Ten-year trends in antimicrobial and analgesic prescribing by NHS dentists in England: a retrospective analysis study

Aims Evidence on long-term National Health Service (NHS) dental prescribing is limited. This study aimed to identify whether utilisation of analgesics and antimicrobials returned to pre-Coronavirus Disease 2019 (COVID-19) levels in primary dental care, highlighting the national efforts needed to ensure patient safety when prescribing in dentistry.Methods Ten years of data from the NHS Business Services Authority on the utilisation of antimicrobials and analgesics by primary care dentists between January 2014 and December 2023 were obtained. Significant distributional changes were analysed using chi-square test, focusing on the impact of COVID-19 restrictions on prescribing.Results Total antimicrobial and analgesic prescribing returned to near pre-pandemic levels by December 2023 (antimicrobials - February 2020: 373.8, December 2023: 358 items/100,000; analgesics - February 2020: 8.78, December 2023: 8.35 items/100,000). Amoxicillin, metronidazole, erythromycin, paracetamol and diclofenac fell significantly versus peak (p <0.05). Clindamycin declined post-pandemic but remained above pre-pandemic levels (February 2020: 1.83, December 2023: 2.00 items/100,000). Dihydrocodeine comprised 42% of analgesics in December 2023 and exceeded pre-pandemic levels (February 2020: 3.22, December 2023: 3.51 items/100,000).Conclusions Prescribing guidelines and stewardship programs contributed to reduced antimicrobial use, though pandemic disruptions reversed progress. Relatively higher clindamycin prescribing raises concerns about Clostridioides difficile risk. Continued reliance on dihydrocodeine despite its side-effect profile highlights the importance of a national plan to ensure regular training and self-audit.