Clinical Decision Making in Restorative Dentistry, Endodontics, and Antibiotic Prescription

Abstract

The purpose of this study was to evaluate the influence of geographic location of graduation (Israel, Eastern Europe, Latin America) on decision making regarding management of dental caries, periapical lesions, and antibiotic prescribing routines. A questionnaire was given to ninety-eight general practitioners regarding demographic and work habits. Photographs of lesions were shown on a screen. Participants reported recommended treatment and whether they would routinely prescribe antibiotics following regular endodontic treatment, retreatment, and impacted third molar surgical extraction in healthy patients. There was a 94 percent (n=92) response rate, of which eighty-five responses were used in the data analysis. Surgical treatment of asymptomatic enamel caries lesions was not recommended by most of the subjects, and surgery was recommended for DEJ caries lesions in low or moderate caries risk patients, both without significant differences between geographic regions of dental school graduation. Israelis had a lower frequency of retreatment in asymptomatic teeth that demonstrated periapical radiolucency with post restoration (without crown) compared to Latin Americans and East Europeans. Most of the participants would not retreat asymptomatic teeth that demonstrated periapical radiolucency with post and crown. After third molar surgery, 46 percent of participants routinely prescribed antibiotics. Significantly more Latin American graduates prescribed antibiotics following endodontic treatment, retreatment, and third molar extractions (p<0.05). Overmedication (antibiotics) and overtreatment (caries) among young practitioners reflect failure of undergraduate education in proper use of antibiotics and management of the carious lesions according to the patient's clinical presentation and caries risk assessment rather than routinely undertaking surgical caries treatment.

Antibiotic prescription for endodontic infections: a survey of Brazilian Endodontists

“…Antibiotic resistance patterns might vary according to geographic locations. Zadik & Levin () evaluated the influence of geographic locations (Israel, Eastern Europe, Latin America) on decision‐making regarding management of dental caries, periapical lesions and antibiotic prescribing routines. Latin American graduates prescribed more antibiotics following endodontic treatment and retreatment.…”

The Pattern of Antibiotic Prescribing by Dental Practitioners in Zagreb, Croatia

“…The percentage of doctors of dental medicine accounts for 7.41% of the overall consumption of antibiotics in Croatia, while the usage of these drugs in hospitals is about 10% (14). Research performed in other countries showed that there is a general trend towards overprescribing (6,10,(15)(16)(17)(18) of antibiotics in dental community, which can significantly contribute to the worldwide problem of bacterial resistance. Although the development of bacterial resistance is not in a simple quantitative relationship with the volume of the drug, the reduction in antibiotic resistance can only occur after a significant reduction in antibiotic use (7).…”

Antibiotic use for treating dental infections in children

“…isuse of antibiotics has given rise to the growing problem of antibiotic resistance. [1][2][3] Even when antibiotics are used correctly, there can be problems because past antibiotic use can be linked to a person's developing resistant microbes. [4][5][6] Therefore, the decision to prescribe an antibiotic is important, and the potential positive results must be weighed against the potential negative consequences.…”