Antibiotic Prescription Practices Among General Dentists Versus House Officers in Kidney Disease Patients Undergoing Root Canal Treatment and Dental Extraction
DOI:
https://doi.org/10.61919/qaqkhm20Keywords:
antibiotic, dental practitioners, kidney disease, root canal treatment, dental extraction, Antibiotic, Kidney disease patients, root canal treatment, dental extraction, dental practitionersAbstract
Background: Chronic kidney disease (CKD) affects approximately 10% of the global population, with a significant proportion in Pakistan, and is associated with increased susceptibility to oral infections and altered pharmacokinetics that complicate antibiotic use. Invasive dental procedures such as root canal treatment (RCT) and dental extraction pose a higher infection risk in this population, warranting careful evaluation of prescribing practices. Objective: To assess the association between dentist designation (general dentists versus house officers) and antibiotic prescription practices for CKD patients undergoing RCT and dental extraction. Methods: A cross-sectional observational study was conducted from January 2024 to January 2025 at Sharif Medical City, Lahore, Pakistan, including 100 dentists (50 general dentists, 50 house officers) with ≥6 months’ clinical experience who had treated CKD patients requiring RCT or extraction. Data were collected using a pre-validated questionnaire (Cronbach’s α = 0.914) and analyzed in SPSS v24 using Chi-square tests; p ≤ 0.05 was considered significant. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: House officers prescribed antibiotics more frequently than general dentists for extractions (84% vs. 54%; OR 4.93, 95% CI 1.82–13.37, p = 0.002) and RCT (68% vs. 26%; OR 6.04, 95% CI 2.67–13.65, p = 0.001). Conclusion: Less experienced practitioners showed significantly higher antibiotic prescribing rates in CKD patients, underscoring the need for targeted stewardship education and guideline-based prescribing protocols.
References
1. Stats FJUDoH, Human Services CfDC, Prevention. National chronic kidney disease fact sheet, 2017. 2017.
2. Webster AC, Nagler EV, Morton RL, Masson PJ. Chronic kidney disease. Lancet. 2017;389(10075):1238-52.
3. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12(1):7-11.
4. Abiraami S. Clinical practise guidelines for patients under hemodialysis requiring dental care. Obstetrics & Gynaecology Forum. 2024.
5. Elhusseiny GA, Saleh W. Oral health in children with chronic kidney disease, hemodialysis, and renal transplantation: a comprehensive narrative review of the oral manifestations and dental implications. Clin Med Insights Pediatr. 2024;18:11795565241271689.
6. Palmeira E, de Liz Pérez‐Losada F, Díaz‐Flores‐García V, Segura‐Sampedro JJ, Segura‐Egea JJ, López‐López J. Prevalence of oral infections in chronic kidney disease patients: A cross‐sectional study. Oral Dis. 2024;30(4):2708-15.
7. Galić M, Miletić I, Poklepović Peričić T, Rajić V, Većek Jurčević NN, Pribisalić A, et al. Antibiotic prescribing habits in endodontics among dentists in the Federation of Bosnia and Herzegovina—A questionnaire-based study. Antibiotics. 2024;13(9):876.
8. Zarbock A, Küllmar M, Kindgen-Milles D, Wempe C, Gerss J, Brandenburger T, et al. Effect of regional citrate anticoagulation vs systemic heparin anticoagulation during continuous kidney replacement therapy on dialysis filter life span and mortality among critically ill patients with acute kidney injury: a randomized clinical trial. JAMA. 2020;324(16):1629-39.
9. Maryam K, Sara MK. Latest concepts in endodontic and periodontal management of diabetic patients. J Coll Physicians Surg Pak. 2024;16(1).
10. Bakhsh AA, Shabeeh H, Mannocci F, Niazi SA. A review of guidelines for antibiotic prophylaxis before invasive dental treatments. Am J Surg. 2020;11(1):311.
11. Prakash S, Pereira BJ. Drug prescribing in patients with chronic kidney disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu AS, Brenner BM, editors. Brenner and Rector’s The Kidney. 7th ed. Philadelphia: Elsevier; 2019.
12. Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: how justified are we. Int Dent J. 2015;65(1):4-10.
13. Wang TZ, Kodiyanplakkal RPL, Calfee DP. Antimicrobial resistance in nephrology. Nat Rev Nephrol. 2019;15(8):463-81.
14. Tesfaye WH, Castelino RL, Wimmer BC, Zaidi STR. Inappropriate prescribing in chronic kidney disease: a systematic review of prevalence, associated clinical outcomes and impact of interventions. Int J Clin Pract. 2017;71(7):e12960.
15. Săndulescu O, Preoțescu LL, Streinu-Cercel A, Şahin GÖ, Săndulescu M. Antibiotic prescribing in dental medicine—best practices for successful implementation. Ther Microbiol Infect Dis. 2024;9(2):31.
16. Sharma R. Antibiotic prescription patterns among dentists for endodontic procedures: A cross-sectional study. J Int Soc Prev Community Dent. 2020;10(2):180-5.
17. Vaishnavi A, Bharti R, Pandey P, Verma P. Exploring dentists' perspectives on endodontic treatment for patients with systemic health conditions: A questionnaire-based study. J Contemp Dent Endod. 2025;28(6).
18. Marra F, George D, Chong M, Sutherland S, Patrick DM. Antibiotic prescribing by dentists has increased: Why? J Am Dent Assoc. 2016;147(5):320-7.
19. Sharma K, Jain P, Sharma A. Knowledge, attitude and perception of medical and dental undergraduates about antimicrobial stewardship. Indian J Pathol Microbiol. 2015;47(6):676-9.
20. Hirayama K, Kanda N, Hashimoto H, Yoshimoto H, Goda K, Mitsutake N, et al. Antibiotic prescription trends in dentistry: A descriptive study using Japan's national database. J Dent Res. 2025;85(2):153-9.
21. Butt H, Waheed Z, Hafeez F, Imran M, Fatima SM, Khan K, et al. Knowledge and practices of dentists regarding antibiotic prescription in medically compromised patients undergoing dental treatment. J Pak Med Assoc. 2020;57(8):1391-6.
22. Walsh L, Ford P, McGuire T, Van Driel M, Hollingworth S. Trends in Australian dental prescribing of antibiotics: 2005–2016. Aust Dent J. 2021;66(Suppl 1):S37-S41.
23. Šutej I, Bašić K, Šegović S, Peroš K. Antibiotic prescribing trends in dentistry during ten years’ period—Croatian national study. Antibiotics. 2024;13(9):873.
24. Okunseri C, Zheng C, Steinmetz CN, Okunseri E, Szabo A. Trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States. J Public Health Dent. 2018;78(2):109-17.
25. Albrecht H, Schiegnitz E, Halling F. Facts and trends in dental antibiotic and analgesic prescriptions in Germany, 2012–2021. Clin Oral Investig. 2024;28(1):100.
26. Al-Haroni M, Skaug N. Knowledge of prescribing antimicrobials among Norwegian dentists. BMC Oral Health. 2007;7:10.
27. Segura-Egea JJ. European Society of Endodontology position statement: The use of antibiotics in endodontics. Int Endod J. 2017;50(12):1057-61.
28. Dar-Odeh NS. Antibiotic prescribing practices by dentists: A review. Ther Clin Risk Manag. 2010;6:301-6.
29. Palmer NAO. A study of antibiotic prescribing by general dental practitioners in the UK. Br Dent J. 2000;188(10):554-8.
30. World Health Organization. Global action plan on antimicrobial resistance. Geneva: WHO; 2015.
31. Centers for Disease Control and Prevention. Core elements of dental antibiotic stewardship. Atlanta: CDC; 2023.
32. National Institute for Health and Care Excellence. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NICE guideline [NG15]. London: NICE; 2021.
33. Poveda-Roda R, Bagan JV, Sanchis-Bielsa JM, Carbonell-Pastor E. Antibiotic use in dental practice: A review. Med Oral Patol Oral Cir Bucal. 2007;12(3):E186-92.
34. Lodi G, Figini L, Sardella A, Carrassi A, Del Fabbro M, Furness S. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev. 2021;(2):CD003811.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Syeda Sara Mehdi, Tayyib Atique, Asma Shakoor, Muhammad Hashir, Malika Attiq, Muhammad Shah Rukh, Hira Butt (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
