Clinical guidelines in recent years have limited the indications for antibiotic prophylaxis before dental procedures. Yet dentists continue to frequently prescribe these medications. Researchers conducted a study to determine whether antibiotics are appropriately prescribed for the prevention of infection before dental procedures.
In this retrospective cohort study, the authors used a national health claims database to obtain data on dental visits from 2011 to 2015 by adults who had commercial dental insurance. They identified patients who had a prescription claim for a two-day-or-less supply of a systemic antibiotic within seven days of a dental visit. Appropriate antibiotic prophylaxis was defined as a prescription dispensed before a dental visit for a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac condition, as indicated by established guidelines.
The researchers found that only 19.1% of prophylactic antibiotics prescribed were appropriate. Unnecessary antibiotic prophylaxis was associated with being female, having prosthetic joint devices, having tooth implant procedures, and living in urban locations or the western United States. Clindamycin was more likely than amoxicillin to be associated with unnecessary antibiotic prophylaxis. The prescription of antibiotic prophylaxis decreased significantly during the study period, during which new guidelines were issued for the prevention of prosthetic joint infections.
The patient cohort comprised adults with commercial insurance, which may not be representative of patients who are uninsured and may be underrepresentative of those covered by Medicare or Medicaid. Also, the researchers note it was difficult to associate a diagnosis with a prescription because dentists are reimbursed based on procedure codes, rarely diagnostic codes. Because of this difficulty in ascertaining specific diagnoses, the researchers broadened the definitions of certain conditions and thus conclude they may have underestimated unnecessary prescribing.
These findings should initiate a call to action to dentists and other health care providers regarding the need to improve antibiotic prescribing for infection prophylaxis, the authors conclude.