Indications for the use of systemic antibiotics in dentistry are limited, as most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures.A recent study highlights the irrational use of antibiotics for oral diseases by dentists in India. This issue is of increasing significance due to rising antimicrobial resistance (AMR).
India is considered to be a major consumer of antibiotics in the world, and this appears to be expanding further. According to the study the estimated antibiotic prescription rate for dental ailments was approximated to be 89.21 prescriptions per 1,000 persons per year which is much higher than the prescription rate of 77.5 prescriptions per 1,000 persons for the United States. The results also suggest that most antibiotics prescribed for infection prophylaxis in dental ailments in India are irrational, the finding is consistent with findings from other countries.
The reason behind over prescription is a combination of clinical, behavioural, and systemic factors. Patients often perceive a consultation as incomplete if antibiotics are not prescribed. In some instances, patients request for a prophylactic courses before procedures such as Root Canal Treatment or report to clinics after self-medicating. Clinical observations include cases of antibiomas resulting from such practices. Patients often believe that taking systemic antibiotics will resolve the infection, and are not aware of the fact that dental infections remain localised to the tooth in most cases. The a drainage established through the tooth(access opening) relieves the pain and removal of infected pulp upon debridement, and bio mechanical preparation resolve the infection. Dentists often comply with such expectations and prescribe antibiotics when not necessary.
Antibiotics should be prescribed only when the signs of systemic illness or extra oral spread are evident in patients.
The absence of oral health in India’s primary antimicrobial frameworks, such as the National Action Plan and ICMR guidelines, represents a significant systemic gap. By omitting dental specific protocols, these national policies leave practitioners without a standardised and a government backed benchmark for prescribing antibiotics.
This dual problem needs to be addressed. Dental specific protocols should be included in the government guidelines and action plans and OTC availability of antibiotics should be stopped. The rising problem of AMR mandates an increase in public awareness regarding the proper use of antibiotics. A collaborative approach is necessary to preserve the efficacy of antimicrobial agents and mitigate the escalating threat of antimicrobial resistance.
Are our prescribing habits inadvertently accelerating antimicrobial resistance?
MBH/AB