Getting to the root of the problem

Study find GPs prescribing ‘unnecessary’ antibiotics for toothache

Over half of all patients who visited their GP with a dental problem in the last 10 years were not offered a long-term treatment for their pain and were instead prescribed antibiotics, often unnecessarily, new University research has found.

In a 10 year retrospective study published in the British Journal of General Practice a team of experts from the School of Dentistry examined dental consultations in UK general practice and the resultant number of antibiotics prescriptions.

The study found many patients are visiting their GP rather than their dentist, and that over half of these consultations resulted in antibiotic prescribing, which is likely to be unhelpful, and potentially harmful.

“Our study found that many people visit their GP rather than their dentist when experiencing dental problems,” said Dr Anwen Cope, a qualified dentist and speciality trainee in Dental Public Health at Cardiff and Vale University Health Board, who completed the research alongside colleagues from the University’s Schools of Dentistry and Medicine.

“Most dental problems cannot be comprehensively managed by a GP. This places an additional burden on already busy GPs when patients should be visiting a dentist.

“The best treatment for severe toothache remains an operative intervention like an extraction or root canal treatment. These treatments can only be undertaken by a dentist. Therefore, we would always encourage patients to see a dentist, rather than a GP, when experiencing dental problems.”

The most alarming finding was the number of unnecessary prescriptions of antibiotics over the last ten years.

The study found over half of patients in the study who consulted their GP with a dental problem were prescribed an antibiotic. This raises serious concerns about the UK’s long-term dental health and the potential contribution to antibiotic resistance.

Antibiotic drug resistance, which occurs when bacterial infections no longer respond to antibiotics, is a serious problem, and the use of antibiotics is the single most important factor leading to resistance.

Dr Cope added: “The widespread use of antibiotics in the management of tooth-related complaints in general practice is concerning.

“Despite antibiotics not providing a definitive treatment for dental problems we found over half of consultations for dental problems resulted in prescription of an antibiotic.

“This presents a number of problems. It means patients are not getting a long-term resolution for their dental problem, and they may even remain in pain for longer.

“Prescribing antibiotics also carries a risk of adverse reaction and is likely to increase the number of medical consultations for dental conditions further down the line.

“More worryingly is the potential impact on the rates of antibacterial resistance. Antibiotics save lives, and therefore it’s important we use them carefully and only when they are really required.

“Improving antibiotic prescribing for dental problems is an important step in ensuring antibiotics will still be available in the years to come.”

This research did not identify the reasons why patients were consulting with a GP rather than a dentist, and it may be that GPs are sometimes treating patients who report being unable to get a timely appointment with a dentist.

Nevertheless, the team hope the study will promote more appropriate consulting for dental problems, and a reduction in antibiotic prescribing by GPs for patients with dental problems.

Dr Cope adds: “The messages from our study are simple: GPs should avoid routinely prescribing antibiotics when patients present with dental problems, and more work is needed to identify how patients experiencing dental problems can be best directed to emergency dental services.

“Understanding the drivers of antibiotic prescribing for oral health problems will help inform educational interventions for GPs to ensure that patients receive the most appropriate care for their dental conditions.”