Table 3. Multivariable Analysis of Factors Associated With Unnecessary Antibiotic Prophylaxis Among 168 420 Dental Visits.
| Variable | Odds Ratio (95% CI) |
|---|---|
| Age category at visit, y | |
| 18-34 | 1 [Reference] |
| 35-44 | 0.90 (0.81-0.99) |
| 45-54 | 0.94 (0.86-1.03) |
| 55-64 | 0.93 (0.85-1.01) |
| ≥65 | 0.71 (0.65-0.78) |
| Sex | |
| Male | 1 [Reference] |
| Female | 1.21 (1.17-1.25) |
| US region | |
| Northeast | 0.76 (0.72-0.81) |
| Midwest | 1 [Reference] |
| South | 0.88 (0.85-0.92) |
| West | 1.15 (1.06-1.25) |
| Unknown | 1.81 (0.64-5.06) |
| Rural vs urban | |
| Rural | 0.78 (0.75-0.82) |
| Urban | 1 [Reference] |
| Year of visit | |
| 2011 | 1 [Reference] |
| 2012 | 0.81 (0.79-0.84) |
| 2013 | 0.70 (0.67-0.72) |
| 2014 | 0.59 (0.56-0.61) |
| 2015 | 0.53 (0.51-0.55) |
| Antibiotic prescribed | |
| Amoxicillin | 1 [Reference] |
| Clindamycin | 1.10 (1.05-1.15) |
| Othera | 1.70 (1.61-1.79) |
| ADA dental procedure categoryb | |
| Diagnostic | 0.90 (0.87-0.92) |
| Preventive | 0.62 (0.60-0.65) |
| Restorative | 0.98 (0.95-1.02) |
| Oral and maxillofacial surgery | 0.72 (0.68-0.75) |
| Periodontics | 0.65 (0.62-0.68) |
| Adjunctive general services | 1.47 (1.32-1.62) |
| Endodontics | 0.62 (0.58-0.65) |
| Implant services | 1.66 (1.45-1.89) |
| Prosthodontics | 1.65 (1.41-1.95) |
| Orthodontics | 3.04 (1.06-8.68) |
| Maxillofacial prosthetics | 1.53 (1.04-2.27) |
| Previsit conditions | |
| Prosthetic joint device | 2.31 (2.22-2.41) |
| Diabetes | 0.87 (0.83-0.91) |
| Immunocompromised state | 0.91 (0.85-0.98) |
| Preindex health service use (yes or no)c | |
| PCP visits | 0.96 (0.94-0.98) |
| Specialist visits | 0.86 (0.84-0.88) |
| ED visits | 0.91 (0.88-0.93) |
| Admissions | 0.86 (0.83-0.88) |
Abbreviations: ADA, American Dental Association; ED, emergency department; PCP, primary care provider.
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 dental procedures codes (Code on Dental Procedures and Nomenclature 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 codes and Healthcare Common Procedure Coding System codes in their standard ADA dental procedure categories.
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).