I’m a lecturer of Dental Therapeutics at the Melbourne Dental School, University of Melbourne. I also work as a dentist in private practice and am a registered pharmacist. My research is primarily about exploring dental prescribing practices, drugs in dentistry and developing tools and educational resources to assist dental practitioners to access drug knowledge and improve prescribing. I’m also Vice President of the ADA Therapeutics Committee.
You are preparing to present at FDIWDC23 this September. What subject matter are you covering and what led you to choose to present on this?
I’m covering a range of topics at Congress, which I’m really excited about – all about drugs in dentistry. Some topics I will cover include dental antibiotic stewardship, opioid prescribing in the context of the opioid crisis in Australia and the US, and prescribing errors and how to mitigate them.
I will also be presenting a prescribing tool that I developed that helps dentists to prescribe according to guidelines. Being a pharmacist and dentist, I realised that there are many drug compendia available, but there are none specific for dentistry. I know that dentists just want to be able to practice safely with respect to medication use, and given how busy dentists are in clinical practice, it can be diffcult for dentists to access quality drug knowledge in a timely manner. Part of my research involves developing a digital clinical decision tool, called Drugs4dent®, which aims to provide dentists with dental-specific drug information, patient education about appropriate antibiotic use, and helps dentists prescribe according to guidelines. So I’ll be presenting this tool at the conference as well.
Tell us about your current work surrounding dental antibiotic stewardship?
Well, antibiotics are the most common drug class prescribed by dentists, and several studies have shown that up to 80% of antibiotics are prescribed inappropriately by dentists globally. Antimicrobial resistance accounts for
700,000 deaths worldwide annually, and so we as dentists have an opportunity to contribute to the global stewardship movement. I am the current Chair of the Global Antibiotic Resistance Dental network group with the FDI World Dental Federation, and we are involved in developing and disseminating research in this space. Together with the FDI Antibiotics Working group, I had input into the World Health Organisation global oral health status report that was released last November during World Antimicrobial Awareness Week, which I found a really insightful process to understand the global focus of oral diseases.
What do you think are the main issues our members need to know about, when prescribing as a dentist?
Going back to basics, safe prescribing is characterised by the ‘four rights’ – the right drug, for the right patient, at the right time, with the right regimen (dose, duration, frequency and route of administration). But prescribing is actually a complex process when broken down, when you have to consider the specific patient, their medical conditions and other medications, the clinical situation, the patient’s decision (shared decision making), and consideration of legalities. So prescribing is actually harder than it seems! These are some of the things to consider… I’ll be speaking on this at Congress if anyone is interested to hear more!
What would you like to see happen in future in the dental/pharmaceutical space?
Drugs in dentistry form a relatively small, but incredibly important part of patient management, especially when dentists have to consider the drugs a patient is taking prior to doing dental treatment, as well as what they prescribe in the context of the patient’s existing medications and co- morbidities. This can be challenging, especially for patients taking multiple medications. In this context, our prescribing tool, Drugs4dent®, aims to help dentists navigate all of that. I also do think the ADA does a great job of always including therapeutics in their CPD programs and ensuring dental practitioners have access to the resources available.
Any exciting projects in the works for you?
We have a few exciting projects going on, one of which is a book, titled Handbook of Dental Therapeutics, which is due to be published at the end of this year. It’s a practical, concise, but comprehensive guide to the use of drugs in dentistry, targeted specifically for both dental students as well as dental practitioners. We cover topics such as your standard ones like antimicrobials, pain relief, anxiolysis and local anaesthetic, but also have chapters dedicated to MRONJ and bleeding risk. In addition, we have chapters about prescribing for pregnant patients, children and the elderly, oral adverse effects and even prescribing legalities.
Secondly, for dentists in Victoria, we are currently undertaking a study where a dentist can refer patients directly for penicillin allergy testing if they need it. We are very excited about this study, which we have called Dental PEARLS: Dental PEnicillin Allergy ReferraL Study, that we are undertaking with eviDent. We think this will have profound benefit in de-labelling patients who incorrectly self-report allergies to penicillin. Please look at your emails from eviDent for more details or visit Evident.
