Over-Prescription of Antibiotics for Pulpitis: A Systematic Review and Meta-Analysis of Cross-Sectional Surveys.

Background

Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists.

Methods

A systematic search of MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest (2015-2025) was performed according to PRISMA guidelines. Observational studies reporting the proportion of dentists prescribing systemic antibiotics for pulpitis were included. Random-effects meta-analyses estimated pooled prevalence for all clinicians, general dental practitioners (GDPs), and endodontists (ENs). Risk of bias was assessed using a modified Newcastle-Ottawa Scale, and certainty of evidence was rated with GRADE.

Results

Twelve cross-sectional studies met the inclusion criteria, including 3189 dentists. The overall pooled prevalence of antibiotic prescribing for pulpitis was 19.2% (95% CI: 10.4-32.6%), with very high heterogeneity (I2 = 98%). GDPs exhibited significantly higher prescribing rates (26.9%, 95% CI: 14.9-43.5%; I2 = 98%) compared with ENs (5.1%, 95% CI: 1.2-19.2%; I2 = 92%). Sensitivity analysis excluding two high-prevalence studies reduced the pooled estimate to 13.3% (95% CI: 8.0-21.3%) but heterogeneity remained substantial (I2 = 95%). Most studies showed moderate-to-high risk of bias, and the certainty of evidence was graded as very low due to inconsistency, indirectness, imprecision, and potential publication bias.

Conclusions

Approximately one in five dentists prescribe antibiotics for pulpitis, despite strong guideline recommendations against their use. However, certainty of evidence was very low. Marked variability across regions and clinical profiles highlights persistent gaps in diagnostic accuracy, access to emergency dental care, and antibiotic stewardship. Targeted education, improved urgent care pathways, and strengthened antimicrobial stewardship programs are needed to reduce unnecessary antibiotic use in pulpitis.