Factors Associated with Potentially Guideline-Discordant Antibiotic Prescribing in Endodontic Practice: A Cross-Sectional Survey of Nigerian Dentists

ABSTRACTBackground: Antibiotic prescribing in endodontic practice is central to dental antimicrobial stewardship because systemic antibiotics are often unnecessary when definitive local treatment and source control are achievable. Evidence on prescribing practices among Nigerian dentists remains limited. This study assessed reported antibiotic prescribing and factors associated with potentially guideline-discordant prescribing among dentists in Nigeria. Methods: A cross-sectional survey of 212 Nigerian dentists was conducted between 27 August and 13 December 2025. The primary outcome was potentially guideline-discordant antibiotic prescribing, defined for this study as selecting at least one of irreversible pulpitis, symptomatic apical periodontitis, or interappointment pain as an indication for systemic antibiotics. Descriptive and bivariate analyses were performed with Holm adjustment for six primary comparisons. Multivariable logistic regression examined associations with private versus public practice, a study-defined junior professional group, fewer than 10 versus at least 10 years of practice, and North East versus other regions. Crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Sensitivity analyses examined alternative outcome definitions and one alternative predictor coding. Results: Overall, 199/212 respondents (93.9%; 95% CI 89.8–96.4%) reported prescribing antibiotics following endodontictreatment. Using the primary definition, 156/212 (73.6%; 95% CI 67.3–79.1%) met the criterion for study-defined potentially guideline-discordant prescribing. Among the 199 prescribers, the most frequently selected indications were acute periapical abscess with diffuse swelling (181/199, 91.0%), acute periapical abscess with localized swelling (170/199, 85.4%), and prescribing following endodontic surgical procedures (165/199, 82.9%). However, symptomatic apical periodontitis (137/199, 68.8%), irreversible pulpitis (92/199, 46.2%), and interappointment pain (73/199, 36.7%) were also selected. In the adjusted model, no statistically significant association was observed for private practice (aOR 1.35, 95% CI 0.41–4.44), junior professional group (aOR 1.02, 95% CI 0.39–2.67), fewer than 10 years of practice (aOR 0.83, 95% CI 0.32–2.15), or North East region (aOR 1.38, 95% CI 0.69–2.77). The model showed weak discrimination (AUC 0.542). The primary findings were unchanged across all sensitivity specifications, except that the junior professional group estimate shifted from 1.02 to 1.59 when interappointment pain was excluded from the outcome. Conclusions: Reported antibiotic prescribing was common among the surveyed sample of Nigerian dentists, and study-defined potentially guideline-discordant prescribing was frequent under the study's predefined clinical-scenario definition. The measured professional, practice-setting, experience and regional characteristics showed no statistically significant adjusted associations with the primary outcome. These findings highlight the need for antimicrobial-stewardship interventions appropriate to the local context in endodontic practice, while recognising the limitations of self-reported behaviour, non-probability sampling, and the cross-sectional design.