Defense Date

2009

Document Type

Thesis

Degree Name

Master of Science

Department

Endodontics

First Advisor

Karan Replogle

Abstract

The purpose of this study was to determine the changes in prescribing habits of active members of American Association of Endodontics (AAE) with regards to antibiotics in comparison to the findings reported by Yingling et al. in 1999. The invitations to take the online survey were sent via email to 2593 active members. A response rate of 37.75% was obtained. It was determined to be adequate for analysis and for comparison to the results obtained by Yingling et al. Comparisons between the percentages shown in this survey and the previous survey were tested using a z-test. An ANOVA model was used to determine the relationships between predictive factors and the number of prescriptions written. The change in distribution of respondents was notable with an increase in younger clinicians (25% in 1999 to 36% at present). They were more likely to be in private practice and much less in part-time academic and private practice setting. The number of patients being seen per week and the number of prescriptions written per week also decreased in comparison (p<0.001). For all the considered factors, it was also noted that board certified endodontists were prescribing less antibiotics per week. A positive correlation was noted for number of years in practice (p=0.0006), type of practice (p<0.001) and number of prescriptions written per week. Changes in choice of antibiotics were also noted. There was a decrease in use of Penicillin (61.48% to 43%), an increase in the use of Amoxicillin (27.5% to 37.6%), and an increase in use clindamycin (45.3% to 64%) for patients with no medical allergies. As for patients with medical allergies, there was a steep incline in the use of clindamycin (56.03% to 90.3%) as first choice to an increase in azithromycin (7.4% to 38%) as a second choice. An improved trend was noted with a significant decrease in use of antibiotics in managing most of the endodontic scenarios given. Antibiotic use in cases of irreversible pulpitis significantly dropped from 16.76% to 12% (p<0.05); in necrotic pulps with acute apical periodontitis with no swelling, a significant decline from 53.9% to 28.3% (p<0.001); significant decreases were also noted for necrotic pulp with chronic apical periodontitis with no/mild symptoms, 18.8% to 16.1% (p=0.029), and necrotic pulp with acute apical periodontitis with swelling and mod/severe symptoms, 99.2% to 92.4% (p<0.001). An exception was noted for necrotic pulp with chronic apical periodontitis with a sinus tract where there was a significant increase in antibiotic use from 11.9% to 29.1% (p<0.001). Many clinicians (19%) were still giving antibiotics due to soliciting of patients and referring general dentists in fear of losing referrals. A disturbing find is that 50% of the respondents were using antibiotics to manage post treatment flare-ups and pain, while 13% were using antibiotics for inter-appointment pain. As for prophylactic antibiotics, most clinicians were aware of the new AHA/ADA guidelines and were abiding by them. Most of the clinicians responding to survey were choosing the appropriate antibiotics and regimen (i.e. dosage, loading dose, and duration). Although there is an improvement in trends, it has to be noted that there is still an indiscriminate and overuse of antibiotics at large. There needs to be greater improvement in the use of antibiotics in endodontics, and a group effort as a specialty is needed in halting this alarming problem of antibiotic resistance globally.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2009

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