices , 2020, Antibiotics.

[15]  L. Levin,et al.  Antibiotic prophylaxis for implant placement: a systematic review of effects on reduction of implant failure , 2020, British Dental Journal.

[16]  B. Lund,et al.  Prophylactic antibiotics for staged bone augmentation in implant dentistry , 2020, Acta odontologica Scandinavica.

[17]  D. Goff,et al.  Review of Guidelines for Dental Antibiotic Prophylaxis for Prevention of Endocarditis and Prosthetic Joint Infections and Need for Dental Stewardship. , 2019, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  E. Abt,et al.  Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. , 2019, Journal of the American Dental Association.

[19]  G. Garber,et al.  Late-Career Physicians Prescribe Longer Courses of Antibiotics. , 2019, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  L. Baddour,et al.  Risk of Adverse Reactions to Oral Antibiotics Prescribed by Dentists , 2019, Journal of dental research.

[21]  Jessina C. McGregor,et al.  Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015 , 2019, JAMA network open.

[22]  M. Kollef,et al.  Duration of Exposure to Antipseudomonal β‐Lactam Antibiotics in the Critically Ill and Development of New Resistance , 2019, Pharmacotherapy.

[23]  K. Suda,et al.  Successful Implementation of an Antibiotic Stewardship Program in an Academic Dental Practice , 2019, Open forum infectious diseases.

[24]  B. Spellberg,et al.  Short Course Antibiotic Therapy-Replacing Constantine Units with "Shorter Is Better". , 2019, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  F. Hernández-Alfaro,et al.  Do Penicillin-Allergic Patients Present a Higher Rate of Implant Failure? , 2018, The International journal of oral & maxillofacial implants.

[26]  M. Junger,et al.  255. Evaluation of Antibiotic Prescribing at University-Affiliated Dental Clinics , 2018, Open Forum Infectious Diseases.

[27]  O. Dyar,et al.  Defensive medicine among antibiotic stewards: the international ESCMID AntibioLegalMap survey , 2018, The Journal of antimicrobial chemotherapy.

[28]  V. Fraser,et al.  An evaluation of dental antibiotic prescribing practices in the United States. , 2017, Journal of the American Dental Association.

[29]  C. Evans,et al.  Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures , 2017, Open forum infectious diseases.

[30]  S. Holzbauer,et al.  Antibiotic Prescribing for Dental Procedures in Community-Associated Clostridium difficile cases, Minnesota, 2009–2015 , 2017, Open Forum Infectious Diseases.

[31]  S. Cosgrove,et al.  Association of Adverse Events With Antibiotic Use in Hospitalized Patients , 2017, JAMA internal medicine.

[32]  C. Willy,et al.  „Antibiotic Stewardship“ , 2017, Der Unfallchirurg.

[33]  R. Quinn,et al.  The American Academy of Orthopaedic Surgeons Appropriate Use Criteria for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. , 2017, The Journal of bone and joint surgery. American volume.

[34]  A. Holmes,et al.  Behaviour change interventions to influence antimicrobial prescribing: a cross-sectional analysis of reports from UK state-of-the-art scientific conferences , 2017, Antimicrobial Resistance & Infection Control.

[35]  K. Suda,et al.  Antibiotic prescriptions in the community by type of provider in the United States, 2005-2010. , 2016, Journal of the American Pharmacists Association : JAPhA.

[36]  A. Akram,et al.  Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia. , 2016, The Journal of infection.

[37]  Daniella Meeker,et al.  Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. , 2016, JAMA.

[38]  S. Schrag,et al.  US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[39]  E. Abt,et al.  Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures , 2013, The Journal of the American Academy of Orthopaedic Surgeons.

[40]  S. Furness,et al.  Antibiotics to prevent complications following tooth extractions. , 2012, The Cochrane database of systematic reviews.

[41]  C Michael Stein,et al.  Azithromycin and the risk of cardiovascular death. , 2012, The New England journal of medicine.

[42]  S. Richmond,et al.  A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting , 2006, British Dental Journal.

[43]  L. Peterson.  Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery. , 1990, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[44]  L. Wolff,et al.  Antimicrobial adjuncts in the management of periodontal and peri-implant diseases and conditions: a narrative review , 2021 .