Assessment of Antibiotic Prescriptions for Pulpal Disease in West Virginia

The inappropriate use of antibiotics and improper prescribing methods by doctors has led to an increase in antibiotic resistance; a worldwide public health problem that continues to grow. According to the American Association of Endodontists (AAE) there are certain indications for the use of antibiotics in combination with root canal therapy. Little research, however, has been done on the prescribing habits of clinicians in a northern Appalachian rural state like West Virginia. Objectives: We were therefore interested in ascertaining whether or not dentists in West Virginia were properly following these guidelines. Methods: To this end we surveyed 250 General Dentists and 12 Endodontists. Questions included demographic information, followed by various case scenarios requiring root canal therapy and the possible need for antibiotic therapy. This allowed us to evaluate trends of antibiotic prescribing methods by General Dentists and Endodontists. Results: The response rate for General Dentists and Endodontists was 18% and 50% percent respectively. Combining both groups, 5.7% of respondents were between the ages of 20-29; 9.4% were between the ages of 30-39; 5.7% were between the ages of 40-49; 47.2% were between the ages of 50-59; 30.2% were between the ages of 60-69; and 1.9% was over 70. Among the key findings, was the scenario involving Irreversible Pulpitis and Acute Apical Periodontitis with moderate preoperative symptoms. For this scenario, General Dentists prescribed an antibiotic 82.2% of the time, while Endodontists only prescribed an antibiotic 16.7% of the time. Using the Fisher's Exact Test, there was a statistical significance difference (P = 0.0028) between the two groups. Conclusions: General Dentists in West Virginia are overprescribing antibiotics in situations involving pulpally diseased teeth. This trend has led some experts to worry that our generation may not have effective antibiotics for use in the management of true orofacial infections.