A Tale of Two Dental Systems: Evaluating Dental Antibiotic Prescribing in VA and Non-VA Settings

Dentists prescribe 10% of all outpatient antibiotic prescriptions in the United States with infection prophylaxis as the most common reason for prescriptions. Dentists provide antibiotic prophylaxis for prevention of infective endocarditis (IE) and or prosthetic joint infection (PJI). While many studies have identified patterns of dental antibiotic prescribing focusing on antibiotics prescribed, geographic prescribing variations, and provider specialty, one feature not studied is the influence of dental setting. The Departments of Veterans Affairs is the largest provider of oral health care in the US and is one of few dental systems with access to an integrated electronic health record (EHR) with dental and medical data. In contrast, those that work in private practices do not have access to medical records. Therefore, the goal of this thesis was to assess whether guideline concordant dental antibiotic prophylaxis among those with cardiac conditions and prosthetic joints differs between VA and non-VA patient populations and whether downstream outcomes of antibiotic prescribing differs. A secondary goal was to understand dentists’ perceptions regarding antibiotic prescribing.