Evaluation of dentists' clinical practices and antibiotic use in managing endodontic emergencies in Karachi, Pakistan: a cross-sectional survey

Endodontic emergencies, often presented as acute pain or swelling, constitute a substantial challenge in dental practice. While effective management emphasizes prompt intervention, antibiotics are typically indicated only when systemic signs and symptoms are present. There is limited research exists on evaluating the knowledge and clinical approach of dental practitioners in managing endodontic emergencies from our region of the world. Therefore, this study aims to evaluate dentists' knowledge, attitude, and practices regarding clinical management and the prescription of antibiotics in endodontic emergency cases. A web-based questionnaire was distributed to working dentists in secondary and tertiary care hospitals and clinics. Eligible participants included dental practitioners, postgraduate trainees, and consultants. The questionnaire included demographic information and inquiries about endodontic emergency treatment approaches, antibiotic prescribing habits, and awareness of guidelines. Statistical analysis was performed Stata software version 17 (StataCorp, College Station, Texas, USA), employing a χ2 test. Of the 527 dentists approached, 409 completed the survey (response rate: 77.6%). The majority of respondents were female (68%) and general dental practitioners (60.32%) with up to 5 years of experience (80.93%). Survey findings highlighted varied treatment approaches, favoring root canal treatment in multiple visits for cases of both irreversible pulpitis (73.59%) as well as with necrotic pulps/periapical lesions (79.95%). Similarly, 45.48% and 37.9% of the respondents favored pulpectomy combined with analgesics and antibiotics in managing irreversible pulpitis and acute apical periodontitis respectively. Moreover, antibiotics were frequently prescribed for acute apical abscess, with amoxicillin-clavulanate being the most common choice (83.6%). Most practitioners (69%) recommended a minimum of 5-day antibiotic course. This study highlights Pakistani dentists' preferences in managing endodontic emergencies and prescribing antibiotics. Despite awareness of guidelines and the consequences of overuse, there's a tendency towards antibiotic overprescription, indicating a need for educational interventions to promote rational antibiotic use and mitigate antibiotic resistance.