The Oral and Dental guidelines have been extensively revised.
When adjunct antibiotics are indicated for acute odontogenic infection,
the timing of a dental procedure to address the source of infection influences antibiotic choice. Penicillin monotherapy is now recommended for nonsevere spreading infections
that are promptly managed with a dental procedure (within 24 hours); if the dental procedure is likely to be delayed, broader-spectrum therapy with a penicillin plus metronidazole,
or amoxicillin+clavulanate, is recommended to provide activity against anaerobes. If features of severe local or systemic odontogenic infection (including sepsis) are present, a new
flow chart guides emergency management in dental practice.
Revised advice on antibiotic prescribing for patients reporting penicillin hypersensitivity
aims to minimise antibiotic-related harms. For patients in community dental practice, cefalexin is recommended for patients reporting nonsevere penicillin hypersensitivity;
use of clindamycin should be limited to patients reporting severe penicillin hypersensitivity. Updated guidance tailored for dental practitioners explains the approach to
assessing the severity of antimicrobial hypersensitivity.
To aid prescribing, amended figures illustrate the correct format for writing prescriptions, with annotations of key elements.
Key considerations are included for prescribing compounded medicines and off-label prescribing. New advice outlines the requirements for supply of medicines by dentists to patients.
To manage anxiety in dentistry, nonpharmacological strategies have been added as the first-line approach. If these are inadequate
and minimal sedation is considered, a new section summarises requirements for safe practice. If benzodiazepines are used, revised drug recommendations allow for an increase in dose at subsequent visits if required.
The role of off-label use of methoxyflurane for minimal sedation in short dental procedures is outlined. Special considerations are outlined on managing children with anxiety in dentistry.
For adults with severe acute or postprocedural dental pain who cannot tolerate oxycodone, tapentadol has been included as an alternative.
Prescription of tapentadol by dental practitioners is subject to state and territory regulations, and requires the prescriber to be familiar with the requirements for safe use.
Advice on chronic orofacial pain includes an expanded classification of pain types and indicators for early referral
(both general indicators and those specific to temporomandibular disorders and trismus).
A new quick-reference table classifies dental procedures and notes key periprocedural considerations. It summarises the use of preventive
measures for managing risks of bleeding, infective endocarditis, surgical-site infection, medication-related osteonecrosis of the jaw (MRONJ) and adrenal crisis.
Safe use of local anaesthesia is a key element of dental practice. Advice on the choice of intermediate-acting local anaesthetic has been revised;
articaine is now included as an option for use in nerve blocks for dental procedures.
Content on complications of oral surgery has been expanded to include oroantral communications, intraoperative fractures and hypochlorite extrusion after
a closed root canal procedure, in addition to revised content on postprocedural pain and swelling, and periprocedural bleeding.
Advice on MRONJ includes a new summary of the incidence rates according to the type of medication and dental procedure. While management of established MRONJ
is guided by a specialist, new advice has been included on nonoperative management that can be undertaken in general dental practice.
New diagrams and photographs illustrate the stages of dental caries development, according to the International Caries Detection and Assessment System (ICDAS).
Advice on fluoride for caries prevention is updated, with added emphasis on the use of varnish and silver diamine formulations in professional formulations for patients at elevated caries risk.
Recent guidance from the European Federation of Periodontology using a 4-step approach to management of periodontitis is outlined and a link is provided to their infographic summaries.
Patients with dental trauma may present to a medical practitioner before a dentist. New guidance outlines emergency management of tooth fractures and luxations (teeth that are displaced but not avulsed),
and new photos demonstrate emergency splinting techniques for luxated or avulsed teeth. Amoxicillin is now preferred for an avulsed permanent tooth because of widespread experience with its use, with doxycycline being limited to patients reporting penicillin hypersensitivity.
Assessment of trauma also highlights the need to consider nonaccidental injury.
In evaluating oral mucosal diseases, it is important to recognise red flags for oral cancer and nonmalignant conditions that require specialist referral; to support this, new content has been added on
oral pigmented lesions and nonmalignant conditions such as oral syphilis. New photographs aid recognition of a range of infectious diseases (eg herpangina; hand, foot and mouth disease; herpes simplex; herpes zoster; oral syphilis).
A new topic outlines the role of the dentist in identifying patients at risk of obstructive sleep apnoea and management using oral appliances (eg mandibular advancement appliances).
Comorbidities are crucial considerations in planning dental treatment. Expanded content on considerations for
patients with medical conditions provides guidance on dental treatment planning for patients with:
Guidance for medical practitioners managing oral and dental issues includes new content on preventive interventions by medical practitioners, highlighting people in whom poor oral health is most prevalent
or in whom specific needs should be considered (eg pregnancy, people with special needs).
