Prescription Patterns of Dentists in Primary Care in Bahrain During COVID-19: A Cross Sectional Study.

Background: Dentists have always been attributed to the ever rising global problem of antibiotic resistance. The recent pandemic due to COVID-19 has caused greater concern and primary dental care practices were suspended in the Ministry of Health in Bahrain between February to August 2020. Dental emergencies were addressed using a triage system and dentists were advised on avoiding invasive and aerosol generating procedures. This means that many dentists opted to prescribe medications without undertaking the necessary dental intervention. Aim: To identify the prescription and drug utilization of primary care dental practitioners during the temporary suspension of routine dental practices due to COVID-19. Method: Anonymized data from out-patient dental prescriptions from February 2020 to August 2020 were collected. Necessary data regarding the number, type and indication for prescription were collected and analyzed using appropriate statistical tests. Results: : An average of two medications were prescribed for each patient, that included systemic and local analgesics and anti-microbials. 33.4% of patients were only prescribed medications without any dental intervention. Approximately 35% of the records showed inappropriate diagnosis and their rationale for prescription could not be determined. 100% of the patients with acute or chronic periapical abscess and 41% with gingivitis or periodontitis were prescribed medications without any dental intervention. Amoxicillin and amoxicillin/clavulanic acid amongst the antimicrobial class; and ibuprofen and acetaminophen amongst the analgesics accounted for 90% of prescribed drugs. Chlorhexidine mouth rinse seemed to be on the regular list for any diagnoses, prescribed between 7 and 14 days, twice or thrice daily. Conclusion: Suspension of dental practices can cause more harm in terms of overuse and unindicated prescription practices in primary dental care. The awareness of the recent guidelines is important to prevent unintended use. Effective infection control practices based on guideline should be in place to contain COVID-19 transmission rather than suspension of dental care.