(21) Are Dentists in Agreement with Antibiotic Guidelines for Odontogenic Infections?

Thursday, September 15, 2022

1:30 PM – 3:00 PM CDT

Clinical Recommendations

Presenting Author(s)

Christopher Shim, DDS, MD

Resident
University of North Carolina - Chapel Hill
Chapel hill, North Carolina, United States

Co-Author(s)

Derrick Nelson, MD, DDS

Resident
University of North Carolina Chapel Hill
Chapel Hill, North Carolina, United States
GB

George H. Blakey, DDS

Chair and Professor of Oral and Maxillofacial Surgery
University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States
CD

Celin Duran, n/a

Dental Student
University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States
JK

John Kwiatkowski, n/a

Dental Student
University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States
RW

Raymond White, DDS, PhD

Faculty Advisor
University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States
Ceib Phillips, PhD, MPH

Faculty Advisor
University of North Carolina - Chapel Hill
Chapel hill, North Carolina, United States

Disclosure(s):

Christopher Shim, DDS, MD: No financial relationships to disclose

George H. Blakey, DDS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Celin Duran, n/a: I do not have any relevant financial / non-financial relationships with any proprietary interests.

John Kwiatkowski, n/a: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Raymond White, DDS, PhD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Ceib Phillips, PhD, MPH: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Abstract: Problem: Excessive use of antibiotics (Abx) in Agriculture and Health Care has led to negative impacts in both fields.

Materials and

Methods: To mitigate the problem the American Dental Association (ADA) (Lockart et al.2019) provided guidelines for Abx in odontogenic infections.
To assess compliance of clinicians in North Carolina an IRB approved (UNC IRB# 20-3540) anonymous Qualtrics survey was emailed to all active dentists, 6041 and responses were collected over a 2 month period.
Three clinical scenarios were designed to assess the likelihood of the clinician to prescribe antibiotics. Based on the guidelines Scenarios 1 and 3 suggested antibiotic use; Scenario 2 against. Options for response were “unsure, more likely, or least likely” to prescribe antibiotics. The final survey question asked if respondents were aware of the ADA guidelines.
The survey also asked demographic information; scope/years of practice.
Our hypothesis was that NC clinicians generally currently practiced within the ADA guidelines.

Results: 784/6041 (13%) NC clinicians responded, a convenience sample. Two-thirds practiced greater than 10 years. Most were General Dentists 73%.
In responses to scenario 1, 75%, and scenario 3, 82%, prescribed Abx, and to scenario 2, 96%, did not. Furthermore, for scenario 2, 88% of those less than 10 years did not prescribe compared to 81% in those greater than 10, (p= 0.0421).

Conclusions: Based on this convenience sample most dentists responded in accordance with recently published ADA guidelines though not all responded being aware of them. Less experienced dentists were more conservative when abx were not indicated.

References:

1. Segura-Egea, Juan José, et al. “Worldwide Pattern of Antibiotic Prescription in Endodontic Infections.” International Dental Journal, vol. 67, no. 4, 2017, pp. 197–205., doi:10.1111/idj.12287.
2. Lockhart, Peter B., et al. “Evidence-Based Clinical Practice Guideline on Antibiotic Use for the Urgent Management of Pulpal- and Periapical-Related Dental Pain and Intraoral Swelling.” The Journal of the American Dental Association, vol. 150, no. 11, 2019, doi:10.1016/j.adaj.2019.08.020.