CEimpact Podcast

Considerations for Antibiotic Use in Dental Care

• CEimpact

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 40:34

Antibiotics are frequently prescribed in dental care, yet evidence suggests they are often unnecessary and can expose patients to significant risks, including Clostridioides difficile infection. This course reviews appropriate antibiotic use in dental settings, including indications, preferred treatment options, and safety concerns associated with specific agents. You will be better prepared to support evidence-based antibiotic use, identify opportunities for intervention, and collaborate with dental colleagues to promote antimicrobial stewardship.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpact

GUEST
Julie Goldberg, DDS
Senior Dental Risk Specialist, Pharmacists Mutual Insurance Group

GET CE FOR LISTENING!
Stay Compliant. Grow Clinically. Practice with Confidence. 

Pharmacist CE Subscription: All your CE in one convenient subscription.
All episodes, CE, and Practice Resources for the GameChangers Clinical Update is included with your Pharmacist CE Subscription. But wait…there’s even more!

The Pharmacist CE Subscription includes: 
-  Compliance and licensure CE 
-  GameChangers Clinical Updates
-  Practical continuing education across patient care topics 

*The subscription does not include microcredentials or certificates, which are available separately for pharmacists seeking specialized service training. 

Purchase Now!



PRACTICE RESOURCE
Receive the exclusive Practice Resource to use as a reference guide for this episode by purchasing the Pharmacist CE Subscription.

 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation to claim credit:


 CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe appropriate indications for antibiotic use in common dental conditions.
2. Compare antibiotic options used in dental care, including safety considerations and risks associated with specific agents.

Rachel Maynard and Julie Goldberg have no relevant financial relationships to disclose.

0.075 CEU/0.75 Hr
UAN: 0107-0000-26-224-H01-P
Initial release date: 6/8/2026
Expiration date: 6/8/2027
Additional CPE details can be found here.

Follow CEimpact on Social Media:
LinkedIn
Instagram

Why Dental Antibiotics Get Overused

SPEAKER_01

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop at listening? You can earn CE credit for this episode and hundreds more by visiting CEimpact.com and logging into your account or creating a new one. Get credit, get inspired, and make your learning count. Hey CE Impact subscribers. Welcome to the Game Changers Clinical Update Podcast. I'm your host, Rachel Maynard. Today we'll look at a topic that sometimes slides under the radar for us as pharmacists, but it shouldn't, and that's appropriate use of antibiotics for dental care. Antibiotics are often prescribed for various dental indications, such as prophylaxis in certain patients before some dental procedures or for dental infections. But that doesn't mean all of these antibiotic prescriptions are appropriate. We know that antibiotics have risks, and mounting evidence over the years suggests that they're often unnecessary for many dental indications. So today we're going to look at when antibiotics are and aren't appropriate for various dental issues, as well as how to ensure safe use if an antibiotic is going to be used. And I'm so thrilled to welcome our expert guest, who's a perfect fit for this topic as a licensed dentist. So welcome, Julie, Dr. Julie Goldberg. So happy to have you.

SPEAKER_00

Yeah, thanks, Rachel. Thanks for having me. I appreciate being a part of your podcast series here. I think it's a really important topic for both pharmacists and dentists alike, for sure.

SPEAKER_01

That's right. Yeah, yeah. And I mean, I would love for um pharmacist listeners to share this with their dental colleagues or other colleagues as well, because it is all about interprofessional collaboration. And so again, very excited to have your uh unique perspective here. So, Julie, maybe you can share a little bit about your your background, your current role, and why you're interested in this topic for our listeners.

SPEAKER_00

Yeah, absolutely. Uh, so I am a general dentist by training. I practiced for about a dozen years clinically before I jumped ship to the insurance industry about 14 years ago. So my current role is as the senior dental risk specialist, kind of a mouthful at Pharmacist Mutual Insurance Company. And the the basis of what I do at an insurance company is to evaluate dental risk, to be sure that the risk is appropriate for our company, and to create educational resources for all of our insureds, keeping in mind that those include pharmacists, dentists, veterinarians, and other healthcare professionals. So this kind of topic where it's interdisciplinary and we can all play a role is really important to me, and I think can be really impactful if we would all share information.

SPEAKER_01

Yeah, absolutely. So it sounds like this is right up your alley, and I'm really excited to hear your thoughts on this topic. Um, and I think in general, what we've seen is that there's a lot more focus in recent years around promoting appropriate antibiotic use in general and ensuring antimicrobial stewardship. And pharmacists play a key role in that for a number of different areas, but dental indications are sort of one specific area that we're going to be narrowing in on. And so maybe just if you could share a little bit of background and perspective on what are some of the most common dental indications for antibiotics and when are they appropriate and maybe not so appropriate. That's a big question. So maybe just you know, starting small with most common indications that are appropriate for dental, dental indications for antibiotics, I would

Dentist Perspective On Common Prescribing

SPEAKER_01

say.

SPEAKER_00

Yeah, it can be really confusing. And it's it's important that that pharmacists understand that historically where dentists are coming from. I like to think maybe I'm not as much of a dinosaur as some others, but I'm getting there. Historically, our education has taught us as dental professionals to prescribe, right? In in most cases. And so it's really difficult to overcome that. Um, but there is a lot of literature out there for dental professionals and pharmacists alike related to indications for prescribing. Um, and current recommendations for antibiotics prior to dental procedures uh have existed for two groups of patients, right? Those with heart conditions that may predispose them to infective endocarditis, and those with prosthetic joints that might be at risk for developing infections around that site of the prosthetic. But compared with prior recommendations, there are currently relatively few patient subpopulations for whom antibiotic prophylaxis is indicated prior to dental procedures. Now, you kind of alluded to this too, Rachel, that antibiotics are also recommended for patients, according to the American Dental Association, who may have systemic infections or a spreading adenogenic infection, a dental infection. So those are the indications that we're currently dealing with.

SPEAKER_01

Okay, so yeah, that's a good distinction here. We're talking about sort of treatment as one bucket and prophylaxis as another bucket. And so for

When Dental Infections Need Antibiotics

SPEAKER_01

dental infections, maybe we can narrow in on that. And when are antibiotics appropriate for a dental infection? Do all dental infections need antibiotics?

SPEAKER_00

No, that's a great question. Not all dental infections require antibiotics. So a dentist is going to want to assess whether that infection is systemic if there is swelling, cellulitis, right? So we're looking for indications for that antibiotic coverage as opposed to patient has pain and requires dental treatment. So the current recommendations from the American Dental Association are that without systemic involvement, without that cellulitis, malaise, fever, that the recommendation is truly for dental care, immediate dental care to remove the source of the infection. And while pharmacists may be wholly aware of this, sometimes dentists forget that antibiotic coverage, sometimes because patients insist on the antibiotic coverage as they think it's going to help, but dentists forget that the antibiotics may not be helpful anyway, because they can't cross over into that pulpal tissue or that nerve tissue that is typically causing the pain or the dental infection itself. So we want to be sure that we're first considering, if we're not seeing those systemic changes, the immediate dental treatment, like root canal therapy, pulpotomies, pulpectomies, extraction, right? Um, as opposed to prescribing antibiotics as our first line of defense.

SPEAKER_01

Okay, that's an excellent clarification that pain does not necessarily translate into the need for an antibiotic. And even with pain, treating it with an antibiotic just by default isn't necessarily helpful because that the infection isn't even if there was infection, necessarily translating to the pain the patient's feeling because of that nerve. You described it as a gap, I think. Um or yeah, yeah.

SPEAKER_00

The pulpal, the antibiotics can't cross that that barrier oftentimes to the pulp tissue. So it it even if there's bacteria within the pulp tissue, we're not touching it with many of these antibiotics.

SPEAKER_01

Okay. And so that's where we're thinking about, as you say, dental interventions like root canal or even like excision and drainage with that incision and drainage to the people. Absolutely. Absolutely.

SPEAKER_00

That's another great example of immediate dental care that that would be helpful.

SPEAKER_01

Yeah. Okay. So that's great to know because often I think patients may report a dental problem to the pharmacist as sort of their first step and pain could be one of those symptoms, but that doesn't necessarily require an antibiotic. It may require other therapies. So that's a really good, important clarification for dental infections. Now, if we think and management of those infections, that it's not all dental infections need antibiotics is sort of the bottom line I'm taking away.

Prophylaxis Rules That Actually Apply

SPEAKER_01

Okay. Correct. And then if we move to the profile access bucket, you did talk about how the thinking has sort of changed over time. And I think the guidelines have changed. So can you get a little bit more into that and and maybe where we were 10, 15 years ago, 20 years ago, and where we are now and what's changed with the evidence and why the thinking has changed?

SPEAKER_00

Yeah, absolutely. Because it has changed a lot. 10, 15 years ago, everybody was getting antibiotics, right? You you even talked about the potential for valve replacement of any kind, or I'm getting a knee replaced, and you were getting covered with antibiotics. There was no clear recommendations on what should be done. So everyone, physicians and dentists alike thought, well, we may as well just cover them, right? Um, but currently in these patients, prophylaxis is really recommended. First, I think it's important to point out for dental procedures, because we want to think about if someone does require prophylaxis, is it for everything? And it's not, right? So for dental procedures that involve manipulation of the gingival or gum tissue, or the periapical region of the of the teeth, which uh is the end of the root, right? So where the root meets the maxillary or mandibular bone tissue, or any perforation of the oral mucosa. So you're cutting cheeks, tongue, lips, that sort of thing. So this means that cleanings, so dental cleanings that may involve bleeding are included, as well as some of the more advanced procedures like root canal treatment, because you're getting to the end of the root of that tooth and potentially entering the bone, extractions, oral biopsies, certainly placement of dental implants. But it's important that we evaluate the recommendations for this subset of patients. So we've got patients who may need prophylaxis. We've identified that it's one of those procedures that we've talked about, right? And if we think about America, the American Heart Association recommendations, they say for infective endocarditis, prophylaxis is indicated only for categories of patients at highest risk for adverse outcomes, while emphasizing the critical role of good oral health and regular access to dental care. So that seems kind of broad, and it sort of is, right? Because maybe there's this thinking that there's this ideal world in which patients are going to listen to dental recommendations, right? And access dental care available to them. And this is where it gets a little dicey from the dental perspective. And I'll get into that in a minute. But the the current guidelines from the American Heart Association state that the use of preventative antibiotics before certain dental procedures is reasonable for certain populations. So patients with prosthetic cardiac valves, those with prosthetic material used for cardiac valve repair, those with a history of infective endocarditis, those with cardiac transplant with valve regurgitation due to maybe a structurally abnormal valve, those with unrepaired cyanotic heart disease, and those with any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or even adjacent to the site of a prosthetic patch or device. So that's a lot of information to take in, right? I know when I was practicing clinically, I would kind of keep these recommendations taped up somewhere so I could reference them because it's just a lot to remember, I think, which is sometimes why dentists just say, you know what, I can't even remember all of this. So we're just going to cover anybody who seems like they might need this, right? And the current guidelines related to antibiotic prophylaxis for patients with prosthetic joints, right? So now we're moving off of that cardiac detail tell us that in general, as opposed to all those details I mentioned when it comes to heart conditions, antibiotics are not recommended prior to dental procedures to prevent infection in cases where for these patients with prosthetic joints. And if antibiotics are deemed necessary, it's it's most appropriate, according to these recommendations, that the surgeon, the orthopedic surgeon, recommend the appropriate antibiotic regimen when reasonable, and write the prescription if possible. So kind of two different buckets of thought here. So for our cardiac patients, we've got this long list of when prophylaxis is indicated. For patients with prosthetic joints, where we used to pretty much cover anybody, even if they were getting a simple knee replacement, the recommendation is that antibiotic coverage is no longer indicated. And the dentist and the orthopedic surgeon should have a conversation in those cases. If the surgeon deems the coverage appropriate, then the recommendation

Patient Fear And The Shifting Standard

SPEAKER_00

is that they write that prescription. But I want to get back to that concept of patients seeking appropriate dentists. Yes, because they don't. So although the recommendation from the uh Heart Association is that that's always the best first option for patients, as dentists, we know they don't do that. Um, and the problem becomes that they come to dental professionals with this long-standing infection that maybe isn't systemic, but we know as soon as we touch that tooth, whether we start a root canal and a pulpotomy or a palpectomy, or even sometimes when we perform an extraction or an incision and drainage, that all of a sudden it may become more systemic in nature because we're stirring the pot there, right? So we've got this bacteria that's been longstanding. We stir the pot, and now there's this problem. So we're we follow recommendations to not provide antibiotic coverage up front because we're supposed to provide immediate dental treatment. And in some cases now, we find this hot tooth has gone awry, and a day or two later, patient has swelling and a more severe infection. And these are the cases I see on my end where patients want someone to blame, though they've been sitting with this hot tooth for three to five years. They want to blame the dentist, and so then all of a sudden we're faced with litigation. And so then it doesn't seem fair when we look at the recommendations, right? Right. But I think it's important in those situations, and I know we're gonna get into this, that that dental professionals, if they are going to prescribe, think about appropriate prescriptions and an antibiotic use as opposed to kind of the strongest thing out there and for the longest period of time. Right, right.

SPEAKER_01

Yeah, and before we get into that, I do I do just want to go back to the uh joint patients, because the patients who've had uh knee replacement, as you said, I think that's where often there's a really big challenge because maybe they had their one knee replaced 10 years ago and the dentist was prescribing antibiotics for prophylaxis at that point, and these more recent guidelines now have changed. So, again, as you said, sort of uh patient expectations, I think are important here too, because they may have been used to that, or even family members who years ago got their joint replaced, now their other families getting it, and just that's been the standard of care. And so, how do you help change the thinking and educate around why that's changed? I think part of it, I do want to talk about the risks of antibiotics because that's one of the reasons why those guidelines, I think, have changed, potential risks. But what else is going on with that change in thought process?

SPEAKER_00

Yeah, I think it's really important uh to bring up because I would even have patients who, you know, they had antibiotics sitting in their medicine cabinet. Yeah. So uh even without me prescribing it to them personally, they would come in as a new patient and say, well, don't worry, don't worry. I already pre-medicated myself. And then like you don't even have a chance to talk to them about, you know, why that's not currently recommended. So it can be really challenging because it's not just educating the dental profession and pharmacy professionals, but the patients themselves. And the dentists can be the first line of defense there. But pharmacists can definitely play a role in helping kind of reinforce that information. Uh, so you know, delivering the message of the risks is really important. And you mentioned going over that, you know, the the risks include antibiotic resistance, right? Um, so delivering that message to the patient that you might think this is okay, but if you're seeing me twice a year minimally for dental cleanings, right, and that doesn't take into account anything else we've got to do, or any other invasive procedures that you have across your body for the rest of the year, right? Or antibiotics you may need for other issues you have during the year. It it the antibiotics antibiotic resistance is real, and we are seeing the implications of that in hospital systems and it's really serious. So delivering that message to the patients about how that resistance can potentially affect them and harm them in the future is important. Um, and then this issue of the appropriate antibiotic being prescribed, right? So if in fact the patient is a candidate for either antibiotic prophylaxis or antibiotic coverage because of a systemic infection, then we want to make sure we're choosing the right antibiotic and educating the patient on that, educating the dentist on that, right? Maybe through through the pharmacist. And we'll talk a little bit about that as we get into this a little more, about adverse reactions that can occur, like like see diff, right, in prescribing clindomycin, because oftentimes we're still seeing that a lot in prescriptions from dental professionals.

SPEAKER_01

Yeah. Yeah. So I think you make a really good point about that antibiotic use. It may seem like a one-time dose before a dental cleaning, but that adds up over time, over the course of your life, as well as with any other antibiotics you might be getting for other reasons. So that's a really good point to keep in perspective, this sort of additive cumulative effect of antibiotic and the risks of resistance there, but also the the immediate adverse effects that patients can have and side effects from taking the antibiotic just on its own as well. And then I think, you know, also just the the lack of evidence for benefit in in using an antibiotic. I think that's what we've seen with that mounting evidence is lack of evidence in using an antibiotic for prophylaxis in those joint patients specifically. Like that has not come to fruition as we might have thought it would. And so it goes back to your point, I think, Julie, about like how dentists were cover them, cover them, right? Like that was the thinking to cover as a safe safety measure. But in the end, what we're seeing is the safety considerations are also on the antibiotic side of things and there's risks there.

SPEAKER_00

Yeah, absolutely. And and I I want your pharmacy audience to understand, you know, I feel like sometimes it's just like anything else in life, right? We we we may not necessarily put ourselves in the shoes of the the person we're interacting with, right? And from the dental perspective, we've got a patient sitting in front of us, and we may wholly know what the current recommendations are, but we've got an older patient sitting in front of us with two knee replacements who is being told that they don't need antibiotic coverage based on the current recommendations, but they've been doing this for the last 20, 30 years, right? Yeah. And and they make a comment to the dentist that goes something like this Well, my uncle knew a guy who also had a knee replaced and And he ended up losing his entire leg because he had a dental cleaning, and it does me no real harm, Doc. So I just want to keep taking it. So just refill my prescription. Or even worse, they make some reference to potential lawsuits if something goes wrong with them. Right. And so the dental professionals then say, well, I mean, what might the real harm be if we just cover this patient in antibiotics? And there can be real harm. So I think it's important for the dental audience as well to understand. And this is why I hope the pharmacists will share this with their dental colleagues, that when it comes to things like this, yeah, absolutely, patients can sue you for anything they want to sue you for, unfortunately. But the fact of the matter is that the current recommendations are what they are. And so the quote unquote standard of care will be tied to the current recommendations as set by the American Heart Association, the ADA, and so on, right? So we're going to reference back to the AHA and the ADA when we are defending a case that would involve perhaps a failure to prescribe antibiotics in those particular cases. So I think it's important that pharmacists understand where the dental professionals are coming from on that line of thinking so they can have those conversations with the dentist, but also important for the dentist to understand that the standard of care is changing and we will defend to the current standard of care.

SPEAKER_01

That is such an excellent summary of multiple issues there. The fact that dental our dental colleagues are sometimes between a rock and a hard place in terms of thinking about how to manage that patient in front of you and set resetting expectations can be very difficult. So understanding that perspective, but then also standard of care is what it is. And even if that has been historically what the patient has had, like you say, there is a new standard of care. And so feel comfortable relying on that too. So yeah, definitely multiple factors coming into that consideration on a case-by-case basis, unfortunately.

Clindamycin Risks And Safer Alternatives

unknown

Yeah. Yeah.

SPEAKER_01

Makes it difficult to standardize. So along those lines, say, say a pharmacist, and I, you know what, let's talk about the antibiotics that are appropriate and how they should be used appropriately. And then we can talk about, okay, if a pharmacist sees one of these, what should they do next? But which antibiotics are recommended and how should pharmacists be evaluating those for, again, for dental indications?

SPEAKER_00

Yeah, I think, you know, the the kind of red flag that we want to talk about today is definitely clindamycin use, right? Um, for decades, this was the go-to for dental professionals, for patients who reported allergies to penicillin or amoxicillin. And the reasoning made sense at the time because of the good coverage for oral anaerobic bacteria, penetrates bone well, availability and familiarity to clinicians, right? It all made sense. But now we know that clindamycin carries one of the highest risks uh for C. diff infections. So despite this growing awareness of these risks, though, clindamycin is still commonly used in dentistry, right? Is it just laziness, right? Not keeping up with literature, habit. I'm not sure. But we're still all of those things, probably, right? A lot of it, right? Yeah. I mean, dentists were taught that it was just the standard for patients who were allergic to penicillin. And penicillin allergies are over-reported, right? And not truly allergy tested enough. So, you know, there's some uncertainty about the alternatives, right? Clinicians are just unsure which antibiotics should replace calendomycin, especially if they're not keeping up with the literature. So what we want to think about, um, and this is important for pharmacists, I think, to consider, and and we'll get into this, but deliver this message to dentists is that when antibiotics are necessary, clinicians want to choose the narrowest effective spectrum, avoid high-risk agents when alternatives exist. We also want to choose the shortest duration possible. So the American Dental Association Guide recommends re-evaluating patients within three days and discontinuing antibiotics 24 hours after symptom resolution rather than using long courses. And I don't know very many people who abide by that. So I think that's really important for pharmacists to deliver that message. I know a lot of my colleagues have discussions about the non-use of clindomycin and when possible getting patients allergy tested if they're reporting penicillin allergies, but I don't often hear those conversations about reevaluation in short term to get patients off of antibiotics. I feel like we're just trained to prescribe seven to 10 days and that's it. So that's a really important point to kind of hit home with dentists. Um second, verifying those penicillin allergies, right? Um, and again, from the dental perspective, what do you do in those emergency situations? You know, you get a you get a patient with a hot tooth, they're insisting on antibiotics because that's what they've had before, right? So even if you think you're gonna extract this tooth and get rid of the source of the infection, you feel like you just want to cover the patient with antibiotics and they say they're allergic to penicillin, you don't have the time to wait for allergy testing, right? So then you're just gonna consider the alternative, right? And I and I think what's important to think about here is yeah, in an ideal world, if there's not a systemic infection, the pharmacist is convincing the dental professional based on current recommendations that we're not gonna cover the patient with antibiotics. But even if antibiotics are selected, we want to make sure that we select the right antibiotic coverage and we avoid that clindamycin use so that then we're not faced with that potential C. diff infection. So Dennis want to consider that current recommendations are moxicillin, penicillin is first-line therapy when it's appropriate and there are no true allergies to the medication, and that the guidelines point us to things like azithromyosin, doxycycline, cephylaxin in cases where there's no anaphylactic history to those medications and allergy testing when possible, right? Um, it's not always possible in emergency situations, but when that is possible, that's also first line of defense in uh deciding what kind of antibiotic

Allergy Checks And Shorter Courses

SPEAKER_00

coverage might be appropriate.

SPEAKER_01

And I think that's a good point for pharmacists to remember too, because we may be the ones taking patient information, setting up profiles, and documenting those allergies as part of our routine intake process. And when patients report that allergy, dig a little deeper to find out what the reaction was, when did it occur, how likely is it to be a true allergy? Some of that initial discussion, I think, can bridge that gap to then maybe thinking about allergy testing preventively so that the record can be cleared if there is no actual allergy, or again, just finding out what the reactions were. And sometimes that clears up the question right off the bat. So I think pharmacists play a really big role there too. And then I love how you pointed out the duration too, because if if you're talking with a patient, you see, regardless of the antibiotic, but clindamycin may be a little bit of a red flag in and of itself. And then if you see it for the seven to ten days, ensuring that they are going to have some kind of ongoing communication, reassessing that in a couple of days after starting it. Again, just trying to narrow that use both in spectrum and in duration as much as possible, I think.

SPEAKER_00

Yeah, yeah, absolutely. The communication is key. It would be so wonderful if, like you say, a patient has interacted with a pharmacist before visiting their dentist. Right. And instead comes in with the message, oh, hey, I've actually found out I'm not allergic to penicillin. It's just that my stomach gets kind of upset. And so I have this sensitivity to it. Um, and so then in those cases, the dentist can consider alternatives.

SPEAKER_01

Mm-hmm. Yeah, absolutely. Proactive approach, which I know is sometimes difficult for all of us in busy practices, but uh that is sometimes can go a long way. That prevention can go a long way. In terms of communicating interprofessionally, so whether it's a dentist communicating with a pharmacist or pharmacist with a dentist, especially if a pharmacist was to see a prescription for clindamycin for 10 days, for example, for a dental indication, it sort of sets off those red flags. What is the best, what are best practices for that communication and ensuring that sort of streamlined approach?

Calling Prescribers Without Escalation

SPEAKER_00

Yeah, it can be challenging, right? That's that I would drop that in the bucket of challenging communication, right? Um, and there are there are lectures and education specifically for those kinds of conversations. I get it, it can be really tense. Um, we're we're all professionals, and oftentimes it feels like that phone call is a challenge, right, to to the other professional that they've done something wrong. So I would encourage pharmacists um to approach this as an educational opportunity and think of it that way and with that intent as opposed to that challenge. And I'm not insinuating that pharmacists do think of it as a challenge to the other provider, but sometimes I feel like there's this sense that, well, I don't, I don't want to make that challenge because that may turn into an escalated conversation or a riskier conversation that I just don't want to have. So I'm just not gonna do it. And I would encourage pharmacists instead to have that conversation, but instead look at it as an educational opportunity for the dentists. And here's why because pharmacists, and I think this is really key, and I read this somewhere and it just kind of stuck with me. Pharmacists are often the last healthcare professional to interact with the patient before therapy begins. Think about how important that is and how critical that is. I think that's a really important statement, and there's a lot of responsibility that then comes with that, right? And so for that reason alone, I would I would encourage pharmacists to kind of seek the strength to have have those conversations with other healthcare providers, approach it from an educational perspective, right? Um it might include something like, hey, I'd like to take this opportunity because I saw this prescription come in for this patient to talk to you about current antibiotic prescribing guidelines, right? I have seen situations in which, right, when there's a clindomycin prescription, we end up with this C diff infection. It turns into this whole crazy ball of wax and lawsuits and what have you. And in my experience, right, words like that, in my experience, when I talk to patients this way and let them know about the current recommendations, they're more amenable to the the this concept of, oh, maybe I don't need a prescription every time I go in for a cleaning because I've had a knee replacement or something like that, right? So using those words like in my experience or I've seen or current recommendations suggest, right? So educating dentists on verifying the indications for antibiotics, even talking to them about how important documenting those indications can be, right? Whether it's for prophylactic use or for infection, identifying duration of use, right? Um again, pointing to those current recommendations. It's the American Dental Association that sets these recommendations, right? Right, right, right. It's not it's not a pharmacy association. So let's just call it what it is, right? Tell the dentist it listen, it's your own association who's setting these guidelines related to the duration of use and re-checking in three days and removing antibiotic use 24 hours after symptoms disappear, right? And then finally talking to them about narrower spectrum antibiotic options, avoiding that glindomycin that has been ingrained into their brains.

SPEAKER_01

Yeah, I I it's just such a there's so much opportunity here. And and I think you you gave a lot of really practical examples. The idea of framing it from in my experience, or this is what I've experienced with talking with patients, this is what's worked for me, also framing it in the perspective of these are dental guidelines, this is just about the evidence, this is what guidelines are recommending, this is not a anything personal, this is what the guidelines support. And so using that to leverage the discussion. And I think too, there's more interprofessional collaboration and interactions happening in healthcare in general. And so taking advantage of that movement and talking about the fact that we're trying to work together and really accomplish the same goals, which is to improve patient care and outcomes. So, you know, we're in the same boat here. Let's work together to promote appropriate use.

SPEAKER_00

Yeah. And I think your comment about being in the same boat is another great way to introduce that conversation. You know, kind of, you know, there's that thought anytime you're about to enter a high risk kind of conversation, that you you bring people down and off guard by saying what your true intent in the conversation is. Just lay it out there, right? Like I know there's a lot of confusion around current recommendations for antibiotic use. I know that patients are uh kind of insisting on antibiotic prescriptions because they're not aware of current guidelines and and and they think they know best about their own medical health and safety. And my intent in having this conversation with you is not to say that something was done inappropriately, but to have a discussion about the current recommendations and how they might apply to this patient in this situation.

SPEAKER_01

I think that's a great summary and just really personalizing it, making it uh a collaborative approach. And yeah, we're we're trying to do the same thing in improved care. So it's and and again, understanding we're all in a between a rock

The Pharmacist As The Game Changer

SPEAKER_01

and a hard place in some of these situations and trying to do the best we can by working together. So I think you just laid out the evidence, the the indications for these antibiotics when appropriate, when not appropriate, very clearly. Also focusing on, again, appropriate choice of antibiotic, appropriate durations, thinking about some of those red flags that we might see in practice and the importance of that interprofessional collaboration, but also communication with patients and helping them set realistic expectations. So just such a great discussion, Julie. Thank you so much for sharing your expertise. And it is the Game Changers Clinical Update podcast. So, you know, we wrap up with the game changer. And what would you say is the game changer for this topic for our listeners?

SPEAKER_00

So it, you know, it's interesting when I was asked to do this and I saw the title, I thought, that's exactly it, right? Remember when I told you that that that phrase that stuck with me that pharmacists are likely the last healthcare provider to interact with the patient before therapy. You are the game changer, right? So that's why I love this title. The pharmacist is the game changer. That I cannot emphasize that that point enough. So take opportunities to educate patients, educate dental professionals, all healthcare professionals that you work with. But today we're talking about dental professionals to avoid patient harm, encourage thoughtful prescribing, not just iterative, this is what I've done all my career, right? And adherence with current recommendations. It's really key.

SPEAKER_01

I love that. Pharmacist is the game changer in the end. That's great. And and I agree that in in the end, we're hoping that this message gets to other healthcare professionals, dentists, and other healthcare professionists. So part of that game changer for us as pharmacists is sharing this message with others and encouraging others to listen to it. So thank you, Julie, so much for your expertise. This is wonderful, and I just really appreciated your insights here.

SPEAKER_00

Oh, I'm so happy to have been here. Thank you so much, Rachel.

SPEAKER_01

Thank you. Appreciate your time. So, listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.