The results of the survey demonstrate differences between general dentists, periodontists
More periodontists than general dentists prescribe antibiotics with scaling and root planing, highlighting differences in antibiotic prescribing patterns, according to a study published in the October issue of The Journal of the American Dental Association.
“Patterns of Antibiotic Prescribing Among US General Dentists and Periodontists”. examined the responses of 256 members of the American Dental Association, who were mostly general dentists, and 250 members of the American Academy of Periodontology to a 15-item survey regarding differences between the two cohorts, factors affecting systemic antibiotic prescribing patterns, and timing prescription.
Overall, 32.4% of participants prescribed systemic antibiotics with scaling and root planing. When comparing the two groups, the authors found that 18.7% of general dentists and 46.4% of periodontists reported prescribing antibiotics.
“In the absence of a full range of evidence-based guidelines for the appropriate use of antimicrobial agents, dentists, including periodontists, remain a group that frequently prescribes antibiotics,” said Ruth Lipman, Ph.D., senior director of evidence synthesis and translation. research with the ADA Science & Research Institute and one of the study’s authors. “We found differences related to the timing of prescribing, factors determining prescribing patterns, and the selection of patient populations thought to benefit most from antibiotics.”
AAP membership, practitioner gender, and years of practitioner experience predicted antibiotic prescribing practices, as AAP members appeared to be four times more likely to prescribe antibiotics with scaling and root planing than general dentists surveyed. Men were also more likely to report prescribing antibiotics, as were professionals with more years of experience. Geographic location of study participants, practice setting (group, solo, or other), and occupation type (private practice, academic, government, or other) did not predict reported prescribing patterns.
The study showed a significant difference between periodontists and general dentists in prescribing time, with periodontists more likely to report prescribing systemic antibiotics during the full course of scaling and root planing than general dentists. However, similar proportions of each group reported prescribing antibiotics only at the initiation of scaling and root planing.
In terms of identifying the most important clinical factor to influence antibiotic prescribing practices, most periodontists identified the rate of periodontitis progression versus the severity of periodontitis or other factors, while general dentists were split between progression, severity and other factors.
Both groups identified patients’ diabetic status, advanced age, immunocompetence, and smoking as factors in determining whether they would benefit more from antibiotics than other patient populations, but periodontists were more likely than general dentists to prescribe antibiotics based on bone loss, as well as disease onset between adolescence and age 30.
“Our study confirmed the need for further research to achieve the ultimate goal of appropriate and individualized use of systemic antibiotics in the treatment of periodontitis,” said Dr. Lipman. “To reduce unnecessary antibiotic use and associated healthcare costs and to control antibiotic resistance, the dental community should conduct large-scale clinical trials that provide a better understanding of the precise use of antibiotics in the treatment of periodontitis.”
The ADA has guidelines for the use of prophylactic antibiotics before dental procedures in patients with prosthetic joints and the use of antibiotics to manage dental pain and intraoral swelling . In the spring of 2023, the ADA Science & Research Institute and the University of Texas Health Science Center at San Antonio plan to begin a clinical trial to study the responsible use of antibiotics in combination with other treatments for periodontal disease. The project is supported by a four-year, $2.4 million grant from the National Institute of Dental and Craniofacial Research.
The JADA study was conducted by researchers from ADASRI, the University of Connecticut, the University of Alabama at Birmingham, New York University, the University of Michigan, the University of Maryland, and the State University of New York at Buffalo.
To read the full study and others from the October issue of JADA online, visit JADA.ADA.org.
