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Prescribing Habits in Implant Dentistry: A Pilot Survey
Alaa Aldaadaa1,2,3 & Sami Stagnell 3,4,5
1 Division of Maxillofacial Diagnostic, Medicine & Surgical Sciences, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London WC1X 8LD •
2 Division of Biomaterials & Tissue Engineering, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London WC1X 8LD •
3 SmileKind Specialist Dental Centre, Bournemouth BH1 4LH •
4 Department of Oral & Maxillofacial Surgery, CareUK Royal Southampton NHS Treatment Centre, Southampton SO14 0YG •
5 Clinical entrepreneurship, NHS England
Aspects investigated in the questionnaire:
1- The country of undergraduate training (UK, Europe, Overseas).
2- Number of years post-graduation.
3- Number of years involving in implant dentistry.
4- Area of specialism (Specialist -OS/Perio/Prostho, DwSI, GDP).
5- Type of implant training (Masters, PGDip, PGCer, Short course).
6- The complexity of dental implant treatments offered.
7- Number of Implant placements per year.
8- The place of work (General practice, Specialist practice, Hospital).
9- Prescribing habits pre-operatively.
10- Prescribing habits post-operatively.
11- Number of days of the antibiotic course of choice.
12- Number of days of the analgesics course of choice.
13- Guidance to support prescribing habits.
Objectives:
In recent years, the threat of antimicrobial resistance has developed an
increasing presence in healthcare. Although dentistry makes up a small
percentage of the bigger picture, in the US it accounts for 10%or antibiotic
prescriptions and this is reflected in Europe too.
As it stands there is little in the way for guidance and evidence around
antibiotic (AB) use in implants and what current practice looks like.
Methods:
Two independent dental societies with a focus on implant dentistry were
contacted in 2017 and an electronic survey was circulated to members
through mailing lists in order to assess behaviours in prescribing habits
around implant dentistry: data was collected over 3 months.
Results:
39 clinicians responded the majority having been involved in implants for
1-5 years (28%) with 41% placing over 100 implants a year.
Pre-operatively, 75% prescribe amoxicillin and 76%ibuprofen for single
implants with a similar pattern for more complex work.With complex work
an increase in the use of dexamethasone was seen and chlorhexidine was
used routinely for most practitioners.
Post-operatively, chlorhexidine/amoxicillin and ibuprofen were most
commonly used. Average post op prescriptions lasted 7 days.
72% cited instruction from courses as their source of evidence and only
33% references Cochrane review.
Conclusion:
With implant dentistry growing in popularity as ameans for the
replacement of missing teeth, there is agrowing need for guidance to
support regular practice to ensure that implantology is supported with an
appropriate evidence base for developing safe prescribing habits.
Industry/company
lead
Short (Weekend)
course
PGCert PGDip MSc/MClinDent Specialty training Independent
courses (multiple
contact days)
Mentoring
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Type of Training in Implant Dentistry
Training Regularly Practice
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Routine Procedures Performed in Implant Dentistry
Implant placement (e.g. single/simple)
Implant placement (e.g. multiple/complex)
Implant placement (e.g. Full arch/advanced)
Restorative only
Sinus lifting
Bone grafting xenografting
Bone grafting autogenous/other
General Practice Referral practice Hospital
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00% Working Environment
Nothing
No antibiotics
Paracetamol
Ibuprofen
Co-codamol
Codeine
Tramadol
Dexamethasone
Amoxicillin
Erythromycin
Metronidazole
Chlorhexidine
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Prescribing Habits pre-operatively
Single implant
Multiple implant
Full arch
rehabilitation
Xenografting
Allografting
Autografting
Sinus lifting
Nothing
No antibiotics
Ibuprofen
Paracetamol
Co-codamol
Codeine
Tramadol
Dexamethasone
Amoxicillin
Erythromycin
Metronidazole
Chlorhexidine
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Prescribing Habits post-operatively
Single implant
Multiple implant
Full arch
rehabilitation
Xenografting
Allografting
Autografting
Sinus lifting
Personal choice Local/regional
preference
Instruction from
training
Discussion at study
group
Academic paper Cochrane guidance Other (please specify)
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Guidance Used to Support Prescribing Habits
1 day 2 days 3 days 4 days 5 days 6 days 7 days 8 days 9 days 10 days 11 days 12 days 13 days 14 days 15 days +
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00% Number of Days of the Antibiotic Course of Choice
UG Dental Training
UK dental school
European dental school
Other international dental school