Variation in knowledge, attitude, and practices toward antibiotic use among diplomates of the American Veterinary Dental College: a survey-based study

Jennifer A. Montebello Arizona Veterinary Dental Specialists, Thrive Pet Healthcare, Peoria, AZ

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 DVM, DAVDC
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Jennifer L. Granick Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN

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Emma R. Bollig Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN

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Stephanie L. Goldschmidt Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA

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Abstract

OBJECTIVE

To evaluate the knowledge, attitudes, and practices toward antibiotic use among board-certified veterinary dentists.

SAMPLE

104 veterinarians board certified by the American Veterinary Dental College.

METHODS

A 30-question survey was generated from an online platform and sent via email listserv to board-certified veterinary dentists. Responses were examined to identify patterns or correlations among the variables of interest.

RESULTS

There were 104 board-certified veterinary dentists who responded. The majority reported using prophylactic intraoperative antibiotics sparingly for dental procedures and predominately for patients with historic endocarditis or on immunosuppressive doses of steroids. For healthy patients, they reported that antibiotics are often prescribed during jaw fracture repair, maxillectomy/mandibulectomy, and treatment of stage 4 periodontal disease or periapical lucencies. Knowledge of antibiotic resistance and evidence-based antibiotic use were not significantly different between different practice sectors (academia vs private practice) or dependent on the duration of board certification. Dentists who did not believe antibiotics used postoperatively reduce local postoperative infection rates were less likely to prescribe injectable intraoperative antibiotics for the prevention of postoperative infection. No other variables were associated with the likelihood of prescribing intraoperative antibiotics. More than 95% of veterinary dentists surveyed agreed that specific antibiotic use guidelines for veterinary dentistry would help reduce inappropriate use of antibiotics.

CLINICAL RELEVANCE

There are differences among veterinary dentists regarding which procedures and patient-specific comorbidities they believe necessitate the use of prophylactic antibiotics. The development of a consensus statement and prospective studies of current antibiotic use are important next steps to improving antibiotic stewardship in veterinary dentistry.

Abstract

OBJECTIVE

To evaluate the knowledge, attitudes, and practices toward antibiotic use among board-certified veterinary dentists.

SAMPLE

104 veterinarians board certified by the American Veterinary Dental College.

METHODS

A 30-question survey was generated from an online platform and sent via email listserv to board-certified veterinary dentists. Responses were examined to identify patterns or correlations among the variables of interest.

RESULTS

There were 104 board-certified veterinary dentists who responded. The majority reported using prophylactic intraoperative antibiotics sparingly for dental procedures and predominately for patients with historic endocarditis or on immunosuppressive doses of steroids. For healthy patients, they reported that antibiotics are often prescribed during jaw fracture repair, maxillectomy/mandibulectomy, and treatment of stage 4 periodontal disease or periapical lucencies. Knowledge of antibiotic resistance and evidence-based antibiotic use were not significantly different between different practice sectors (academia vs private practice) or dependent on the duration of board certification. Dentists who did not believe antibiotics used postoperatively reduce local postoperative infection rates were less likely to prescribe injectable intraoperative antibiotics for the prevention of postoperative infection. No other variables were associated with the likelihood of prescribing intraoperative antibiotics. More than 95% of veterinary dentists surveyed agreed that specific antibiotic use guidelines for veterinary dentistry would help reduce inappropriate use of antibiotics.

CLINICAL RELEVANCE

There are differences among veterinary dentists regarding which procedures and patient-specific comorbidities they believe necessitate the use of prophylactic antibiotics. The development of a consensus statement and prospective studies of current antibiotic use are important next steps to improving antibiotic stewardship in veterinary dentistry.

Supplementary Materials

    • Supplementary Material S1 (PDF 144 KB)

Contributor Notes

Corresponding author: Dr. Montebello (jennifer.a.montebello@gmail.com)
  • 1.

    World health statistics 2022: monitoring health for the SDGs, sustainable development goals. World Health Organization. Accessed May 3, 2023. https://www.who.int/publications-detail-redirect/9789240051157

  • 2.

    Antimicrobial resistance: global report on surveillance. World Health Organization. Accessed May 3, 2023. https://apps.who.int/iris/handle/10665/112642

  • 3.

    Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629655. doi:10.1016/S0140-6736(21)02724-0

    • Search Google Scholar
    • Export Citation
  • 4.

    O'Neill, J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. Review on Antimicrobial Resistance. Wellcome Trust and HM Government; 2016.

    • Search Google Scholar
    • Export Citation
  • 5.

    Hicks LA, Bartoces MG, Roberts RM, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015;60(9):13081316. doi:10.1093/cid/civ076

    • Search Google Scholar
    • Export Citation
  • 6.

    Soukup JW, Hetzel S, Paul A. classification and epidemiology of traumatic dentoalveolar injuries in dogs and cats: 959 injuries in 660 patient visits (2004–2012). J Vet Dent. 2015;32(1):614. doi:10.1177/089875641503200101

    • Search Google Scholar
    • Export Citation
  • 7.

    Wallis C, Holcombe LJ. A review of the frequency and impact of periodontal disease in dogs. J Small Anim Pract. 2020;61(9):529540. doi:10.1111/jsap.13218

    • Search Google Scholar
    • Export Citation
  • 8.

    De Paolo MH, Arzi B, Pollard RE, Kass PH, Verstraete FJM. Craniomaxillofacial trauma in dogs–part I: fracture location, morphology and etiology. Front Vet Sci. 2020;7:241. doi:10.3389/fvets.2020.00241

    • Search Google Scholar
    • Export Citation
  • 9.

    Antimicrobial resistance fact sheet. World Health Organization. Accessed May 3, 2023. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

  • 10.

    Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019. Centers for Disease Control and Prevention; 2019. doi:10.15620/cdc:82532

    • Search Google Scholar
    • Export Citation
  • 11.

    Smith DR, Gaunt PS, Plummer PJ, et al. The AVMA's definitions of antimicrobial uses for prevention, control, and treatment of disease. J Am Vet Med Assoc. 2019;254(7):792797. doi:10.2460/javma.254.7.792

    • Search Google Scholar
    • Export Citation
  • 12.

    Weese JS, Blondeau J, Boothe D, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J. 2019;247:825. doi:10.1016/j.tvjl.2019.02.008

    • Search Google Scholar
    • Export Citation
  • 13.

    Lappin MR, Blondeau J, Boothe D, et al. Antimicrobial use guidelines for treatment of respiratory tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med. 2017;31(2):279294. doi:10.1111/jvim.14627

    • Search Google Scholar
    • Export Citation
  • 14.

    Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Vet Dermatol. 2014;25(3):163e43. doi:10.1111/vde.12118

    • Search Google Scholar
    • Export Citation
  • 15.

    Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116(15):17361754. doi:10.1161/CIRCULATIONAHA.106.183095

    • Search Google Scholar
    • Export Citation
  • 16.

    Jevsevar DS, Abt E. The new AAOS-ADA clinical practice guideline on prevention of orthopaedic implant infection in patients undergoing dental procedures. J Am Acad Orthop Surg. 2013;21(3):195197. doi:10.5435/JAAOS-21-03-195

    • Search Google Scholar
    • Export Citation
  • 17.

    Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. J Am Dent Assoc. 2019;150(11):906921.e12. doi:10.1016/j.adaj.2019.08.020

    • Search Google Scholar
    • Export Citation
  • 18.

    Bellows J, Berg ML, Dennis S, et al. 2019 AAHA dental care guidelines for dogs and cats. J Am Anim Hosp Assoc. 2019;55(2):4969. doi:10.5326/JAAHA-MS-6933

    • Search Google Scholar
    • Export Citation
  • 19.

    The use of antibiotics in veterinary dentistry. American Veterinary Dental College. Accessed April 30, 2023. https://avdc.org/about/#pos-stmts

  • 20.

    Yue Yi EK, Siew Ying AL, Mohan M, Menon RK. Prevalence of postoperative infection after tooth extraction: a retrospective study. Int J Dent. 2021;2021:6664311. doi:10.1155/2021/6664311

    • Search Google Scholar
    • Export Citation
  • 21.

    Goormans F, Coropciuc R, Vercruysse M, Spriet I, Willaert R, Politis C. Systemic antibiotic prophylaxis in maxillofacial trauma: a scoping review and critical appraisal. Antibiotics (Basel). 2022;11(4):438. doi:10.3390/antibiotics11040483

    • Search Google Scholar
    • Export Citation
  • 22.

    Kamolratanakul P, Jansisyanont P. A review of antibiotic prophylaxis protocols in oral and maxillofacial surgery. J Oral and Maxillofac Surg Med Pathol. 2018;30(5):395404. doi:10.1016/j.ajoms.2018.03.008

    • Search Google Scholar
    • Export Citation
  • 23.

    Rigby BE, Malott K, Hetzel SJ, Soukup JW. Incidence and risk factors for surgical site infections following oromaxillofacial oncologic surgery in dogs. Front Vet Sci. 2021;8:760628. doi:10.3389/fvets.2021.760628

    • Search Google Scholar
    • Export Citation
  • 24.

    Milic T, Raidoo P, Gebauer D. Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg. 2021;59(6):633642. doi:10.1016/j.bjoms.2020.09.020

    • Search Google Scholar
    • Export Citation
  • 25.

    Tou SP, Adin DB, Castleman WL. Mitral valve endocarditis after dental prophylaxis in a dog. J Vet Intern Med. 2005;19(2):268270. doi:10.1892/0891-6640(2005)192.0.co;2

    • Search Google Scholar
    • Export Citation
  • 26.

    Peddle GD, Drobatz KJ, Harvey CE, Adams A, Sleeper MM. Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs. J Am Vet Med Assoc. 2009;234(1):100107. doi:10.2460/javma.234.1.100

    • Search Google Scholar
    • Export Citation
  • 27.

    Weese JS. Antimicrobials in veterinary dentistry. In: The Veterinary Dental Patient: a Multidisciplinary Approach. John Wiley & Sons Ltd; 2021:87107.

    • Search Google Scholar
    • Export Citation
  • 28.

    Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021;143(20):e963e978. doi:10.1161/CIR.0000000000000969

    • Search Google Scholar
    • Export Citation
  • 29.

    Danilkowicz RM, Lachiewicz AM, Lorenzana DJ, Barton KD, Lachiewicz PF. Prosthetic joint infection after dental work: is the correct prophylaxis being prescribed? A systematic review. Arthroplast Today. 2021;7:6975. doi:10.1016/j.artd.2020.11.007

    • Search Google Scholar
    • Export Citation
  • 30.

    Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners–a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015;146(1):1116.e8. doi:10.1016/j.adaj.2014.11.012

    • Search Google Scholar
    • Export Citation
  • 31.

    Nicholson M, Beal M, Shofer F, Brown DC. Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: a retrospective study of 239 dogs and cats. Vet Surg. 2002;31(6):577581. doi:10.1053/jvet.2002.34661

    • Search Google Scholar
    • Export Citation
  • 32.

    Espinel-Rupérez J, Martín-Ríos MD, Salazar V, Baquero-Artigao MR, Ortiz-Díez G. Incidence of surgical site infection in dogs undergoing soft tissue surgery: risk factors and economic impact. Vet Rec Open. 2019;6(1):e000233. doi:10.1136/vetreco-2017-000233

    • Search Google Scholar
    • Export Citation
  • 33.

    Smiley CJ, Tracy SL, Abt E, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015;146(7):525535. doi:10.1016/j.adaj.2015.01.026

    • Search Google Scholar
    • Export Citation
  • 34.

    Ioannidou E, Geurs N, Lipman R, et al. Antibiotic prescription patterns among US general dentists and periodontists. J Am Dent Assoc. 2022;153(10):979988. doi:10.1016/j.adaj.2022.06.013

    • Search Google Scholar
    • Export Citation
  • 35.

    Weese JS. Investigation of antimicrobial use and the impact of antimicrobial use guidelines in a small animal veterinary teaching hospital: 1995–2004. J Am Vet Med Assoc. 2006;228(4):553558. doi:10.2460/javma.228.4.553

    • Search Google Scholar
    • Export Citation
  • 36.

    Fowler H, Davis MA, Perkins A, et al. A survey of veterinary antimicrobial prescribing practices, Washington State 2015. Vet Rec. 2016;179(25):651. doi:10.1136/vr.103916

    • Search Google Scholar
    • Export Citation
  • 37.

    Langford BJ, Morris AM. Is it time to stop counselling patients to :finish the course of antibiotics”? Can Pharm J (Ott). 2017;150(6):349350. doi:10.1177/1715163517735549

    • Search Google Scholar
    • Export Citation
  • 38.

    Sousa CA, Chatfield J, File TM, et al. Hostage to history – questioning the duration of systemic antimicrobial therapy for the treatment of canine superficial bacterial folliculitis. J Am Vet Med Assoc. 2022;260(10):11531156. doi:10.2460/javma.22.03.0113

    • Search Google Scholar
    • Export Citation
  • 39.

    Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162(2 Pt 1):505511. doi:10.1164/ajrccm.162.2.9909095

    • Search Google Scholar
    • Export Citation
  • 40.

    Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):25882598. doi:10.1001/jama.290.19.2588

    • Search Google Scholar
    • Export Citation

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