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Ni C, Wu G, Miao T, Xu J. Wnt4 prevents apoptosis and inflammation of dental pulp cells induced by LPS by inhibiting the IKK/NF‑κB pathway. Exp Ther Med 2022; 25:75. [PMID: 36684653 PMCID: PMC9842946 DOI: 10.3892/etm.2022.11774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
Wnt4 has been shown to promote the recovery of odontogenic differentiation of dental pulp stem cells under inflammatory conditions, but its role in inflammation and apoptosis of pulpitis remains to be elucidated. Lipopolysaccharide (LPS) (10 µg/ml) was applied to treat the human dental pulp cells (HDPCs) for 24 h. Western blotting measured the expressions of inflammatory cytokines and apoptosis-related proteins. Cell apoptosis was measured by flow cytometry. The level of Wnt4 was evaluated by reverse transcription-quantitative PCR and western blotting. The results indicated that LPS could promote inflammatory response and apoptosis in HDPCs and downregulated Wnt4 expression was found in LPS-HDPCs. Overexpression of Wnt4 ameliorated cell inflammatory response and apoptosis, presented by reduced expressions of IL-8, IL-6, TNF-α, IL-1β, Bax, cleaved-caspase 3 and enhanced Bcl-2 expression as well as decreased apoptosis rate. Moreover, overexpression of Wnt4 reduced the phosphorylation levels of IKK2, IκBα and p65 proteins upregulated by LPS. Finally, overexpression of IKK2 reversed the effects of Wnt4 on inflammation and apoptosis of LPS-HDPCs and NF-κB inhibitor reversed the effect of IKK2 overexpression in LPS-HDPCs. Wnt4 inhibited LPS-triggered inflammation and apoptosis in HDPCs via regulating the IKK/NF-κB signaling pathway, which provided a new viewpoint for understanding the pathological mechanism of pulpitis.
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Affiliation(s)
- Chengli Ni
- College of Stomatology, Anhui Medical College, Hefei, Anhui 230601, P.R. China,Correspondence to: Ms. Chengli Ni, College of Stomatology, Anhui Medical College, 632 Furong Road, Hefei, Anhui 230601, P.R. China
| | - Gang Wu
- Shanghai Smartee Denti-Technology Co., Ltd., Shanghai 200120, P.R. China
| | - Tingting Miao
- College of Stomatology, Anhui Medical College, Hefei, Anhui 230601, P.R. China
| | - Jianguang Xu
- Key Laboratory of Oral Disease Research of Anhui Province, Department of Orthodontics, Stomatologic Hospital and College, Anhui Medical University, Hefei, Anhui 230032, P.R. China
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Huang F, Cheng L, Li J, Ren B. Nanofibrous scaffolds for regenerative endodontics treatment. Front Bioeng Biotechnol 2022; 10:1078453. [PMID: 36578510 PMCID: PMC9790898 DOI: 10.3389/fbioe.2022.1078453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Untreated dental caries, tooth trauma and dental anatomical variations such as dens invaginatus can result in pulpitis. However, standard root canal therapy cannot treat immature permanent teeth due to an open apical foramen and thin dentinal walls. Thus, regenerative endodontics treatment (RET) following a disinfection step with pulp regeneration has been developed. Pulp connective-tissue, dentin formation, revascularization and reinnervation can occur in this procedure which should be supplemented with intelligent biomaterials to improve repeatability and support well-coordinated regeneration. Furthermore, nanofibrous scaffolds, as one of the most commonly used materials, show promise. The purpose of this article is to highlight the advantages of nanofibrous scaffolds and discuss the future modification and application of them.
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Affiliation(s)
- Fangting Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Preventive Dentistry, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Jiyao Li, ; Biao Ren,
| | - Biao Ren
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Jiyao Li, ; Biao Ren,
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Abuhassna MA, Aldajani HA, AlQahtani KW, Alzahrani AK, AlAwwad DA, Suliman O, Rajeh MT, Ashraf S, Al-Maweri SA. Antibiotic Prescription During Endodontic Treatment: Knowledge and Practices of Dental Interns in Saudi Arabia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1321-1328. [PMID: 36281459 PMCID: PMC9586888 DOI: 10.2147/amep.s376333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Antibiotics are widely used in dental practice, especially for endodontic infections. The present survey aimed to investigate the knowledge and practices of dental interns in Saudi Arabia regarding antibiotic prescription for endodontic treatment. METHODS The present online questionnaire-based, cross-sectional study involved dental interns in private and public dental schools, Saudi Arabia. A pre-validated questionnaire was distributed to 900 dental interns via different social media platforms. The questionnaire consisted of 16 close-ended questions related to participants' demographic data and knowledge and practices of antibiotic prescription in context of endodontic treatments. Data were managed and analyzed using IBM-SPSS version 25, and Chi-square test was used to compare between the groups. RESULTS A total of 555 dental interns completed the questionnaire, giving a response rate of 61.1%. Overall, the surveyed participants revealed inadequate knowledge and unnecessary use of antibiotics during endodontic procedures. While majority of the participants (75.3%) correctly identified the first choice of antibiotics during endodontic treatments, a considerable proportion of the participants did not recognize the clinical indications of antibiotics in endodontic patients. Additionally, around one-fifth (18.9%) of the participants were unaware of the potential side effects of the prescribed antibiotics. CONCLUSION The present survey revealed unsatisfactory knowledge and practices of antibiotic prescription in context of endodontic therapy among Saudi dental interns. Therefore, dental schools in Saudi Arabia should address such a gap through updating the curriculum and integrating real-world clinical scenarios using problem-based learning. Additionally, periodic continuous education courses aiming at improving dental professionals' knowledge about antibiotics and their clinical uses for endodontic therapy are highly encouraged.
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Affiliation(s)
| | | | | | | | | | - Oubada Suliman
- Prosthodontics Department, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Mona Talal Rajeh
- Dental Public Health Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sajna Ashraf
- Department of Oral Medicine and Diagnostic Sciences, Vision Colleges, Riyadh, Saudi Arabia
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Ramnarain P, Singh S. Public healthcare practitioners’ knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use in Pietermaritzburg, KwaZulu-Natal. Health SA 2022; 27:1832. [PMID: 35548063 PMCID: PMC9082215 DOI: 10.4102/hsag.v27i0.1832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is limited published evidence on health workers’ perspectives on trends in oral antibiotic prescription for dental conditions in the public health sector. Aim This study set to determine healthcare practitioners’ knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use. Setting This included two public hospitals in Pietermaritzburg. Methods This was a cross-sectional study using quantitative data. Purposive sampling was used to select medical and dental practitioners from Institution A and B (n = 122). A self-administered questionnaire was developed using open and close-ended questions. Data were collected and analysed using the Statistical Package for Social Sciences (IBM SPSS version 25R). Results The response rate for the study was 72.1%. The majority of study participants (n = 72, 81.8%) indicated awareness of an antibiotic stewardship programme in their respective institutions. However, a significant number (n = 42; 47.7%) of participants were unsure of whether this programme was active. Most participants (n = 80, 90.9%) indicated the need for improving oral antibiotic prescription for dental conditions. Participants indicated prescription of antibiotics for orofacial swellings (n = 52; 59.0%) and dental pain related to irreversible pulpitis (n = 29; 32.9%), reversible pulpitis (n = 33; 37.5%) and dental fillings (n = 15; 17.0%). Antibiotics were also prescribed for pericoronitis (n = 58; 65.9%), periodontitis (n = 57; 64.7%) and impacted teeth (n = 21; 23.8%). All dental practitioners (n = 14) supported the need for antibiotic cover for pericoronitis and periodontitis. Conclusion The results indicated inconsistencies in healthcare practitioners’ reported knowledge, attitudes and practices related to antibiotic prescription patterns. Contribution This study highlights the need for clear evidence-based guidelines for antibiotic prescription for dental conditions.
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Affiliation(s)
- Prishana Ramnarain
- Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Shenuka Singh
- Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Šimundić Munitić M, Šutej I, Ćaćić N, Tadin A, Balić M, Bago I, Poklepović Peričić T. Knowledge and attitudes of Croatian Dentists Regarding Antibiotic Prescription in Endodontics: A Cross-sectional Questionnaire-based Study. Acta Stomatol Croat 2021; 55:346-358. [PMID: 35001930 PMCID: PMC8734455 DOI: 10.15644/asc55/4/2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess dentists' level of knowledge and practice concerning antibiotic usage in endodontics using the European Society of Endodontology position statement as a reference. MATERIALS AND METHODS A cross-sectional study was conducted in the form of an electronic questionnaire consisting of 23 questions, including dentists' demographic and professional characteristics, attitudes as well as experiences regarding antibiotics in endodontics. Data were evaluated by the Mann-Whitney test or the Kruskal Wallis 1-way ANOVA, α = 5%. RESULTS The overall mean self-reported knowledge of antibiotics usage in endodontics was 11.7±2.5 points, out of a maximum possible score of 23. The factors associated with a higher knowledge were: age (P≤0.001), clinical experience (P≤0.001), specialist training (P=0.008), and adherence to the guidance on the use of systemic antibiotics in endodontics (P=0.006). Dentists who specialized in endodontics (16.1±2.2) achieved higher levels of knowledge. CONCLUSION Knowledge on antibiotic usage in endodontics among dentists in Croatia is insufficient. There is a need for continuing education on the use of antibiotics among general dentists.
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Affiliation(s)
| | - Ivana Šutej
- Department of Pharmacology, School of Dental Medicine, University of Zagreb, Croatia
| | - Nensi Ćaćić
- Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | - Antonija Tadin
- Department of Restorative Dental Medicine and Endodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | | | - Ivona Bago
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Croatia
| | - Tina Poklepović Peričić
- Department of Prosthodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
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Abstract
Patients sometimes present to a medical practitioner with dental pain if they cannot see a dentist Doctors need to be aware of the common dental diseases that result in pain so they can help to manage the patient’s symptoms until they are able to see a dentist Appropriate advice regarding analgesics for dental pain is important. Paracetamol and ibuprofen are more effective in combination than either of them alone, with or without opioids Antibiotics are only indicated as an adjunct to dental treatment when there are signs of systemic involvement, progressive and rapid spread of infection, or when the patient is immunocompromised
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Tampi MP, Pilcher L, Urquhart O, Kennedy E, O'Brien KK, Lockhart PB, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Lang MS, Patton LL, Paumier T, Suda KJ, Cho H, Carrasco-Labra A. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019; 150:e179-e216. [PMID: 31761029 DOI: 10.1016/j.adaj.2019.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
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Bansal R, Jain A, Goyal M, Singh T, Sood H, Malviya HS. Antibiotic abuse during endodontic treatment: A contributing factor to antibiotic resistance. J Family Med Prim Care 2019; 8:3518-3524. [PMID: 31803645 PMCID: PMC6881914 DOI: 10.4103/jfmpc.jfmpc_768_19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
Antibiotic resistance is one of our most serious global health threats. The adverse effects of overusing and misusing antibiotics are highly publicized in the health professional literature. Antibiotic abuse occurs during routine endodontic treatment and there are deficiencies in knowledge regarding prescribing antibiotic and appropriate prophylactic antibiotic use. Multidisciplinary coordination and cooperation among dentists, pharmacists, and patients is needed to curb antibiotic abuse. As endodontists, we can become part of the solution to the antibiotic resistance crisis and deal with it conclusively. This review article discusses antibiotic resistance resulting from antibiotic abuse during endodontic treatment, various factors contributing to it, and measures required for stopping antibiotic abuse in endodontic treatment. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.
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Affiliation(s)
- Ramta Bansal
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Aditya Jain
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Mehak Goyal
- Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Tejveer Singh
- Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Himanshu Sood
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Harjeet Singh Malviya
- Department of Conservative Dentistry and Endodontics, Geetanjali Dental and Research Institute, Udaipur, Rajasthan, India
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Bjelovucic R, Par M, Rubcic D, Marovic D, Prskalo K, Tarle Z. Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study. Int Dent J 2019; 69:273-280. [DOI: 10.1111/idj.12460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
BACKGROUND Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth, the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2016. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched Cochrane Oral Health's Trials Register (to 18 February 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 18 February 2019); MEDLINE Ovid (1946 to 18 February 2019); Embase Ovid (1980 to 18 February 2019); US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (searched 18 February 2019); and the World Health Organization International Clinical Trials Registry Platform (searched 18 February 2019). There were no language restrictions in the searches of the electronic databases. SELECTION CRITERIA Randomised controlled trials which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. DATA COLLECTION AND ANALYSIS Three review authors screened studies and extracted data independently. We assessed the certainty of the evidence of included studies using GRADE. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS No additional trials could be included in this update. One trial at low risk of bias evaluating oral penicillin in combination with analgesics versus placebo with analgesics, involving 40 participants was included in a former update of the review. The certainty of the evidence was rated low for the different outcomes. Our primary outcome was patient-reported pain (intensity/duration) and pain relief. There was a close parallel distribution of the pain ratings in both the intervention (median 6.0, interquartile range (IQR) 10.5), and for placebo (median 6.0, IQR 9.5) over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.20 (standard deviation (SD) 6.02) in the penicillin group versus 9.60 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.90 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This Cochrane Review which was based on one low-powered small sample trial assessed as at low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
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Affiliation(s)
| | | | | | - Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | - Julie Sprakel
- University of Sao PauloDepartment of Gynecology and Obstetrics, Ribeiro Preto Medical SchoolSao PauloBrazil
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Alonso-Ezpeleta O, Martín-Jiménez M, Martín-Biedma B, López-López J, Forner-Navarro L, Martín-González J, Montero-Miralles P, Jiménez-Sánchez MDC, Velasco-Ortega E, Segura-Egea JJ. Use of antibiotics by spanish dentists receiving postgraduate training in endodontics. J Clin Exp Dent 2018; 10:e687-e695. [PMID: 30057712 PMCID: PMC6057074 DOI: 10.4317/jced.54894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/09/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics. MATERIAL AND METHODS Dentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test. RESULTS The average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract. CONCLUSIONS The results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Key words:Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training.
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Affiliation(s)
| | | | - Benjamín Martín-Biedma
- Department of Endodontics, School of Medicine and Dentistry, University of Santiago, Spain
| | - José López-López
- Department of Oral Medicine, School of Medicine and Dentistry, University of Barcelona, Spain
| | - Leopoldo Forner-Navarro
- Department of Oral Medicine, School of Medicine and Dentistry, University of Valencia, Spain
| | | | | | | | - Eugenio Velasco-Ortega
- Department of Comprehensive Dentistry, School of Dentistry, University of Sevilla, Spain
| | - Juan J Segura-Egea
- Department of Endodontics, School of Dentistry, University of Sevilla, Spain
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Durkin MJ, Feng Q, Warren K, Lockhart PB, Thornhill MH, Munshi KD, Henderson RR, Hsueh K, Fraser VJ. Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States. J Am Dent Assoc 2018; 149:372-381.e1. [PMID: 29703279 PMCID: PMC5995471 DOI: 10.1016/j.adaj.2017.11.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States. METHODS We used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription. RESULTS Overall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P = .001). CONCLUSIONS Overall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time. PRACTICAL IMPLICATIONS From these authors' definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists.
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Maslamani M, Sedeqi F. Antibiotic and Analgesic Prescription Patterns among Dentists or Management of Dental Pain and Infection during Endodontic Treatment. Med Princ Pract 2017; 27:66-72. [PMID: 29262417 PMCID: PMC5968269 DOI: 10.1159/000486416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/20/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine prescription patterns of antibiotics and analgesics among dentists in the management of dental pain and infection for medically healthy patients undergoing endodontic management. MATERIALS AND METHODS This descriptive cross-sectional survey was based on a structured questionnaire. The questionnaire collected data on age, gender, years of experience, and the qualifications of dentists. Feedback on prescription patterns for antibiotics and analgesics was collected for a number of clinical scenarios. Participants' choices regarding the type, dose, and duration of antibiotics/analgesics were recorded. Completed questionnaires were analyzed using the Statistical Package for Social Sciences (SPSS; version 24) to determine relationships between prescription patterns, age, gender, and educational qualification. RESULTS Of the 227 participants surveyed, 190 (83.7%) did not prescribe antibiotics for patients complaining of severe pain. There were significant associations between age and years of experience and antibiotic prescription for pain management (p = 0.035 and 0.04, respectively). Of the participants, 199 (87.7%) never prescribed antibiotics for reversible pulpitis with normal periapical area; there was a statistical significance in relation to gender (p = 0.044). Amoxicillin 500 mg was prescribed most of the time (51.5%). Diclofenac K (50 mg) was prescribed by 41% of the participants, while 39.2% of the participants very often prescribed ibuprofen (600 mg). CONCLUSION Most dentists prescribed analgesics and antibiotics as recommended, but more education on the proper use of these medicines is needed for dentists and patients.
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Affiliation(s)
- Manal Maslamani
- Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, Kuwait, Kuwait
| | - Faraj Sedeqi
- Department of Prosthodontics, Ministry of Health, Kuwait, Kuwait
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Löffler C, Böhmer F. The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review. PLoS One 2017; 12:e0188061. [PMID: 29136646 PMCID: PMC5685629 DOI: 10.1371/journal.pone.0188061] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/31/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Abundant evidence in dentistry suggests that antibiotics are prescribed despite the existence of guidelines aiming to reduce the development of antibiotic resistance. This review investigated (1) which type of interventions aiming to optimise prescription of antibiotics exist in dentistry, (2) the effect of these interventions and (3) the specific strengths and limitations of the studies reporting on these interventions. METHOD Literature search was based on Medline, Embase, Global Health, Cochrane CENTRAL, ClinicalTrials.gov and Current Controlled Trials. Studies with one of the two primary outcomes were included: (1) The number of antibiotics prescribed and/or (2) the accuracy of the prescription, commonly measured as a percentage of adherence to local clinical guidelines. RESULTS Nine studies met these inclusion criteria. Five studies reported on the prescription of antibiotics in primary dental care and four studies focused on outpatient dental care. Interventions used in primary dental care included a combination of audit, feedback, education, local consensus, dissemination of guidelines and/or academic detailing. Trials in the outpatient setting made use of expert panel discussions, educational feedback on previous acts of prescribing, the dissemination of guidelines and the establishment of internal guidelines. All studies successfully reduced the number of antibiotics prescribed and/or increased the accuracy of the prescription. However, most studies were confounded by a high risk of selection bias, selective outcome reporting and high variance across study groups. In particular, information relating to study design and methodology was insufficient. Only three studies related the prescriptions to the number of patients treated with antibiotics. CONCLUSIONS This systematic review was able to offer conclusions which took the limitations of the investigated studies into account. Unfortunately, few studies could be included and many of these studies were confounded by a low quality of scientific reporting and lack of information regarding study methodology. High-quality research with objective and standardised outcome reporting, longer periods of follow-up, rigorous methodology and adequate standard of study reporting is urgently needed.
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Affiliation(s)
- Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
| | - Femke Böhmer
- Institute of General Practice, Rostock University Medical Center, Rostock, Germany
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Segura‐Egea JJ, Gould K, Hakan Şen B, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. European Society of Endodontology position statement: the use of antibiotics in endodontics. Int Endod J 2017; 51:20-25. [DOI: 10.1111/iej.12781] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 04/19/2017] [Indexed: 01/15/2023]
Affiliation(s)
- J. J. Segura‐Egea
- Department of Endodontics School of Dentistry University of Sevilla Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology Institute of Odontology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics University of Cagliari Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences DIBINEM University of Bologna Bologna Italy
| | - H. Sunay
- Department of Endodontology Dental Faculty of Istanbul Kemerburgaz University Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases Helsinki University Hospital University of Helsinki Helsinki Finland
- Research Unit of Oral Health Sciences Medical Research Center Oulu (MRC Oulu) University Hospital and University of Oulu Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical & Life Sciences Cardiff University Cardiff UK
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16
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Koyuncuoglu CZ, Aydin M, Kirmizi NI, Aydin V, Aksoy M, Isli F, Akici A. Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications? Eur J Clin Pharmacol 2017; 73:1027-1032. [PMID: 28462430 DOI: 10.1007/s00228-017-2258-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists' antibiotic prescriptions in a diagnosis-based manner in Turkey. METHODS This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists. RESULTS A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained "single diagnosis and at least one antibiotic." The number of antibiotics per prescription was 1.01. "Periapical abscess without sinus" (28.1%), "dental examination" (20.7%), and "dental caries" (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate "cellulitis and abscess of mouth" diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, "amoxicillin + enzyme inhibitor" (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred "amoxicillin + enzyme inhibitor" prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001). CONCLUSIONS This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.
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Affiliation(s)
- Cenker Z Koyuncuoglu
- Department of Periodontology, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
| | - Mehtap Aydin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Baskent University, Istanbul, Turkey
| | - N Ipek Kirmizi
- Department of Medical Pharmacology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Volkan Aydin
- Department of Medical Pharmacology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara, Turkey
| | - Fatma Isli
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara, Turkey
| | - Ahmet Akici
- Department of Medical Pharmacology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
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17
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Aaron S. Key Factors in Treating the Emergency Patient. Prim Dent J 2017; 6:71-73. [PMID: 28668103 DOI: 10.1308/205016817821281800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Martín‐Jiménez M, Martín‐Biedma B, López‐López J, Alonso‐Ezpeleta O, Velasco‐Ortega E, Jiménez‐Sánchez MC, Segura‐Egea JJ. Dental students’ knowledge regarding the indications for antibiotics in the management of endodontic infections. Int Endod J 2017; 51:118-127. [DOI: 10.1111/iej.12778] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/29/2017] [Indexed: 12/24/2022]
Affiliation(s)
- M. Martín‐Jiménez
- Department of Endodontics School of Dentistry University of Sevilla Sevilla Spain
| | - B. Martín‐Biedma
- Department of Endodontics School of Dentistry University of Santiago de Compostela Santiago de Compostela Spain
| | - J. López‐López
- Department of Oral Medicine School of Medicine and Dentistry University of Barcelona Barcelona Spain
| | - O. Alonso‐Ezpeleta
- Department of Endodontics School of Dentistry University of Zaragoza Zaragoza Spain
| | - E. Velasco‐Ortega
- Department of Comprehensive Dentistry School of Dentistry University of Sevilla Sevilla Spain
| | | | - J. J. Segura‐Egea
- Department of Endodontics School of Dentistry University of Sevilla Sevilla Spain
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Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. Int Endod J 2017; 50:1169-1184. [DOI: 10.1111/iej.12741] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J. J. Segura-Egea
- Department of Endodontics; School of Dentistry; University of Sevilla; Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics; University of Cagliari; Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences; DIBINEM; University of Bologna; Bologna Italy
| | - H. Sunay
- Department of Endodontology; Dental Faculty of Istanbul Kemerburgaz University; Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Research Unit of Oral Health Sciences; Medical Research Center Oulu (MRC Oulu); Oulu University Hospital and University of Oulu; Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry; College of Biomedical & Life Sciences; Cardiff University; Cardiff UK
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