Patterns, predictors, and decision-support in antibiotic and analgesic use in endodontics: A cross-sectional survey

Abstract Introduction: In endodontics, antibiotics and analgesics are frequently prescribed, yet many prescriptions remain inappropriate, contributing to antimicrobial resistance, adverse drug events, and increased healthcare burden. Despite clear recommendations from the American Association of Endodontists (AAE), European Society of Endodontology, and American Dental Association (ADA), a knowledge–practice gap persists. Clinical decision-support systems (CDSS) may help standardize prescribing, but their role in endodontics remains underexplored. This study aimed to assess antibiotic and analgesic prescribing patterns among endodontic clinicians, evaluate adherence to stewardship guidelines, identify predictors of inappropriate prescribing, and explore the potential role of CDSS. Materials and Methods: A cross-sectional survey was conducted among 385 participants (postgraduate students, academic faculty, and private practitioners) across India. A validated questionnaire collected demographic data, prescribing behavior in five structured clinical vignettes and perceptions of CDSS. Appropriateness was evaluated against AAE/ADA recommendations. Data were analyzed using descriptive statistics, Chi-square tests, and logistic regression. Results: Overall, 33.8% of prescriptions were inappropriate. Inappropriate prescribing was highest among postgraduate students (36.5%), followed by faculty (34.1%). Guideline awareness showed no significant association with appropriateness ( χ ² =0.27, P = 0.60). Logistic regression revealed no significant predictors, though postgraduate and faculty status showed nonsignificant higher odds of inappropriate prescribing. Nonsteroidal anti-inflammatory drugs were most commonly prescribed (54.5%), whereas 11.7% reported opioid use. Notably, 68.8% of respondents expressed support for CDSS integration. Conclusion: Inappropriate prescribing remains prevalent in endodontics, unaffected by guideline awareness or practice type. Persistent suboptimal analgesic patterns highlight the need for multifaceted stewardship interventions. Integration of CDSS, alongside education and system-level measures, may improve alignment with evidence-based practice.