Irreversible Pulpitis - A Source of Antibiotic Over-Prescription?

Abstract

Antibiotic resistance is a growing public health concern. Antibiotics continue to be prescribed by some clinicians to resolve dental pain even though research indicates that antibiotics are not effective for treating conditions such as irreversible pulpitis. The objective of this study was to determine the extent to which current research and evidence around irreversible pulpitis has been translated into dental practice and the gaps in dentists’ knowledge. An on-line clinical vignette format survey questionnaire about treatment of irreversible pulpitis was distributed to the members of the Academy of Operative Dentistry and Academy of General Dentistry (US based international dental bodies). Their responses were recorded and evaluated. A total of 403 dentists participated in the survey. Over a third (39.3%) indicated they would prescribe antibiotics for symptomatic irreversible pulpitis in a permanent tooth occurring without any signs of systemic infection. The rest indicated they would not prescribe antibiotics; most of them would prescribe an analgesic combined with pulpectomy. Those who had undertaken advanced education training achieved a significantly higher mean knowledge score compared to those with just a primary dental degree (p=0.011). Similarly, full or part time academicians had a higher mean knowledge score than the clinicians who work only in private practice (p=0.014). Some dentists continue to prescribe antibiotics inappropriately for alleviating pain due to irreversible pulpitis. Antibiotic prescribing practices of dentists with advanced education or academic engagement were better as compared to the other participants. There is clear evidence of antibiotic over-prescribing for irreversible pulpitis which needs to be addressed urgently.

How did COVID-19 impact on dental antibiotic prescribing across England?

“…10 In the absence of infection, antibiotics are inappropriate, yet studies and audits consistently show that dentists prescribe them for conditions such as irreversible pulpitis. 11,12,13,14 A variety of approaches to optimise dental antibiotic prescribing across England have been developed and, in 2016, they were brigaded into a dedicated, national, online dental antimicrobial stewardship toolkit. 15 A downward trend in dental antibiotic use since 2011 has been reported in England.…”

Antibiotics usage, how well we know it? KAP survey among the dentist population in Mumbai

“…A self designed questionnaire survey was designed to assess the knowledge of dental practitioners regarding the guidelines for the use of antibiotics. The survey questionnaire was constructed after thorough review of literature 3,[5][6][7][8][9] . The questions were customized as to fit into the criteria of the present study.…”

“…Clinical situations that require antibiotic therapy on an empirical basis are limited and include oral infection with evidence of systemic spread such as lymphadenopathy and trismus. 3 Endodontic conditions like reversible pulpitis, irreversible pulpitis with moderate/severe preoperative symptoms with/without apical periodontitis do not warrant antibiotic coverage. Despite these facts, there has been a tendency to prescribe antibiotics for this conditions.…”

Trends in Antibiotic Self-Medication for Dental Pathologies among Patients in the Dominican Republic: A Cross-Sectional Study

“…Antibiotic prescription in dentistry is considered to constitute approximately 7–10% [ 22 , 23 , 24 ] of global antibiotic prescriptions, and it is estimated that 80% of these prescriptions are inappropriate across dentalcare [ 24 , 25 ]. Reasons for engaging in this practice may include the high cost of treatment, poor socioeconomic status, inadequate access to a dental care environment, insufficient insurance coverage [ 5 , 26 , 27 , 28 ], cultural influence on some diseases, and dental phobia/anxiety [ 29 ].…”