FGDP(UK) and FDS publish antimicrobial prescribing guidelines for all dentists

The Faculty of General Dental Practice UK (FGDP) and the Faculty of Dental Surgery of the Royal College of Surgeons of England (FDS) have published the third edition of Antimicrobial Prescribing in Dentistry – Good Practice Guidelines.

Developed by an intercollegiate working group led by Dr Nick Palmer FDSRCS(Eng) FFGDP(UK), it updates FGDP’s well-known Antimicrobial Prescribing for General Dental Practitioners guidance to reflect changes in the evidence base since the previous edition, and covers a much wider range of conditions.

Its scope has been extended to include management of oral and dental infections by all prescribers, not only general dental practitioners but those working in secondary dental care (including trainees), specialists (including oral and maxillofacial surgeons), and those involved in dental education and research. Its recommendations are also now appropriate for all dental patients, including adults, children, the elderly and those with special needs treated in the primary and secondary care setting.

Inappropriate prescribing of antimicrobials can exacerbate the problem of antimicrobial resistance, which leads to antibiotics no longer being effective in treating even simple infections. There are serious consequences for everyone, but particularly those undergoing major surgery, chemotherapy, organ or stem cell transplants. Every year, 25,000 people across Europe, and 700,000 worldwide, die from antibiotic-resistant infections, and the UK government predicts the annual global toll could be 10 million by 2050.

Prudent prescribing of antimicrobials can slow down the further development of antimicrobial resistance, and all healthcare prescribers play a vital role. Dentists prescribe an estimated 10% of all oral antimicrobials prescribed in England, and are required by legislation to ensure appropriate use of antimicrobials.

Published following consultation with a range of specialist societies and national dental organisations, Antimicrobial Prescribing in Dentistry – Good Practice Guidelines offers clear guidance on when to prescribe antimicrobials, what to prescribe, for how long and at what dosage.

It is available free of charge in PDF format at https://www.fgdp.org.uk/guidance-standards and https://www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines, and print copies can be purchased at https://www.fgdp.org.uk/shop.

Dr Nick Palmer, Editor of Antimicrobial Prescribing in Dentistry – Good Practice Guidelines, said: “Antimicrobials can be an important adjunctive therapy in treating oral infection, but side effects, potential adverse reactions and the growing threat of antimicrobial resistance mean they should be prescribed judiciously. On behalf of the guideline development group, I hope dentists in all settings will find Antimicrobial Prescribing in Dentistry a useful aid to appropriate prescribing in their everyday practice.”

He has also written a blog about the threat of antimicrobial resistance, and how the new guidance can help dentists slow its growth: AMR: a greater threat to public health than COVID.

Ian Mills, Dean of FGDP(UK), commented: “For 20 years, FGDP’s guidance on the prescribing of antimicrobials has helped GDPs raise standards of care, and the new edition will undoubtedly continue to be a key reference document for the dental team. I’d like to thank Dr Nick Palmer and his colleagues for their tireless dedication in producing it, and our colleagues at the FDS for their collaboration in extending the publication to deliver guidance for the dental profession as a whole.”

Matthew Garrett, Dean of the FDS, added: “The FDS has worked assiduously in recent years to highlight the importance of antimicrobial stewardship, and Antimicrobial Prescribing in Dentistry is an important resource to support all dentists to prescribe responsibly. The new guidance is a great example of the breadth and depth of expertise that we can bring to bear for the benefit of dental patients, and I thank all those involved in its development.”

To mark the publication of Antimicrobial Prescribing in Dentistry, the FGDP(UK) is distributing print copies to all its members in January, and new members who join before 31 January 2021 will be sent a copy with their welcome pack. Non-members can buy print copies at www.fgdp.org.uk/shop, and until 31 March 2021 FGDP is offering a 30% discount when buying its complete set of print guidance publications, which also includes Standards in DentistryClinical Examination and Record-KeepingSelection Criteria for Dental RadiographyGuidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment and Dementia-Friendly Dentistry.

Oral health inequalities a major issue in reducing extractions, says BFS

Targeted Community Water Fluoridation (CWF) should be included in any programme to drive down the unacceptable level of dental decay in children, says  The British Fluoridation Society in a response to the Faculty of Dental Surgery at the Royal College of Surgeons of England (FDS RCSEng).

While supporting the call from FDS (in a press release issued 23/09/20) for the roll-out of supervised tooth brushing schemes in early years settings and for a renewed commitment to sugar taxes, BFS spokesperson Ray Lowry highlighted  the important role of water fluoridation.

He said: “Water fluoridation requires no behaviour change and the evidence (1) shows that it is highly effective in reducing dental decay and delivers the most benefit to the most deprived. Let us not forget that the oral health of children in England generally is improving at the same time as worsening among those living in areas of high need.  Work to reduce decay among the most deprived is ongoing and needs to be multi-faceted.”

Dr Lowry added: “Uncertainty over public health is a worry following the disbandment of Public Health England (PHE) but their work continues to inspire and inform. For instance, their guidance on water fluoridation for local authorities and water monitoring reports (2,3).”

“Following on from its excellent green paper on prevention (4), we would like to see the Government rolling back the cuts it has made to local authorities who have responsibility for public health and allow them to invest in areas of highest need. ”

References:

1)   https://academic.oup.com/ije/article-abstract/49/3/908/5826797

2)   https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2018

3)   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/774128/Fluoridation_Toolkit_-_Publications_gateway_version_20160304.pdf

4)   https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

Faculty of Dental Surgeons publishes guidance on prioritising patients

As practices begin to reopen, the Faculty of Dental Surgeons (FDS) has published guidance on prioritising patients. The prioritisation guidance was coordinated by a short term working group which included representatives from the Association of Dental Hospitals, Specialist Associations and Societies, the Faculty of General Dental Practice (UK) and the Faculty of Dental Surgery, Royal College of Surgeons of England. 

Commenting on the guidance, Professor Michael Escudier, Dean of the Faculty of Dental Surgeons at the Royal College of Surgeons of England, said: “Dental practices are restarting services, and difficult decisions will need to be made about how patients are prioritised. Understandably there will be patients desperate to finish the treatment plan they started before Covid-19 hit, but ultimately a patient who is in excruciating pain needs to be prioritised over a planned root canal or filling. They will also need to manage patient expectations, particularly as there will be a huge backlog of patients, yet fewer patients will be able to be treated in the same time-frame before the outbreak.

“FDS, in collaboration with a range of stakeholders, has published prioritisation guidance intended to assist oral health care professionals in triaging and managing patients as we transition to recovery. This should be used in conjunction with national guidance relating to good practice and infection prevention and control. National guidance is available online for EnglandScotlandWales and Northern Ireland. It will likely be some months before services return to providing care in a similar manner to that seen before lockdown, and the pace is dependent on a continuing decline in Covid infections.”