Adherence to clinical guidelines is recommended to promote appropriate antibiotic use in dentistry and address concerns about increasing antibiotic resistance. Guidelines for antibiotic prophylaxis before invasive dental procedures were updated in 2007 and 2015. In an effort to inform antibiotic stewardship efforts, a study was undertaken to assess the knowledge of antibiotic usage guidelines and antibiotic-prescribing practices among Minnesota dentists. During September 2015, a 22-question online survey was sent to the state dental association membership. Among 437 respondents, dentists reported a median of 4 antibiotic prophylaxis and 5 treatment prescriptions per month. Dentists reported prescribing antibiotics for prophylaxis before invasive dental procedures for patients with "high-risk conditions" (84%) and localized swelling (70%) as well as for a number of reasons that are not recommended by current guidelines, such as an upcoming vacation for the patient (38%), gingival pain (38%), legal concerns (24%), patient demand (22%), and failed local anesthesia (21%). Dentists defined high-risk conditions as a history of infective endocarditis (75%), prosthetic cardiac valve (70%), selected congenital heart disease (68%), cardiac transplantation with cardiac valvulopathy (4%), and primary care physician recommendation (59%). In addition, some dentists assigned a high-risk category to conditions that do not fall within current guideline recommendations, including prosthetic joints (39%), poorly controlled type 2 diabetes (27%), human immunodeficiency virus (18%), chronic kidney disease (13%), mitral valve prolapse (11%), all congenital heart disease (4%), and well-controlled type 2 diabetes (1%). Respondents indicated that common challenges to stewardship of antibiotic use included perceived conflicting provider guidelines (44%), conflicting scientific evidence (44%), or lack of information on antibiotic selection (19%) or risks (23%). Dentists reported greater antibiotic use than currently recommended by existing guidelines. Antibiotic stewardship efforts in dentistry should address challenges to guideline adherence.
Keywords: antibiotic prophylaxis; antibiotic stewardship; resistance.