Patients need procedures not prescriptions!

Dr Wendy Thompson, a dentist at {my}dentist and a leading authority on antibiotic resistance, discusses the changes that need to be made – inside and outside the dental practice – to curb overprescribing and prevent a future pandemic caused by antibiotic resistant infections.

Just last month (June) the World Health Organisation warned that the increased use of antibiotics being used to fight Covid-19 is strengthening bacterial resistance and will lead to more deaths during and after the pandemic.

Clinicians across the world know all about antibiotic resistance, but during the lock down especially, dentists have been put in a difficult position.

The guidance has been AAA – provide advice, analgesia or antimicrobials. This, and capacity issues in urgent dental centres has resulted in some dentists feeling under pressure to prescribe antibiotics where they wouldn’t have done previously.

But in dealing with one pandemic this way, we could be contributing to another.

Antibiotics are, as the song states ‘wonderful pills, but don’t ever think they can cure all your ills’.

They are life-saving drugs. When people need antibiotics to treat life threatening infections it is vital that antibiotics work.  But increasingly infections are becoming resistant to antibiotics because of repeated use.

From my extensive research into the topic, I believe that instead of simply understanding antibiotic resistance we need to personalise it.

Exposing patients to antibiotics for toothache could be making them (or more accurately their microbiome) resistant to the very antibiotics which they may need to save their lives in the future. Not to mention by disturbing the balance between good and bad bacteria, the antibiotics people take make them less healthy.

This personalisation of the risk of antibiotic resistance is something the public needs to be aware of too.

From the Covid-19 pandemic we’ve all learnt our individual actions can impact not only our own health, but that of our friends and loved ones as well.

People can die from Covid-19. People can also die from an infection that’s resistant to antibiotics – but that’s not a message that’s been openly discussed.

Take for example someone who is being treated for cancer. After chemotherapy their immune system is on its knees and sadly, they often develop infections, such as pneumonia. The more antibiotics they take, the more likely the next infection has become resistant. And when antibiotics don’t work some infections are fatal.

The chances are the loved ones of that patient will believe they passed away because of cancer.

The truth is the person died with cancer and from an infection that was resistance to antibiotics.

That is a powerful message to make people think again before demanding a prescription from their GP or dentist.

It provides us all with a sense of personal jeopardy – that could happen to me, a loved one, my patients.

But, let’s be clear, people can only be prescribed antibiotics if we, as clinicians, reach for our prescription pad.

In normal times, all my research indicates that dentists have no issue saying no to patients if they demand something that is not good for them. We’ve all declined to extract healthy teeth for patients who believe they would prefer straight teeth on a denture or implants.

Dentists know antibiotics can’t stop toothache caused by pulpitis and that patients need procedures, not prescriptions.

But what my research did uncover was that it is often the situation that dictates whether a  prescription gets written or not. And surprisingly for some, it is not just the clinician in which influences that decision.

Here’s a familiar scenario for most busy dental practices.

A patient calls with dental pain and speaks to the practice receptionist hoping to get an emergency appointment. The receptionist can see a fully diary for the day ahead but squeezes in the emergency appointment at the end of the day.

When the patient comes to see the clinician, it is clear that a procedure is needed but because of the time available, the clinician writes a prescription and arranges for the patient to come back for the procedure at another time.

This patient experience could have been so different if the receptionist had felt empowered to manage the day’s bookings and make time earlier for the emergency appointment.

I was speaking at an event about the findings of this research recently and at the back of the hall I could hear a bit of a kerfuffle when I mentioned empowering receptionists. When I asked what was happening I learnt that a practice owner had responded emphatically to their practice manager with, “don’t even think about it!”.

As a lecturer and dentist at {my}dentist I know that receptionists, practice managers and dental nurses know their patients very well. They can look at a diary and make an informed judgement call on whether some patients would be happy or not to have their routine check-up rescheduled to make space for an emergency case.

Lack of access has been something we have all felt in the last few months. But we all know antibiotics aren’t the answer – despite the mixed messages from the urgent dental care system in some areas during the lockdown.

The guidance given to prescribe antibiotics to patients where appropriate, has been misinterpreted/mistranslated in some areas to help manage access issues. Giving antibiotics when they are not required is fraught with danger. Now that we are back able to see and treat patients again, hopefully we can all get back to providing procedures rather than prescriptions for managing acute dental problems.

My career didn’t start in dentistry but instead in microbiology and science policy. I retrained through a graduate entry course at UCLAN in my mid-30s and since then I’ve been fortunate enough to be supported by {my}dentist to research and lecture on antibiotic resistance.

It’s a challenge we need to overcome. But it can only be achieved together. Let’s collectively take responsibility for tackling antibiotic resistance and prevent another pandemic.

Author biography

Dr Wendy Thompson is general dental practitioner with {my}dentist in Kirkby Lonsdale, an academic dentist at University of Manchester, an Honorary Consultant with Office of the Chief Dental Officer (England), a specialist adviser for NICE  and a member of the BNF dental advisory group.

Her PhD research was funded through a prestigious National Institute for Health Research (NIHR) Doctoral Research Fellowship (DRF).

Check out one of the outputs from her PhD: Tales from the Dentist’s Chair – a drama about antibiotics. You can access it from the PHE Dental Antimicrobial Stewardship Toolkit:

Dr Thompson regularly lectures about antibiotic prescribing, resistance and stewardship nationally and internationally.

Leave a Reply

Your email address will not be published.