Daniel B Carlsen1, Michael J Durkin2, Gretchen Gibson3, M Marianne Jurasic4,5, Ursula Patel1, Linda Poggensee6, Margaret A Fitzpatrick6,7, Kelly Echevarria8, Jessina McGregor9,10,11, Charlesnika T Evans6,12, Katie J Suda13,14. 1. Pharmacy Department, Edward Hines Jr, Veterans' Affairs (VA) Hospital, Hines, Illinois. 2. Washington University School of Medicine, St Louis, Missouri. 3. Oral Health Quality Group, Veterans' Health Care System of the Ozarks, Fayetteville, Arkansas. 4. VA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans' Hospital, Bedford, Massachusetts. 5. Boston University Henry M Goldman School of Dental Medicine, Boston, Massachusetts. 6. Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois. 7. Loyola University Chicago Stritch School of Medicine, Maywood, Illinois. 8. VA Pharmacy Benefits Management Services, San Antonio, Texas. 9. College of Pharmacy, Oregon State University, Corvallis, Oregon. 10. Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon. 11. VA Portland Health Care System, Portland, Oregon. 12. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 13. Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania. 14. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
OBJECTIVE: United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription. DESIGN: Cross-sectional analysis. METHODS: We performed an analysis of national VA data from January 1, 2017, to December 31, 2017. We identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription. RESULTS: Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days' supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%-49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics. CONCLUSIONS: Most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.
OBJECTIVE: United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription. DESIGN: Cross-sectional analysis. METHODS: We performed an analysis of national VA data from January 1, 2017, to December 31, 2017. We identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription. RESULTS: Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days' supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%-49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics. CONCLUSIONS: Most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.
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