Perception of Final Year Dental Students on Pattern of Medication for Pulpitis

Abstract

Background: Numerous studies have examined the pattern of various analgesics and antibiotics prescribed by primary dental health care practitioners to manage irreversible pulpitis.
Aim: To determine the pattern of medicines for irreversible pulpitis in undergraduate dental students.
Methodology: A cross sectional survey of open ended questionnaire based on dental scenarios of irreversible pulpitis for child, pregnant woman and apical periodontitis for man was carried out at department of operative dentistry. The questionnaire sought mock medications by the 5th year undergraduate dental students. Responses (n=111) were collected and analysed by frequency for drug prescribed. Data included the name of medicines, dose and presentation of the drugs.
Results: Of the 57 distributed questionnaires, 37 (63%) respondents returned completed forms. A total of 24 (64.8%) of the respondents were female. Majority of mock prescriptions (97.4%) had a combination of antibiotics and analgesics to male patients having apical periodontitis. Almost 25% suggested antibiotics to the pregnant women of 1st trimester, while 81.9% suggested antibiotic and analgesic in tablet form to a child patient. In analgesic and antibiotics groups, acetaminophen (75.5%) and amoxicillin (56.7%) were highest respectively. Abbreviated drug name (11.7%
analgesic and 0.9% antibiotic), and incorrect strengths (7.3% antibiotics and 14 % analgesics) were found.
Conclusion: Amoxicillin and acetaminophen were primary medication for irreversible pulpitis. More clinical trai

Full text

Dentistry
Akram et al., Dentistry 2012, 3:2
http://dx.doi.org/10.4172/2161-1122.1000159
Open Access
Research Article
Volume 3 • Issue 2 • 1000159
Dentistry
ISSN: 2161-1122 Dentistry, an open access journal Biomechanics and Clinical Dentistry
Perception of Final Year Dental Students on Pattern of Medication for
Pulpitis
Ashfaq Akram1,2*, Nabishah Mohamad1, Abdus Salam1, Dalia Abdullah3 and Ruzana zamzam4
1Department of Medical Education, Universiti Kebangsaan Malaysia (UKM), Malaysia
2Faculty of Medicine, Allianze University College of Medical Sciences (AUCMS), Malaysia
3Department of Operative Dentistry, Universiti Kebangsaan Malaysia (UKM), Malaysia
4Department of Psychiatric, Universiti Kebangsaan Malaysia (UKM), Malaysia
Abstract
Background: Numerous studies have examined the pattern of various analgesics and antibiotics prescribed by
primary dental health care practitioners to manage irreversible pulpitis.
Aim: To determine the pattern of medicines for irreversible pulpitis in undergraduate dental students.
Methodology: A cross sectional survey of open ended questionnaire based on dental scenarios of irreversible
pulpitis for child, pregnant woman and apical periodontitis for man was carried out at department of operative dentistry.
The questionnaire sought mock medications by the 5th year undergraduate dental students. Responses (n=111) were
collected and analysed by frequency for drug prescribed. Data included the name of medicines, dose and presentation
of the drugs.
Results: Of the 57 distributed questionnaires, 37 (63%) respondents returned completed forms. A total of 24
(64.8%) of the respondents were female. Majority of mock prescriptions (97.4%) had a combination of antibiotics and
analgesics to male patients having apical periodontitis. Almost 25% suggested antibiotics to the pregnant women of 1st
trimester, while 81.9% suggested antibiotic and analgesic in tablet form to a child patient. In analgesic and antibiotics
groups, acetaminophen (75.5%) and amoxicillin (56.7%) were highest respectively. Abbreviated drug name (11.7%
analgesic and 0.9% antibiotic), and incorrect strengths (7.3% antibiotics and 14 % analgesics) were found.
Conclusion: Amoxicillin and acetaminophen were primary medication for irreversible pulpitis. More clinical training
on medication is suggested.
*Corresponding author: Ashfaq Akram, Department of Medical Education,
Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Jalan Yaqaab
HUKM, Cheras, Kuala Lumpur 56000, Malaysia, Tel: 06-03 91457973; Fax: 06-03
91738790; E-mail: ashfaqakram@hotmail.com
Received February 23, 2012; Accepted April 18, 2012; Published April 20, 2012
Citation: Akram A, Mohamad N, Salam A, Abdullah D, Zamzam R (2012)
Perception of Final Year Dental Students on Pattern of Medication for Pulpitis.
Dentistry 3: 159. doi:10.4172/2161-1122.1000159
Copyright: © 2012 Akram A, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Analgesics; Antibiotics; Dental students; Irreversible
pulpitis; Medication
Introduction
Dental medications, as complementary component of treatment
of various dental procedures to get relief of dental pain, comprise of
analgesics and antibiotics [1,2]. Prescribing medication varies from 74
- 97 % in dental practice during a week [3]. In the UK, 40% dentists
prescribe antibiotics in a week [4]. More than 50% dental prescriptions
have antibiotic, analgesic and mouthwash [5]. In Brazil, the most
commonly prescribed medications by dental practitioners were
amoxicillin (26%) and diclofenac (35 %) [6]. Dar-Odeh et al. [7] found
amoxilcillin (60%) and metronidazole (39.4%) as higher prescribed
antibiotics by dentists in Jorden. Chate et al. [8] observed the pattern
of prescribing antibiotics and found 21.4 % prescriptions with error
associated with abbreviation of drug name, dose and strength.
Most studies on medication pattern involve the qualied dental
graduates. Limited data is available on undergraduate dental students
in this aspect. Dental training aims to acquire prescribing skill by dental
students. us clinical instructors of dental schools take technical skills
as the primary component of a ‘good’ dentist [9]. Undergraduate dental
students, though, are not allowed to prescribe medicines; they are
trained to prescribe medicines under supervision of clinical teachers.
is study aimed to nd the pattern of medicines suggested by
nal year undergraduate students for irreversible pulpitis and apical
periodontitis. An ethical approval was obtained from the Research
Committee of Faculty of Medicine, Universiti Kebangsaan Malaysia.
Methodology
A cross sectional survey having open ended questionnaires was
used. e questionnaire comprised of three scenarios based on dental
problems of a child, pregnant woman and man. e provided mock
scenarios had diagnosis such as irreversible pulpitis for child and
pregnant woman and apical periodontitis for man. us each surveyor
prescribed mock medications for three multiple patients. irty
seven out of 57 students completed the survey of mock prescriptions.
Responses (n=111) were analysed by frequency and percentage. Data
included the name and type of medicines, dose and presentation of the
drugs.
Results
Of the distributed 57 questionnaires, 37 (63%) students returned
completed mock prescriptions. A total of 24 (64.8 %) of the respondents
were female. e acetaminophen (75.5%) and amoxicillin (56.7%) were
the primary medications (Table 1).
Majority of students (97.4%) prescribed a combination of
antibiotics and analgesics to a man with apical periodontitis. Almost
25% students suggested antibiotics and analgesic to the pregnant
woman of 1st trimester with irreversible pulpitis. A large number

Citation: Akram A, Mohamad N, Salam A, Abdullah D, Zamzam R (2012) Perception of Final Year Dental Students on Pattern of Medication for
Pulpitis. Dentistry 3: 159. doi:10.4172/2161-1122.1000159
Page 2 of 3
Volume 3 • Issue 2 • 1000159
Dentistry
ISSN: 2161-1122 Dentistry, an open access journal Biomechanics and Clinical Dentistry
(75.5%) of mock medications had analgesic primarily acetaminophen
while one had sole antibiotic (2.7%) for the 1st trimester pregnant
woman. To an eight year child with irreversible pulpitis, more than two
third (81.9%) suggested antibiotic and analgesic in tablet form (Table
2). Abbreviated drug name (11.7% analgesic and 0.9% antibiotic), the
incorrect strengths (7.3% antibiotics and 14 % analgesics) and incorrect
dose upto 20 percent were found (Table 3).
In summary, acetamionphen (75.7 %), amoxicillin (56.7 %) and
metronidazole (40.4%) were the common suggested medicines for
irreversible and apical periodontitis. However some prescribing errors
were found in mock prescriptions of dental students.
Discussion
In dental practice, along procedures, antibiotics and analgesics
are prescribed. e most used antibiotics like amoxicillin, penicillin,
metronidazole and amoxicillin and clavunate are prescribed by dentists
[10-16]. ough performing pelpectomy is the best management of
irreversible pulpitis but prescribing medication is still part of practical
dental practice. In US, more than 60% endodontists prescribe penicillin
VK as the rst choice of antibiotic followed by 57% clindamycin and
erythromycin (26.65%) [17]. is study primarily focused on the pattern
of medicines, suggested by undergraduate dental students for pulpitis
either irreversible or periapical. Acetaminophen was the most highly
(76.7%) prescribed medicines for irreversible and periapical pulpitis
(Table 1). Donaldson & Goodchild [18] found that acetaminophen and
NSAIDs were the most appropriate choices for the treatment of acute
dental pain such as Pulpitis.
Many studies have shown that amoxicillin is the rst choice of
antibiotic and commonly prescribed (40- 60 percents) for irreversible
pulpitis [19-22]. From Table 1, it is evident that the most commonly
prescribed antibiotic was amoxicillin (57.7%) for irreversible pulpitis
as well as apical periodontitis. e pattern of suggesting medicines by
undergraduate dental students was similar to graduate dentists. In this
study, students suggested, though limited, antibiotics, amoxicillin 57.7
percent and metronidazole 40.4 percent. All other antibiotics were 1.9
percent. e reason could be the less clinical experience.
e administration of penicillin requires analgesics to be added in
the regime to reduce dental pain signicantly [23]. Majority of dental
students suggested amoxicillin in combination of acetaminophen
(Table 2). is shows a similar pattern of dental medication of students
and it is hoped that dental students would follow the same pattern in
their real practice upon graduation.
Many studies indicate acetaphinomen and ibuprofen are eective
therapy for dental pain taken aer dental procedure especially
extraction or even before procedure [24,25]. In this study, students
suggested almost three quarters (75-80 percent) analgesic mainly
acetaphinomen especially for child and pregnant woman. is shows
a similar pattern on analgesics; however, students prescribed a limited
analgesics and antibiotics variety. It could be due to less ward training
and less interaction with patients.
Children’s dosage is based on a single dose of 10 mg acetaminophen
per kilogram bodyweight which can be repeated 4-6 hourly per
24 hours. Acetaminophen in syrup form or oral suspension is
recommended for a child up to 12 year of age [25]. e results show
Analgesic (n=111) Antibiotic (n= 52)
Medicine No. students Frequency Percentage Medicine No. Students Frequency Percentage
Acetaminophen 28 84 75.7 Amoxicillin 21 30 56.7
Mefnemic acid 08 24 21.6 Metronidazole 15 21 40.4
Others 01 3 2.7 Others 01 1 2.7
Total 37 111 100 Total 37 52 100
Table 1: Mock Medicines by Dental Students for Irreversible Pulpitis.
Type of patient Medicine group
Students
N=37
Frequency %
Child Analgesic 30 81.1
Antibiotic & Analgesic 7 18.9
Pregnant women
Analgesic 28 75.7
Antibiotic 1 2.7
Antibiotic & Analgesic 8 21.6
Adult men
Analgesic - -
Antibiotic 1 2.7
Antibiotic & Analgesic 36 97.3
Table 2: Pattern of mock medicines by dental students for irreversible pulpitis.
Drug related
Errors
Analgesic
(n =111)
Percent Antibiotic
(n = 52) Percent
Incorrect dose 7 6.3 8 15.3
Incorrect strength
Abbreviated name
Drug form (syrup) child*
Drug form (tablet )child*
15
13
7
30
13.5
11.7
18.9
81.9
4
1
-
-
7.6
1.9
-
-
Child* (n) =37
Table 3: Commission Errors of Mock Prescription of Dental Students.

Citation: Akram A, Mohamad N, Salam A, Abdullah D, Zamzam R (2012) Perception of Final Year Dental Students on Pattern of Medication for
Pulpitis. Dentistry 3: 159. doi:10.4172/2161-1122.1000159
Page 3 of 3
Volume 3 • Issue 2 • 1000159
Dentistry
ISSN: 2161-1122 Dentistry, an open access journal Biomechanics and Clinical Dentistry
almost 81.9% mentioned tablet form medicine for 8 year child (Table
2). From guideline of pharmacology, a child of eight year old should
be given medicine in syrup form [26]. Syrup (liquid) form is easy to
take as compared to tablet form. However, in clinical practice, patient
(child)’ consent is taken before prescribing any form of medicine. Due
to absence of real child patient, students might not have taken this
aspect. ey concentrated on choice of drug rather than form of drug.
Table 2 illustrates the drug description for pregnant woman
of 1st trimester. Almost one h students (21.6 percent) suggested
antibiotic and analgesics. Medication of amoxicillin is in safe zone
while metronidazole is contraindicated in 1st trimester [27]. Almost
40 percent responses contained antibiotics for pregnant woman. In
practice, doctors prefer to avoid prescribing antibiotics in 1st trimester
of pregnancy. e students were under clinical training and they
followed the guidelines of books. is could be the reason of suggesting
antibiotics in 1st trimester of pregnancy. e facts indicated of more
clinical training on medication process of patient management. Bottom
of Form
Conclusion
Dental students in mock prescriptions prescribed acetaminophen
and amoxicillin as the analgesic and antibiotic agents for irreversible
pulpitis. However, for multiple choices and selection of drugs, less
variety of multiple medications was found which suggested more
clinical training of dental students.
References
1. Doyle G, Javawardena S, Ashraf E, Cooper SA (2002) Efcacy and tolerability
of non prescription ibuprofen versus celecoxib for dental pain. J Clin Pharmacol
42: 912-919.
2. Morse Z, Tump A, Kevelham E (2006) Ibuprofen as a pre-emptive analgesic
is as effective as rofecoxib for mandibular third molar surgery. Odontology 94:
59-63.
3. Hind V, Waterhouse PJ, Maguire A, Tabari D, Lloyd J (2009) Developing a
primary dental care outreach (PDCO) course-part-1: practical issues and
evaluation of clinical activity. Euro J Dent Educ 13: 203-209.
4. Lewis MA, (2008) Why we must reduce dental prescription of antibiotics:
European Union antibiotic awareness day. Br Dent J 205: 537-538.
5. Dar–Odeh N, Ryalat S, Shayyab M, Abu-Hammad O (2008) Analysis of clinical
records of dental patients attending Jordan University Hospital:Documentation
of drug prescription and local anaesthetic injections. Ther Clin Risk Manag 4:
1111-1117.
6. Mendonca JM, Lyra DP Jr, Rabelo JS, Siqueira JS, Balisa-Rocha BJ, et al.
(2010) Analysis and detection of dental prescribing errors at primary health
care units in Brazil. Pharm World Sci 32: 30-35.
7. Dar-Odeh, NS, Abu-Hammad OA, Khraisat AS, El Maaytah MA, Shehabi A
(2008) An analysis of therapeutic, adul antibiotic prescriptions issued by dental
practitioners in Jordan. Chemotherapy 54: 17-22.
8. Chate RA, White S, Hale LR, Howat AP, Bottomley J, et al. (2006) The impact
of clinical audit on antibiotic prescribing in general dental practice. Br Dent J
201: 635-641.
9. Buck D, Malik S, Murphy N, Patel V, Singh S, et al. (2000) What makes a
good dentist and do recent trainees make the grade? The views of vocational
trainers. Br Dent J 189: 563-566.
10. Palmer NO, Martin MV, Pealing R, Ireland RS (2000) An analysis of antibiotic
prescriptions from general dental practitioners in England. J Antimicrob
Chemother 46: 1033-1035.
11. Demirbas F, Gjermo PE, Preus HR (2006) Antibiotic prescribing practices
among Norwegian dentists. Acta Odontol Scand 64: 355-359.
12. Al-Haroni M, Skaug N (2007) Incidence of antibiotic prescribing in dental
practice in Norway and its contribution to national consumption. J Antimicrob
Chemother 59: 1161-1166.
13. Al-Mubarak S, Al-Nowaiser A, Rass MA, Alsuwyed A, Algholi A, et al. (2004)
Antibiotic prescription and dental practice within Saudi Arabia; the need to
reinforce guidelines and implement speciality needs. J Int Acad Periodontol
6: 47-55.
14. Al-Haroni M, Skaug N (2006) Knowledge of prescribing antimicrobials among
Yemeni general dentists. Acta Odontol Scand 64: 274-280.
15. Sarkar C, Das B, Baral P (2004) An audit of drug prescribing practices of
dentists. Indian J Dent Res 15: 58-61.
16. Murti A, Morse Z (2007) Dental antibiotic prescription in Fijian adults. Int Dent
J 57: 65-70.
17. Yingling NM, Byrne BE, Hartwell GR (2002) Antibiotic Use by Members of the
American Association of Endodontists in the year 2000: Report of a National
Survey. J Endod 28: 396-404.
18. Donaldson M, Goodchild JH (2010) Appropriate analgesic prescribing for the
general dentist. Gen Dent 58: 291-297.
19. Rodriquez-Nunez A, Cisneros-Cabello R, Velasco- Ortega E, Llamas-Carreras
JM, Tórres-Lagares D, et al. (2009) Antibiotic use by members of the Spanish
Endodontic Society. J Endod 35: 1198-1203.
20. Segura-Egea JJ, Velasco-Ortega E, Torres-Lagares D, Velasco-Ponferrada
MC, Monsalve-Guil L, et al. (2010) Pattern of antibiotic prescription in the
management of endodontic infections amongst Spanish oral surgeons. Int
Endod J 43: 342-350.
21. Salako NO, Rotimi VO, Adib SM, Al-Mutawa S (2004) Pattern of antibiotic
prescription in the management of oral diseases among dentists in Kuwait. J
Dent 32: 503-509.
22. Mainjot A, D’Hoore W, Vanheusden A, Van Nieuwenhuysen JP (2009)
Antibiotic prescribing in dental practice in Belgium. Int Endod J 42: 1112-1117.
23. Nagle D, Reader A, Beck M, Weaver J (2000) Effect of systemic penicillin on
pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 90: 636-640.
24. Møller PL, Nørholt SE, Ganry HE, Insuasty JH, Vincent FG, et al. (2000) Time
to onset of analgesia and analgesic efcacy of effective acetaminophen 1000
mg compared to tablet acetaminophen 1000 mg in postoperative dental pain:
a single –dose, double –blind randomized, placebo-controlled study. J Clin
Pharmacol 40: 370-378.
25. Olson NZ, Otero AM, Marrero I, Tirado S, Cooper S, et al. (2001) Onset of
analgesia for liquigel ibuprofen 400 mg, acetaminophen 1000 mg, ketoprofen
25 mg and placebo in the treatment of postoperative dental pain. J Clin
Pharmacol 41: 1238-1247.
26. Dinesh Mehta (2000) British National Formulary. Pharmaceutical Press 40.
27. George R Sratto, Adrienne L Woods (2008) Nurse’s drug handbook. The
information standard for prescription drugs and nursing considerations.
Thomson learning Inc.
This article was originally published in a special issue, Biomechanics and
Clinical Dentistry handled by Editor(s). Dr. Kenko Jian-hong Yu, China
Medical University, China
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