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We need to reduce dental consultations in GP surgeries and pharmacies

The paper by Cope et al. (Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study, Br J Gen Pract 2016) is a timely update on dental consultations in general practice and related antibiotic prescribing rates by GPs. It would be most helpful if the data presented in this paper could be complemented by data on the management by emergency medical services and pharmacists of people with dental problems.

In the meantime, the findings by Cope et al. debunk the myth that changes to NHS dental services provisions in 2006 resulted in an increase in dental consultations in general practice. In contrast, the conclusions by Cope et al. reinforce concerns over the inappropriate prescribing of antibiotics by GPs for dental conditions. Access to dental services Monday to Friday should be possible, so the finding that the vast majority of the dental consultations in general practice occurred on weekdays may be explained by drivers, such as concerns over cost or phobia of dental treatment.

Although inappropriate prescribing is multifactorial and difficult to resolve, it should be addressed in the best interests of patients and as a positive measure to optimise the prescription of antibiotics. Pharmacists may assist in this process by, among other measures, encouraging people who present with dental conditions to seek dental rather than medical assistance. Clear and consistent messages are also important for managing patient expectations: ‘antibiotics don’t cure dental pain’ is increasingly a mantra within dentistry.

Considerable resources are spent each year on oral and dental products and aids. More interprofessional working between pharmacy and dental teams will help focus this spending on improved clinical outcomes in the management of dental conditions, much needed oral health gains and, in turn, enhanced general health and well-being. General measures may include interprofessional dental education and combined healthcare action to encourage greater uptake of dental services by, in particular, individuals who have a fear of dentists and dental procedures.

Concurrently, future contractual and commissioning arrangements for dental services should empower dental teams to encourage patients with dental problems to seek their services rather than those of GPs and pharmacists. The shift to such arrangements, which will involve behavioural change by both healthcare professionals and patients, will take time. In the interim, it is to be hoped that GPs will act on the conclusions of Cope et al, together with the messages included in a soon to be published editorial in the British Journal of General Practice (Renton T & Wilson NHF. Understanding and managing dental and orofacial pain in general practice. In press). It is time that dental services are fully integrated into the general healthcare system, and patients are better educated about state-of-the-art dental care. Through joined-up working, there will be an opportunity to make dental consultations with GPs and pharmacists rare events, if not a thing of the past.

Nairn H F Wilson

Professor of dentistry

King’s College London Dental Institute 

Wendy Thompson

General dental practitioner PhD student

University of Leeds


Citation: Clinical Pharmacist DOI: 10.1211/CP.2016.20201054

Readers' comments (2)

  • Have I done the correct thing in your opinion, in the following scenario just presented to me this week? Amoxicillin 500mg tds 7days post an uncomplicated adjustment with "drilling,to refit 'pegs' in the gum to support a currently used partial denture" (obviously I am unable to give the precise nature of the procedure, as I report what the patient told me).

    He presented immediately after the procedure, with no pain and no bleeding, and no complicated dental history, and no other meds are routinely taken.

    I asked if he would be happy for me to treat the script as a delayed rx, holding onto it in our pharmacy for a week or two. I asked him to collect the rx and take the full 1week course of treatment only if he developed quite a lot of pain and swelling, but that in that case first come and talk to us or telephone us again, and or contact the dentist again.

    I ensured he had paracetamol, in case of any pain. (not ibuprofen as he was in his 60s-70s, and I prefer paracetamol for this age group).

    Of some relevance could have been that it was a Friday afternoon - however we are open on Saturday, and town centre pharmacies are open on Sundays, as is the NHS Walk in - and weekend dental provision is available in our county.

    Would this have been your suggestion? Should we perhaps have been brave enough to phone to the dentist, to explain that we questioned their rx?

    I assume this could be a good learning exercise for students?

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  • Sorry for the very delayed response on this. My advice to you would have been to call the dentist and to check whether antibiotics were indicated. From what the patient describes, it doesn't sound like they were. The indications for dental antibiotics are an infection with an associated swelling spreading towards the eye or throat. To me it sounds like the patient had had a routine procedure and was seeking prophylaxis, which may well have already been refused by the dentist.

    If you do get someone in with a dental infection which you can see as being swollen without looking inside of the mouth - and with pyrexia, you might find the PHE guidance useful to work out how to treat: There is a section on dental infections.

    Please note however that toothache is very often not caused by an infection but rather by an inflammation, in which case analgesics rather than antibiotics are indicated. The National Medicines Information Service dental team suggest 1g paracetamol and up to 600mg ibuprofen (prescription only dose) QDS taken together at meal times to manage toothache until the patient can see a dentist.

    Hope you find this useful.

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