Doctors should confirm penicillin allergy claims to prevent antibiotic overuse in dentistry

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Doctors should confirm penicillin allergy claims to prevent antibiotic overuse in dentistry

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According to Dr Bodil Lund, about 10% of patients tell their dentist that they’re allergic to penicillin, even though only about 1% of the population actually is. (Image: rSnapshotPhotos/Shutterstock)

STOCKHOLM, Sweden: Antibiotic resistance as a result of overprescription is a topic of great concern for researchers and activists across all specialties within medicine, dentistry not excluded. Dr Bodil Lund, professor of oral and maxillofacial surgery and head of the Department of Dental Medicine at Karolinska Institutet in Sweden is a supporter of rational antibiotic therapy in dentistry.

“Penicillin works very well on dental infections. However, about 10% of patients tell their dentist that they’re allergic to penicillin, even though only about 1% of the population actually is. The allergic patients are given clindamycin, which is a broad-spectrum antibiotic. I usually urge dentists here to ask their patients to get checked out by a doctor,” said Prof. Lund in an interview conducted by the Karolinska Institutet.

Prof. Lund cited examples from Sweden where there has been a 30% drop in the number of prescriptions written by Swedish dentists since 2007. However, there are still stark differences in the number of antibiotic prescriptions in different regions, and there is a greater reduction in prescriptions in public dental care than there is in the private sector.

Dentists the world over have initiated antibiotic education campaigns in recent years. In the UK, a number of organisations, including the British Dental Association, the College of General Dentistry and the Association of Clinical Oral Microbiologists, have joined forces to encourage dental professionals and patients to remember the simple message that “Antibiotics do not cure toothache”. In addition, recent studies have indicated that antibiotic prophylaxis may not prevent postoperative infections.

According a 2020 study published in the British Dental Journal, even prior to the pandemic, 80% of the antibiotics prescribed by dentists in the UK and the US resulted in unnecessary antibiotic use that was not in accordance with general guidelines.

Meanwhile, in Sweden, Prof. Lund is pushing for more education and research into antibiotic overuse. She co-authored a recent study that indicated that the risk of endocarditis is not heightened with reduced antibiotic administration. The study found no significant indications of increased morbidity in patients at high risk of infective endocarditis after Sweden’s move to reduce antibiotic use—a move meant to reduce antibiotic resistance and borne of a lack of evidence of its necessity.

“Treating infections ‘just to be on the safe side’ is a thing of the past,” commented Prof. Lund on the troubling trend. “Broad-spectrum antibiotics also need to be used less,” she added. Lund and her colleagues at Karolinska Institutet are striving to understand where knowledge is lacking within dentistry in order to best respond to the large number of unnecessary prescriptions.

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