The Importance of Medication Stewardship in Dentistry

Medication stewardship programs are important efforts by all frontline healthcare workers and are becoming more common in dental practices, as well. Stewardship promotes the safe and appropriate use of medications by focusing on the “five rights:” Right patient, right drug, right time, right dose and right duration. In dental practices, dentists should exercise particular caution when prescribing antibiotics and opioids.

Antibiotics and opioids both carry potential risk because they can be dangerous when misused. Overuse of antibiotics can lead to bacterial resistance, making further antibiotic treatments less effective and risking diseases with worse outcomes. Opioids are highly addictive, and over-prescription can lead to misuse, overdose and even death. Sadly, between 1999 and 2018, more than 232,000 people in the United States died of an overdose involving a prescription opioid.

Dentists have an important role in responsible medication prescriptions. Studies have shown that dentists prescribe high amounts of antibiotics and opioids. Medication stewardship programs are new in the dental setting, but they could help practices prevent unnecessary prescriptions and take better care of their patients. Stewardship protects patients from the dangers of antibiotic and opioid misuse and safeguards dentists from potential liability that could stem from prescribing medication inappropriately or unnecessarily.  

Implementing medication stewardship in dental practices is not easy. Dentists face the slow adoption of electronic health records in dental practices, which makes comprehensive data collection and reporting difficult. Dentists also do not always have access to a patient’s medical history, keeping them from viewing past antibiotic prescriptions. Furthermore, with 80% of dentists owning private practices in 2015, many dentists have practice responsibilities beyond clinical care, and medication stewardship programs become a lower priority.

Despite the challenges, it is vital to encourage safe prescribing to protect your patients’ health and protect your practice from liability. Keep stewardship in mind when prescribing antibiotics and opioids. Here are some ways to make sure you are exercising caution when it comes to these potentially risky medications.

1. Review New York’s Prescription Monitoring Program (PMP) registry, also known as I-STOP, before prescribing an opioid. The PMP Registry gives dentists and other practitioners access to prescription histories for their patients to determine whether there may be abusive or non-medical use.
2. Screen the patient’s risk before prescribing opioids by asking about family history of drug abuse or addiction.
3. Consider non-opioid alternatives first, with the potential to escalate to opioids should the pain continue or worsen.
4. Review the Centers for Disease Control and Prevention Core Elements of Outpatient Antibiotic Stewardship.
5. Consult reference sheets from other professional societies. Start with the following:

• The American Dental Association (ADA) antibiotic stewardship reference page
• The ADA clinical practice guidelines for pain management
• The American Heart Association recommendations for antibiotic use during dental procedures among patients at risk of infective endocarditis

Dentists are reminded to visit the New York State Dental Association website for up-to-date information on NYS Health Law alerts and more. MLMIC also encourages dentists to monitor updates on our resources page and find additional guidance for dental practices on our blog.