title: Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study.
abstract: BACKGROUND
  The frequency of consulting for dental problems in general medical practice, and antibiotic prescribing associated with these consultations, is poorly described.
  
  
  OBJECTIVE
  To describe consultation rates and antibiotic use for dental problems in UK general medical practice, and explore factors associated with antibiotic prescribing for dental conditions.
  
  
  METHODS
  A retrospective cohort study using Clinical Practice Research Datalink, a database of general practice patient records in the UK.
  
  
  METHODS
  All dental consultations between 2004 and 2013 were identified. The main outcome was the prescription of an antibiotic during a dental consultation. Multilevel logistic regression was conducted to examine factors associated with antibiotic prescription.
  
  
  RESULTS
  In all, 288 169 dental consultations were included in the cohort. The average rate of dental consultations was 6.06 consultations per 1000 patient-years. Rates of dental consultation decreased from 6.84 consultations per 1000 patient-years in 2008, to 4.23 consultations per 1000 patient-years in 2013. Consultation rates were higher among females than males and highest in patients aged 20-29 years. An antibiotic was prescribed in 57.1% of consultations. Significant predictors (P<0.001) of antibiotic prescribing included: patient middle age, male sex, and previous consultations for tooth-related problems. Antibiotics were more likely to be prescribed during consultations in December (odds ratio [OR] 1.18, 95% confidence interval [CI] = 1.13 to 1.24, P<0.001, reference month: June) and on a Monday (OR 1.10, 95% CI = 1.07 to 1.13, P<0.001) or a Friday (OR 1.15, 95% CI = 1.12 to 1.18, P<0.001, reference day: Wednesday).
  
  
  CONCLUSIONS
  Consultation rates for dental problems in UK general practice are relatively low but more than half result in the prescription of an antibiotic. This raises concerns about patient morbidity and contributions to antimicrobial resistance.
authors.affiliation: Cardiff and Vale University Health Board, University Dental Hospital, Cardiff.
authors.forename: Anwen L
authors.initials: AL
authors.lastname: Cope
authors.affiliation: Professor and honorary consultant in dental public health, School of Dentistry;
authors.forename: Ivor G
authors.initials: IG
authors.lastname: Chestnutt
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff.
authors.forename: Fiona
authors.initials: F
authors.lastname: Wood
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D058006:General Practice / Q000191:economics / Q000706:statistics & numerical data; D005792:General Practice, Dental / Q000191:economics* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibacterial agents; dental care; dentistry; general practice; inappropriate prescribing; physician’s practice patterns