Antibiotic Aftershocks

This is part 2 in a three-part series on potential harms from taking antibiotics for dental procedures. Part 1 was published yesterday. Part 3 will publish tomorrow. All will be available here.

About once a week, Erinne Kennedy, DMD, MPH, treats patients with complex dental infections who need antibiotics.

She writes these prescriptions with care, because she knows the harm they can cause. In 2015, Kennedy’s grandmother suffered multiple infections with a superbug called Clostridioides difficile, also known as C difficile or C diff, which is associated with antibiotic use.

Watching her grandmother battle the infection, which kills nearly 30,000 people in the United States each year, “was really devastating,” said Kennedy, assistant dean for curriculum and integrated learning at Kansas City University College of Dental Medicine in Missouri. 

“I was able to see the impact of antibiotics on her quality of life,” said Kennedy, whose grandmother passed away later that year from causes unrelated to C diff. “I remember thinking, ‘We need to do this differently, not just for her, but for everyone.’”

Doctors and dentists have been aware of the risks of inappropriately prescribing antibiotics for decades. In addition to causing C difficile infections, overuse of antibiotics increases the risk of antimicrobial resistance (AMR), which occurs when bacteria evolve to become difficult or impossible to kill. AMR contributes to an estimated 5 million deaths worldwide each year.

Although doctors are prescribing fewer antibiotics, a CIDRAP News investigation has found that dental antibiotic use has remained stubbornly high for years. In a three-part series this week, CIDRAP News is investigating why overuse of antibiotics remains common in dentistry, as well as steps that policy makers and consumers can take to reduce the risk of harm. 

Like the opioid epidemic, antimicrobial resistance has been fueled by legal prescriptions from well-meaning health care providers, including dentists. Tackling the problem requires a broad-based effort, said Kennedy, a board member of the nonprofit Association for Dental Safety (ADS) who leads the group's efforts to prescribe antibiotics more judiciously, a practice known as antibiotic stewardship. 

Dentists, professional societies, state boards of dentistry, and patients all need to play a role, she said. With enough will, the strategies that led health care providers to prescribe fewer addictive painkillers have the potential to transform how dentists use antibiotics.

“Antibiotic resistance impacts us all,” Kennedy said. “The problem is so great that we’re all called to action.”

Dentists responded to the opioid epidemic by changing the way they prescribe. A study published in 2021 found that dental prescriptions for opioid pain medications dropped by 20% from 2012 to 2017. 

“We learned that a simple, five-day course of Vicodin could lead to a lifelong addiction,” said Debra Goff, PharmD, a professor of pharmacy practice at The Ohio State University College of Pharmacy, referring to the powerful opioid painkiller once commonly prescribed by dentists. “We have unlearned a bad habit.”

Dentists didn’t change their opioid prescribing practices alone.

All 50 states passed laws limiting opioid prescribing. Many restricted initial opioid prescriptions to a maximum of seven days, in an effort to reduce the risk of addiction. States also created prescription drug monitoring programs (PDMPs), electronic databases that track controlled substance prescriptions. Clinicians can use the database to learn whether patients have filled multiple opioid prescriptions, a potential red flag.