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    The dental prescriptions that are killing your patients

    Are your prescribing habits leading to harmful consequences for your patients?

    Common dental prescriptions like antibiotics and opioids can have severe harmful consequences for your patients. The American Dental Association’s (ADA) recommendations for both types of drugs have changed based on the latest scientific evidence. While both have their time and place in your practice to maintain a proper standard for patient care, overprescribing in either category can lead to serious conditions for some patients.

    Dr. Jennifer Sanders, DMD, has a succinct summary of the dental industry’s stance on prescription medication: “Honestly, most things, like antibiotics and opioids, are overprescribed.” This sentiment is echoed by the literature, the Centers for Disease Control and Prevention (CDC) and the ADA.

    Christopher Cook, DMD, is a private practice endodontist in Louisville, Kentucky, who has been practicing since 1995. Earlier in his career, when the literature showed that they were safe, Dr. Cook prescribed opioids, but usually no more than three days’ worth. Today, he estimates that in the last 18 months he has written two prescriptions for opioids. He also explains to his patients why they’re no longer the answer.

    Read more: What dentists NEED to know about the opioid epidemic

    “Education, for me, is critical. You have to tell them, ‘Here’s what I am going to ask you to take to make the pain or discomfort go away if you have any pain or discomfort.’ For me, it’s the nonsteroidal anti-inflammatories (Motrin, ibuprofen, Advil). If it’s still hurting, add one over-the-counter Tylenol in between and that should work, and if not I expect a call,” Dr. Cook says.

    The dental industry is contributing to the antibiotic overprescribing problem in the U.S. Per the CDC, dentistry as a whole prescribed 24.9 million prescriptions of oral antibiotic prescriptions in 2014.1 Most, if not all, of these antibiotic prescriptions were for prophylaxis before certain patients’ dental procedures and to treat dental infections.
    Dentistry prescribed only 6.4 percent (16.3 million) of the overall opioid prescriptions in 2012, which the CDC reported over 255 million for all health care providers in 2012.2 However, since dentists tend to write opioid prescriptions for adolescent patients having their wisdom teeth removed, dentists are usually the first healthcare provider to introduce patients to opioids.

    What harm does overprescribing cause?

    Overprescribing antibiotics contributes to antibiotic resistance, where the drugs are no longer effective against the bacteria the drug seeks to eliminate. According to the CDC, antibiotic resistance is an urgent threat to public health.3 The bacteria resistant to antibiotics are difficult and expensive to treat. In extreme cases, antibiotic-resistant infections can have serious consequences, such as physical disability and even death. As part of their Be Antibiotics Aware campaign, the CDC reports that 2 million people suffer infections caused by antibiotic-resistant bacteria and these infections lead to at least 23,000 deaths.4

    However, antibiotic resistance is only part of the risk of overprescribing antibiotics. Another significant problem is an allergic reaction. Per the ADA, there were 145,000 emergency hospital visits between 2011 and 2015 for adverse events associated with antibiotics and 75 percent involved allergic reactions.5 Allergic reactions range from minor skin irritation and digestive tract issues to more severe symptoms, like wheezing, trouble breathing and anaphylaxis.

    Dental prescriptionsAnother serious concern associated with antibiotics is the increasing cases of Clostridium difficile (C. diff), a serious and sometimes fatal condition. When antibiotics eliminate the protective bacteria that live in the gastrointestinal tract, the C. diff bacteria multiply, causing severe diarrhea. According to Sciencedaily.com, the Minnesota Department of Health (MDH) reported that 15 percent of the cases they kept track of over six years were from antibiotics prescribed by the patients’ dentists.6 The lead author of the study, Dr. Stacy Holzbauer, says that reducing outpatient antibiotic prescriptions would lower C. diff rates that don’t occur at hospitals by 17 percent.7

    Trending article: Achieving optimal oral health with preventive care products

    Antibiotic overprescribing is an issue that’s personal for Dr. Cook. His mother died of a perforated bowel resulting from a C. diff infection following antibiotic therapy. She died within 24 hours. “She got an antibiotic every time she turned around,” he says of his mother’s case.

    Dr. Cook believes that antibiotic resistance is a crucial issue for prescribers today. His patients often come in and demand antibiotics for a toothache. That’s when he educates his patients about antibiotic use. “It’s the whole premise of if you have a splinter in your arm, are you going to take an antibiotic to make it feel better or take the splinter out?” he says.

    The opioid crisis has been increasing in the U.S. at an alarming rate. Opioids interfere with pain signals in a patient’s brain and provide pain relief. There are several different types, from natural opioids like morphine and codeine to semi-synthetic opioids such as hydrocodone (Vicodin) and oxycodone (Percoset) and even fully synthetic opioids like fentanyl and methadone.

    Last October, U.S. President Donald Trump declared the opioid epidemic a public health emergency and urged the country to be the generation that ends the overdose crisis. Per the American Society of Addiction Medicine (ASAM), 2 million people in the U.S. were addicted to prescription pain relievers in 2015.  Those numbers are expected to rise since 2015.8 The National Institute on Drug Abuse reports that as many as 115 people in the U.S. die of overdosing on opioids every day.9

    Up next: What dentists can do to protect patients


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