Are dentists causing a deadly infection in patients?

Antibiotics are prescribed by dentists for various treatments and the prevention of infection. And the rate of antibiotic prescribing by dentists seems to be increasing, according to a May 2016 study published in the Journal of the American Dental Association.

But what happens when, rather than preventing infections, those antibiotics end up causing infections in patients? According to research presented at IDWeek 2017 in San Diego, antibiotics prescribed by dentists may be contributing to a serious and potentially deadly infection.

According to the study, Clostridium difficile infections (C.diff) are the leading cause of health care-associated diarrhea. Two of the greatest risk factors for C.diff infections are antibiotic use and health care exposure.

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The Minnesota Department of Health tracked community-associated C.diff infections in five counties in the state. From 2009 to 2015, 2,176 presumptive community-associated C.diff infection cases were reported to the health department. Of the 1,626 infection cases that were confirmed and interviewed, 926 (57 percent) were prescribed antibiotics and 136 (15 percent) were prescribed antibiotics for dental procedures. The health department also discovered that 46 cases (34 percent) reported being prescribed antibiotics that weren’t documented in their medical records.

Stacy Holzbauer, DVM, MPH, lead author of the study and career epidemiology field officer for the Minnesota Department of Health, explains that the health department, which is part of the CDC Emerging Infections Program, collects data to measure the burden of C.diff infections in the population, characterize different strains associated with the disease and monitor trends in the disease over time.

“In Minnesota, the majority of C. diff infections occur outside the hospital and are driven by antibiotic use in community or outpatient settings,” Holzbauer says. “In addition to reviewing outpatient and hospital medical records of cases reported to the health department, we interview patients with C. diff who were not hospitalized or had an overnight stay in a nursing home prior to their infection (community-associated C. diff cases) to identify potential risks for developing C. diff infection, including identifying antibiotics received outside of routine healthcare settings.

“During routine collection of surveillance data of community-associated C. diff cases, we noticed that patients were consistently reporting in interviews taking antibiotics for dental reasons,” she continues. “In our summary of six years of surveillance data, upper respiratory infections were the most common indication for antibiotics in CA-CDI cases, followed by dental procedures.”

The Minnesota Department of Health concluded that dental antibiotic prescribing rates are likely underestimated and recommended that stewardship programs should address dental prescribing and alert dentists to C.diff infections subsequent to antibiotics prescribed for dental procedures.

This isn’t the first time antibiotics have been put under a microscope. In 2015, researches in Shangai looked for a solution to deal with antibiotic resistance when treating dental disease. They discovered that a material called graphene oxide can help to eliminate antibiotic-resistant bacteria in the mouth. They concluded that the material could have practical applications in dental care.

Holzbauer says that dentists aren’t always aware of the complications that develop from antibiotic use, and that better communication is needed between patients, dentists and medical providers.

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“Because our knowledge of best antibiotic use practices continues to evolve, dentists should routinely review and incorporate available guidelines into their daily clinical practice and seek continuing education on proper treatment and management of oral infections,” she says. “Guidelines from the ADA, the American Academy of Pediatric Dentistry and the American Association of Endodontists exist to help dentists make informed decisions on antibiotic prescribing.

“Dentists have often been overlooked as major partners in programs that promote appropriate antibiotic use, and it is critical dentists are included in efforts to improve antibiotic prescribing,” Holzbauer continues. “All prescribers, including dentists, should examine prescribing behaviors for appropriateness.”

The full study, titled “Antibiotic Prescribing for Dental Procedures in Community-Associated Clostridium difficile cases, Minnesota, 2009–2015,” appeared in Open Forum Infectious Diseases.