Overview of drug use in dental practice
In dental practice, drugs are usually an adjunct to dental treatment. Appropriate dental treatment can minimise or avoid the need for drugs (eg dental treatment of a localised odontogenic infection usually avoids the need for antibiotics). The use of drugs can often be deferred until the response to dental treatment has been reviewed. If drugs are necessary, they are more likely to be effective if the cause of the disease has been addressed and dental treatment has been provided. Drug choice is based on efficacy, safety, suitability (eg adherence issues, patient comorbidities, drug formulation), and cost.
Inappropriate prescribing can lead to ineffective and unsafe treatment, exacerbate or prolong illness, distress or harm the patient, be costly, and, for antimicrobials, contribute to antimicrobial resistance in the wider community. In Australia, medication-related problems cause approximately 250 000 hospital admissions annually, and up to 400 000 presentations to emergency departments annually1 . This does not include adverse medication events for which the patient does not present to hospital. Many adverse medication events can be prevented by taking a detailed history and prescribing rationally.
Patients often attend a dental appointment with an expectation of a particular treatment (eg analgesics, antibiotics), which may have been influenced by advertising, unrealistic expectations or drug dependence. Always consider alternatives to drug treatment and involve the patient in treatment decisions. Patients are more likely to choose conservative treatment strategies when a shared decision-making approach is adopted.
Consider the likely benefits and potential harms of drug therapy. If drug therapy is appropriate, choose an evidence-based treatment for the condition, with consideration of individual patient factors. Evaluate drug information to determine the therapeutic value; new and expensive drugs should be critically evaluated in comparison to established treatments.