Pathway Project Title
Understanding the Use of Antibiotics for Primary Care Dental Problems (APICAL).

Prof Christopher Butler, Prof Ivor Chestnutt, Dr Fiona Wood, Dr Nick Francis.

Start date
October 2011

PhD Funder
President's Research Scholarship

The aims of this project:

  • What are the factors that influence the use of antibiotics in Primary Dental Care?
  • What are the issues surrounding antibiotic prescribing for dental problems by general medical practitioners?
  • What would dentists find acceptable as an educational tool to facilitate an evidence-based approach to decisions on prescribing?

Antibiotics are used in dentistry for two principle purposes: (i) to manage acute infections, and (ii) in the prophylaxis of infection, either local or systemic. Antibiotics are largely ineffective for acute dental problems related to the dental pulp, and often dental infections are more effectively treated by surgical means. NICE has recommended a paradigm shift away from routine prophylaxis for the avoidance of invective endocarditis in patients undergoing dental procedures. A review of antibiotic resistance in general dental practice concluded; “that better use of diagnostic services, surveillance and improvements in dental education were required now, to lessen the impact of antibiotic resistance in the future”.

Dental prescribing accounts for 9% of total antibiotic prescribing in primary care in Wales, and 67% of all dental prescriptions are for antibiotics. While the factors influencing antibiotic prescribing for infections in general medical practice have been extensively investigated, the decision making process leading to the use of antibiotics in dentistry is not well understood.

To obtain an overall understanding for antibiotic prescribing for dental problems we will also investigate the issues of antibiotic prescribing for dental problems by general medical practitioners.

Key themes of the Wales School for Primary Care Research (WSPCR) include the use of antibiotics and management of infections, and health communication and behaviour change in primary care. This builds on extensive, internationally recognised expertise within the WSPCR Board. This proposal represents the opportunity to extend these themes from general medical practice to dental practice. It also provides a valuable mechanism to initiate the development of dental practice based primary care research in Wales.