Methods: A prospective observational study conducted between October 2012 and May 2013. Practitioners were recruited from lists of both private and NHS registered GDPs in Wales. GDPs recorded anonymous clinical information about consecutive patients with a pulpal or periapical condition on case report forms (CRFs) after treating them according to their usual practice. Information was collected about patient demographics, clinical history and presentation, diagnosis and management. Practitioners were also asked to record whether their management of the patient was influenced by non-clinical factors such as the available clinical time. Demographic and postgraduate education status of the practitioners was also recorded.
Results: A total of 550 CRFs were received from 41 GDPs. Half of patients with a pulpal or periapical pathology received antibiotics as part of their management, including 37.6% of patients with irreversible pulpitis. Two-thirds of antibiotic prescriptions were given in situations where there was no evidence of spreading infection. Furthermore, only 46.6% of patients with signs of a spreading infection or systemic involvement received an operative intervention as part of their management. An association was found between an inappropriate antibiotic prescription and a dentist reporting having insufficient time to treat a patient (RR 2.18 (95% CI 1.70, 2.54)).
Conclusion: There is widespread use of antibiotics by GDPs in the treatment of pulpal and periapical pathologies. The majority of antibiotics are provided without adjunctive local measures and often in situations where they are not justified according to clinical guidelines.