Understanding the impact of COVID-19 on dental antibiotic prescribing across England: ‘It was a minefield’

Introduction: The COVID-19 pandemic impacted significantly on the delivery of dentistry across England.
Objective: To explore how and why antibiotic prescribing by primary care dentists was affected by the pandemic.
Methods: Mixed-methods study: secondary analysis of routinely-collected NHS dental antibiotic prescribing data from before and during the pandemic; and an online survey of dentists (NHS and private) across England’s regions.
Results: Dental antibiotic prescribing increased 22% in the first year of the pandemic, with variation between regions from a 12.1% increase in London to 29.1% in East of England. Of the 159 dentists surveyed, 60% had prescribed ‘many more’ antibiotics and some urgent dental centres had required antibiotics before accepting referrals, irrespective of clinical appropriateness. Diagnosing remotely was hard, and antibiotics were used to delay aerosol-generating procedures and fill gaps in services. There was widespread frustration with the situation.
Discussion: Maintaining access to urgent dental care during a future pandemic would include ensuring availability of high-grade personal protective equipment for dental teams. Everyone needs to understand the impact of poor access to dentistry on antibiotic overprescribing and hence antibiotic resistance.
Conclusion. Ensuring access for all to urgent dental care is an important element of global efforts to tackle antibiotic resistance.