KNOWLEDGE AND PATTERNS OF ANTIBIOTIC PRESCRIPTION AMONG DENTAL PRACTITIONERS IN HAIL, SAUDI ARABIA

Table 4. Preferred antibiotics for selected clinical conditions by dental practitioners

in terms of swelling, trismus or fever outcomes, the authors thought a small percentage may be benefited from antibiotics. However, antibiotics are encouraged for patients undergoing contaminated, long-duration surgery. 37 Etiology of alveolar osteitis, also known as dry socket, is multifactorial in origin and its incidence is low. 38, 39 Nearly 49 % of the respondents would prescribe antibiotics to patients suffering from dry socket. There is no sound evidence to support the notion that dry socket is a complication caused by infection, therefore, antibiotics are of no value in curing the condition. 40 A quite sensible percentage( 56.4 %) of dental practitioners would prescribe antibiotics for replantation of teeth. Systemic use of antibiotics for such conditions has been questioned and the clinical studies do not recommend such regime, as no value was achieved. Nevertheless, immersing the avulsed teeth in antibiotic solution, such as tetracycline has been advocated. Experimental studies however, revealed some positive benefits and this is the reason behind its current recommendation by the scholars of dental

41, 42

traumatology. The most worrying malpractice is the unjustified overuse of antibiotics in conditions related to pulp pathology. The only therapy needed for these cases is local clinical intervention. In periodontal conditions, except those associated with abscess, most of the cases require local management. A percentage like 52 % of the respondents who are motivated to prescribe antibiotics for chronic periodontitis cannot be underestimated. On the other hand, consideration of antibiotic therapy for pericoronitis by 68.3 % is acceptable. Nonetheless, mild to moderate pericoronitis without signs of spread can be treated effectively by normal saline irrigation avoiding systemic antibiotic therapy. Necrotizing ulcerative gingivitis is caused by anaerobic microorganisms and warrants specific antibiotic therapy. About 64.4 % of the dental practitioners would prescribe antibiotics treatment of such conditions, though the management should emphasize on local debridement and antimicrobial mouth rinses, and systemic

Stomatology Edu Journal antibiotics should be reserved for cases associated with signs and symptoms of infection spread. Antibiotic therapy for odontogenic sinusitis was considered by 67 % of the dental practitioners. Because of the vicinity of upper apices of posterior teeth to the floor of maxillary sinus, there is no doubt of potential odontogenic infection spread. However, diagnosis of such cases needs to be meticulous to avoid unnecessary or overuse of antibiotics. Cellulitis is a serious acute condition and warrants systemic antibiotic. As nearly as 90 % of dental practitioners would prescribe systemic antibiotics to avoid further complications. Trismus is the hallmark of a masticatory space infection or infection in the anterior compartment of lateral pharyngeal space and about 41 % of the respondents opted to prescribe antibiotics. Both cellulitis and sever trismus are considered as serious medical conditions, therefore, proper diagnosis and management including referrals are crucial. On the other hand, it is very painful to see a considerable percentage( 34.7 %) of the surveyed dental surgeons would still prescribe antibiotics for normal extraction, acute periapical infection( 57.4 %) and for acute pulpitis( 38.6 %). These conditions need immediate intervention rather than systemic antibiotic therapy. Many dental surgeons believe that antibiotics reduces acute pulpal pain. Nevertheless, there is insufficient evidence to support this concept. 43 Use of antibiotics for various apical pathology are still high and would be considered by more than 60 % of the respondents. The available evidence does not provide clinicians with reliable and proper guidelines for treating periapical lesions, 44 therefore, use of antibiotics in such conditions is questionable. Unfortunately, many dental practitioners would still prescribe antibiotics for simple dental procedures;, such as restorative treatment, pulp capping, scaling and polishing, and the current percentages are higher compared to those reported by Alkhabuli et al. 22 When a question regarding antibiotic preference