Knowledge, Attitudes and Practices Related to the use of Antibiotics in Odontogenic Bacterial Infections among Indian Dentists: A Cross-sectional Study

Introduction: Odontogenic Infections (ODIs) are common, originating from dental or supporting structures, often presenting as periapical abscesses, pericoronitis, or periodontal abscesses, and are polymicrobial in nature and often require antibiotic treatment. If left untreated, they can lead to severe complications. Most ODIs can be managed with local treatments, and antibiotics are only recommended when systemic symptoms are present, to prevent Antimicrobial Resistance (AMR). Despite clear guidelines, inappropriate antibiotic prescribing remains widespread in dental practice, contributing significantly to the growing burden of AMR, especially in countries like India. Aim: To understand the Knowledge, Attitudes, and Practices (KAP) of Indian dentists in treating ODIs. Materials and Methods: The present descriptive crosssectional survey was conducted across 12 Indian cities from August to September 2024 with 250 dentists. A questionnaire comprising seven main questions and 47 Likert-style statements was utilised. Using Computer-Assisted Personal Interviewing (CAPI), KAP on antibiotic use was assessed. Data were analysed descriptively using R software (v4.3.1). Results: Of the 250 dentists enrolled in the study, 110 were from metro cities, 80 were from tier 1, and 60 belonged to tier 2 cities. Most dentists, 225/250 (90%), scored 50-79% on knowledge questions. Most dentists (n=232/250; 92.8%) emphasised updating antibiotic knowledge for ODIs. Notably, 68.4% agreed (171/250) that adding metronidazole to amoxicillin-clavulanic acid improves outcomes. Of the participants, 36% (n=90/250) of dentists believed antibiotic resistance is rarely encountered in practice, while 38% (n=95/250) had no opinion. Only 46% (n=115/250) felt that clinical experience alone should guide antibiotic selection for ODIs, with 30.4% (n=76/250) believed it as sometimes. A majority (78%; 194/250) believed local measures should be prioritised before prescribing antibiotics. Additionally, 58.8% (n=147/250) agreed that culture and sensitivity testing is essential for selecting oral antibiotics. Most dentists follow thorough clinical protocols- 96.4% (n=241/250) assess patient history and symptoms, and 90.8% (n=227/250) use X-rays. While 49.2% (n=123/250) prescribe empiric broadspectrum antibiotics, 85.6% (n=214/250) switch if there's no improvement. Conclusion: The present study identified current practices and possible gaps in appropriate antibiotic prescribing for ODIs. Targeted education programs for dentists, leveraging appropriate methods, are desirable to mitigate antibiotic misuse.