Dentists’ Knowledge and Awareness of Antibiotic Prescribing Practices in Damascus, Syria

Dentists’ Knowledge and Awareness of Antibiotic Prescribing Practices in Damascus, Syria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Dentists’ Knowledge and Awareness of Antibiotic Prescribing Practices in Damascus, Syria Jana Alkhouli, Khaldoun Darwish, MUAAZ ALKHOULI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8752613/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Inappropriate antibiotic prescribing in dental practice contributes significantly to antimicrobial resistance, yet data on dentists’ prescribing knowledge and behaviors in Damascus, Syria remain limited. This cross-sectional observational study assessed antibiotic-related knowledge and prescribing practices among dentists in Damascus. Conducted between January and March 2024, the study included 844 practicing dentists who completed a validated 48-item electronic questionnaire covering antibiotic indications, dosage, duration, prophylactic use, and management of antibiotic allergies. Knowledge scores (range: 0–48) were categorized as low, moderate, or high. Statistical analysis involved one-way ANOVA with Bonferroni post hoc tests and independent samples t-tests (P < 0.05). Knowledge scores ranged from 10 to 44, with a mean of 28.11 ± 4.61. Low knowledge levels were observed in 46.4% of participants, while 28.6% demonstrated moderate knowledge and 25% high knowledge. Significant differences were found among dental specialties (P < 0.05), with oral and maxillofacial surgeons scoring highest. General dentists were more likely to prescribe antibiotics in inappropriate clinical situations, including chronic periodontitis and localized gingival swelling. No significant associations were found between knowledge scores and years of experience or workplace sector. These findings highlight the need for targeted educational interventions and standardized national guidelines to promote rational antibiotic use in dental practice. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Microbiology Antibiotics Dentistry Prescribing patterns antimicrobial resistance Knowledge assessment Damascus Syria Figures Figure 1 Introduction Antibiotics play a crucial role in the management of oral and maxillofacial infections and are frequently prescribed in dental practice for both therapeutic and prophylactic purposes[ 1 , 2 ]. Dentists commonly prescribe antibiotics to manage acute dental infections, prevent the progression of localized disease, and reduce the risk of systemic complications [ 3 , 4 , 5 ]. Prophylactic antibiotic use is also recommended for patients at increased risk of focal infections, such as those with infective endocarditis risk factors or joint prostheses [ 6 , 7 , 8 , 9 ]. However, the misuse and overuse of antibiotics in dentistry have become major contributors to the global rise in antimicrobial resistance [ 10 , 11 , 12 ]. Prolonged or unnecessary antibiotic prescriptions impose selective pressure on bacterial populations, encouraging the development of resistant strains and ultimately diminishing the effectiveness of commonly used antibiotics [ 13 , 14 ]. This highlights the essential need for rational antibiotic-prescribing practices among dentists [ 15 , 16 ]. Despite the significant role of antibiotics in dentistry, studies assessing prescribing patterns among dental practitioners are limited, especially in low- and middle-income countries [ 17 ]. There remains a notable gap in understanding prescribing behaviors, levels of knowledge, and factors influencing decision-making among dentists [ 18 , 19 ]. To the best of our knowledge, this is the first study to investigate the antibiotic-prescribing profiles and knowledge levels of dentists practicing in Damascus, Syria. The study aims to provide evidence-based data that may guide future educational programs, improve antibiotic stewardship, and contribute to more rational prescribing habits in dental practice. Methods Study Design This cross-sectional observational study was designed in accordance with the COSMIN guidelines. Data collection occurred over a two-months period between January 2024 and March 2024. The study followed the ethical standards of the Declaration of Helsinki and received approval from the Research Ethics Committee of the Faculty of Dentistry, Damascus University (Approval date: 22-12-2023; Approval number available upon request). Study participants Participation was voluntary and anonymous. All participants were asked to provide an informed consent electronically before involving them within the study. A structured online questionnaire was developed and distributed through multiple Syrian dentist Facebook groups and the official page of the Syrian Dentists Syndicate, ensuring wide national coverage. A total of 844 dentists completed all questionnaire items and were included in the final analysis. Sample Size According to the formula of Kothari [ 20 ], the sample size was 362 dentists. However, we left the questionnaire available for dentists who want to participate for one month, and a total number of 844 responses were obtained. $$\:n=\frac{p\left(1-p\right)}{{A}^{2}∕{z}^{2}+\left(P\left(1-P\right)∕N\right)∕R}$$ where n is the sample size. N is the population size, which was considered as the number of dentists practicing in Damascus (N = 3600). P is the estimated variance for the population, as it was assumed that almost 50% of the population would agree to the statements of the scale (P = 0.5). A is the desired precision, which depends on the margin of the error that was set as 0.05. z was 1.96 as the confidence level of this study was 95%. R is the response rate of the audience, and it was set as 85%. Questionnaire Development A PubMed search was conducted using keywords such as antibiotics, questionnaire, instrument, awareness and dentistry. Although several validated questionnaires existed, a more comprehensive instrument was developed for this study by selecting and integrating relevant items from previously validated tools. Content validity was assessed through expert review by a panel of dental specialists. The questionnaire was piloted on a group of 20 volunteer dentists to ensure clarity and relevance; necessary modifications were made based on their feedback. Internal consistency reliability was evaluated using Cronbach’s alpha, which demonstrated acceptable reliability (α > 0.7). The final questionnaire contained 48 items that were assessing knowledge regarding antibiotic indications, choices, dosing, duration, trauma cases, prophylaxis, and management of allergic patients. Responses allowed multiple selections. All answers were adhered to the clinical guidelines of antibiotics use in dentistry releases by the American Dental Association ADA. Table 1 shows all items asked within the questionnaire. Table − 1- all questions of the questionnaire Scoring item Answer Score 1- Cases in which antibiotics are prescribed: Post simple teeth extraction No 1 Post surgical teeth extraction Yes 1 Periapical infection Yes 1 Cellulitis, ludwig’s angina and other space infection Yes 1 Acute periapical infection Yes 1 Chronic periapical infection No 1 Pericoronitis Yes 1 Reversible pulpitis No 1 Irreversible pulpitis No 1 Implant surgery with bone graft Yes 1 Dry socket No 1 After root canal treatment No 1 After orthognathic surgery Yes 1 Periodontitis after root canal treatment No 1 Sinusitis Yes 1 2- Cases in which antibiotics venous injection used: Acute abscess that doesn’t respond to antibiotics Yes 1 space infection and ludwig’s angina Yes 1 3- Duration of antibiotics prescription: 3 days No 1 5 days Yes 1 4- Diagnosis serving as a clinical signal for prescribing antibiotics: Spontaneous pain No 1 Pain on palpation or on chewing or on percussion No 1 Localized gingival edema No 1 Fever Yes 1 Fatigue and weakness Yes 1 Buccal edema Yes 1 Swollen lymph nodes Yes 1 5- Dental trauma cases in which antibiotics are prescribed: Re-implantation after tooth avulsion Yes 1 Intrusion Yes 1 Lateral luxation Yes 1 Subluxation No 1 6- Criteria for prescribing prophylactic antibiotics: Type of procedure Yes 1 Long surgical procedure Yes 1 Oral environment that contains infectious foci Yes 1 Patient has health problems that demand prophylaxis Yes 1 7- Types of prophylactic antibiotics which are prescribed: Amoxicillin 2g orally Yes 1 Cephalexin 2g orally Yes 1 Ceftriaxone 1g IV/IM Yes 1 Ceftriaxone 1g orally No 1 8- When selecting antibiotics for treatment, you choose: Amoxicillin for negative gram bacteria Yes 1 Amoxicillin + clavulanic acid as a broad-spectrum antibiotic Yes 1 Metronidazole for aerobic bacteria No 1 Clindamycin as a broad-spectrum antibiotic Yes 1 9- If patient doesn’t respond to the first antibiotic prescribed, you prescribe: Clindamycin Yes 1 Amoxicillin + clavulanic acid (augmentin) Yes 1 IM injection or IV injection No 1 10- If patient has an allergic to penicillin, you prescribe: Erythromycin Yes 1 Clindamycin Yes 1 Cephalexin No 1 Score : 48 Scoring System Each correct response was assigned a score of (1). Incorrect answers received a score of (0). All items were equally weighted because each represents an independent evidence-based guideline. The maximum achievable score was 48. Based on total knowledge scores, participants were categorized into: Low knowledge: 0–16 Moderate knowledge: 17–34 High knowledge: 35–48 Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics v13. Normality of data was tested using the Kolmogorov–Smirnov test. One-way ANOVA was used to compare mean knowledge scores between specialties and between experience groups. Moreover, Bonferroni post-hoc tests were conducted to identify pairwise differences. Independent samples t-test compared knowledge scores between public and private sector dentists. A significance level of P < 0.05 was adopted. Results Personal characteristics of the participants A total of 844 dentists completed the questionnaire. 56% of the participants were male. Regarding the specialization of participants, the largest proportion of the research sample consisted of general practitioners, who made up 44% of the total sample size (371 dentists). The smallest proportion of the research sample was made up of oral medicine and diseases specialists, who constituted only 2% of the total sample size (16 dentists). Moreover, two to five years of experience represented the largest proportion of the research sample, making up 35.1% of the total sample size (297 dentists). In contrast, the smallest proportion was for dentists with over 20 years of experience, who constituted only 7.6% of the total sample size (64 dentists). Finally, the proportion of dentists participating in this research who work in the private sector was 70.6% of the total sample size. In contrast, the proportion of dentists working in the public sector was 29.4% of the total sample size. Table 2 demonstrates all personal characteristics of the sample regarding gender, specialization, years of experience and workplace. Table − 2- personal characteristics of participants Gender Male 56% (472 dentists) Female 44% (372 dentists) field of specialization General Dentist 44% (37dentists) Oral and Maxillofacial Surgery 16% (135 dentists) Restorative and Cosmetic Dentistry 10% (85 dentists) Periodontics 8% (68 dentists) Pediatrics 8% (68 dentists) Fixed and Removable Prosthodontics 7% (59 dentists) Orthodontics and Dentofacial Orthopedics 5% (42 dentists) The number of years of experience Less than 2 years 34.1% (28 dentists) 2–5 years 35.1% (297 dentists) 5–10 years 14.7% (124 dentists) 10–20 years 8.5% (71 dentists) More than 20 years 7.6% (64 dentists) Workplace Private sector 70.6% (59 dentists) Public sector 29.4% (248 dentists) Analytic statistics Knowledge scores of the participant dentists ranged from 10 to 44, with a mean score of 28.11 ± 4.61. The majority of participant dentists had a low level of knowledge with a percentage of 46.4% of all of the studied sample. 28.6% of the dentists had a moderate knowledge of antibiotics use. Only 25% of the studied sample had a high level of knowledge. The ANOVA test showed statistically significant differences between dental specialties in antibiotic-prescribing knowledge ( P < 0.05). Oral and maxillofacial surgeons demonstrated significantly higher average knowledge scores than all other specialties, while general practitioners, prosthodontists, and orthodontists scored significantly lower. The analysis revealed specialty-specific patterns of incorrect responses regarding antibiotic use. Among general dentists, the most frequent mistake concerned the inappropriate duration of antibiotic prescriptions, with only 20.6% providing the correct response. Oral and maxillofacial surgeons most commonly erred in selecting cephalexin as a prophylactic antibiotic, yielding a correct response rate of 30%. For restorative and cosmetic dentists, the predominant mistake also involved the duration of antibiotic therapy (five days), with a correct response rate of 33.3%. Periodontists demonstrated the lowest accuracy in decisions related to prescribing antibiotics for traumatic intrusion injuries, with only 29% responding correctly. Similarly, pediatric dentists most frequently erred in determining the appropriate duration of antibiotic prescriptions (five days), achieving a correct response rate of 29.4%. Orthodontists showed the greatest difficulty in identifying indications for antibiotic use in intrusion injuries, with a correct response rate of 23.8%. Finally, fixed and removable prosthodontists most commonly selected erythromycin for penicillin-allergic patients inappropriately, with only 33.8% providing the correct answer. Diagram 1 demonstrates the mean of scientific knowledge values between dentist regarding the field of specialization Regarding years of experience, although differences in mean scores were noted, they were not statistically significant ( P > 0.05). In addition, no significant difference was found in knowledge scores between public and private sector dentists. Table 3 demonstrates the results of analytical statistics. Table − 3- Results of analytical statistics The mean of scientific knowledge values Test value P -value the field of specialization General Dentist 15.4 0.44 0.001 1 Oral and Maxillofacial Surgery 42.1 Restorative and Cosmetic Dentistry 30.5 Periodontics 35.7 Pediatrics 32.3 Orthodontics and Dentofacial Orthopedics 21.1 Fixed and Removable Prosthodontics 19.7 Years of experience Less than 2 years 25.1 0.11 0.011 2–5 years 21.6 5–10 years 21.1 10–20 years 28.6 More than 20 years 29.1 Workplace Public sector 27.6 1.12 0.032 Private sector 22.6 There is statistically significant difference Discussion This study represents the first comprehensive assessment of antibiotic-prescribing practices and knowledge levels among dentists in Damascus, Syria. The findings reveal substantial gaps in antibiotic use across multiple dental specialties, with particularly pronounced deficiencies among general practitioners and specialties that infrequently encounter infectious or traumatic dental conditions. These results underscore the urgent need for targeted educational interventions and reinforcement of evidence-based prescribing guidelines. General practitioners exhibited a greater probability to prescribe antibiotics in clinical situations where their use is not routinely indicated, including chronic periodontitis, post-endodontic pain, and localized gingival edema. Moreover, they were more likely to progress treatment to intravenous or intramuscular antibiotic administration when oral therapy was perceived as ineffective. This practice may reflect uncertainty in infection management, limited exposure to complex cases, or insufficient familiarity with current clinical guidelines. Consistent with this observation, the most common error among general dentists in the present study was related to the inappropriate duration of antibiotic prescriptions, with only 20.6% selecting the correct treatment duration. This finding highlights a critical need for additional training focused on optimizing antibiotic course length to reduce unnecessary exposure and the risk of antimicrobial resistance [ 21 , 22 ]. These findings are consistent with previously published data from other countries. For example, a study conducted in the United States reported that 39% of general dentists prescribed antibiotics for chronic periodontitis, closely mirroring the patterns observed in the present study [23]. Similarly, an analysis of antibiotic prescriptions by general dentists in the United States found that approximately 14% of antibiotic prescriptions were classified as inappropriate based on the agent selected and/or treatment duration, underscoring persistent gaps in guideline-concordant antibiotic use among dental practitioners [ 24 ]. Such parallels suggest that inappropriate antibiotic use among general dentists is a global concern rather than a region-specific issue. Oral and maxillofacial surgeons demonstrated the highest overall knowledge scores, which is expected given their extensive training and frequent involvement in managing severe odontogenic infections and surgical complications. Their appropriate use of intravenous antibiotics in life-threatening conditions, such as Ludwig’s angina, reflects sound clinical judgment. However, the most frequent error within this group involved the selection of cephalexin as a prophylactic antibiotic, with a correct response rate of only 30%. This finding suggests a need to reinforce evidence-based recommendations regarding prophylactic antibiotic selection, even among highly trained specialists. This observation is supported by previous findings showing considerable variability in antibiotic prescribing practices among oral and maxillofacial surgeons, with many prophylactic regimens deviating from evidence-based recommendations, despite their advanced surgical training [ 25 , 26 ]. Restorative and cosmetic dentists also showed notable gaps in knowledge, particularly regarding the appropriate duration of antibiotic therapy. Only 33.3% correctly identified the recommended five-day course, indicating that misconceptions about treatment length persist even in procedures with relatively limited infection risk. Similarly, pediatric dentists demonstrated a low correct response rate (29.4%) for antibiotic duration, raising concerns about potential overuse or misuse of antibiotics in children, a population especially vulnerable to adverse drug effects and antimicrobial resistance. Surveys of dental practitioners consistently demonstrate suboptimal knowledge and inconsistency in antibiotic prescribing, including variability in when antibiotics are indicated and in appropriate treatment duration, highlighting widespread misconceptions across dental specialties that may contribute to unnecessary prescribing and increased antimicrobial resistance [27]. In addition, in a cross-sectional survey assessing dentists’ antibiotic knowledge and awareness, significant inconsistency in prescribing practices was identified among general and pediatric dentists, indicating persistent gaps between guideline recommendations and actual practice [ 26 ]. Periodontists most frequently erred in decisions related to antibiotic prescribing for traumatic intrusion injuries, with a correct answer rate of only 29%. This finding suggests insufficient familiarity with dental trauma management protocols, which may fall outside the routine scope of periodontal practice. Orthodontists likewise demonstrated limited awareness of appropriate antibiotic indications in intrusion injuries, with the lowest correct response rate observed across specialties (23.8%). Given that orthodontic treatment often involves children and adolescents—who are more prone to dental trauma—this knowledge gap warrants attention. Consistent with our findings of suboptimal decision-making for traumatic intrusion injuries among periodontists and orthodontists, broader surveys of dental practitioners have reported only moderate levels of knowledge regarding evidence-based management of dental trauma, indicating persistent educational gaps in this domain that likely contribute to inappropriate antibiotic prescribing choices in trauma cases [ 28 ]. Fixed and removable prosthodontists exhibited their most common error in selecting erythromycin as an alternative for penicillin-allergic patients, with only 33.8% answering correctly. This highlights a broader issue regarding knowledge of appropriate antibiotic alternatives and evolving resistance patterns, particularly as erythromycin is no longer considered a first-line substitute in many guidelines. This finding is consistent with current evidence-based recommendations, which no longer support erythromycin as a first-line alternative for penicillin-allergic patients due to increasing resistance and unfavorable pharmacokinetic profiles, instead favoring agents such as azithromycin, clarithromycin, or clindamycin where appropriate [9, 29]. An interesting trend emerged when analyzing clinical experience. Dentists with fewer than two years of practice achieved relatively higher knowledge scores, possibly reflecting recent academic training and greater exposure to updated antibiotic-prescribing guidelines. This observation aligns with findings from a Turkish study that reported higher knowledge levels among dental students compared with practicing general dentists [ 10 ]. Knowledge scores increased again among dentists with more than ten years of experience, suggesting that accumulated clinical experience and long-term decision-making may compensate for outdated formal education [ 30 ]. Conversely, mid-career practitioners appeared to be at greater risk of knowledge decay, emphasizing the importance of continuous professional development. Finally, specialties such as prosthodontics and orthodontics, which infrequently require antibiotic prescriptions, demonstrated the lowest overall knowledge scores. While this outcome is not unexpected given the nature of their clinical practice, it nonetheless emphasizes the need for baseline competency in antibiotic stewardship across all dental specialties to ensure patient safety and responsible antimicrobial use. Limitations The present study was confined to dentists practicing in Damascus. Therefore, the findings may not be fully representative of dental practitioners across all Syrian regions, which should be considered when interpreting the results. Conclusions This study revealed substantial variations in antibiotic-prescribing knowledge among dental specialties in Damascus. Oral and maxillofacial surgeons demonstrated the highest knowledge levels, while general dentists and specialties that rarely prescribe antibiotics showed significantly lower awareness. Years of experience and workplace (public vs. private) did not significantly influence knowledge levels. These findings underscore the need for targeted educational programs, updated training modules, and national antibiotic-prescribing guidelines to promote evidence-based practice and limit antimicrobial resistance. Declarations Author Contribution J.A. contributed in study design; collection of data; data analysis/interpretation and writing of the manuscript.M.A. contributed in collection of data; data analysis/interpretation and writing of the manuscript. K.D. contributed in study design, data analysis and writing of the manuscript. Data Availability The data provided for the results presented in this study is available through the corresponding author upon request. References Contaldo, M. et al. Antibiotics in dentistry: a narrative review of the evidence beyond the myth. Int. J. Environ. Res. Public. Health . 20 , 6025 (2023). Bahl, R. et al. Odontogenic infections: microbiology and management. Contemp. Clin. Dent. 5 , 307–311 (2014). Al-Khatib, A. & AlMohammad, R. A. Dentists’ habits of antibiotic prescribing may be influenced by patient requests for prescriptions. Int. J. Dent. 5318753 (2022). (2022). Robertson, D. & Smith, A. The microbiology of the acute dental abscess. J. Med. 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Badrov, M., Marovic, D. & Tadin, A. Antibiotics knowledge and prescription patterns among dental practitioners in Croatia, Bosnia and Herzegovina, and Serbia: a comparative e-survey with a focus on medically healthy and compromised patients. Antibiotics 13 , 1061 (2024). Hartmann, R. C. et al. Dentists’ knowledge of dental trauma based on the International Association of Dental Traumatology guidelines: a survey in South Brazil. Dent. Traumatol. 35 , 27–32 (2019). Guillaud, M., Blatier, J. & Quillon, A. Prevention of infective endocarditis: are recommendations about oral health procedures for high or moderate risk patients respected? Rev. Epidemiol. Sante Publique . 53 , 398–408 (2005). Chambers, D. Learning curves: what do dental students learn from repeated practice of clinical procedures? J. Dent. Educ. 76 , 291–302 (2012). Additional Declarations No competing interests reported. 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Dentists commonly prescribe antibiotics to manage acute dental infections, prevent the progression of localized disease, and reduce the risk of systemic complications [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Prophylactic antibiotic use is also recommended for patients at increased risk of focal infections, such as those with infective endocarditis risk factors or joint prostheses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the misuse and overuse of antibiotics in dentistry have become major contributors to the global rise in antimicrobial resistance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Prolonged or unnecessary antibiotic prescriptions impose selective pressure on bacterial populations, encouraging the development of resistant strains and ultimately diminishing the effectiveness of commonly used antibiotics [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This highlights the essential need for rational antibiotic-prescribing practices among dentists [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the significant role of antibiotics in dentistry, studies assessing prescribing patterns among dental practitioners are limited, especially in low- and middle-income countries [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. There remains a notable gap in understanding prescribing behaviors, levels of knowledge, and factors influencing decision-making among dentists [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, this is the first study to investigate the antibiotic-prescribing profiles and knowledge levels of dentists practicing in Damascus, Syria. The study aims to provide evidence-based data that may guide future educational programs, improve antibiotic stewardship, and contribute to more rational prescribing habits in dental practice.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003e This cross-sectional observational study was designed in accordance with the COSMIN guidelines. Data collection occurred over a two-months period between January 2024 and March 2024. The study followed the ethical standards of the Declaration of Helsinki and received approval from the Research Ethics Committee of the Faculty of Dentistry, Damascus University (Approval date: 22-12-2023; Approval number available upon request).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStudy participants\u003c/p\u003e \u003cp\u003eParticipation was voluntary and anonymous. All participants were asked to provide an informed consent electronically before involving them within the study.\u003c/p\u003e \u003cp\u003eA structured online questionnaire was developed and distributed through multiple Syrian dentist Facebook groups and the official page of the Syrian Dentists Syndicate, ensuring wide national coverage. A total of 844 dentists completed all questionnaire items and were included in the final analysis.\u003c/p\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003cp\u003eAccording to the formula of Kothari [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the sample size was 362 dentists. However, we left the questionnaire available for dentists who want to participate for one month, and a total number of 844 responses were obtained.\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{p\\left(1-p\\right)}{{A}^{2}∕{z}^{2}+\\left(P\\left(1-P\\right)∕N\\right)∕R}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere n is the sample size. N is the population size, which was considered as the number of dentists practicing in Damascus (N\u0026thinsp;=\u0026thinsp;3600). P is the estimated variance for the population, as it was assumed that almost 50% of the population would agree to the statements of the scale (P\u0026thinsp;=\u0026thinsp;0.5). A is the desired precision, which depends on the margin of the error that was set as 0.05. z was 1.96 as the confidence level of this study was 95%. R is the response rate of the audience, and it was set as 85%.\u003c/p\u003e \u003cp\u003eQuestionnaire Development\u003c/p\u003e \u003cp\u003eA PubMed search was conducted using keywords such as antibiotics, questionnaire, instrument, awareness and dentistry. Although several validated questionnaires existed, a more comprehensive instrument was developed for this study by selecting and integrating relevant items from previously validated tools.\u003c/p\u003e \u003cp\u003eContent validity was assessed through expert review by a panel of dental specialists. The questionnaire was piloted on a group of 20 volunteer dentists to ensure clarity and relevance; necessary modifications were made based on their feedback. Internal consistency reliability was evaluated using Cronbach\u0026rsquo;s alpha, which demonstrated acceptable reliability (α\u0026thinsp;\u0026gt;\u0026thinsp;0.7).\u003c/p\u003e \u003cp\u003eThe final questionnaire contained 48 items that were assessing knowledge regarding antibiotic indications, choices, dosing, duration, trauma cases, prophylaxis, and management of allergic patients. Responses allowed multiple selections. All answers were adhered to the clinical guidelines of antibiotics use in dentistry releases by the American Dental Association ADA. Table\u0026nbsp;1 shows all items asked within the questionnaire.\u003c/p\u003e \u003cp\u003eTable\u0026thinsp;\u0026minus;\u0026thinsp;1- all questions of the questionnaire\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoring item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnswer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e1- Cases in which antibiotics are prescribed:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost simple teeth extraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost surgical teeth extraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriapical infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCellulitis, ludwig\u0026rsquo;s angina and other space infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute periapical infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic periapical infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePericoronitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReversible pulpitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIrreversible pulpitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplant surgery with bone graft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDry socket\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter root canal treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter orthognathic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontitis after root canal treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSinusitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e2- Cases in which antibiotics venous injection used:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute abscess that doesn\u0026rsquo;t respond to antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003espace infection and ludwig\u0026rsquo;s angina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e3- Duration of antibiotics prescription:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e4- Diagnosis serving as a clinical signal for prescribing antibiotics:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpontaneous pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain on palpation or on chewing or on percussion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocalized gingival edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue and weakness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuccal edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwollen lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e5- Dental trauma cases in which antibiotics are prescribed:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-implantation after tooth avulsion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral luxation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubluxation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e6- Criteria for prescribing prophylactic antibiotics:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong surgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral environment that contains infectious foci\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient has health problems that demand prophylaxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e7- Types of prophylactic antibiotics which are prescribed:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmoxicillin 2g orally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCephalexin 2g orally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftriaxone 1g IV/IM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftriaxone 1g orally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e8- When selecting antibiotics for treatment, you choose:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmoxicillin for negative gram bacteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmoxicillin\u0026thinsp;+\u0026thinsp;clavulanic acid as a broad-spectrum antibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetronidazole for aerobic bacteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClindamycin as a broad-spectrum antibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e9- If patient doesn\u0026rsquo;t respond to the first antibiotic prescribed, you prescribe:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClindamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmoxicillin\u0026thinsp;+\u0026thinsp;clavulanic acid (augmentin)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIM injection or IV injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e10- If patient has an allergic to penicillin, you prescribe:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErythromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClindamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCephalexin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScore\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e48\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eScoring System\u003c/p\u003e \u003cp\u003eEach correct response was assigned a score of (1). Incorrect answers received a score of (0).\u003c/p\u003e \u003cp\u003e All items were equally weighted because each represents an independent evidence-based guideline. The maximum achievable score was 48. Based on total knowledge scores, participants were categorized into:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eLow knowledge: 0\u0026ndash;16\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eModerate knowledge: 17\u0026ndash;34\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHigh knowledge: 35\u0026ndash;48\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics v13.\u003c/p\u003e \u003cp\u003eNormality of data was tested using the Kolmogorov\u0026ndash;Smirnov test. One-way ANOVA was used to compare mean knowledge scores between specialties and between experience groups. Moreover, Bonferroni post-hoc tests were conducted to identify pairwise differences. Independent samples t-test compared knowledge scores between public and private sector dentists. A significance level of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ePersonal characteristics of the participants\u003c/p\u003e\n\u003cp\u003eA total of 844 dentists completed the questionnaire. 56% of the participants were male.\u003c/p\u003e\n\u003cp\u003eRegarding the specialization of participants, the largest proportion of the research sample consisted of general practitioners, who made up 44% of the total sample size (371 dentists). The smallest proportion of the research sample was made up of oral medicine and diseases specialists, who constituted only 2% of the total sample size (16 dentists).\u003c/p\u003e\n\u003cp\u003eMoreover, two to five years of experience represented the largest proportion of the research sample, making up 35.1% of the total sample size (297 dentists). In contrast, the smallest proportion was for dentists with over 20 years of experience, who constituted only 7.6% of the total sample size (64 dentists).\u003c/p\u003e\n\u003cp\u003eFinally, the proportion of dentists participating in this research who work in the private sector was 70.6% of the total sample size. In contrast, the proportion of dentists working in the public sector was 29.4% of the total sample size.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003edemonstrates all personal characteristics of the sample regarding gender, specialization, years of experience and workplace. Table\u0026thinsp;\u0026minus;\u0026thinsp;2- personal characteristics of participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56% (472 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44% (372 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003efield of\u003c/p\u003e\n\u003cp\u003especialization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGeneral Dentist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44% (37dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOral and Maxillofacial Surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16% (135 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRestorative and Cosmetic Dentistry\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10% (85 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeriodontics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8% (68 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePediatrics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8% (68 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFixed and Removable Prosthodontics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7% (59 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodontics and Dentofacial Orthopedics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5% (42 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eThe number of years of experience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than 2 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.1% (28 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.1% (297 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.7% (124 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;20 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.5% (71 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore than 20 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.6% (64 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eWorkplace\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate sector\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70.6% (59 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePublic sector\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.4% (248 dentists)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAnalytic statistics\u003c/p\u003e\n\u003cp\u003eKnowledge scores of the participant dentists ranged from 10 to 44, with a mean score of 28.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.61. The majority of participant dentists had a low level of knowledge with a percentage of 46.4% of all of the studied sample. 28.6% of the dentists had a moderate knowledge of antibiotics use. Only 25% of the studied sample had a high level of knowledge.\u003c/p\u003e\n\u003cp\u003eThe ANOVA test showed statistically significant differences between dental specialties in antibiotic-prescribing knowledge (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Oral and maxillofacial surgeons demonstrated significantly higher average knowledge scores than all other specialties, while general practitioners, prosthodontists, and orthodontists scored significantly lower.\u003c/p\u003e\n\u003cp\u003eThe analysis revealed specialty-specific patterns of incorrect responses regarding antibiotic use. Among general dentists, the most frequent mistake concerned the inappropriate duration of antibiotic prescriptions, with only 20.6% providing the correct response.\u003c/p\u003e\n\u003cp\u003eOral and maxillofacial surgeons most commonly erred in selecting cephalexin as a prophylactic antibiotic, yielding a correct response rate of 30%. For restorative and cosmetic dentists, the predominant mistake also involved the duration of antibiotic therapy (five days), with a correct response rate of 33.3%. Periodontists demonstrated the lowest accuracy in decisions related to prescribing antibiotics for traumatic intrusion injuries, with only 29% responding correctly.\u003c/p\u003e\n\u003cp\u003eSimilarly, pediatric dentists most frequently erred in determining the appropriate duration of antibiotic prescriptions (five days), achieving a correct response rate of 29.4%. Orthodontists showed the greatest difficulty in identifying indications for antibiotic use in intrusion injuries, with a correct response rate of 23.8%. Finally, fixed and removable prosthodontists most commonly selected erythromycin for penicillin-allergic patients inappropriately, with only 33.8% providing the correct answer.\u003c/p\u003e\n\u003cp\u003eDiagram 1 demonstrates the mean of scientific knowledge values between dentist regarding the field of specialization\u003c/p\u003e\n\u003cp\u003eRegarding years of experience, although differences in mean scores were noted, they were not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eIn addition, no significant difference was found in knowledge scores between public and private sector dentists.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003edemonstrates the results of analytical statistics. Table\u0026thinsp;\u0026minus;\u0026thinsp;3- Results of analytical statistics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eThe mean of scientific knowledge values\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ethe field of specialization\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGeneral Dentist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e0.001\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOral and Maxillofacial Surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRestorative and Cosmetic Dentistry\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeriodontics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePediatrics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOrthodontics and Dentofacial Orthopedics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFixed and Removable Prosthodontics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eYears of experience\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess than 2 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e0.011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;20 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore than 20 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eWorkplace\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePublic sector\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate sector\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003col\u003e\u003cli\u003e\u003cspan\u003e There is statistically significant difference\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents the first comprehensive assessment of antibiotic-prescribing practices and knowledge levels among dentists in Damascus, Syria. The findings reveal substantial gaps in antibiotic use across multiple dental specialties, with particularly pronounced deficiencies among general practitioners and specialties that infrequently encounter infectious or traumatic dental conditions.\u003c/p\u003e \u003cp\u003e These results underscore the urgent need for targeted educational interventions and reinforcement of evidence-based prescribing guidelines.\u003c/p\u003e \u003cp\u003eGeneral practitioners exhibited a greater probability to prescribe antibiotics in clinical situations where their use is not routinely indicated, including chronic periodontitis, post-endodontic pain, and localized gingival edema.\u003c/p\u003e \u003cp\u003eMoreover, they were more likely to progress treatment to intravenous or intramuscular antibiotic administration when oral therapy was perceived as ineffective. This practice may reflect uncertainty in infection management, limited exposure to complex cases, or insufficient familiarity with current clinical guidelines.\u003c/p\u003e \u003cp\u003eConsistent with this observation, the most common error among general dentists in the present study was related to the inappropriate duration of antibiotic prescriptions, with only 20.6% selecting the correct treatment duration. This finding highlights a critical need for additional training focused on optimizing antibiotic course length to reduce unnecessary exposure and the risk of antimicrobial resistance [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings are consistent with previously published data from other countries. For example, a study conducted in the United States reported that 39% of general dentists prescribed antibiotics for chronic periodontitis, closely mirroring the patterns observed in the present study [23].\u003c/p\u003e \u003cp\u003eSimilarly, an analysis of antibiotic prescriptions by general dentists in the United States found that approximately 14% of antibiotic prescriptions were classified as inappropriate based on the agent selected and/or treatment duration, underscoring persistent gaps in guideline-concordant antibiotic use among dental practitioners [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSuch parallels suggest that inappropriate antibiotic use among general dentists is a global concern rather than a region-specific issue.\u003c/p\u003e \u003cp\u003eOral and maxillofacial surgeons demonstrated the highest overall knowledge scores, which is expected given their extensive training and frequent involvement in managing severe odontogenic infections and surgical complications. Their appropriate use of intravenous antibiotics in life-threatening conditions, such as Ludwig\u0026rsquo;s angina, reflects sound clinical judgment.\u003c/p\u003e \u003cp\u003eHowever, the most frequent error within this group involved the selection of cephalexin as a prophylactic antibiotic, with a correct response rate of only 30%. This finding suggests a need to reinforce evidence-based recommendations regarding prophylactic antibiotic selection, even among highly trained specialists.\u003c/p\u003e \u003cp\u003eThis observation is supported by previous findings showing considerable variability in antibiotic prescribing practices among oral and maxillofacial surgeons, with many prophylactic regimens deviating from evidence-based recommendations, despite their advanced surgical training [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRestorative and cosmetic dentists also showed notable gaps in knowledge, particularly regarding the appropriate duration of antibiotic therapy. Only 33.3% correctly identified the recommended five-day course, indicating that misconceptions about treatment length persist even in procedures with relatively limited infection risk. Similarly, pediatric dentists demonstrated a low correct response rate (29.4%) for antibiotic duration, raising concerns about potential overuse or misuse of antibiotics in children, a population especially vulnerable to adverse drug effects and antimicrobial resistance.\u003c/p\u003e \u003cp\u003eSurveys of dental practitioners consistently demonstrate suboptimal knowledge and inconsistency in antibiotic prescribing, including variability in when antibiotics are indicated and in appropriate treatment duration, highlighting widespread misconceptions across dental specialties that may contribute to unnecessary prescribing and increased antimicrobial resistance [27]. In addition, in a cross-sectional survey assessing dentists\u0026rsquo; antibiotic knowledge and awareness, significant inconsistency in prescribing practices was identified among general and pediatric dentists, indicating persistent gaps between guideline recommendations and actual practice [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePeriodontists most frequently erred in decisions related to antibiotic prescribing for traumatic intrusion injuries, with a correct answer rate of only 29%. This finding suggests insufficient familiarity with dental trauma management protocols, which may fall outside the routine scope of periodontal practice. Orthodontists likewise demonstrated limited awareness of appropriate antibiotic indications in intrusion injuries, with the lowest correct response rate observed across specialties (23.8%). Given that orthodontic treatment often involves children and adolescents\u0026mdash;who are more prone to dental trauma\u0026mdash;this knowledge gap warrants attention.\u003c/p\u003e \u003cp\u003eConsistent with our findings of suboptimal decision-making for traumatic intrusion injuries among periodontists and orthodontists, broader surveys of dental practitioners have reported only moderate levels of knowledge regarding evidence-based management of dental trauma, indicating persistent educational gaps in this domain that likely contribute to inappropriate antibiotic prescribing choices in trauma cases [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFixed and removable prosthodontists exhibited their most common error in selecting erythromycin as an alternative for penicillin-allergic patients, with only 33.8% answering correctly. This highlights a broader issue regarding knowledge of appropriate antibiotic alternatives and evolving resistance patterns, particularly as erythromycin is no longer considered a first-line substitute in many guidelines.\u003c/p\u003e \u003cp\u003eThis finding is consistent with current evidence-based recommendations, which no longer support erythromycin as a first-line alternative for penicillin-allergic patients due to increasing resistance and unfavorable pharmacokinetic profiles, instead favoring agents such as azithromycin, clarithromycin, or clindamycin where appropriate [9, 29].\u003c/p\u003e \u003cp\u003eAn interesting trend emerged when analyzing clinical experience. Dentists with fewer than two years of practice achieved relatively higher knowledge scores, possibly reflecting recent academic training and greater exposure to updated antibiotic-prescribing guidelines. This observation aligns with findings from a Turkish study that reported higher knowledge levels among dental students compared with practicing general dentists [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Knowledge scores increased again among dentists with more than ten years of experience, suggesting that accumulated clinical experience and long-term decision-making may compensate for outdated formal education [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Conversely, mid-career practitioners appeared to be at greater risk of knowledge decay, emphasizing the importance of continuous professional development.\u003c/p\u003e \u003cp\u003eFinally, specialties such as prosthodontics and orthodontics, which infrequently require antibiotic prescriptions, demonstrated the lowest overall knowledge scores. While this outcome is not unexpected given the nature of their clinical practice, it nonetheless emphasizes the need for baseline competency in antibiotic stewardship across all dental specialties to ensure patient safety and responsible antimicrobial use.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThe present study was confined to dentists practicing in Damascus. Therefore, the findings may not be fully representative of dental practitioners across all Syrian regions, which should be considered when interpreting the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study revealed substantial variations in antibiotic-prescribing knowledge among dental specialties in Damascus. Oral and maxillofacial surgeons demonstrated the highest knowledge levels, while general dentists and specialties that rarely prescribe antibiotics showed significantly lower awareness. Years of experience and workplace (public vs. private) did not significantly influence knowledge levels.\u003c/p\u003e \u003cp\u003e These findings underscore the need for targeted educational programs, updated training modules, and national antibiotic-prescribing guidelines to promote evidence-based practice and limit antimicrobial resistance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.A. contributed in study design; collection of data; data analysis/interpretation and writing of the manuscript.M.A. contributed in collection of data; data analysis/interpretation and writing of the manuscript. K.D. contributed in study design, data analysis and writing of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data provided for the results presented in this study is available through the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eContaldo, M. et al. Antibiotics in dentistry: a narrative review of the evidence beyond the myth. \u003cem\u003eInt. J. Environ. Res. Public. Health\u003c/em\u003e. \u003cb\u003e20\u003c/b\u003e, 6025 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahl, R. et al. Odontogenic infections: microbiology and management. \u003cem\u003eContemp. Clin. Dent.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e, 307\u0026ndash;311 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Khatib, A. \u0026amp; AlMohammad, R. A. 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Traumatol.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e, 27\u0026ndash;32 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuillaud, M., Blatier, J. \u0026amp; Quillon, A. Prevention of infective endocarditis: are recommendations about oral health procedures for high or moderate risk patients respected? Rev. \u003cem\u003eEpidemiol. Sante Publique\u003c/em\u003e. \u003cb\u003e53\u003c/b\u003e, 398\u0026ndash;408 (2005).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChambers, D. Learning curves: what do dental students learn from repeated practice of clinical procedures? \u003cem\u003eJ. Dent. Educ.\u003c/em\u003e \u003cb\u003e76\u003c/b\u003e, 291\u0026ndash;302 (2012).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antibiotics, Dentistry, Prescribing patterns, antimicrobial resistance, Knowledge assessment, Damascus, Syria","lastPublishedDoi":"10.21203/rs.3.rs-8752613/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8752613/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eInappropriate antibiotic prescribing in dental practice contributes significantly to antimicrobial resistance, yet data on dentists\u0026rsquo; prescribing knowledge and behaviors in Damascus, Syria remain limited. This cross-sectional observational study assessed antibiotic-related knowledge and prescribing practices among dentists in Damascus. Conducted between January and March 2024, the study included 844 practicing dentists who completed a validated 48-item electronic questionnaire covering antibiotic indications, dosage, duration, prophylactic use, and management of antibiotic allergies. Knowledge scores (range: 0\u0026ndash;48) were categorized as low, moderate, or high. Statistical analysis involved one-way ANOVA with Bonferroni post hoc tests and independent samples t-tests (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eKnowledge scores ranged from 10 to 44, with a mean of 28.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.61. Low knowledge levels were observed in 46.4% of participants, while 28.6% demonstrated moderate knowledge and 25% high knowledge. Significant differences were found among dental specialties (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with oral and maxillofacial surgeons scoring highest. General dentists were more likely to prescribe antibiotics in inappropriate clinical situations, including chronic periodontitis and localized gingival swelling. No significant associations were found between knowledge scores and years of experience or workplace sector. These findings highlight the need for targeted educational interventions and standardized national guidelines to promote rational antibiotic use in dental practice.\u003c/p\u003e","manuscriptTitle":"Dentists’ Knowledge and Awareness of Antibiotic Prescribing Practices in Damascus, Syria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 05:24:04","doi":"10.21203/rs.3.rs-8752613/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83967876-719e-447a-88bf-21e99b5247b2","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":62544999,"name":"Health sciences/Diseases"},{"id":62545000,"name":"Health sciences/Health care"},{"id":62545001,"name":"Health sciences/Medical research"},{"id":62545002,"name":"Biological sciences/Microbiology"}],"tags":[],"updatedAt":"2026-03-10T11:54:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 05:24:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8752613","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8752613","identity":"rs-8752613","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}