(22) Do Dental Students Agree With ADA Treatment Guidelines Regarding When to Prescribe Antibiotics for Odontogenic Infections?

Abstract: Most infections involving the head and neck are due to a dental source. Dental infections can usually be resolved through three treatment options: antibiotics only, antibiotics with source control such as tooth removal, or source control without antibiotics. Patients with these infections often seek the care of a dentist or primary care physician. Antibiotic prescription selection is variable between the two professions. To assist with more cohesive treatment, the American Dental Association (ADA) published guidelines in 2019. Current treatment recommendations support source control of the infection as the definitive treatment with antibiotics as adjunctive therapy. This study aims to identify if dental students are aware of the ADA guidelines.

An anonymous Qualtrics survey was created and administered to third- and fourth-year University of North Carolina (UNC) dental students (N-f170). The survey consisted of 3 case-based scenarios describing instances of immunocompetent patients with presentations ranging from symptomatic pulpitis to pulpal necrosis with or without signs of localized acute infection. The study was submitted to the Institutional Review Board (IRB) and received exemption. Participants responded “yes” or “no” on prescribing antibiotics. Scenarios 1 and 3 aligned with guideline recommendations for antibiotic use, whereas scenario 2 opposed use. The students were then provided with the ADA guidelines on prescribing antibiotics for odontogenic infections and the questions were repeated without the ability to change the original responses.

McNemar analysis was used to assess the difference in the discordances between the first response (before) and second response (after guidelines). Level of significance was set at .05. In Scenario 1, correct responses for prescribing antibiotics rose from 81% to 82% after reviewing ADA guidelines. In scenario 2 there was an increase from 72% to 88% for correctly answering “no,” while Scenario 3 improved from 93% to 99% for “yes.” The percentage of students who changed their perception of whether antibiotics were needed after reviewing the guidelines for scenario 1 (12%) and scenario 3 (8%) was not statistically significant. There was a statistically significant difference (P = .007) in how students responded to scenario 2 (no indication for antibiotics) with 27% of respondents changing their response following review of ADA guidelines. Of those who would not have prescribed in their first response, only 8% changed to prescribe while 76% of those who responded would prescribe the first time changed to “do not prescribe” after reading the guidelines.

Dental infections account for approximately 10% of all antibiotic prescriptions. These infections can have severe consequences such as localized abscesses, deep neck infections and mediastinitis, where emergency procedures including tracheostomy may be required. The complications can be life-threatening, highlighting the need for accurate diagnosis and safe treatment. A study at UNC conducted by Nelson et al looked at whether dentists practicing in the state of North Carolina were aware of the ADA guidelines identifying that community dental providers generally agree on antibiotic use for odontogenic infections, but those with 10+ years of experience were more likely to overprescribe. Just over half of the responding dentists indicated they were aware of the recent ADA guidelines.

This study found that student doctors are mostly aligned with ADA guidelines. There is a discrepancy regarding whether post-operative antibiotics are indicated in an immunocompetent patient where definitive treatment was provided the same day. Students, although seemingly familiar with ADA guidelines for scenario 1 and 3, were not as familiar with the guidelines for scenario 2 as illustrated by the proportion (76%) who changed their response from prescribe to do not prescribe. This highlights a possible gap in pre-doctoral coursework and the need for better education to align clinical practice with current guidelines to reduce unnecessary antibiotic use.
McNemar Analysis