Dental Procedure Antibiotics Link to Clostridium difficile

Many times dentists are not aware that complications can develop from antibiotic use.

Antibiotics prescribed by dentists may contribute to Clostridium difficile (C. diff) infections, suggests new research from the Minnesota Department of Health (MDH).

The MDH tracked community-associated C. diff infections in 5 counties of Minnesota, and throughout the 6-year period, determined 15% of those infected were prescribed antibiotics for dental procedures. One-third of the patients’ medical charts however, included no mention of receiving dental procedure-related antibiotics.

“Dentists have been overlooked as major partners in programs that promote appropriate antibiotic use,” Stacy Holzbauer, DVM, MPH, Minnesota Department of Health, said. “It’s critical that dentists are included in all efforts to improve antibiotic prescribing.”

MDH researchers interviewed 1,626 people with community-associated C. diff between 2009—2015 and of those, 926 (57%) reported they were prescribed antibiotics and 136 (15%) of those, for dental procedures.

“C. difficile is a known complication that accounts for more than 453,000 cases per year, causing an excess financial burden of more than $1 billion annually,” Holzbauer said. “Dentists need to be included in antibiotic stewardship programs. They’ve often been overlooked and it’s absolutely critical that they are included to improve prescribing across all modalities.”

The study found patients who were prescribed antibiotics for dental procedures tended to be older and more likely to receive clindamycin, an antibiotic associated with C. diff. Of those receiving antibiotics, 35% had no mention of antibiotics listed in medical charts, illustrating the disconnect between dental and medical care.

While the ADA expressed a commitment to and is an active partner in antibiotic stewardship, a 2015 MDH survey of dentists found fewer than half were concerned about adverse drug effects, antibiotic resistance or C. diff as factors influencing prescribing decision, which is likely attributed to the fact that prescribers are unaware when their patients develop C. diff.

“Many times dentists are not aware that complications can develop from antibiotic use. Better communication is needed between patients, dentists and medical providers,” she said.

Another survey previously conducted by MDH, demonstrated that 36% of dentists prescribed antibiotics in situations not recommended by the American Dental Association (ADA) and reported challenges to making appropriate antibiotic prescribing decisions including confusion about or perceived conflicts among prescribing guidelines.

While dentists appropriately prescribe antibiotics in certain situations such as for the treatment of infections stemming from a tooth abscess, some dentists prescribe antibiotics prophylactically before a dental procedure to prevent a heart infection in patients with heart conditions, or to prevent an infection of an artificial joint. The ADA no longer recommends preventive antibiotics in most of the cases.

Current recommendations note the risk of antibiotics is greater than the risk of infection, however inappropriate use of antibiotics helps fuel drug-resistant bacteria.

The study, “Antibiotics For Dental Procedures Linked to Superbug Infection” was made available.

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