New guideline on the prudent prescription of antibiotics by dentists

date: 20/11/2020

Belgium remains one of the largest prescribers of antibiotics in Europe for outpatient care. Approximately 6 % of these antibiotics are prescribed by dentists. The Belgian Health Care Knowledge Centre (KCE) developed an evidence-based guideline for dentists, based on scientific evidence to encourage them to prescribe these medicinal products more rationally. This guideline is the result of a cooperation between field practitioners and academics.

The guideline contains recommendations for the (non-)use of antibiotics in a number of common situations in dental practices. For infections of the oral cavity, for instance, the best way to treat the cause of the infection is a dental treatment. Antibiotics are rarely necessary.

When should the dentist prescribe antibiotics? 
Antibiotics are regularly prescribed in dental practices, for example in cases of toothache, abscess, tooth replacement after a trauma, periodontitis or tooth extraction. KCE researchers sought to determine whether antibiotics add real value in these and other situations.

The guideline states that in the case of an infection of the oral cavity – just as infections elsewhere in the body - the cause of the problem must be treated with an appropriate dental treatment (e.g. tooth denervation), after which antibiotics are rarely necessary. In fact, antibiotics are rarely recommended in these situations. They should be considered only when an infection seems to spread (swollen face or lymph nodes, fever, discomfort ... ). It is however recommended that a single dose of antibiotics is administered before dental implantology. The same applies to invasive dental procedures for people at risk of heart infection (endocarditis). It is not necessary to administer antibiotics before a dental procedure to people with knee or hip prosthesis.

The guideline is also intended for general practitioners who receive patients with dental problems. In such cases, it is important that they refer the patients to a dentist so that a correct diagnosis can be made and an appropriate dental treatment can be started.

Pharmacists should be able to supply exact number of tablets
Antibiotics on the Belgian market are often packaged in boxes that are too large for a single treatment. As a result, people accumulate leftover antibiotics in their medicine cabinet, thereby increasing the risk of self-medication. Moreover, these leftovers risk polluting the environment if thrown in the bin. The KCE therefore reiterates its recommendation to allow pharmacists to supply no more than the exact number of antibiotic tablets needed. The FAMHP will examine the feasibility of doing so in the future.

More information
Belgian Health Care Knowledge Centre
European Antibiotic Awareness Day

Last updated on 30/11/2020