Title
A description of the management of dental pulpal and apical pathologies in primary care, use of antibiotics and the influences on prescribing behaviours for these conditions.

Lead Researcher
Professor Ivor Chestnutt, School of Dentistry, Cardiff University

Research question
What factors affect the engagement of community pharmacists in Wales with the spontaneous reporting scheme for adverse drug reactions (ADRs) i.e. the ‘yellow card scheme’?

Aim
  1. To comprehensively describe the management of adult patients who present to a general dental practitioner (GDP) with pulpitis, periapical periodontitis and dental abscesses. The description will specifically focus on the use of systemic antibiotics to treat these conditions.
  2. To describe the influences on the management of pulpitis, apical periodontitis and dental abscesses by GDPs. In particular, the factors influencing the decision to prescribe a systemic antibiotic for these conditions.
  3. To understand the attitudes of general medical practitioners (GMPs) towards the management of dental problems in general practice and influences on their antibiotic prescribing habits for these conditions.
Background
In a recent survey 28% of the Welsh population reported suffering acute dental pain in the preceding year. A large proportion of these patients will be suffering from pulpitis, apical periodontitis or a dental abscess. Treating these patients requires a substantial proportion of the NHS dental budget, detracting from routine scheduled care. Furthermore, a substantial number of patients seek treatment for dental problems from their GMP, distributing the burden across other divisions of the health service.

National guidelines state that primary treatment of the aforementioned conditions should be surgical intervention. Research demonstrates that antibiotics are of little or no benefit in the majority of these conditions. Despite this, there is reported to be widespread use of antibiotics in the emergency dental service, often in the absence of an operative intervention.

There is international concern about the overuse of antibiotics and the emergence of antibiotic resistant bacteria. Inappropriate use of antibiotics not only drives resistance and misuses resources, it increases the risk of potentially fatal anaphylactic reactions and exposes patients to unnecessary side effects. It is therefore of significant concern that antibiotics may be being widely and indiscriminately used to treat dental conditions where they may be of little or no benefit.

Study design summary

Phase one is an observational study of the prescribing habits of GDPs (both private and NHS). The target population are dentists working in general dental practice providing care to adult patients with pulpitis, apical periodontitis, or dental abscesses.
The second phase of the study takes the form of 30 minute semi-structured telephone interviews with approximately 20 GDPs from phase one.
The third phase involves 30 minute semi-structured telephone interviews with approximately 20 GMPs.

Total awarded
£8,400