Key Points
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Details the importance of appropriate management of patients attending emergency out of hours clinics.
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Highlights the continued inappropriate use of antibiotics for treating certain conditions.
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Demonstrates that there exists a poor understanding of clinical and best practice guidelines among some clinicians with respect to the examination and management of emergency patients.
Abstract
Aim To investigate the clinical management of patients attending for emergency dental treatment.
Design A retrospective analysis of clinical record cards.
Method Information was collected from patient record cards concerning the patient's reason for attendance and their management at an emergency dental clinic in South Sefton, Liverpool.
Results Over a nine month period, 1,718 patients attended the clinic; 1,472 record cards were analysed. Over 80% of the patients attending the out of hours (OOH) clinic had pain associated with a localised dental infection or dental abscess. Where a diagnosis was recorded, only 67% of patients received appropriate treatment. Over 50% of patients received antibiotics alone with no other definitive treatment provided. The principal antibiotic prescribed for both adult and child patients was amoxicillin.
Conclusion The current study has highlighted that GDPs working within the OOH services are not adhering to current clinical and best practice guidelines with respect to patient examination, diagnosis, management, in particular the correct prescribing of antibiotics for dental infections, and clinical record keeping.
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References
Departmentof Health. Commissioning of out of hours services and urgent treatment. London: Department of Health, 2006. Gateway reference 6990, Factsheet 7b.
The National Health Service (General Dental Services Contracts) Regulations 2005. London: The Stationery Office, 2005. Statutory Instrument 2005 No. 3361.
Palmer N O . Clinical audit of emergency out-of-hours service in general practice in Sefton. Primary Dent Care 1996; 3: 65–67.
Thomas D W, Satterthwaite J, Absi E G, Lewis M A, Shepherd J P . Antibiotic prescription for acute dental conditions in the primary care setting. Br Dent J 1996; 181: 401–404.
Dailey Y M, Martin M V . Are antibiotics being used appropriately for emergency dental treatment? Br Dent J 2001; 191: 391–393.
Standing Medical Advisory Committee. The path of least resistance. London: Department of Health, 1998.
Department of Health Statistical Division. Dental practitioner prescribing - antimicrobials, 2005. Prescription cost analysis system. London: Department of Health, 2005.
Topping G V . Out-of-hours emergency dental services - evaluation of the first year of a pilot project in Fife. Br Dent J 2005; 198: 193–197.
Portman-Lewis S. An analysis of the out-of-hours demand and treatment provided by a general dental practice rota over a five-year period. Primary Dent Care 2007; 14: 98–104.
Anderson R, Thomas D W, Phillips C J . The effectiveness of out-of-hours dental services: I. Pain relief and oral health outcome. Br Dent J 2005; 198: 91–97
Anderson R, Thomas D W, Phillips C J . The effectiveness of out-of-hours dental services: II. Patient satisfaction. Br Dent J 2005; 198: 151–156.
Anderson R . Patient expectations of emergency dental services: a qualitative interview study. Br Dent J 2004; 197: 331–334.
Burke F J, McCord J F, Cheung S W . The provision of emergency dental care by general dental practitioners in an urban area. Dent Update 1994; 21: 184–186.
Department of Health. Commissioning primary dental care services: meeting the NHS operating framework objectives. London: Department of Health, 2008. Gateway Reference 8903.
Huovinen P, Cars O . Control of antimicrobial resistance: time for action. The essentials of control are already well known. BMJ 1998; 317: 613–614.
Anon. Monitoring and management of bacterial resistance to antimicrobial agents: a World Health Organization symposium. Geneva, Switzerland, 29 November-2 December, 1995. Clin Infect Dis 1997; 24 (Suppl 1): S1–S176.
Faculty of General Dental Practice (UK). Clinical examination and record keeping: good practice guidelines. London: FGDP(UK), 2001.
Anderson R, Thomas D W . 'Toothache stories': a qualitative investigation of why and how people seek emergency dental care. Community Dent Health 2003; 20: 106–111.
Matthews R, Scully C, Porter K, Griffiths M . An analysis of conditions presenting to a dental hospital emergency clinic. Health Trends 1992; 24: 126–128.
Nagle D, Reader A, Beck M, Weaver J . Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 636–640.
Keenan J V, Farman A G, Fedorowicz Z, Newton J T . Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2005; 2: CD004969.
McDougal R A, Delano E O, Caplan D, Sigurdsson A, Trope M . Success of an alternative for interim management of irreversible pulpitis. J Am Dent Assoc 2004; 135: 1707–1712.
Faculty of General Dental Practice (UK). Adult antimicrobial prescribing in primary dental care for general dental practitioners. London: FGDP(UK), 2000.
Faculty of Dental Surgery. National clinical guidelines. London: Faculty of Dental Surgery of the Royal College of Surgeons of England, 1997.
Eaton K (ed). Standards in dentistry. London: FGDP(UK), 2006.
Canadian Collaboration on Clinical Practice Guidelines in Dentistry. Clinical practice guideline on emergency management of acute apical periodontitis in adults. Canadian Collaboration on Clinical Practice Guidelines in Dentistry, 2002. http://www.cda-adc.ca/_files/dental_profession/practising/Â clinical_practice_guidelines/FULL_VERSION.pdf
Palmer N A, Pealing R, Ireland R S, Martin M V . A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000; 188: 554–558.
Palmer N A, Dailey Y M, Martin M V . Can audit improve antibiotic prescribing in general dental practice? Br Dent J 2001; 191: 253–255.
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Tulip, D., Palmer, N. A retrospective investigation of the clinical management of patients attending an out of hours dental clinic in Merseyside under the new NHS dental contract. Br Dent J 205, 659–664 (2008). https://doi.org/10.1038/sj.bdj.2008.1044
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DOI: https://doi.org/10.1038/sj.bdj.2008.1044
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