Dental Antibiotics and C diff

The Center for Infectious Disease Research and Policy (CIDRAP) is raising the alarm about antibiotics prescribed by dentists and a possible connection to rising cases of Clostridium difficile. Researchers from the Minnesota Department of Health (MDH) conducted a study and found that 15% of the patients diagnosed with community-associated C difficile infection (CA CDI) between 2009 and 2015 had been prescribed antibiotics for a dental procedure.

CDI causes inflammation of the colon and severe, sometimes deadly diarrhea. It most frequently occurs in older patients who are taking antibiotics for other infections. The antibiotics disrupt the normal gut flora, wiping out both good and bad bacteria and allowing C difficile, a common environmental bacterium, to flourish in the intestinal tract.

In the study, the MDH researchers, interviewed 1,626 people from five Minnesota counties. Over half of them had been prescribed an antibiotic, and 15% of those prescriptions were for a dental procedure. Further, 136 had no mention of antibiotics in their medical chart. That finding highlights a disconnect between dental care and medical care. Dentist may not give patients enough information about potential side effects and patients don’t inform their medical doctors about what they’ve been prescribed for dental care. The situation presents an opportunity to educate patients, dentists and medical providers and encourage communication among all the members of patient’s healthcare team.

Inappropriate antibiotic use in dentistry

The authors of the study question how many of the prescriptions were necessary. Lead author and MDH epidemiologist Stacy Holzbauer, DVM, MPH told reporters, “Many of these prescriptions may not be meeting current prescribing guidelines. All prescribers, including dentists, should examine prescribing behavior for appropriateness.”

Dentists prescribe antibiotics to treat oral infections caused by tooth abscesses, and they also prescribe them prophylactically to prevent infections in patients with heart conditions and artificial joints. However, updated guidelines from the American Heart Association and American Dental Association (ADA) recommend prophylactic antibiotics only in a small number of patients with heart conditions, and not at all in patients with artificial joints. Antibiotics aren’t warranted for a tooth abscess in healthy individuals unless there are signs of systemic infection.

This is another area where further education and outreach is warranted. “Dentists need to be included in antibiotic stewardship programs,” Holzbauer said. “They’ve often been overlooked, and it’s absolutely critical that they are included to improve prescribing.”

For more on this see: