The Scottish Dental Clinical Effectiveness Programme (SDCEP) develops evidence-based guidance to help dental teams provide high-quality patient care. Its prescribing guidance, in particular, aims to ensure patient safety and promote the effective use of medicines in dentistry. This guidance is built on the principle of using the best available evidence to inform clinical decisions.
Foundational Principles of SDCEP Prescribing
A core concept of the SDCEP guidance is that prescribing medication is an adjunct to, not a replacement for, definitive dental treatment. The guidance emphasizes that a clear diagnosis must be established before any prescription is considered. This involves a thorough patient assessment, including a detailed review of their medical history, current medications, and any known allergies.
The guidance also directs dental prescribers to use the Dental Prescriber’s Formulary (DPF), which is part of the British National Formulary (BNF). The DPF specifies the drugs that dentists can prescribe under the National Health Service (NHS). By adhering to this formulary, dentists ensure they are prescribing within their recognized scope of practice.
Guidance on Antimicrobial Prescribing
A significant focus of the SDCEP guidance is on antimicrobial stewardship, which involves the responsible use of antibiotics to combat the global threat of antimicrobial resistance. The guidance makes it clear that antibiotics should only be prescribed when there is a clinical necessity, such as evidence of a spreading bacterial infection or systemic involvement like fever or cellulitis.
The guidance provides specific examples of common dental conditions where antibiotics are generally not indicated. These include irreversible pulpitis, uncomplicated pericoronitis, and dry socket. For these conditions, local treatment measures are recommended as the primary approach. When an antibiotic is deemed necessary for a typical odontogenic infection, phenoxymethylpenicillin is recommended as the first-line choice due to its narrow spectrum of activity.
For patients who have a penicillin allergy, the guidance offers alternative antibiotic options. The choice of an alternative depends on the nature of the allergy and the clinical situation.
Managing Acute Dental Pain
The SDCEP guidance for managing acute dental pain prioritizes local operative measures as the most effective way to provide relief. Pharmacological interventions are considered a secondary, supportive measure. When medication is needed, the guidance recommends a stepped-care approach, starting with simple analgesics.
The first step on the pharmacological ladder is paracetamol or a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen. These can be used alone or in combination, depending on the severity of the pain. The guidance provides detailed information on appropriate dosages and contraindications for these medications.
The use of opioid analgesics is strongly discouraged in most cases due to the risks of dependence and other adverse effects. Opioids are reserved for situations where other analgesics are ineffective or contraindicated. Even then, they should only be prescribed for a short duration.
Prescribing for Specific Patient Groups
The SDCEP guidance also addresses the need to adapt prescribing practices for specific patient groups who may be more vulnerable to the effects of medication. This includes pregnant or breastfeeding patients, individuals with medical conditions such as renal or hepatic impairment, and the elderly. For these groups, a careful risk assessment is necessary to avoid potential harm.
When prescribing for children, the guidance highlights the importance of calculating doses based on age and weight, rather than simply using a fraction of an adult dose. This ensures that children receive a safe and effective amount of medication. The guidance also provides specific recommendations for patients on anticoagulants, as some medications can interact with these drugs and increase the risk of bleeding.
Utilizing SDCEP Resources for Prescribers
To support dental professionals in implementing its guidance, the SDCEP provides a range of practical resources. The comprehensive “Drug Prescribing for Dentistry” guidance document is available on the SDCEP website and serves as a primary reference for prescribers. This document brings together information from the BNF and BNF for Children (BNFC) in a problem-orientated style.
In addition to the main guidance document, SDCEP has developed the Dental Prescribing website, which replaces the former mobile app. This online resource provides quick access to the formulary, dosage information, and management flowcharts. The website is regularly updated to reflect the latest changes in the BNF and BNFC, ensuring that prescribers have access to current information. The Dental Companion website is another resource that provides guidance toolkits on various topics, including the management of patients taking anticoagulants and those at risk of medication-related osteonecrosis of the jaw.