Inappropriate prescribing of antibiotics must stop

Julian Webber, principal of the Harley Street Centre for Endodontics, welcomed the prospect of tighter restrictions on the prescribing of antibiotics.

Dr Webber estimates that, for a significant number of dental patients with endodontic disease, antibiotics are prescribed inappropriately.

If a correct diagnosis is made when a patient experiences their first symptoms, he says, the need for antibiotics should be minimal.

His comments are made in the wake of the annual report by Chief Medical Officer Sally Davies in which she warned of the dangers posed by drug-resistant bacteria, strains of organisms that cannot be killed off by the antibiotics available today. 

Dr Davies says that Britain's health system could slip back by 200 years unless the ‘catastrophic threat’ of antibiotic resistance is successfully tackled.

As a specialist referral practice which works daily to save teeth through root canal treatment, Dr Webber and his team already operate to clear guidelines which are underpinned by evidence that antibiotics are not effective for pain relief in cases of irreversible pulpitis.

Dr Webber said: ‘Symptoms of an irreversible pulpitis such as hot and cold sensitivity that lingers and continuous throbbing pain but where the pulp still tests vital will not be ameliorated in any way by antibiotic prescribing. Extirpation of the inflamed dental pulp and root treatment is the only real solution.’

He continued: ‘Even where a necrotic dental pulp is diagnosed, indicating a non vital tooth, antibiotics would still not be necessary unless there is facial swelling and systemic effects of infection.’

“Everything comes down to the diagnosis and the tests that can be carried out to identify whether a tooth is vital or non-vital. Whilst the remedy for both a vital tooth with irreversible pulpits or a necrotic tooth non vital tooth is endodontic treatment, the requirements for antibiotics are really minimal.’

He continued: All dentists should have the diagnostic skills to differentiate a reversible pulpitis from an irreversible pulpitis, and diagnose whether a tooth is vital or non-vital. With these diagnostic skills appropriate treatment can be undertaken and the administration of antibiotics kept to a minimum”.

Dr Webber concluded: “Unnecessary prescribing must be curtailed, both in the dental and the medical sectors. Research shows that unless there is a reduction in appropriate prescribing, we may not have effective antibiotics for use in the management of true orofacial infections in the future.”

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