Should you be sending oral microbiological samples to the laboratory?

Key Points

• Dentists need to improve prescribing in general practice.

• The clinical laboratory can help by providing data on which therapeutic decisions can be made that discourage the development of antibiotic resistance.

• Collection of an appropriate specimen is crucial to obtaining a useful laboratory report.

• Clinical specimens from the community are an essential prerequisite for the development of rational antibiotic policies.

• Diagnostic laboratories must be more proactive in encouraging appropriate use and making their facilities as accessible as possible.

Abstract

Objective To identify barriers on the use of diagnostic microbiology facilities in general dental practice.

Design A cross-sectional survey using a postal questionnaire.

Setting Primary/secondary care interface between the diagnostic oral microbiology laboratory, University of Glasgow Dental Hospital and School, Glasgow and dental practitioners within the surrounding health boards, 1998.

Subjects All GDPs (797) within Argyll and Clyde, Ayrshire and Arran, Lanarkshire and Greater Glasgow Health Boards.

Main outcome measures The responses were expressed as both absolute and relative frequencies.

Results Responses were received from 430 (55%). The most frequent reason for failure to use the service was lack of information, with more than half of the respondents claiming to be unaware of the facility. Lack of request forms and sampling equipment were also viewed as barriers to using the service.

Conclusions The laboratory is failing to successfully communicate its role in addressing the growing burden of antibiotic resistance in the community and must be more proactive in encouraging appropriate use and increasing accessibility of the service to GDPs.

Main

Barriers to the use of a diagnostic oral microbiology laboratory by general dental practitioners K M Roy, A Smith, J Sanderson, J Bagg, D MacKenzie, M S Jackson, G Taylor, and J McEwen Br Dent J 1999; 186: 345–347

Comment

Antibiotics are prescribed widely by dental practitioners. However, whether the appropriate antimicrobial is always used is questionable.

Diagnostic oral microbiology services can play a key role in the management of acute and chronic oral infections by giving the clinician information on the nature and sensitivity of pathogens. Such laboratories also act in a surveillance function, monitoring the changes in sensitivity of microorganisms and providing information for empirical antibiotic regimes. The value of diagnostic oral microbiology services are understood by hospital clinicians that use their services, but are poorly used by general dental practitioners. This paper examines the reasons why general dental practitioners do not use diagnostic oral microbiology services.

The design of the study was a questionnaire which was sent to 797 general dental practitioners in Scotland. The questionnaire was in three parts and sought information principally about the knowledge of oral microbiology services, sampling equipment, cost and transportation of samples to the laboratory.

The questionnaire was well supported and 450 (55%) replies were received. The most frequent reason for the failure to use the laboratory was lack of information, almost half the respondents claiming not to know the facilities were available. Lack of equipment and request forms was also perceived as a problem. Suprisingly, cost and the time taken to get a result was not perceived as an obstacle to taking samples.

It is clear from this study that there is a lack of awareness of the role of oral microbiology diagnostic services in the management of oral infection. Thus it is perhaps the duty of the oral microbiology laboratories to make practitioners aware of these services, and to provide suitable equipment and arrangements for sampling.

More widespread use of these services in the dental community will provide information on any changes in antimicrobial resistance in oral microorganisms. This excellent paper shows some of the barriers to obtaining samples from the community through dental practice to assess patterns of microbial resistance. Information on microbial resistance in oral microorganisms would be enormously beneficial in the design of antibiotic policies. Let us hope that practitioners are encouraged by this paper to send samples to their local oral microbiology laboratory.