You Are a Professional – People Trust You

Hello. My name’s Shaun Howe. Trust– hard fought for and easily lost. People we barely know trust us, trust us enough to allow us to work in their mouths, to provide operative treatment in their mouths. Why is that? The psychologists tell us it’s because of our role. Dental professionals are trusted health care professionals. This places us in a very privileged position. People listen to us. So when we say that taking antibiotics too often is a bad thing, they listen to us. When we say dental procedures rather than antibiotics are necessary to treat their toothache, they believe us. But do they? Well, whilst many do, some people have learned through experience that some clinicians will readily prescribe antibiotics for dental conditions. Why?

Why do some of our colleagues choose the option of prescribing rather than providing a procedure to treat our patients? There are very many reasons, which you will have the opportunity to explore in more detail as part of an exercise later in this week’s learning material. Going back to the time before antibiotic resistance became a problem, antibiotics were seen as a wonder drug, cure-alls. At that time, no one knew any better. Many health care professionals, dentists included, used to hand out antibiotics without concern. And that’s how many patients learned to associate antibiotics with toothache. Even now, in some circumstances, antibiotics may seem the easiest option to both patients and dentists, a quick fix. We all work under time pressures.

But we need to use our outstanding professionalism to convince our patients that in the right circumstances, a procedure, not a prescription, is the better option; the better option for them, for you, and for the wider society. We all benefit from antibiotics which work. A world in which antibiotics no longer work does not bear thinking about. We use our professionalism daily to consent our patients and to provide their care. To do this, we rely on the trust that we have built. On occasions, this can include declining to provide treatment which our patients request, but which is not, in our clinical judgement, in the patient’s best interest. Extracting rather than restoring healthy teeth is one example.

Providing antibiotics rather than a procedure to treat toothache is another. As a dental therapist in the United Kingdom, I am able to diagnose abscessed primary teeth and extract or provide a pulpotomy as appropriate. If my patient needs antibiotics, however, they must be prescribed by a dentist. This works in the patient’s favour, because it makes a clinical procedure to remove the source of infection more likely whilst ensuring they still have antibiotics when necessary, such as in cases of spreading infection. People are well used to hearing about the risk of antibiotics. But they are yet to hear routinely that antibiotics don’t cure a toothache. The dental profession has much to do to change the public’s perception that links antibiotics and toothache.

In one of last week’s videos, Julie reminded us that giving antibiotic as a quick fix without providing a dental procedure to cure the problem commits patients to a cycle of repeated antibiotics. And you know from other parts of this course that the more antibiotics you take, the higher your risk of adverse outcome. This may not impact you immediately. But when you need antibiotics, maybe as a part of a treatment for a joint replacement or cancer care, you need them to work. This concept is sometimes more challenging when treating patients in an emergency context. And this is where trust, professionalism, and our experience really helps us.

For too long, many in dentistry have taken the path of least resistance, except it isn’t. As you now know, it’s the path that leads to the most resistance. People trust us. Let us use this trust to raise awareness about antibiotic resistance and to share the message that the quickest fix for toothache is a procedure, not a prescription.