BACKGROUND: The American Heart Association (AHA) and American Dental Association (ADA) recently updated guidelines regarding antibiotic prophylaxis before invasive dental procedures among patients with certain heart conditions and removed such recommendations for patients with prosthetic joints. We assessed knowledge and practices of dentists regarding antibiotic use in Minnesota. METHODS: We designed a 22-question online survey. In September 2015, the survey was sent to the state dental association membership (i.e., ~70% of licensed Minnesota dentists), followed by four reminders during two months. Findings were analyzed by using SAS 9.3®. RESULTS: Among 437 respondents, 275 (63%) dentists had practiced for >20 years, 192 (44%) had a solo practice, and 65 (15%) had a specialty certification. Dentists reported a median of four antibiotic prophylaxis and five antibiotic treatment prescriptions per month. Dentists reported prescribing prophylactic antibiotics before invasive dental procedures for high-risk conditions (n = 365; 84%), localized swelling (n = 306; 70%), patient on vacation (n = 166; 38%), gum pain (n = 165; 38%), legal concerns (n = 105; 24%), patient expectation (n = 98; 22%), or failed local anesthesia (n = 92; 21%). Dentists defined high-risk conditions as previous infective endocarditis (n = 329; 75%), prosthetic cardiac valve (n = 307; 70%), selected congenital heart disease (i.e. unrepaired cyanotic congenital heart disease, repaired congenital heart defect with prosthetic material or device six months after the procedure, or repaired congenital heart defect with residual defect) (n = 299; 68%), primary care physician recommendation (n = 259; 59%), prosthetic joints (n = 172; 39%), poorly controlled diabetes mellitus type 2 (n = 118; 27%), cardiac transplantation recipients with cardiac valvulopathy (n = 19; 4%), human immunodeficiency deficiency virus (n = 77; 18%), chronic kidney disease (n = 56; 13%), mitral valve prolapse (n = 47; 11%), all congenital heart disease (n = 19; 4%), or well controlled diabetes mellitus type 2 (n = 5; 1%). Common antibiotic decision barriers included perceived conflicting guidelines (n = 189; 44%), perceived conflicting scientific evidence (n = 194; 44%), or needing additional information concerning antibiotic selection (n = 82; 19%) or risks (e.g. resistance, Clostridium difficile, or adverse drug effects) (n = 101; 23%).
CONCLUSIONS: Dentists reported antibiotic use rationales that are inconsistent with AHA/ADA recommendations. Perceived conflicting guidelines and evidence were reported as antibiotic decision barriers. Dentists also reported needing additional information concerning antibiotic selection and risks. Antibiotic stewardship among dentists should address these barriers.