Antibiotic-prescribing for endodontic therapies: a comparative survey between general dental practitioners (GDPs) and final-year Bachelor of Dental Surgery (BDS) students in Cardiff, UK

Abstract

Aim

To evaluate the views of final-year dental surgery (BDS; G1) students at Cardiff University and general dental practitioners (GDPs; G2) within the city of Cardiff, Wales on antibiotic prescribing for endodontic conditions, and investigate the potential differences between the two groups.

Methods

A cross-sectional online questionnaire-based survey of 12 qualitative and quantitative questions was distributed to 76 final-year BDS Cardiff University students and 55 dental practices within Cardiff, UK. Six questions recorded general information and the remaining questions included a series of hypothetical clinical scenarios, where the participants were asked to state whether they would or would not prescribe antibiotics. The data were analyzed using SPSS V23 to produce descriptive statistics, contingency tables, and to run Chi-Square (χ²) tests, Fisher's-exact tests, and relative-risk calculations.

Results

The response rate was 60% (n=79). All G1 were aware of the consequences of antibiotic over-use. Approximately 60% were aware of guidelines for antibiotic use in endodontic therapies, and 83% would only use antibiotics for a limited selection of patients (e.g. patients with systemic complications). G1 responses to clinical-scenarios indicated overall that they were comparable to the ideal answers except for acute apical abscess (64% believed that antibiotics were indicated). The majority of G2 were aware of the consequences of antibiotic over-use. Only 28% of G2 were aware of guidelines for antibiotic use in endodontic therapies. Overall responses revealed that antibiotics would be prescribed for: systemic complications (78%), acute apical abscess (72%) and symptomatic apical periodontitis (28%). The clinical-scenarios revealed G1 were more likely to prescribe antibiotics compared to G2 for cases of necrotic pulps with symptomatic apical periodontitis without systemic complications (Q7, incorrect indication) and less likely to other clinical scenarios such as necrotic pulps and asymptomatic apical periodontitis for patients with a history of rheumatic fever (ideal answer), symptomatic irreversible/reversible pulpitis, failure to achieve anaesthesia chronic apical abscess for patients with diabetes. The recognition of antibiotic prescription for cases with signs of spreading infection was more evident in G2.

Conclusion

Final year undergraduate students were aware of the antibiotic resistance crisis, although a third were not aware of guidelines for use of antibiotics in endodontic conditions; their responses to clinical scenario were more compatible with the guidelines. General dentists were less aware of the implications of over-use of antibiotics and the existence of guidelines, and their responses were occasionally incompatible with antibiotic-guidelines for endodontic therapies.

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