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Dentists urged to back off on antibiotics

By Michael Mui, 24 Hours Vancouver



Dentists in B.C. are increasingly prescribing more and stronger types antibiotics — sparking concerns that the pattern could increase superbugs and the risks of diseases spreading.

Dr. Fawziah Marra, with the University of B.C., examined 17 years worth of antibiotic prescriptions in collaboration with the B.C. Centre for Disease Control. Her findings revealed that dentists prescribed 62.2% more antibiotics between 1997 and 2013.

The general thinking in modern medicine recommends reducing the reliance on antibiotics due to the inherent risks of using them too much, she said.

“You’re potentially exposing the patient to adverse effects associated with antibiotics,” Marra said, pointing to C. difficile as one risk.

“Secondly, we have the issue of resistance. We know there’s a direct correlation between the amount of antibiotics we use at the population level and the amount of resistance (in bacteria) we see.”

Physicians and surgeons appear to understand the concerns. Even though they prescribe 87.5% of all antibiotics in B.C., they prescribed 18.2% less antibiotics in 2013 when compared to 1997.

Dentists, for some reason, increased usage instead. Dentists are also the second biggest prescribers of antibiotics, making up 11.3% of all prescriptions.

Marra said the data shows dentists primarily use a strong antibiotic called Amoxicillin, when weaker variants such as Penicillin V might have been just as effective. During those 17 years, the use of Amoxicillan by dentists increased by 143%, while the use of Penicillin V fell by 67%.

Penicillin V, Marra said, is generally used to treat skin and mouth bacteria, which should be sufficient for dental needs.

“Amoxicillin covers the skin and mouth bacteria as well as other bacteria, bacteria which causes urinary tract infections and other hospital-related infections like gastrointestinal, pneumonia,” she said.

“There’s no reason to use a broad spectrum agent. If something narrow can work just as well, why would you want to eliminate all the flora in the patient?”

She doesn’t know exactly why dentists are prescribing so much, but a small survey of dentists suggested that antibiotics may be being prescribed to some of the youngest and oldest patients — specifically, people older 60 receiving dental implants and young people having their wisdom teeth removed.

The other suggestion could be that patients with tight budgets might be choosing antibiotics over more invasive and expensive treatment options.

“They may have an infection, but instead of getting a root canal done by the dentist they end up getting an antibiotic because they don’t have dental coverage,” Marra said.

“We’ve contacted the Canadian Dental Association ... we are hoping to work with them in terms of creating a survey which we hope to send out to all dentists in the fall, to try to identify why they may be prescribing and where we can work with them in terms of changing prescribing habits.”