Students: Do you Know What You Are Prescribing?

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How do you prescribe?

All dentists must learn to prescribe medicine as it forms an integral part of their profession.  Learning how to prescribe as a Dental student can be quite a challenging task, however.  Students tradtitionally begin to tackle the problem through pharmacology classes, however these tend to be taught within the early part of the degree and the information, when required, is quite often forgotten or diluted due to the passage of time.

 

Most professional dentists continue to insist, however, that a true understanding of the context in which medications are prescribed eventually comes about through repeated experiences in daily clinical practice and is not really adequately incorporated into basic pharmacology courses.

 

The World Health Organization (WHO) recommends that a prescription should contain the following minimum information:
1. Professional identification of the dentist
2. Clear identification of the patient
3. The name of the drug (or generic equivalent)
4. The mode of administration of the drug
5. The pharmaceutical form of the drug
6. The drug dosage
7. The recommended frequency of drug use
8. The total duration of treatment
9. Standard patient guidance
10. Special Information
How many of the items on the above list did you miss out on your last patient prescription?
It is of great importance that students must try to avoid errors in medical prescriptions as they may not only lead to difficulties and mistakes in dispensing medicines, but may also result in incorrect drug use that could have potentially fatal effects in the patient.
Studies have shown that although there may be flaws in the training of dental students as prescribers, students eventually do end up developing  the ability to prescribe during the course of their degree program.  A recent study showed that in general, students learn through observing their teachers and more experienced colleagues.
Recommendations
The image below shows the current best-practice recommendations with respect to prophylactic antibiotic use when confronted with common dental complaints.
Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909496/pdf/tcrm-6-301.pdf
Additionally,
  • Drainage is the recommended treatment for periapical periodontitis and for localized dentoalveolar abscess, with
    incisional drainage rather than via the root canal preferred.
  • Empirical antibiotic therapy and drainage are recommended for more severe infections such as facial cellulitis,
    pericoronitis, lateral periodontal abscess, and necrotizing ulcerative gingivitis.
  • Patients who are allergic to penicillin should benefit from clindamycin; it is active against some oral anaerobes and facultative bacteria, and has the advantage of good bone penetration.
  • Infections in which anaerobic bacteria are implicated (such as pericoronitis, periodontal abscess and necrotizing ulcerative gingivitis) are better treated with metronidazole

It is important to remember that in addition to the proper dosing regimens and professionally responsible prescribing practices, the general public needs to be educated about the importance of restricting the use of antibiotics to only cases of severe infection.

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