Are antibiotics overprescribed for apical periodontitis in dental practice?

There is a discrepancy in the databases and data sources mentioned by the authors. The abstract references four databases, which differ from those listed in the materials and methods section. According to the methods, the literature search was conducted across three databases: PubMed-MEDLINE, EMBASE, and Scielo. However, the abstract mentions four databases, including MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus.

All relevant articles were searched using specific keywords derived from Medical Subject Headings (MeSH) terms and text words (TW) related to the topic. Following the screening of titles and abstracts, the full texts of the selected studies were reviewed, and inclusion and exclusion criteria were applied. Any disagreements regarding study inclusion were resolved by consensus. Studies that reported data on antibiotic prescription patterns by dentists for the treatment of apical disease were included.

Data extraction was carried out by three independent reviewers, with a fourth author resolving any disagreements. Extracted data included publication details (authors, year of publication), number of respondents, response rate, survey location, and prescriber type (general practitioner, endodontist, or dental surgeon). The primary outcome measured was the percentage of dentists prescribing antibiotics for each form of periapical endodontic disease.

The search strategy identified a total of 96 studies, of which 39 cross-sectional studies met the inclusion criteria. Dentists prescribed antibiotics in 25.8% of cases of symptomatic apical periodontitis (AP) and in 31.5% of asymptomatic AP cases. In instances of acute symptomatic apical abscess with swelling and moderate to severe symptoms, approximately 89% of dentists prescribed antibiotics, compared to nearly 100% of endodontists.

Endodontists demonstrate more appropriate antibiotic-prescribing practices than general practitioners. Globally, dentists tend to over-prescribe antibiotics for managing apical disease. Therefore, there is a pressing need to enhance antibiotic prescribing practices in the treatment of endodontic infections.