JADA study finds variability in antibiotic prescribing with scaling and root planing

Survey results demonstrate differences between general dentists, periodontists

More periodontists than general dentists prescribe antibiotics with scaling and root planing, highlighting differences in antibiotic prescription patterns, according to a study published in the October issue of The Journal of the American Dental Association.

"Antibiotic Prescription Patterns Among US General Dentists and Periodontists" looked at the responses of 256 members of the American Dental Association who were mostly general dentists and 250 members of the American Academy of Periodontology to a 15-item survey addressing differences between the two cohorts, factors affecting systemic antibiotic prescription patterns, and prescription timing.

Overall, 32.4% of the participants prescribed systemic antibiotics with scaling and root planing. When comparing the two groups, the authors found 18.7% of the general dentists and 46.4% of the periodontists reported prescribing antibiotics.

"In the absence of a full spectrum of evidence-based guidelines for the appropriate use of antimicrobial agents, dentists, including periodontists, remain a group often prescribing antibiotics," said Ruth Lipman, Ph.D., senior director of evidence synthesis and translation research with the ADA Science & Research Institute and one of the study's authors. "We found differences related to prescription timing, factors determining prescription patterns and the selection of patient populations thought to benefit more from antibiotics."

AAP membership, practitioner sex and years of practitioner experience predicted antibiotic prescription practices, as AAP members seemed to be four times more likely to prescribe antibiotics with scaling and root planing than the general dentists surveyed. Men were also more likely to report prescribing antibiotics, as were practitioners with more years of experience. Survey participants' geographic location, practice setting (group, solo or other) and occupation type (private practice, academic, government or other) did not predict reported prescribing patterns.

The study showed a significant difference between periodontists and general dentists in prescription timing, with periodontists more likely to report prescribing systemic antibiotics during the full course of scaling and root planing than general dentists. However, similar proportions of each group reported prescribing antibiotics only at the start of scaling and root planing.

In terms of identifying the most important clinical factor that would influence antibiotic prescription practices, most periodontists recognized periodontitis progression rate over periodontitis severity or other factors, while general dentists were split among progression, severity and other factors.

Both groups identified patients' diabetic status, advanced age, immunocompetence and smoking status as factors for determining if they would benefit more from antibiotics than other patient populations, but periodontists were more likely than general dentists to prescribe antibiotics based on bone loss, as well as disease onset between puberty and 30 years of age.

"Our study confirmed the need for further research to attain the ultimate goal of an appropriate and personalized use of systemic antibiotics in the treatment of periodontitis," Dr. Lipman said. "To reduce the unnecessary use of antibiotics and the associated health care cost and to control antibiotic resistance, the dental community would need to perform large-scale clinical trials that offer a better understanding of the precise use of antibiotics in the treatment of periodontitis."

The ADA has guidelines on the use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints and the use of antibiotics for the management of dental pain and intraoral swelling . In spring 2023, the ADA Science & Research Institute and University of Texas Health Science Center at San Antonio plan to begin a clinical trial to study the responsible use of antibiotics in combination with other treatments for periodontal disease. The work is supported by a four-year, $2.4 million grant from the National Institute of Dental and Craniofacial Research.

The JADA study was conducted by researchers from the ADASRI, University of Connecticut, University of Alabama at Birmingham, New York University, University of Michigan, University of Maryland and State University of New York at Buffalo.

To read the full study and others from the October issue of JADA online, visit JADA.ADA.org.