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We investigated the use of oral antibiotics related to normal tooth extraction and extraction of impacted mandibular third molars in the outpatient clinic before and after the start of the Antimicrobial Stewardship Program (ASP) by the dental Infection Control Team (ICT). The medication records were extracted through a retrospective survey using an electronic medical record system from January 2015 to December 2018 (four-year duration). Survey items included the presence or absence of oral antibiotics, type of oral antibiotics, and so on. From the second half of the study period, we conducted an e-learning training, which included questions about antimicrobial stewardship for extraction; at the same time, related information was shared among all the dental staff. As a result, out of all the 12,225 normal tooth extraction cases, 68.1% (4110/6036) in the first half received oral antibiotic medication on the day of tooth extraction and 50.4% (3120/6189) in the second half. The extraction of impacted mandibular third molars had 4740 cases in total, and the cases that received medication on the day of tooth extraction were 90.5% (2130/2354) in the first half and 60.3% (1419/2354) in the second half. According to the guidelines, antibiotics are not required during normal tooth extraction, whereas preoperative administration is recommended for the extraction of impacted mandibular third molars, suggesting that proper medication use with the guideline in mind tends to increase over time. The types of oral antibiotics are shifting from third-generation cephems to penicins. The use of third-generation cephems for normal tooth extraction is 86.9% in the first half of 2015 to 28.3% in the second half of 2018, and the use of third-generation cephems for lower jaw impacted tooth extraction is 87.4% in the first half of 2015 to 8.5% in the second half of 2018. From a series of examinations, it was inferred that ASP led by the dental ICT contributed to the proper use of oral antibiotics for normal tooth extraction and extraction of impacted mandibular third molars.

Antimicrobial Stewardship Program by the Dental ICT for Extraction in an Outpatient Dental Clinic