Research Article
BibTex RIS Cite

Knowledge, attitudes and behaviors of Tunisian dentists on the prescription of antibiotics

Year 2025, Volume: 28 Issue: 3, 361 - 369, 30.09.2025

Aymen Ben Hadj Khalifa , Hanen Boukhris , Ghada Ayari , Dhia Eddine Ben Mansour , Chiraz Baccouche

https://doi.org/10.7126/cumudj.1656296

Abstract

Introduction : The misuse of antibiotics in dentistry contributes to antimicrobial resistance. Understanding dentists' knowledge, attitudes, and behaviors is crucial for promoting rational antibiotic use.
Objective: This study aims to assess Tunisian dentists' knowledge levels on antibiotic prescription, as well as their attitudes, behaviors and current practices regarding antibiotic use.
Material and Methods: A descriptive cross- sectional KAP study including 16 questions was delivered to Tunisian dentists based on an online questionnaire. The questionnaire is composed of 2 parts, a knowledge assessment based on the indication or not of antibiotics in specific clinical conditions then the respondents were categorized based on the scores they obtained. The second part based on non-clinical situations aims to assess their attitudes regarding the prescription of antibiotics.
Results: A total of 258 dentists were included in the study. Most Tunisian dentists (84.5%) showed an average level of knowledge regarding the indications of antibiotic. There is no statistically significant relationship between knowledge levels and their years of experience. For non-clinical factors, the high rate of prescribing antibiotics is only when it is necessary to delay treatment (33.7%). Participants disagreed on prescribing antibiotics when requested by patients and when pressed for time with rates of 83.3% and 55.4% respectively. However, dentists have shown a lack of individual practices aimed at improving the prescription of antibiotics including participation in continuing training on prescription (15.5%). Conclusion: This study highlighted shortcomings in antibiotic prescribing in our dental practice. Targeted action plans for the latter could be a first step in the implementation of a policy on the proper use of antibiotics in dentistry.

Keywords

Knowledge attitude practice antibiotic resistance dentists treatment

References

  • 1. Rodríguez-Fernández A, Vázquez-Cancela O, Piñeiro-Lamas M, Herdeiro MT, Figueiras A, Zapata-Cachafeiro M. Magnitude and determinants of inappropriate prescribing of antibiotics in dentistry: a nation-wide study. Antimicrob Resist Infect Control 2023;12:20.
  • 2. WHO. Antibiotic resistance. https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Accessed 21 Jan 2022.
  • 3. Teixeira Rodrigues A, Roque F, Falcão A, Figueiras A, Herdeiro MT. Understanding physician antibiotic prescribing behaviour: a systematic review of qualitative studies. Int J Antimicrob Agents 2013;41:203‑212.
  • 4. Servia-Dopazo M, Figueiras A. Determinants of antibiotic dispensing without prescription: a systematic review. J Antimicrob Chemother 2018;73:3244‑3253.
  • 5. Stein K, Farmer J, Singhal S, Marra F, Sutherland S, Quiñonez C. The use and misuse of antibiotics in dentistry. J Am Dent Assoc 2018;149:869-884.e5.
  • 6. Marra F, George D, Chong M, Sutherland S, Patrick DM. Antibiotic prescribing by dentists has increased. J Am Dent Assoc 2016;147:320‑327.
  • 7. Chopra R, Merali R, Paolinelis G, Kwok J. An Audit of Antimicrobial Prescribing in an Acute Dental Care Department. Prim Dent J 2014;3:24‑29.
  • 8. Salako NO, Rotimi VO, Adib SM, Al-Mutawa S. Pattern of antibiotic prescription in the management of oral diseases among dentists in Kuwait. J Dent 2004;32:503‑509.
  • 9. Al-Sebaei MO, Jan AM. A survey to assess knowledge, practice, and attitude of dentists in the Western region of Saudi Arabia. Saudi Med J 2016;37:440‑445.
  • 10. Köhler M, Meyer J, Linder M, Lambrecht JT, Filippi A, Kulik Kunz EM. Prescription of antibiotics in the dental practice: a survey of dentists in Switzerland. Schweiz Monatsschr Zahnmed 2013;123:748‑759.
  • 11. Teoh L, Marino RJ, Stewart K, McCullough MJ. A survey of prescribing practices by general dentists in Australia. BMC Oral Health 2019;19:193.
  • 12. Palmer NAO, Pealing R, Ireland RS, Martin MV. A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000;189:43-46.
  • 13. Palmer NO, Martin MV, Pealing R, Ireland RS, Roy K, Smith A, et al. Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland. J Antimicrob Chemother. 2001;47:233‑237.
  • 14. Wright C. Therapeutic Guidelines: Oral and Dental. Version 2. Aust Prescr 2012;35:182‑182.
  • 15. Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. European Society of Endodontology position statement: the use of antibiotics in endodontics. Int Endod J 2018;51:20‑25.
  • 16. Blair FM, Chapple IL. Prescribing for Periodontal Disease. Prim Dent J 2014;3:38‑43.
  • 17. Cope AL, Francis N, Wood F, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2018;9(9):CD010136
  • 18. Contaldo M, D'Ambrosio F, Ferraro GA, Di Stasio D, Di Palo MP, Serpico R, Simeone M. Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth. Int J Environ Res Public Health 2023;20:6025.
  • 19. Lockhart PB, Tampi MP, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Kennedy E, Lang MS, Patton LL, Paumier T, Suda KJ, Pilcher L, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling. J Am Dent Assoc 2019;150:906-921.e12.
  • 20. Al-Haroni M, Skaug N. Knowledge of prescribing antimicrobials among Yemeni general dentists. Acta Odontol Scand 2006;64:274‑280.
  • 21. Cope AL, Francis NA, Wood F, Chestnutt IG. Antibiotic prescribing in UK general dental practice: a cross‐sectional study. Community Dent Oral Epidemiol 2016;44:145‑153.
  • 22. Teoh L, Stewart K, Marino RJ, McCullough MJ. Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study. J Oral Pathol Med 2019;48:647‑654.
  • 23. Özdemir Kabalak M, Aytac EN, Tarhan N, Karabulut E, Keceli HG. Potential barriers to the rational antibiotic use in dental and periodontal practice: A questionnaire-based online survey. Dent Med Probl 2024;61:373‑383.
  • 24. Agnihotry A, Thompson W, Fedorowicz Z, Van Zuuren EJ, Sprakel J. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2019;5(5):CD004969.
  • 25. Palmer NOA. Antibiotic prescribing in general dental practice. Prim Dent J 2014;3:52‑57.
  • 26. Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. Int Endod J 2017;50:1169‑1184.
  • 27. Tampi MP, Pilcher L, Urquhart O, Kennedy E, O'Brien KK, Lockhart PB, Abt E, Aminoshariae A, Durkin MJ, Fouad AF, Gopal P, Hatten BW, Lang MS, Patton LL, Paumier T, Suda KJ, Cho H, Carrasco-Labra A. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019;150:e179‑216.
  • 28. Parekh A, Balasubramanian K, Bhate P, Kalra D. Antibiotics usage, how well we know it? KAP survey among the dentist population in Mumbai. International Journal of Basic & Clinical Pharmacology 2020;9:1713‑1720.
  • 29. Farkaš M, Ivančić Jokić N, Mavrinac M, Tambić Andrašević A. Antibiotic Prescribing Habits and Antimicrobial Resistance Awareness of Dental Practitioners in Primorsko-Goranska County, Croatia. Microb Drug Resist 2021;27:1482‑1488.
  • 30. Palmer, N. (Ed). Antimicrobial Prescribing in Dentistry: Good Practice Guidelines. 3rd Edition. London, UK: Faculty of General Dental Practice (UK) and Faculty of Dental Surgery; 2020.
  • 31. Kwon G, Serra M. Pericoronitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 /
  • 32. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021;162:e183‑353.
  • 33. Candan M. Infective Endocarditis Prophylaxis in Dentistry: Current Perspective. Cumhuriyet Dent J 2021;24:96‑104.
  • 34. Lesclous P. Prescription des antibiotiques en pratique bucco-dentaire: Recommandations Afssaps 2011. Med Buccale Chir Buccale 2011;17:334‑346.
  • 35. Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: how justified are we. Int Dent J 2015;65:4‑10.
  • 36. Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, O'Connell A, Flores MT, Day PF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020;36:331‑342.
  • 37. Pantlin L. Is there a Role for Antibiotics in Periodontal Treatment? Dent Update 2008;35:493‑496.
  • 38. Mahuli SA, Zorair AM, Jafer MA, Sultan A, Sarode G, Baeshen HA, Raj AT, Sarode S, Patil S. Antibiotics for Periodontal Infections: Biological and Clinical Perspectives. J Contemp Dent Pract 2020;21:372‑376.
  • 39. Herrera D, Sanz M, Jepsen S, Needleman I, Roldán S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 2002;29:136‑159.
  • 40. Kissa J, Chemlali S, Gharibi A. Systemic antibiotic prescribing patterns of dentists in Morocco: A questionnaire study. Ann Afr Med 2023;22:293-299.
  • 41. Khattri S, Kumbargere Nagraj S, Arora A, Eachempati P, Kusum CK, Bhat KG, Johnson TM, Lodi G. Adjunctive systemic antimicrobials for the non-surgical treatment of periodontitis. Cochrane Database Syst Rev 2020;11(11):CD012568.
  • 42. Baillie EJ, Merlo G, Van Driel ML, Magin PJ, Hall L. Early-career general practitioners’ antibiotic prescribing for acute infections: a systematic review. J Antimicrob Chemother 2024;79:512‑525.
  • 43. Lodi G, Azzi L, Varoni EM, Pentenero M, Del Fabbro M, Carrassi A, Sardella A, Manfredi M. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev 2021;2(2):CD003811.
  • 44. Sancho-Puchades M, Herráez-Vilas JM, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Analysis of the antibiotic prophylaxis prescribed by Spanish Oral Surgeons. Med Oral Patol Oral Cir Bucal 2009;14:e533-537.
  • 45. Mainjot A, D’Hoore W, Vanheusden A, Van Nieuwenhuysen JP. Antibiotic prescribing in dental practice in Belgium. Int Endod J 2009;42:1112‑1117.
  • 46. Pipalova R, Vlcek J, Slezak R. The trends in antibiotic use by general dental practitioners in the Czech Republic (2006-2012). Int Dent J 2014;64:138‑143.
  • 47. Pisarnturakit PP, Sooampon S, Sooampon S. Managing knowledge for health care quality: An investigation of rational antibiotic use among Thai dentists. Int J Health Plann Manage 2020;35:606‑613.
  • 48. Gross AE, Hanna D, Rowan SA, Bleasdale SC, Suda KJ. Successful Implementation of an Antibiotic Stewardship Program in an Academic Dental Practice. Open Forum Infect Dis 2019;6:ofz067.
  • 49. Thornhill MH, Dayer MJ, Durkin MJ, Lockhart PB, Baddour LM. Oral antibiotic prescribing by NHS dentists in England 2010-2017. Br Dent J 2019;227:1044‑1050.
  • 50. Rejeb MB, Marzougui L, Fradj MB, Bouallègue O, Said-Latiri H. Résistance bactérienne et prescription antibiotique : perceptions, attitudes et connaissances d’un échantillon de médecins hospitaliers. Étude au CHU Sahloul – Sousse – Tunisie. Rev Epidemiol Sante Publique 2014;62:S230‑231.
  • 51. Bel Haj Ali K, Sekma A, Messous S, Trabelsi I, Ben Youssef J, Maghraoui H, Razgallah R, Walha A, Grissa MH, Beltaief K, Mezgar Z, Coubantini A, Bouida W, Msolli MA, Boukef R, Boubaker H, Nouira S. Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study. BMC Prim Care 2022;23:295.
  • 52. Brahmi N, Blel Y, Kouraichi N, Ben Hamouda R, Thabet H, Amamou M. Impact d’une politique de prescription d’antibiotiques dans un service de réanimation tunisien. Med Mal Infect 2006;36:460‑465.
  • 53. McMahon SR, Iwamoto M, Massoudi MS, Yusuf HR, Stevenson JM, David F, Chu SY, Pickering LK. Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics 2003; 111: e299-e303.
There are 53 citations in total.

Details

Primary Language English
Subjects Dental Therapeutics, Pharmacology and Toxicology, Oral Medicine and Pathology, Dental Public Health
Journal Section RA
Authors

Aymen Ben Hadj Khalifa 0000-0001-5080-4179

Hanen Boukhris 0000-0001-7574-1872

Ghada Ayari 0009-0003-8976-2799

Dhia Eddine Ben Mansour 0009-0007-7271-4087

Chiraz Baccouche 0000-0002-2980-9191

Publication Date September 30, 2025
Submission Date March 15, 2025
Acceptance Date July 24, 2025
Published in Issue Year 2025 Volume: 28 Issue: 3

Cite

EndNote Ben Hadj Khalifa A, Boukhris H, Ayari G, Ben Mansour DE, Baccouche C (September 1, 2025) Knowledge, attitudes and behaviors of Tunisian dentists on the prescription of antibiotics. Cumhuriyet Dental Journal 28 3 361–369.
 Download Cover Image

Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.


CDJ accepts articles in English. Submitting a paper to CDJ is free of charges. In addition, CDJ has not have article processing charges.

Frequency: Four times a year (March, June, September, and December)

IMPORTANT NOTICE

All users of Cumhuriyet Dental Journal should visit to their user's home page through the "https://dergipark.org.tr/tr/user" " or "https://dergipark.org.tr/en/user" links to update their incomplete information shown in blue or yellow warnings and update their e-mail addresses and information to the DergiPark system. Otherwise, the e-mails from the journal will not be seen or fall into the SPAM folder. Please fill in all missing part in the relevant field.

Please visit journal's AUTHOR GUIDELINE to see revised policy and submission rules to be held since 2020.