Table 2. Descriptive Characteristics of Eligible Dental Visits (2011-2015) and Unadjusted Associations With the Appropriateness of Antibiotic Prophylaxis Among 168 420 Dental Visits.
| Variable | Total (N = 168 420) | Appropriate Antibiotic Prophylaxis (n = 32 243) | Unnecessary Antibiotic Prophylaxis (n = 136 177) |
|---|---|---|---|
| Age at visit, y | |||
| Mean (SD) | 62.2 (14.8) | 63.3 (15.9) | 61.9 (14.5) |
| Median (IQR) | 63 (55-72) | 64 (55-75) | 62 (55-71) |
| Age category at visit, y, No. (%) | |||
| 18-34 | 9175 (5.4) | 1941 (6.0) | 7234 (5.3) |
| 35-44 | 8276 (4.9) | 1782 (5.5) | 6494 (4.8) |
| 45-54 | 22 749 (13.5) | 4129 (12.8) | 18 620 (13.7) |
| 55-64 | 57 979 (34.4) | 9217 (28.6) | 48 762 (35.8) |
| ≥65 | 70 241 (41.7) | 15 174 (47.1) | 55 067 (40.4) |
| Female sex, No. (%) | 96 262 (57.2) | 17 081 (53.0) | 79 181 (58.1) |
| US region, No. (%)a | |||
| Northeast | 22 695 (13.5) | 4947 (15.3) | 17 748 (13.0) |
| Midwest | 78 948 (46.9) | 14 374 (44.6) | 64 574 (47.4) |
| South | 52 987 (31.5) | 10 781 (33.4) | 42 206 (31.0) |
| West | 13 735 (8.2) | 2134 (6.6) | 11 601 (8.5) |
| Rural vs urban, No. (%) | |||
| Rural | 72 905 (43.3) | 15 399 (47.8) | 57 506 (42.2) |
| Urban | 95 515 (56.7) | 16 844 (52.2) | 78 671 (57.8) |
| Antibiotic prescribed, No. (%)b | |||
| Amoxicillin | 116 908 (69.4) | 24 466 (75.9) | 92 442 (67.9) |
| Clindamycin | 27 031 (16.0) | 5066 (15.7) | 21 965 (16.1) |
| Cephalexin | 13 879 (8.2) | 1470 (4.6) | 12 409 (9.1) |
| Azithromycin | 5297 (3.1) | 694 (2.2) | 4603 (3.4) |
| Penicillin | 3620 (2.1) | 505 (1.6) | 3115 (2.3) |
| Doxycycline | 1656 (1.0) | 135 (0.4) | 1521 (1.1) |
| Otherc | 4666 (2.8) | 624 (1.9) | 4042 (3.0) |
| ADA dental procedure category, No. (%)d | |||
| Diagnostic | 118 215 (70.2) | 24 899 (77.2) | 93 316 (68.5) |
| Preventive | 99 059 (58.8) | 21 902 (67.9) | 77 157 (56.7) |
| Restorative | 30 955 (18.4) | 4884 (15.1) | 26 071 (19.1) |
| Oral and maxillofacial surgery | 10 808 (6.4) | 1611 (5.0) | 9197 (6.8) |
| Periodontics | 11 995 (7.1) | 2431 (7.5) | 9564 (7.0) |
| Adjunctive general services | 4842 (2.9) | 607 (1.9) | 4235 (3.1) |
| Endodontics | 3503 (2.1) | 706 (2.2) | 2797 (2.1) |
| Implant services | 2456 (1.5) | 168 (0.5) | 2288 (1.7) |
| Prosthodontics | 2147 (1.3) | 285 (0.9) | 1862 (1.4) |
| Orthodontics | 224 (0.1) | 10 (0.0) | 214 (0.2) |
| Maxillofacial prosthetics | 22 (0.0) | 1 (0.0) | 21 (0.0) |
| Category not available | 2803 (1.7) | 7 (0.0) | 2796 (2.1) |
| Gingival manipulation, No. (%) | 152 711 (90.7) | 32 243 (100.0) | 120 468 (88.5) |
| Previsit conditions, No. (%) | |||
| Prosthetic joint device | 71 651 (42.5) | 8041 (24.9) | 63 610 (46.7) |
| Cardiac conditione | 35 224 (20.9) | 32 243 (100.0) | 2981 (2.2) |
| Diabetesf | 38 421 (22.8) | 7986 (24.8) | 30 435 (22.3) |
| Immunocompromised stateg | 9211 (5.5) | 1733 (5.4) | 7478 (5.5) |
| Preindex health service useh | |||
| PCP visits, mean (SD) | 1.7 (3.5) | 1.9 (4.0) | 1.6 (3.4) |
| Any PCP visit, No. (%) | 85 399 (50.7) | 16 504 (51.2) | 68 895 (50.6) |
| Specialist visits, mean (SD) | 7.3 (9.9) | 8.4 (10.6) | 7.0 (9.8) |
| Any specialist visit, No. (%) | 135 375 (80.4) | 27 144 (84.2) | 108 231 (79.5) |
| ED visits, mean (SD) | 0.2 (0.8) | 0.3 (0.9) | 0.2 (0.7) |
| Any ED visit, No. (%) | 24 361 (14.5) | 6199 (19.2) | 18 162 (13.3) |
| Admissions, mean (SD) | 0.2 (0.4) | 0.2 (0.5) | 0.1 (0.4) |
| Any admission, No. (%) | 21 985 (13.1) | 4530 (14.0) | 17 455 (12.8) |
Abbreviations: ADA, American Dental Association; ED, emergency department; IQR, interquartile range; PCP, primary care provider.
A total of 55 observations were missing, 7 in the appropriate group and 48 in the unnecessary group.
There could be multiple antibiotic dispensing records associated with the same visit (2.7% had >1 antibiotic associated with the dental visit).
Other antibiotics include the following: ampicillin (n = 358), cefaclor (n = 30), cefadroxil (n = 235), cefazolin (n = 2), cefdinir (n = 37), cefixime (n = 49), cefoxitin (n = 5), cefpodoxime (n = 20), cefprozil (n = 9), ceftazidime (n = 3), ceftriaxone (n = 54), cefuroxime (n = 86), ciprofloxacin (n = 1336), clarithromycin (n = 336), demeclocycline (n = 2), dicloxacillin (n = 15), erythromycin (n = 860), gemifloxacin (n = 3), levofloxacin (n = 439), lincomycin (n = 1), linezolid (n = 7), minocycline (n = 102), moxifloxacin (n = 117), ofloxacin (n = 51), sulfamethoxazole-trimethoprim (n = 434), tetracycline (n = 19), trimethoprim (n = 38), and vancomycin (n = 19).
The ADA has a standardized system to group Code on Dental Procedures and Nomenclature (CDT) codes (dental procedure codes) into categories (shown in the Table). There could be multiple procedures performed during the same visit. The ADA does not include Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes in their standard ADA dental procedure categories. The CPT and HCPCS codes are included in “category not available.”
Cardiac conditions were defined according to the study by Wilson et al5 as those at the highest risk of infective endocarditis.
The diabetes category includes those with type 1 and type 2 diabetes.
Immunocompromised state was defined according to previous guidelines from the ADA and the American Academy of Orthopaedic Surgeons.25
Health service use assessed over the 6-month predental visit period, not accounting for enrollment in dental or medical plans. We defined outpatient clinic visits with a health care provider type of nurse practitioners, physician assistants, or medical doctors. Medical doctors with a specialty of internal medicine or family medicine were included as PCPs. Other types of clinical encounters were defined as a specialist visit and may include health care encounters without a medical care provider (eg, nurse visit or laboratory visit).