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Galić M, Miletić I, Poklepović Peričić T, Rajić V, Većek Jurčević NN, Pribisalić A, Medvedec Mikić I. Antibiotic Prescribing Habits in Endodontics among Dentists in the Federation of Bosnia and Herzegovina-A Questionnaire-Based Study. Antibiotics (Basel) 2024; 13:876. [PMID: 39335048 PMCID: PMC11428614 DOI: 10.3390/antibiotics13090876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/09/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUNDS Antibiotics are used in endodontic treatment to control acute odontogenic infection and for prophylactic purposes. This study aimed to investigate the knowledge of dentists from the Federation of Bosnia and Herzegovina about the choice and the routes of antibiotic administration in endodontics. METHODS This cross-sectional study involved dentists in Federation of Bosnia and Herzegovina health institutions. The Dental Chamber sent a twelve-question survey to members' email addresses. They were asked about the type, dosage, indications, and side effects of antibiotics used in endodontics. The obtained data were screened and analyzed. RESULTS A total of 180 questionnaires were filled out. The most commonly prescribed antibiotic was amoxicillin with clavulanic acid. Pulp necrosis with symptomatic apical periodontitis, swelling, and moderately severe symptoms were the main indications for the therapeutic use of antibiotics. Amoxicillin, administered orally at 2 g 1 h before endodontic surgery for patients with bacterial endocarditis, was mostly indicated for the prophylactic use of antibiotics. CONCLUSIONS Based on the results of this study, we can conclude that dentists from the Federation of Bosnia and Herzegovina have limited knowledge regarding antibiotic use in endodontics. Educational activities and campaigns are necessary to raise awareness about antibiotics in dental medicine in the Federation of Bosnia and Herzegovina.
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Affiliation(s)
- Matea Galić
- Private dental practice Grizelj, 88340 Grude, Bosnia and Herzegovina;
| | - Ivana Miletić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (I.M.); (V.R.)
| | - Tina Poklepović Peričić
- Department of Prosthodontics, Study of Dental Medicine, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Valentina Rajić
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (I.M.); (V.R.)
| | | | - Ajka Pribisalić
- Department of Public Health, School of Medicine, University of Split, 21000 Split, Croatia;
- The University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Ivana Medvedec Mikić
- Department of Dental Medicine, University Hospital Center of Split, 21000 Split, Croatia
- Department of Endodontics and Restorative Dentistry, Study of Dental Medicine, School of Medicine, University of Split, 21000 Split, Croatia
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Mubarak A, Alwafi MM, Alharbi RM, Alserhani SA, Khushaim RF, Almadani GZ, Nourwali IM, Alassaf MS. Knowledge and Attitude Toward Antibiotic Prescription Among Dental Students and Interns at Multiple Universities in Saudi Arabia. Cureus 2024; 16:e51777. [PMID: 38187030 PMCID: PMC10771713 DOI: 10.7759/cureus.51777] [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] [Accepted: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Dental students in Saudi Arabia are authorized to write prescriptions for antibiotics during practical training. Adverse side effects and resistance could result from inappropriate prescription. Accordingly, there is a need to evaluate the knowledge of dental students regarding guidelines and applications of antibiotic prescription. OBJECTIVES To assess the knowledge and attitude toward guidelines and applications of antibiotic prescription among dental students and interns at multiple universities in Saudi Arabia. METHODS A cross-sectional study was conducted among dental students in their final clinical years (4th to 6th year) and dental interns. The study data were collected using a valid and reliable structured questionnaire comprising three domains: 1) demographic characteristics, 2) knowledge, and 3) attitude toward antibiotic prescription for dental and systemic conditions. The data were analyzed and presented as frequency percentages, and the chi-square test was used to compare the knowledge and attitude items between the dental students and interns. The statistical significance level was set at p ≤ 0.05. RESULTS A total of 248 participants (women: 55.6%, men: 44.4%) were included in the study. Approximately 21.8% were 4th year students; 17.7%, 5th year students; 12.9%, 6th year students; and 47.6%, interns. For most items, the knowledge level was relatively high, and the attitude was generally positive among the participants. Approximately, 87.1% had good knowledge about current guidelines for antibiotic prophylaxis, 83.9% about antibiotic prescription, and 95.2% about antibiotic resistance. The interns showed significantly higher knowledge levels and favorable attitude, particularly for guidelines and applications of antibiotic prescription and correct use of antibiotics for oral cases, than did the students. Amoxicillin was the most frequently prescribed antibiotic among the participants. CONCLUSION The interns and 6th-year students demonstrated a relatively high knowledge level and positive attitude toward appropriate antibiotic prescriptions. However, deficiencies were observed among the students in their early clinical years, particularly for systemic conditions. These findings highlight the importance of implementing educational campaigns and providing guidelines to promote the appropriate use of antibiotics among dental students in their final clinical years.
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Affiliation(s)
| | - Malak M Alwafi
- Pediatric Dentistry and Orthodontics, Taibah University, Madinah, SAU
| | - Rahaf M Alharbi
- Department of Dental Education, Taibah University, Madinah, SAU
| | | | | | | | - Ibrahim M Nourwali
- Department of Oral and Maxillofacial Surgery, Taibah University, Madinah, SAU
| | - Muath S Alassaf
- Orthodontics and Dentofacial Orthopedics, Taibah University, Madinah, SAU
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A Survey of Systemic Antibiotic Prescription Patterns Amongst Iraqi Dentists. Int Dent J 2021; 72:338-345. [PMID: 34344542 PMCID: PMC9275136 DOI: 10.1016/j.identj.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The misuse of antibiotic prescriptions is a common behavior amongst dentists worldwide. Over-prescription of these agents is associated with multiple adverse effects and risk of developing bacterial resistance. The aim of this study was to assess systemic antibiotic prescription patterns amongst dentists in Iraq. METHODS A questionnaire-based survey was conducted in dental centres distributed in 12 Iraqi governates. The questionnaire was composed of two main sections: The first was dedicated to collecting demographic and work-related information, and the second section included questions seeking details about antibiotic prescriptions for different oral and dental conditions. RESULTS A total of 481 valid questionnaires were considered in the final analysis. The numbers of correct and incorrect patterns of prescribing antibiotics for different dental/oral conditions were almost equal (49.6% and 50.4%, respectively). Amongst independent variables investigated, qualification of the dentist and work domain were found to have significant associations with correct prescribing patterns (odds ratio, 1.166 and 1.197, respectively). The majority of dentists preferred amoxicillin as the first-choice antibiotic, followed by "Augmentin" (43.7% and 35.5%, respectively), whilst clarithromycin was the lowest on the list. Azithromycin was the most recommended antibiotic (55.9%) in cases of allergy to penicillin. CONCLUSIONS In general, antibiotics are prescribed for recommended conditions, but the prescription for nonrecommended conditions was also evident amongst Iraqi dentists. Correct pattern of antibiotic prescribing was significantly associated with specialists and those working in the academic field. Additionally, amoxicillin and its derivatives are the most preferred drugs.
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Evaluation of Antibiotic Prescribing Patterns in Paediatric Dental Patients: Cross - Sectional Epidemiological Study. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary
Background/Aim: The purpose of this study was to investigate the antibiotic prescribing patterns for the treatment of paediatric oral infection, dental trauma and prophylaxis among dentists in Turkey.
Material and Methods: A total of 206 paediatric dentists, including general dentists, paediatric dentists and specialist dentists, participated in this cross-sectional study. The questionnaire included questions about the number of paediatric patients treated and antibiotics prescribed, the most commonly prescribed antibiotic for oral infections and the clinical conditions under which antibiotics were prescribed. The participants’ ages, workplaces and professional experience were also evaluated.
Results: The majority of the participants were paediatric dentists (45.1%) and general dentists (42.7%). For the management of dental infections, most dentists prescribed penicillin (94.7%). Their foremost prescription choices for the presence of an anaerobic infection were metronidazole (48.5%) and penicillin (32%). For dental trauma, the most common antibiotic-prescribed cases were avulsion and contaminated wounds, followed by alveolar fracture. Antibiotics were prescribed as a first choice for dental infections and dental infections of anaerobic origin, with no significant differences between professional experience or dental specialty in the dentists (p > 0.05). Practitioners belonging to Ministry of Health dental centres significantly differed from all other groups in preferring the antibiotic cephalosporin for dental infections of anaerobic origin.
Conclusions: Adherence to published guidelines for antibiotic prescriptions for anaerobic dental infections and dental trauma was low. Clearer, more specific guidelines and increased post-graduate education could lead to a reduction in the negative consequences of this issue’s resultant over-prescribed antibiotics.
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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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Stein K, Farmer J, Singhal S, Marra F, Sutherland S, Quiñonez C. The use and misuse of antibiotics in dentistry: A scoping review. J Am Dent Assoc 2019; 149:869-884.e5. [PMID: 30261952 DOI: 10.1016/j.adaj.2018.05.034] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND To describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review. TYPES OF STUDIES REVIEWED The authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Management's critical appraisal of a survey checklist. RESULTS The authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons. CONCLUSIONS AND PRACTICAL IMPLICATIONS Considering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.
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Dana R, Torneck CD, Iglar K, Lighvan NL, Quiñonez C, Azarpazhooh A. Knowledge and Practices of Family and Emergency Physicians in Managing Nontraumatic Dental Conditions: A Case-based Survey. J Endod 2019; 45:263-271.e1. [PMID: 30803533 DOI: 10.1016/j.joen.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Physicians are often patients' first point of contact for management of nontraumatic dental conditions (NTDCs). This study's aim was to evaluate the knowledge and practices of Ontario physicians in managing NTDCs, with a specific focus on antibiotic usage. METHODS A Web-based survey featured 4 NTDC clinical scenarios: irreversible pulpitis, localized acute apical abscess with or without systemic involvement, and chronic apical abscess. The survey link was distributed to active Ontario family and emergency physicians. The sample group was asked questions about their management of and experience with NTDCs, and demographic and practice characteristics were collected. Descriptive and multivariate logistic regression analyses were undertaken (P ≤ .05). RESULTS Sampled Ontario physicians tend to manage NTDCs in a manner that is not consistent with evidence-based care. For irreversible pulpitis and for localized acute apical abscess with or without systemic involvement, most physicians would prescribe an antibiotic (57.4%, 84.8%, and 96.3%, respectively), and 23.5% would prescribe an antibiotic for chronic apical abscess. Approximately half the sample (52.9%) felt discomfort in managing NTDCs, and 85.3% felt they were inadequately trained to manage NTDCs. CONCLUSION Areas that present opportunities for improvement in the physician management of NTDCs were identified, including the incorporation of further NTDC training in medical curricula and continuing medical education courses, and development and dissemination of guidelines for physicians in managing NTDCs.
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Affiliation(s)
- Ralph Dana
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Calvin D Torneck
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Karl Iglar
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada; Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Opioid analgesics and antibiotics prescribed by dentists is a useful and cost-effective measure when prescribed appropriately. Common dental conditions are best managed by extracting the offending tooth, restoring the tooth with an appropriate filling material, performing root canal therapy, and/or fabricating a prosthesis for the edentulous space. Unnecessary prescription of opioid analgesics and antibiotics to treat dental pain and bacterial infection is a growing public health concern. This article highlights the state of the literature on opioid analgesic and antibiotic prescribing practices in dentistry, the impact of opioid analgesic overdose, and prevention strategies to reduce opioid analgesics and antibiotic overprescription.
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Baskaradoss JK, Alrumaih A, Alshebel A, Alfaqih A, Aleesa M, Alkhashan S, Altuwaijri M. Pattern of antibiotic prescription among dentists in Riyadh, Saudi Arabia. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2018; 9:e12339. [PMID: 29607628 DOI: 10.1111/jicd.12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/13/2018] [Indexed: 12/22/2022]
Abstract
AIM The aim of the present study was to investigate the pattern of antibiotic prescription and dentists' awareness about the recent guidelines for antibiotic prescription. METHODS This cross-sectional study was conducted among 282 dentists practicing in Riyadh, Saudi Arabia. The data were collected from 20 randomly-selected dental clinics from each of the five administrative blocks in Riyadh. In addition, data were also collected from four tertiary care centers and three academic universities. The questionnaire measured the antibiotic prescription pattern of the dentists and their choice of antibiotics for various dental conditions. RESULTS Amoxicillin was the most commonly prescribed antibiotic. More than 70% of dentists prescribed antibiotics for dental patients with various cardiac conditions. Bivariate analysis showed that female dentists had significantly higher mean scores for ideal prescription pattern (P = .04) compared to male dentists. Saudi nationals, especially those working in the government sector were found to have better prescription pattern compared with others (P = .02). Dentists with higher educational qualifications (board certificate and above) had a more ideal prescription pattern than other dentists (P = .04). CONCLUSION Inappropriate antibiotic prescription practice was highly prevalent in this population.
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Affiliation(s)
- Jagan K Baskaradoss
- Department of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait
| | - Abdulaziz Alrumaih
- Department of Preventive Dental Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Abdulrahman Alshebel
- Department of Preventive Dental Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Ahmed Alfaqih
- Department of Preventive Dental Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Mohammed Aleesa
- Department of Preventive Dental Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Saleh Alkhashan
- Department of Preventive Dental Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Mohamad Altuwaijri
- Department of Preventive Dental Science, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
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Parhizkar A, Nojehdehian H, Asgary S. Triple antibiotic paste: momentous roles and applications in endodontics: a review. Restor Dent Endod 2018; 43:e28. [PMID: 30135847 PMCID: PMC6103545 DOI: 10.5395/rde.2018.43.e28] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/10/2018] [Indexed: 12/23/2022] Open
Abstract
This study investigated the latest findings and notions regarding ‘triple antibiotic paste’ (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.
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Affiliation(s)
- Ardavan Parhizkar
- Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Nojehdehian
- Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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AboAlSamh A, Alhussain A, Alanazi N, Alahmari R, Shaheen N, Adlan A. Dental Students' Knowledge and Attitudes towards Antibiotic Prescribing Guidelines in Riyadh, Saudi Arabia. PHARMACY 2018; 6:pharmacy6020042. [PMID: 29735914 PMCID: PMC6025366 DOI: 10.3390/pharmacy6020042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 04/28/2018] [Accepted: 05/04/2018] [Indexed: 01/21/2023] Open
Abstract
Background: The use of antibiotics prophylactically and therapeutically in dentistry has become common practice. Inappropriate prescription may lead to adverse side effects and bacterial resistance. During clinical training, dental students in Saudi Arabia are authorized to prescribe antibiotics. Aim: To evaluate dental students’ knowledge and attitudes regarding antibiotic prescription in Riyadh, Saudi Arabia. Methods: A cross-sectional study based on a validated questionnaire consisting of 34 questions focusing on antibiotic indications in dentistry, antibiotic regimens, and knowledge regarding resistance was distributed amongst dental students in five leading dental colleges in Riyadh. Results: A large proportion of students (71.7%) were familiar with the concept of antibiotic resistance. When comparing junior and senior dental students’ knowledge with regards to indications of antibiotic use in commonly encountered conditions, it was found that there was no significant difference in antibiotic prescription frequency between these groups. Most dental students choose to prescribe amoxicillin as their first-choice of antibiotic (88.4%), and most also chose to use it for a duration of 3–5 days (69.2%). Conclusions: This study concludes that dental students may prescribe antibiotics inappropriately to manage various conditions when not indicated. This may indicate a defect in education of students with regards to current antibiotic guidelines.
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Affiliation(s)
| | | | - Nawaf Alanazi
- College of Dentistry, Al Jouf University (JU), Sakakah 72388, Saudi Arabia.
| | - Rakan Alahmari
- College of Dentistry, King Khalid University (KKU), Abha 62529, Saudi Arabia.
| | - Naila Shaheen
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14811, Saudi Arabia.
| | - Abdallah Adlan
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 14811, Saudi Arabia.
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16S Ribosomal RNA Gene Sequencing to Evaluate the Effects of 6 Commonly Prescribed Antibiotics. J Endod 2017; 43:1984-1989. [DOI: 10.1016/j.joen.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 06/23/2017] [Accepted: 07/02/2017] [Indexed: 11/22/2022]
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Hussein RJ, Krohn R, Kaufmann-Kolle P, Willms G. Quality indicators for the use of systemic antibiotics in dentistry. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 122:1-8. [DOI: 10.1016/j.zefq.2017.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 03/07/2017] [Accepted: 04/01/2017] [Indexed: 11/24/2022]
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Alattas HA, Alyami SH. Prescription of antibiotics for pulpal and periapical pathology among dentists in southern Saudi Arabia. J Glob Antimicrob Resist 2017; 9:82-84. [PMID: 28455077 DOI: 10.1016/j.jgar.2017.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Few dental conditions require treatment with antibiotics, yet dentists account for 7% of antimicrobial prescribing. In light of the emerging global problem of antibiotic resistance, this fact is problematic. Little is known about the antibiotic prescribing practices of dentists in Saudi Arabia. This study therefore aimed to investigate the attitudes of dentists in Saudi Arabia towards the prescription of antibiotics for pulpal and periapical pathology. METHODS This was a cross-sectional study involving an online questionnaire on antibiotic prescribing practices. A total of 195 dentists in three areas of southern Saudi Arabia (Najran, Gizan and Asser) completed the survey. RESULTS No significant differences in prescribing habits were found among respondents according to age, sex, level of education or time in endodontic practice. The percentage of respondents who reported that they would prescribe antibiotics for five endodontic conditions not requiring antibiotic treatment ranged from 8.1% to 28.1%. Most respondents (81.9%) would correctly prescribe antibiotics for a necrotic pulp with acute apical periodontitis and swelling; this result was consistent with previous studies. Reported antibiotic usage among the surveyed dentists was quite high. CONCLUSIONS Relatively high antibiotic use suggests a need to educate both dentists and patients about restricting the use of antibiotics to cases of severe infection and when indicated. More educational initiatives to rationalise the use of antibiotics in dental practice are needed to avoid further contributing to antibiotic resistance.
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Affiliation(s)
- Hussien A Alattas
- Department of Restorative Dental Sciences, College of Dentistry, Najran University, P.O. Box 1988, Najran, Saudi Arabia.
| | - Saif H Alyami
- Department of Restorative Dental Sciences, College of Dentistry, Najran University, P.O. Box 1988, Najran, Saudi Arabia
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Akbar I. Efficacy of Prophylactic use of Antibiotics to Avoid Flare up During Root Canal Treatment of Nonvital Teeth: A Randomized Clinical Trial. J Clin Diagn Res 2015; 9:ZC08-11. [PMID: 25954695 DOI: 10.7860/jcdr/2015/12046.5620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Flare-up during root canal treatment of non vital teeth is a common clinical incident. The aim of the present study was to assess the effect of prophylactic use of antibiotics to avoid flare up during root canal treatment of the teeth having asymptomatic necrotic pulp. MATERIALS AND METHODS A randomized double blind clinical trial with parallel design was conducted on 100 subjects with asymptomatic non vital teeth. They were randomly divided into two groups. The first group (50 participants) was given two gram amoxicillin one hour before the first visit of root canal treatment; the second group (50 participants) did not receive any treatment (control group). In both groups, root canal treatment was performed in two visits. The flare up was assessed by the pain visual analogue scale and based on the swelling criteria. The data were processed and analyzed using SPSS statistical software 17. A p-value of 0.05 or less was considered statistically significant. RESULTS A total of 80% of participants in the experimental group had flare up while 12% of participants had flare up in the control group. Prophylactic Amoxicillin had no effect on inter-appointment flare up (p > 0.05). There was no relationship between flare up and patient's age, gender and tooth type (p > 0.05). CONCLUSION Prophylactic use of Amoxicillin in asymptomatic non vital teeth before root canal treatment had no effect on the incidence of flare-up.
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Affiliation(s)
- Iftikhar Akbar
- Assistant Professor, Department of Conservative Dentistry, College of Dentistry, Aljouf University , Sakaka, Saudi Arabia
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Eliyas S, Barber MW, Harris I. Do general dental practitioners leave teeth on 'open drainage'? Br Dent J 2013; 215:611-616. [PMID: 24357764 DOI: 10.1038/sj.bdj.2013.1192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is a need to ascertain the use of evidence-based dentistry in both primary and secondary care in order to tailor education. This study aims to evaluate the use of 'open drainage' as part of endodontic treatment in primary care in South Yorkshire. METHODS A questionnaire was circulated to 141 randomly selected general dental practitioners in the South Yorkshire area between January 2012 and January 2013. RESULTS The response rate was 79% (112/141). Five of the returned questionnaires were incomplete and therefore not usable. Seventy-nine percent of respondents were general dental practitioners (GDPs) working in mainly NHS or mixed practices. The year of graduation varied between 1970 and 2011. Forty-one percent (44/107) stated that they had never left a tooth on open drainage. Twenty-nine percent (31/107) stated that they sometimes leave teeth on open drainage. Of those respondents who currently leave teeth on open drainage, most (68%) would leave teeth on open drainage for one to two days or less. CONCLUSIONS This survey revealed that the practice of leaving teeth on open drainage is still present in general dental practice. Current guidelines do not comment on the use of this treatment modality. There is a need to ascertain further information about practices throughout the United Kingdom in order to provide clear evidence-based guidelines.
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Affiliation(s)
- S Eliyas
- Head and Neck Rehabilitation Fellow in Restorative Dentistry, Central Manchester University Hospitals NHS Foundation Trust, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Aintree University Hospitals NHS Foundation Trust.,Consultant In Restorative Dentistry (Endodontics), Charles Clifford Dental Hospital, Sheffield Teaching Hospital NHS Foundation Trust
| | - M W Barber
- Specialist Registrar in Restorative Dentistry, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
| | - I Harris
- Consultant In Restorative Dentistry (Endodontics), Charles Clifford Dental Hospital, Sheffield Teaching Hospital NHS Foundation Trust
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Petrini M, Ferrante M, Ciavarelli L, Brunetti L, Vacca M, Spoto G. Prostaglandin E2 to diagnose between reversible and irreversible pulpitis. Int J Immunopathol Pharmacol 2012; 25:157-63. [PMID: 22507328 DOI: 10.1177/039463201202500118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this work is to verify a correlation between the grade of inflammation and the concentration of PGE2 in human dental pulp. A total of 25 human dental pulps were examined by histological analysis and radioimmunologic dosage of PGE2. The pulps used in this experiment were from healthy and symptomatic teeth; the first ones were collected from teeth destined to be extracted for orthodontic reasons. An increase was observed of PGE2 in reversible pulpitis compared with healthy pulps and with the irreversible pulpitis and the clear decrease of these when NSAIDs are taken. This study demonstrates that PGE2 level is correlated to histological analysis thus allowing to distinguish symptomatic teeth in reversible and irreversible pulpitis.
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Affiliation(s)
- M Petrini
- Department of Oral Sciences, Nano and Biotechnology, University G. d'Annunzio, Chieti, Italy
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20
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How can we as dentists minimize our contribution to the problem of antibiotic resistance? Oral Maxillofac Surg Clin North Am 2012; 23:551-5, vi-vii. [PMID: 21982608 DOI: 10.1016/j.coms.2011.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
More than 30 million pounds of antibiotics are used in the United States per year, more than 90% for nontherapeutic purposes in animals. Environmental contamination by trace amounts of antibiotics and highly resistant bacteria can lead to resistant infections in humans. Oral and maxillofacial infections are largely mediated by biofilms, which are resistant to antibiotics. Primary treatment is surgical debridement, removal of the cause of the infection, and drainage of pus. Current best practices indicate the use of antibiotics as adjunctive therapy to surgery only when regional, distant, or systemic spread of the infection is a significant risk.
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21
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Ellison SJ. An outcome audit of three day antimicrobial prescribing for the acute dentoalveolar abscess. Br Dent J 2011; 211:591-4. [DOI: 10.1038/sj.bdj.2011.1051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2011] [Indexed: 12/11/2022]
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Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, Khraisat AS, Shehabi AA. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag 2010; 6:301-6. [PMID: 20668712 PMCID: PMC2909496 DOI: 10.2147/tcrm.s9736] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Indexed: 01/04/2023] Open
Abstract
Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.
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23
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The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of acute dentoalveolar abscesses--a review. Br Dent J 2009; 206:357-62. [PMID: 19357666 DOI: 10.1038/sj.bdj.2009.257] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2009] [Indexed: 12/29/2022]
Abstract
Antibiotics are the most widely prescribed category of drugs issued on prescription by general dental practitioners. Despite this there remains little evidence-based literature on what should be prescribed for any given clinical situation, at what dosage and for how long. Given the current climate of evidence-based research, the need to keep antibiotic prescribing to an acceptable minimum, increasing levels of resistance of micro-organisms and widespread hospital infections with 'superbugs', there is a distinct need for appropriate prescribing guidelines. Considering best practice, an extensive review of the literature and a thorough understanding of current empirical treatment regimes, an attempt has been made to recommend suitable antibiotic prescribing for the adult patient suffering from acute dentoalveolar infections based on evidence.
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Harris T, Crawford PJM. Case report: teeth and tonsils: the use of culture and sensitivity testing for antibiotic prescribing in dental infection. Br Dent J 2007; 202:463-4. [PMID: 17471206 DOI: 10.1038/bdj.2007.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2006] [Indexed: 11/09/2022]
Abstract
This case report highlights the usefulness of bacterial culture and sensitivity testing in the prescribing of antibiotics for dental infections, demonstrated by the management of a 10-year-old child with a non-vital upper central incisor and, reportedly, associated recurrent tonsillitis.
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Affiliation(s)
- T Harris
- Child Dental Health Department, Bristol Dental Hospital, Bristol, UK
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25
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Ainsworth G. Preoperative clindamycin prophylaxis does not prevent postoperative infections in endodontic surgery. Evid Based Dent 2006; 7:72. [PMID: 17003795 DOI: 10.1038/sj.ebd.6400428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gillian Ainsworth
- Department of Oral Surgery, Glasgow Dental Hospital and School NHS Trust, Glasgow, Scotland, UK
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26
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Lindeboom JAH, Frenken JWH, Valkenburg P, van den Akker HP. The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study. Int Endod J 2005; 38:877-81. [PMID: 16343114 DOI: 10.1111/j.1365-2591.2005.01030.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine the value of clindamycin prophylaxis in the prevention of postoperative wound infections in patients undergoing endodontic surgery. METHODOLOGY This study included 256 patients undergoing endodontic surgery in a prospective double-blind placebo-controlled trial comparing oral administration of an oral placebo versus a preoperative 600 mg dose of clindamycin. After randomization the study medication was administered orally 1 h before surgery in a double-blind fashion. For a period of 4 weeks the postoperative course was observed according to clinical parameters of infection. Primary end-point was infection at the surgical site. RESULTS The mean age of the study population was 44.4 years (SD 11.4, range 18-82 years) with a sex distribution of 147 females (47.4%) and 109 males (42.6%). Mean age of the patients in the clindamycin group was 44.7 years (SD 12.0), and the mean age in the placebo group was 44.1 years (SD 10.8) (P = 0.49). In the clindamycin group, the mean duration of surgery was 32.3 min (SD 8.8) and in the placebo group the mean duration of surgery was 32.5 min (SD 8.4) (P = 0.89). Two infections [1.6%; 95 confidence interval (CI): 0.48-4.72] were identified in the clindamycin group and four (3.2%; 95 CI: 0.42-1.33) in the placebo group (P = 0.448). CONCLUSIONS No statistically significant difference was found between clindamycin prophylaxis and placebo with regard to the prevention of postoperative infection in endodontic surgical procedures.
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Affiliation(s)
- J A H Lindeboom
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre Amsterdam and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
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Abstract
Clindamycin is an antimicrobial agent that dentists use in the UK for infective endocarditis prophylaxis but rarely for other clinical situations that require antimicrobial intervention. This has been largely due to its association with acute pseudomembranous colitis. Up to date information on the efficacy and safety of this antimicrobial agent should be known before prescription.
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Affiliation(s)
- L D Addy
- Cardiff University Dental Hospital, Heath Park, Cardiff, CF14 4XY
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28
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Isla A, Canut A, Gascón AR, Labora A, Ardanza-Trevijano B, Solinís MA, Pedraz JL. Pharmacokinetic/Pharmacodynamic Evaluation of Antimicrobial Treatments of Orofacial Odontogenic Infections. Clin Pharmacokinet 2005; 44:305-16. [PMID: 15762771 DOI: 10.2165/00003088-200544030-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the efficacy of antimicrobial therapy in oral odontogenic infections using estimated pharmacokinetic/pharmacodynamic parameters or efficacy indices, and to compare pharmacokinetic/pharmacodynamic breakpoints with National Committee for Clinical Laboratory Standards' (NCCLS) breakpoints. STUDY DESIGN Retrospective literature search to obtain minimum inhibitory concentration (MIC) values, pharmacokinetic parameters of antimicrobials and NCCLS breakpoints. Pharmacokinetic simulations were carried out using WinNonlin software (Pharsight Corporation, Mountain View, CA, USA). METHODS For antimicrobials with time-dependent activity, the time that the plasma drug concentration exceeds the MIC as the percentage of dose interval at steady state was calculated. For antimicrobials with concentration-dependent activity, the total area under the plasma concentration-time curve over 24 hours at steady state divided by the MIC was calculated. Pharmacokinetic/pharmacodynamic breakpoints were calculated according to these parameters. RESULTS Only amoxicillin/clavulanic acid and clindamycin showed adequate efficacy indices against the most commonly isolated bacteria in odontogenic infections. Metronidazole reached good indices against anaerobes only. Pharmacokinetic/pharmacodynamic susceptibility breakpoints do not coincide exactly with NCCLS breakpoints. CONCLUSION Owing to the scarcity of double-blind, clinical trials on the use of antimicrobials in endodontics, this study may be useful in determining the best antimicrobial treatment in these infections. However, as we have not used concentration data in infected tissue to determine pharmacokinetic/pharmacodynamic indices, it would be necessary to design clinical trials in order to confirm these results.
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Affiliation(s)
- Arantxa Isla
- Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain
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Abstract
The swift and correct diagnosis of emergency problems is essential when providing treatment, especially in a busy dental practice. A diagnosis must be made and appropriate treatment provided in usually just a few minutes. The sequence considered here encompasses problems presenting before, during and after dental treatment. Various diagnostic aids are considered, and some unusual presenting conditions discussed.
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Affiliation(s)
- P Carrotte
- Clinical Lecturer, Department of Adult Dental Care, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ, Scotland, UK.
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30
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Tang G, Samaranayake LP, Yip HK. Molecular evaluation of residual endodontic microorganisms after instrumentation, irrigation and medication with either calcium hydroxide or Septomixine. Oral Dis 2004; 10:389-97. [PMID: 15533217 DOI: 10.1111/j.1601-0825.2004.01015.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The correct choice of antimicrobial agents as inter-appointment medicaments is as important as the instrumentation and irrigation to remove pathogens from infected root canals. Calcium hydroxide [Ca(OH)2] and framycetin sulfate (Septomixine) are common endodontic medicaments. Therefore, we evaluated the efficacy of either calcium hydroxide or Septomixine in eliminating residual intra-canal bacteria, particularly Actinomyces spp., during inter-appointment interval in endodontic therapy using molecular methods. METHODS A total of 31 single-rooted teeth with primary root canal infections were studied immediately after opening the canals and subsequently after instrumentation, irrigation with sterile saline and 1-week medication with either Ca(OH)2 (n = 25) or Septomixine (n = 6). Whole bacterial genomic DNA was isolated directly from samples and PCR with universal primers performed to detect total intra-canal bacteria. The variable regions of 16S rDNA of bacteria were amplified and labeled with digoxigenin for further hybridization to detect Actinomyces spp. A total of seven oligonucleotide probes specific for A. bovis, A. gerencseriae, A. israelii, A. meyeri, catalase-negative A. naeslundii (genospecies 1 and 2), catalase-positive A. naeslundii genospecies 2 and A. odontolyticus were used to detect Actinomyces spp. in 22 of 31 medicated root canals [Ca(OH)2: n = 17; Septomixine: n = 5]. RESULTS The PCR results showed that 25 of 31 examined canals were positively detected with residual microorganisms after instrumentation, irrigation with sterile saline and 1-week medication with either Ca(OH)2 (n = 20) or Septomixine (n = 5). Thus, only six canals [Ca(OH)2: n = 5, Septomixine: n = 1] were aseptic after treatment. Hybridization results showed higher detection frequency of both A. odontolyticus and A. gerencseriae after treatment. Significant correlation was found between exposed pulp before treatment and positive detection of Actinomyces spp., particularly A. odontolyticus on the second visit (P < 0.05). CONCLUSION The conventional, 1-week medication of either Ca(OH)2 or Septomixine in endodontic therapy may not effectively inhibit residual bacterial growth in all root canals during inter-appointment intervals. Further investigations using, for instance quantitative real-time PCR analyses, are required to substantiate the present findings.
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Affiliation(s)
- G Tang
- Oral Bio-Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong
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