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clean effectively tooth-loss needn’t be inevitable.
Crossing the line
Hani Mostafa encourages the promotion patient responsibility in gum care.
In an independent review of NHS painful burden on the individual and the It is therefore imperative we teach
our patients that good gum health is
and as such, a significant public health the key to their good general health.
consequences and costs’. That was back providers is considerable, even more in 2009, and the fact still remains that treatment of these patients includes: the disease, continues to place a significant indices and pocket depths; scaling; and, use of dental floss is often recommended dentate population in the UK will suffer that, in the main, people are using their plaque. These traditional treatments can stage in their lives, be it an inflammation traditional toothbrush incorrectly and 4mm or greater. Periodontal disease is a with discomfort for the patient and have disease and its wider effects is also very limited evidence for sustained efficacy. 83 per cent believed that their patients with a large body of patients presenting with advanced symptoms of periodontal taught by Philip Ower and the late Hani Mostafa
their condition and the effect it is having the dentist, and more importantly the 44 The Dentist June 2012
central to prescribing these techniques. an interdental brush is far more effective is a key policy driver in the new NHS. at the University of Warwick notes; ‘In manage hygiene themselves first. Patient light of recent studies, and a believable with our patients, we will start to see a Antimicrobial prescribing for GDPs
The Faculty of General Dental Practitioners is renowned for its thoughtful and comprehensive publications. Previous publications on standards, radiography and clinical examination and record keeping are the gold standards that all GDPs should aspire to. This new publication on antimicrobial prescribing is long overdue. As the Dean, Russ Ladwa, points out in his foreword, it is not meant to replace the BNF but is there to provide advice.
In the introduction the book explains these guidelines are compromised patients is to rationalise and improve the standards of antimicrobial prescribing in primary dental care. Unlike many of the processes and procedures that the present GDP has to adhere to this guidance is based on scientific literature and uses available evidence. The book has 13 chapters covering everything that the GDP needs to know and takes the reader logically through each topic with reasoned explanations, dosages and alternative medications. It is easy sensible suggestions and alterative measures. The final two to pick up, clear to read and providing logical outcomes.
chapters are on antiviral and antifungal therapy.
There is a chapter on prescription writing which is simple I really enjoyed reading this book. It isn’t onerous to read and direct with a quick résumé for an easy check at the end and certainly not very wordy. Every sentence has been of it. There is a really useful paragraph in indications for carefully thought out and presented in an easily digestible prescribing antimicrobials to show to the insistent patient manner. I trialled this on my five colleagues in the practice who is determined to leave with a prescription – absolutely and the result was unanimous – it is excellent and we no justification for the prescribing of antimicrobials for want one each! It is expected that we have protocols acute pulpitis! There is a helpful flow chart showing how to for just about everything. My latest protocol is to order cope with acute dento-alveolar infections with first, second more copies so that every surgery has its own copy of this and third choice of antimicrobials. A warning also stresses invaluable book If I was a CQC inspector with a remit that the inappropriate use of clindamycin, cephalosporin for looking after the best interests of patients I would have or co-amoxiclav will lead to resistance and possible this on my list of boxes to tick. There is no excuse any Clostridium difficile infections.
longer for overprescribing or prescribing dangerously. I In chapter five there is another flow chart for chronic cannot recommend this book strongly enough. At £20 for dento-alveolar infections - where there’s long standing members and £25 for non-members it is a must for every chronic infection refer to a consultant specialist. The GDP. You will sleep well with a clear conscience and advice for periodontal disease is simple and well laid out patients can be shown it when demanding unnecessary including aggressive and chronic periodontitis - sensible prophylactic antimicrobials. Perhaps it should be shown recommendations are made - the local use of antimicrobials to some orthopaedic surgeons who still persist in insisting on antibiotic cover for total joint replacement patients Another algorithm for pericoronitis is a valuable standby undergoing dental treatment. Thank you FGDP and in along with the management of dry socket and whole particular Niklaus Palmer for such superb editing – a chapters on acute sinusitis and endodontic therapy. The chapter on prophylactic antimicrobials is exceptional. Meredyth Bell
46 The Dentist June 2012

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