these recommendations can be controversial. Regardless of these issues, the appropriate prescribing of antibiotics, while Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing
challenging for dental and medical professionals alike, is vitally important in the overall management of patients.
implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
The practice of overprescribing or misprescribing antibiotics in certain medical and dental situations, as well as development of antibiotic- resistant strains of bacteria, could be greatly abated with closer attention to basic prescription-writing principles. As part of the efforts to curb antibiotic resistance, a National Action Plan on Combating Antibiotic-Resistant Bacteria (CARB), 2020-2025 provides strategies to decrease patient harm while preserving patient access to antibiotics (The White House, 2020). The purpose of this course is to review the pharmacology of antimicrobial agents and present current guidelines and therapeutic choices in order to optimize antibiotic prescribing practices. Since the goal of antibiotic therapy is to ensure selection of the right drug at the right time and at the right dose, for the right patient and the right procedure, the information presented in this course should be considered essential
knowledge for all OHCPs – those just starting their careers and those needing a mid-career refresher. After completing this course, the participant will be able to discuss the differences among antibiotics typically prescribed for orofacial infections. In the case of special patient populations such as orthopedic, cardiac, and immunosuppressed individuals, the selection and timing of appropriate prophylactic antibiotics will be made clear. The principles learned will also be directly applicable to the appropriate selection of antimicrobial therapy for the pregnant or breastfeeding patient and will aid in recognizing those patients with a significant allergic history and how to best and safely treat them. This intermediate-level course is specifically designed for all members of the dental healthcare team: dentists, dental hygienists, and dental assistants.
PATHOGENS MOST COMMONLY ASSOCIATED WITH OROFACIAL INFECTIONS
● Fusobacterium, Bacteroides, Prevotella, Porphyromonas, Pseudomonas. ● Actinomyces, Corynebacterium, Eubacterium, Leptotrichia. ● Lactobacillus. ● Veillonella. (Han & Wang, 2013; Bahl et al. 2014) Figure 1: Stepwise Guidelines in Considering the Prescribing of an Antibiotic
While most cases of oral pathology seen by oral healthcare providers (OHCPs) are inflammatory conditions associated with pain, a significant percentage of dental pain originates from either acute or chronic infections, which necessitate operative intervention followed by analgesic therapy, rather than antibiotics alone (American Dental Association, 2021b). Clinical situations requiring antibiotic therapy are limited and typically include oral infections accompanied by elevated body temperature and evidence of systemic spread, such as lymphadenopathy and trismus. In general, antibiotics are either required for treatment of an existing infection or prophylaxis for a potential infection, depending on the immuno- competency of the patient. Figure 1 outlines the stepwise guidelines for the prescribing of an antibiotic. Treatment of an existing infection with systemic antimicrobials should be used only in acute conditions for which OHCPs know the most commonly associated pathogens. Correctly diagnosing the infecting microorganism(s) and choosing the most targeted and effective antibiotic will help ensure clinical effectiveness. While bacteriologic assessment and identification should ideally be completed before treatment is begun, an acutely ill patient cannot have antibiotic treatment delayed for the 48 hours or more that may be needed to acquire the results of bacteriologic testing. For this reason, the choice of antibiotic must be based empirically on the OHCP’s knowledge of the usual causative microorganisms and the antibiotic(s) to which these organisms are typically susceptible (The Sanford Guide to Antimicrobial Therapy, 2021). The predominant cultivable flora associated with orofacial infections are outlined in Table 1 (Paster et al., 2001; Bahl et al. 2014; Diaz, Hoare, & Hong, 2016). The most common pathogens associated with orofacial infections, in the order of their prevalence, are as follows:
Therefore, in treating an acute orofacial infection, it is reasonable to start with an antibiotic to which the probable organisms (gram-positive aerobes and intraoral anaerobes) are susceptible. However, it is important to recognize that orofacial infection flora can change over time. While early, acute infections tend
● Streptococcus . ● Staphylococcus. ● Peptostreptococcus.
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Book Code: DFL3024
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