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Turkish dentists found to overprescribe antibiotics for endodontic infections

By Dental Tribune International
September 07, 2020

ANKARA, Turkey: It is well known that antibiotic resistance is a growing problem and that some bacteria have become resistant to even the most powerful medication. However, it is frequently found that dentists prescribe antibiotics unnecessarily. A recent study has confirmed this to be the case with dentists in Turkey and has also examined the clinical situations that lead to this type of decision.

In 2019, researchers at Oregon State University in Corvallis in the US found that antibiotics prescribed by dentists as prophylaxis against infection are unnecessary 81% of the time. A more specific study by Dr Derya Deniz Sungur and her team at Hacettepe University in Ankara examined antibiotic prescribing patterns for endodontic infections based on reports by Turkish dentists who are, it appears, also prone to overprescribing. A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases were delivered to the email addresses of general dentists and specialists listed on the database of the Turkish Dental Association.

A total of 1,007 responses were obtained from 17,827 dentists. Of these responses, the majority (80%) were from general dental practitioners, whereas 8% were from endodontists. The general dental practitioners prescribed antibiotics twice as often as the specialists did, and dental practitioners in public hospitals prescribed antibiotics three times as often as the specialists and academic clinicians did.

Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by ornidazole (25%). Clindamycin was the drug of choice prescribed for patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%), and the avoidance of swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescription. Completing a course of prescribed antibiotics was recommended by most clinicians (75%).

About 10% of the participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with endodontic treatment and asymptomatic apical periodontitis without endodontic treatment (8%, 12% and 11%, respectively). Up to 20% of the dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13% and 23%, respectively). Almost one-third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions, whereas 34% prescribed antibiotics for acute apical abscesses with localised swelling without systemic involvement.

“I have found that general dentists cannot distinguish endodontic diseases in the same way that we, as endodontists, can”

Sungur, an assistant professor in the university’s Department of Endodontics, told Dental Tribune International in an interview that she wanted to create awareness about this issue, as she finds it very disquieting. She said: “In our study design, we wanted to describe the diseases clearly with their radiographic and clinical findings and not only the end result of the disease. The reason for this is that, personally, I have found that general dentists cannot distinguish endodontic diseases in the same way that we, as endodontists, can. For example, they may think that asymptomatic apical periodontitis is vital! So, here, the cases are really defined well but, in the clinics, dentists sometimes don’t consider vitality, for example, and especially if the patient is in pain, they may prescribe antibiotics.”

She went on by saying that the percentage results are below her initial expectations. “I think this is a natural result that is related to this type of study. In surveys, when the participants are evaluating a defined situation, they may express their conclusions differently than when they are face to face with the problem itself under clinical conditions,” Sungur added.

The scientists hope that this survey will help future research and add a different perspective to the topic because it is not only the prescription rates that are important but also the various kinds of situations that lead dental professionals to the decision to prescribe antibiotics. These can include pain, previous root canal therapy, sinus tracts and other factors, such as patient demands or lack of time.

The study, titled “The prescribing of antibiotics for endodontic infections by dentists in Turkey: A comprehensive survey”, was published online on 17 August 2020 in the International Endodontic Journal, ahead of inclusion in an issue.

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