Objective: To investigate prescription of antibiotics by dental practitioners at a dental teaching hospital in Yogyakarta, Indonesia, and to establish whether it conforms to major guidelines. Methods: A cross-sectional study of adult outpatients' medical records was conducted in order to scrutinize antibiotic prescriptions. The results were compared with recommendations in four published guidelines. Results: Dental practitioners prescribed a wide range of antibiotics to treat 121 diagnoses. Amoxicillin (78.8%) was most commonly prescribed, followed by clindamycin (9.9%), metronidazole (5.0%), and lincomycin (2.1%). Among all prescriptions, 79.5% were for generic antibiotics. The most common diagnoses were dental pulp gangrene followed by dental pulp necrosis (26.7% and 8.8%, respectively). According to guidelines-1 through-4, the percentages of antibiotic prescriptions that were evaluated as appropriate for the reported diagnosis were 15.1%, 7.2%, 7.5%, and 16.3%, respectively. However, 9.9%, 84.0%, 83.7% and 67.8% of prescriptions could not be classified as appropriate or inappropriate because the respective guidelines neither listed the antibiotic nor gave statement regarding appropriate indications. Conclusion: Our results suggest that significant inappropriate antibiotic prescribing occurred at a dental teaching hospital in Yogyakarta, Indonesia, according to major antibiotics guidelines. However, the four guidelines failed to list some antibiotics, failed to list indications for prescription in some cases, and were inconsistent in their recommendations. There is a need to introduce specific institutional guidelines. Our findings should be helpful for developing public health policy guidelines to minimize inappropriate antibiotic prescribing at dental hospitals.

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According to the data of Global Burden Disease in 2016, periodontal disease is the 11th disease suffered by 750,487 people worldwide. Gingivitis occurs due to dental plaque formation. A half of bacterial plaque populations are Streptococcus sp. Streptococcus sanguinis is a predominant bacterial that initiates plaque formation. The adherence of this bacteria is mediated by fimbriae, pilus protein, lipoprotein, and glucosyltransferase enzymes. Hibiscus flower has a potential as an antimicrobial agent that may inhibit plaque formation due its active component i.e. flavonoid, tannins, and saponin. This study aimed to investigate the effect of Hibiscus rosa-sinensis L. flower extract concentration on the growth of Streptococcus sanguinis. Wells diffusion method was used in this study, using 100 μl bacterial suspension of 1,5 x 108 CFU/ml of bacteria. Hibiscus flower extract (2%, 4%, 6%), chlorhexidine 0,12% as a positive control, and distilled water as a negative control were added in the agar wells. The results showed that all concentrations (2 %, 4%, 6 %) of Hibiscus flower extract higher significantly compared to negative control. The concentration of 4% and 6% are higher ;significantly compared to positive control. The largest inhibitory zone was at a concentration of 6% (6,35±0,09 mm) and the smallest inhibitory zone was at a concentration of 2% (2,51±0,12 mm). The conclusion is that the concentration of Hibiscus rosa-sinensis L. flower extract affects the growth of Streptococcus sanguinis.