Are dentist trapped
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If you chase perfection, you often catch excellence.

William Fowble

Medical health care services are revamping rapidly with the latest scientific research and technology advancements. Patients are getting aware of dental treatments due to educational programs and are becoming more demanding. Some patients are coming to doctors by Google diagnosis and demand for various available treatments on Google. Antibiotics are common treatment in dentistry.

Antibiotic resistance complication is commonly seen and heard in dentistry during this era. There is ample evidence showing significant relationship between increases in antimicrobial resistance to bacteria isolated from areas with higher antibiotic utilisation compared with lower antibiotic utilisation areas.

Proper knowledge about dosage, indications and their side effects should be known before prescribing it to patients.

Every dentist dreams to make perfect anatomically correct restorations. Patients don’t always accept and appreciate dentist’s effort. Some patients even accept poorly done restorations, as long as they don’t affect them adversely.

That’s why patient’s satisfaction in dentistry is of utmost importance after every treatment. In a true sense, dentists are trapped between perfection and patient satisfaction.

Treatment success depends on dentist’s skills, patient cooperation and the adeptness of the dental technician or ceramist. A drawn balance between all these factors can provide amazing results; a missing component will offer limited outcome.

Not always will we get a cooperative appreciating patient and doing a job for an uncooperative customer can be a difficult and thankless task. In such situations, dentists apply all their knowledge, clinical skills as well as patient communication and management skills for an ideal result.

Every dentist is skilful after the precious time spent in dental school, careful patient handling and management is the key to success in situations like these.

Sometimes dentists have to perform out of box treatments at patient’s demands and satisfaction as in case of a decayed tooth which needs root canal treatment, patients do not wish to undergo root canal treatment instead demands a cement filling.

After explaining all the possibilities without root canal treatment, patient stick to their wish and dentists performs fillings to appease the patient. Care must be taken during such treatments, and doctors must ensure the patient fills a consent form before undergoing the procedure to avoid later any backlash from the patients.

Are dentists prescribing unnecessary prescriptions? Well, this is an individual centric problem. I don’t think that dentists are prescribing unnecessary prescriptions some might be but not all.

Some patients demand prescriptions to alleviate pain instead of treatment or addressing the root cause. Dental diseases are chiefly caused by microorganisms. Antibiotics are often used in endodontic cases; however, successful treatment can predominantly be achieved by mechanical and chemical cleaning of the canal.

Dentist is the most antibiotic prescribing medical practitioners. In dentistry, antibiotics are prescribed after tooth extractions, root canal treatments and while treating Periodontitis. Whether to prescribe routine antibiotics during root canal or not, is a debatable question. But what we are following is what we were taught in dental school, recent updates in dentistry, dental journals and articles.

Prescription of antibiotics during routine root canal treatment is unnecessary and doing this unnecessarily increases antibiotics resistance. One day, no antibiotic will work because of the resistance. Dental infections are due to most complex anaerobic bacteria to suppress their activity one has to prescribe antibiotics.

Antibiotic prescription is blind in dentistry because dental practitioners do not know which microorganisms are responsible for the infection, as samples from the root canal or periapical region are not routinely taken and analysed, also not economic for each and every case.

Based on clinical and bacterial epidemiological data, the microorganisms responsible for the infections are being suspected, and treatment is decided on a presumptive basis with broad‐spectrum antibiotics (Poveda Roda et al. 2007). There is clear guideline to prescribe antibiotics in dental conditions as given in the chart.

Pulp/Periapical condition Clinical and radiographic data Antibiotics as adjunct
Symptomatic irreversible pulpitis
  • Pain
  • No others symptoms and signs of infection
NO
Pulp necrosis
  • Nonvital teeth
  • Widening of periodontal space
NO
Acute apical periodontitis
  • Pain
  • Pain to percussion and biting
  • Widening of periodontal space
NO
Chronic apical abscess
  • Teeth with sinus tract
  • Periapical radiolucency
NO
Acute apical abscess with no systemic involvement
  • Localized fluctuant swellings
NO
Acute apical abscess in medically compromised patients
  • Localized fluctuant swellings
  • Patient with systemic disease causing impaired immunologic function
YES
Acute apical abscess with systemic involvement
  • Localized fluctuant swellings
  • Elevated body temperature (>38 °C)
  • Malaise
  • Lymphadenopathy
  • Trismus
YES
Progressive infections
  • Rapid onset of severe infection (less than 24 h)
  • Cellulitis or a spreading infection
  • Osteomyelitis
YES
Persistent infections
  • Chronic exudation, which is not resolved by regular intracanal procedures and medications
YES

 

 

References

  1. https://onlinelibrary.wiley.com/doi/full/10.1111/iej.12741
  2. Nabavizadeh MR, Sahebi S, Nadian I. Antibiotic Prescription for Endodontic Treatment: General Dentist Knowledge + Practice in Shiraz, Iran Endod J. 2011;6(2):54-9.
  3. https://www.aae.org/specialty/2016/08/19/antibiotics-a-risky-prescription/
Dr Harshal Patil
Dr Harshal Patil Master of Dental Surgery Periodontics and Implantolgy Private Practice Kandivali East Mumbai.

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