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
General dental practitioner PhD student
University of Leeds