Practicing physicians continue to prescribe systemic antibiotics for localized endodontic infections contrary to current recommendations. An American study attempted to determine what factors underlie these decisions and what is the prevalence of such practice among dentists.
The study was conducted through the National Dental Practice-Based Research Network in the USA and included 104 general practitioners and 49 endodontists. Between April and September 2017, participants treated 1,723 patients requiring non-surgical endodontic root canal treatment. Researchers collected data on antibiotic prescriptions and analyzed the relationship with clinical signs and physician characteristics.
Approximately one in five patients received systemic antibiotics following endodontic procedure. Antibiotics were prescribed more frequently in cases where the tooth demonstrated tenderness on percussion or radiological signs of periapical periodontitis. However, these clinical signs are not independent indications for systemic antibiotic therapy according to current clinical guidelines.
The authors suggested that such practice reflects insufficient understanding of the differences between inflammatory signs and true infection requiring systemic antibiotic therapy. This points to the need for better education of physicians regarding differential diagnosis of endodontic complications.
Antibiotic prescriptions varied significantly depending on clinician characteristics. Physicians younger than 45 years, specialists of non-Hispanic origin, and professionals working in large group or educational organizations prescribed antibiotics less frequently. Researchers suggested that lower prescription rates among younger physicians may reflect contemporary education focused on current clinical guidelines. Regarding physicians in large organizations, they have greater exposure to evidence-based protocols and policies.
A separate analysis of prescriptions in the USA during 2018–2022 showed discouraging results. The frequency of antibiotic prescriptions by general practitioners did not decrease even after the American Dental Association issued recommendations in 2019. This indicates that publication of clinical guidelines is insufficient to change entrenched practices.
Guidelines from the American Dental Association and the American Association of Endodontists do not support routine prescription of systemic antibiotics for localized endodontic infections if definitive dental treatment can be provided. Antibiotic therapy is considered an adjunctive measure only in the presence of systemic signs of infection, patient immunosuppression, or inability to perform adequate endodontic treatment in a timely manner.
The study authors concluded that the identified discrepancy between recommendations and practice requires a comprehensive approach. To change prescribing practices, continuing education of physicians, development of clearer clinical decision support tools, including algorithms integrated into electronic patient management systems, and possible policies at the healthcare system level are necessary. Implementation of quality control systems and feedback mechanisms may also help reduce inappropriate antibiotic prescriptions.
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