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Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study. Beirut Lebanon. Jounieh Lebanon. School of Medicine, University of Nicosia. Nicosia Cyprus. Faculty of Dental medicine, Saint-Joseph University. Dentists play an essential role in providing high-quality dental care, taking into consideration the clinical context and concomitant medications taken by the patients. This study aimed to assess drug-prescribing perception and practices in addition to drug-related educational needs among Lebanese dentists; it also evaluated the need for interprofessional collaboration between dentists and pharmacists. An exploratory cross-sectional study using an online questionnaire targeted a sample of dentists from all Lebanese districts. Participants gave their consent by accepting to complete the survey ethics approval reference: USJ The questionnaire consisted of closed-ended questions exploring: 1 drug-prescribing perception, 2 drug-prescribing practice, and 3 collaboration with pharmacists regarding their respective roles in providing appropriate counseling to patients. Two indexes were created: the first evaluated self-confidence in prescribing medications, and the second assessed dentists' confidence in pharmacists. Logistic regressions were performed, taking each index as a dependent variable. The majority had a fair to good perceived knowledge in pharmacology and therapeutics Dentists exhibited particularly low perceived knowledge about prescribing in elderly patients, dosing, medication use in pregnancy, drug interactions, and adverse reactions. Also, Lebanese dentists reported some lack of knowledge and confidence in prescribing practices. Education, training, and close collaboration between pharmacists and dentists are essential to overcome these problems and avoid potential harm to patients. Implementing evidence-based oral health practices is essential to the general health and quality of life of patients. Their role is essential in providing high-quality dental care and personalized quality use of medicines, taking into account the clinical context and other medications patients take. Therefore, dentists should continuously improve their knowledge, competencies, and practice about medications, such as their side effects, contraindications, and interactions, to define the best treatment for each patient. For all these reasons, identifying contributing factors to inappropriate drug prescribing in Lebanon would help us better shape the size of the problem and implement a clear strategic plan to improve prescription practice and raise awareness of dentists about the proper use of medications. The ultimate goal would be to establish policies to promote the critical role of dentists in medication safety. Therefore, the primary objective of our study was to assess drug-prescribing perception, practices, in addition to drug-related educational needs among dental care providers in Lebanon. The secondary objective was to evaluate the need for further interprofessional collaboration between dentists and pharmacists regarding medications and oral health. All participating dentists gave their consent by accepting to complete the online survey. An exploratory cross-sectional study was carried out between November 1 st , , and January 31 st , , using an online questionnaire targeting a sample of dentists from all Lebanese districts Beirut, Mount Lebanon, North, South, and Beqaa. Data were collected using the snowball technique. The questionnaire was developed on Surveytuner, and the link was sent to the Faculty of Dental Medicine at the Saint-Joseph University and the Lebanese Dental Association in North Lebanon, to be dispatched by e-mail to Lebanese dentists who were asked to share it with their colleagues. Reminders were sent every two weeks for a total of 3 reminders per contact. The study objectives were stated on the first webpage of the survey, and participation was voluntary. A total of dentists enrolled and completed the online questionnaire that required approximately minutes to complete. The online questionnaire was available in French or English, the two languages of dental education in Lebanon, and the most commonly spoken languages by the Lebanese population in addition to Arabic. The questionnaire consisted of mandatory closed-ended questions prepared according to previous surveys and adjusted for the Lebanese population. The questionnaire initially created in French was translated into English by a pharmacist, then back into French by another pharmacist to ensure translation accuracy. Both versions were pilot-tested on a sample of ten dentists before starting data collection. The few translation discrepancies detected were resolved by investigators pharmacists and dentists in agreement with the two translators. The final datasheet did not include the results of the sample. Two indexes were created for this study. The first evaluated self-confidence of dentists in prescribing medications, while the second assessed their confidence in pharmacists. Both indexes were measured on a 5-point Likert scale from 1 strongly disagree to 5 strongly agree. For each index, the total score was calculated by summing the answers to all questions. The confidence in pharmacists was assessed by three questions: 1 Do you encourage patients to talk to pharmacists about their medications; 2 Do you consider that oral health advice should be provided in community pharmacies; and 3 Do you consider that your patients get enough counseling from their pharmacist about oral health. A descriptive analysis was performed using frequencies and percentages for multinomial and dichotomous variables, while means and standard deviations were reported for continuous variables. Since the normality and homoscedasticity assumptions were not met in the linear regressions, two logistic regressions were performed, taking the dichotomized dentist's self-confidence in prescribing drugs and dentist's confidence in pharmacists indexes as dependent variables, respectively. Dependent variables were divided based on each score's median. We forced age and implication in academia into the models due to their importance. A total of dentists completed the online survey. The mean age of participants was Almost half of the sample had an academic activity Table 1 summarizes the socio-demographic and socioeconomic characteristics of the participants. Table 1. Sociodemographic characteristics of the participants. The mean self-confidence in prescribing drugs index was Table 2 presents the results of the dentists' perception of prescribing practice. The majority of dental care providers considered that they have fair to good perceived knowledge in pharmacology and therapeutics Prescribing for older patients, dosing, medication use in pregnancy, avoiding drug interactions, and assessing adverse reactions explore whether the side effect reported by the patients might be related to a prescribed drug and report it to the pharmacovigilance system , were associated with low percentages of perceived knowledge Table 2. Table 2. Drug-prescribing perception questions. Figure 1 summarizes the level of confidence of dentists in prescribing. Figure 1. The most prescribed drug classes included mainly antibiotics Most dentists turned to pharmaceutical companies and medical representatives The majority of dentists used drug information to manage their patients Most dentists declared spending no more than 10 minutes explaining the drug regimen to patients Table 3. Table 3. Practice questions regarding drug prescriptions. The majority of dentists considered that seminars and close collaboration with pharmacists were the primary sources to update their information about medications, and The majority Table 4. Attitude questions regarding prescribing practices role in oral health. A higher mean self-confidence in prescribing and a higher mean confidence in pharmacists were found in dentists who did not specialize in periodontics compared to those who did Table 5. Bivariate analyses of factors associated with the dentist's self-confidence in prescribing drugs and the confidence in pharmacists indexes. Table 6. Multivariable analysis. This study assessed dentists' perception, practice, and confidence in prescribing drugs. Almost all participants considered they had fair to good perceived knowledge in pharmacology and therapeutics, but very few thought they had sufficient training to prescribe medications safely. This discrepancy might be related to the misleading information they might be getting from different sources. Indeed, in our study, pharmaceutical companies and medical representatives ranked first as sources of information on medications. Previous reports from Lebanon had highlighted the influence the pharmaceutical industry has on medical education activities, probably to promote a culture of acceptance. A recent study exploring the effect of a multimodal intervention on prescribing practices showed that targeted education and the use of educational prescribing websites would improve knowledge and confidence among practitioners. Regarding antibiotics, the lack of confidence and low perceived knowledge identified in our study was similar to previous national and international findings in terms of adherence to antibiotic stewardship. Inappropriate antibiotic prescriptions can lead to detrimental consequences, such as increased resistance, development of multidrug-resistant organisms, waste in healthcare resources and expenditures, and a higher number of adverse events, including the emergence of C. Therefore, in such a complex environment, educational interventions whether at the pre-graduate or post-graduate levels are crucial to help dentists understand and apply the latest guidelines to improve antibiotic selection practices. As for analgesics, while pain management is essential in dental practice, dentists, periodontists, in particular, should be aware of the risks of opioid misuse and abuse. Indeed, implants and periodontal procedures were among the four dental procedures that require the highest doses of opioids after adjusting for patients' characteristics. However, acknowledging their inherent risks, weak opioids such as codeine and tramadol were classified as controlled drugs and cannot be dispensed by pharmacists without a doctor's prescription, including dentists. Therefore, dentists should advise their patients to avoid self-medication and should be extremely cautious when prescribing this class of analgesics in older patients, in patients with gastrointestinal problems, or taking aspirin, oral anticoagulants vitamin K antagonists , or corticosteroids, due to the risk of gastric bleeding and peptic ulcer disease. Besides the specific drug classes, dentists exhibited low perceived knowledge about prescribing in elderly patients, dosing, medication use in pregnancy, drug interactions, and adverse reactions. Moreover, their confidence in prescribing was the lowest in patients with organ impairment, cancer, and neurological disorders. This point is problematic, as several physiological changes can occur, whether in pharmacokinetics or pharmacodynamics of drugs, in these specific populations, with complex medical conditions and taking multiple medications. Drug-induced oral adverse effects are manifold and include xerostomia opioids, anticholinergic antidepressants, first-generation anti-histamine, benzodiazepine , taste alteration amitriptyline, aripiprazole, olanzapine, quetiapine , bruxism quetiapine and paroxetine , gingival overgrowth nifedipine and phenytoin , higher risk of bleeding oral anticoagulants , and osteonecrosis of the jaw bisphosphonates, denosumab, antiangiogenic agents. Our study finally assessed the relationship between dentists and pharmacists. All these results suggest a reticence felt by both professions regarding collaboration and the need to be more open to this perspective. Joint seminars, congresses, and interdisciplinary meetings will foster professional relationships and improve patient care and prescribing skills. Implementing innovative learning techniques in a dental curriculum, such as interactive sessions with pharmacists, can be a good alternative. Such interprofessional education would promote communication between professionals while helping students to manage medication allergies, interactions, and adverse effects. In that context, the Saint-Joseph University of Beirut added interactive pharmacology sessions to the pathology modules, provided the dental care center with a drug interaction checker, and trained dental students on how to handle the most frequently encountered drug prescription issues and communicate with the physician or the pharmacist. Our study has some limitations, particularly related to the small sample size. Selection bias is possible due to the low number of questionnaires returned, and we couldn't calculate the exact response rate since the snowball technique was used for data collection. Information bias is possible due to the potential misunderstanding of questions, the non-use of validated scales, or the inclusion of specialists who do not use prescriptions as others, such as orthodontists or public health dentists. Further validation of the suggested indexes is warranted to confirm our findings. Additionally, although we conducted a multivariable analysis, residual confounding cannot be ruled out since we could not assess all potential confounders, such as the university of graduation, continuing education related to pharmacology, and other factors not measured. Finally, the described patterns among dentists may not be representative of all dental practices in the country; further studies with larger samples using validated scales are warranted to confirm our results. Nevertheless, to the best of our knowledge, this study is the first to evaluate the drug-prescribing perception and practice among dentists; it has a hypothesis-generating potential for both research and education fields. Lebanese dentists reported some lack of knowledge and confidence in prescribing, particularly to specific populations. Education, training, and close collaboration between pharmacists and dental healthcare professionals are essential to overcome these problems and avoid potentially harmful effects due to prescribing errors, medication misuse, or drug interactions. The impact of pharmacy services on opioid prescribing in dental practice. J Am Pharm Assoc An evaluation of dental antibiotic prescribing practices in the United States. J Am Dent Assoc. Using the Beers criteria to identify potentially inappropriate medication use by older adult dental patients. J Public Health Dent. Combating an Epidemic of Prescription Opioid Abuse. J Calif Dent Assoc. Role of dentists in prescribing opioid analgesics and antibiotics:an overview. Dent Clin North Am. American Dental Association. Statement on the use of opioids in the treatment of dental pain. Eur J Clin Pharmacol. Front Pharmacol. Fadlallah R, El-Jardali F. Improving the prescribing pattern and quality of pharmaceutical drugs in Lebanon. Prescription and dispensing guidelines in Lebanon:initiative of the Order of Pharmacists of Lebanon. J Pharm Policy Pract. Knowledge, practice and attitudes regarding antibiotics use among Lebanese dentists. Pharm Pract Granada. J Contemp Dent Pract. A survey of UK dental health professionals using a medicines information service:what questions do they ask and do they get useful answers?. Br Dent J. Knowledge regarding prescription of drugs among dental students:A descriptive study. J Basic Clin Pharm. Lieb K, Scheurich A. Contact between doctors and the pharmaceutical industry, their perceptions, and the effects on prescribing habits. PLoS One. Improvement of dental prescribing practices using education and a prescribing tool:A pilot intervention study. Br J Clin Pharmacol. A survey of prescribing practices by general dentists in Australia. BMC Oral Health. Int J Periodontics Restorative Dent. Open Forum Infect Dis. Rational use of medicine in dentistry:do dentists prescribe antibiotics in appropriate indications?. Dental guideline on prescribing opioids for acute pain management. Pain Med. Use of the Beers criteria to identify potentially inappropriate drug use by community-dwelling older dental patients. Interventions for managing medication-related osteonecrosis of the jaw. Cochrane Database Syst Rev. Bleeding risk in patients using oral anticoagulants submitted to surgical procedures in dentistry:a systematic review protocol. BMJ Open. Assessment of knowledge, attitude and practice among community pharmacists towards dental care:A national cross sectional survey. Saudi Pharm J. Developing confidence in basic prescribing skills during medical school:a longitudinal questionnaire study investigating the effects of a modified clinical pharmacology course. Interprofessional pharmacy observation activity for third-year dental students. J Dent Educ. Data curation: FA. Formal analysis: PS, SH. Supervision: LRK. Writing - original draft: AH, CA. Servicios Personalizados Revista. Original Research Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study. ABSTRACT Background: Dentists play an essential role in providing high-quality dental care, taking into consideration the clinical context and concomitant medications taken by the patients. Objective: This study aimed to assess drug-prescribing perception and practices in addition to drug-related educational needs among Lebanese dentists; it also evaluated the need for interprofessional collaboration between dentists and pharmacists. Methods: An exploratory cross-sectional study using an online questionnaire targeted a sample of dentists from all Lebanese districts. Conclusions Lebanese dentists reported some lack of knowledge and confidence in prescribing practices. Data collection process Data were collected using the snowball technique. Questionnaire The online questionnaire was available in French or English, the two languages of dental education in Lebanon, and the most commonly spoken languages by the Lebanese population in addition to Arabic. Measurements Two indexes were created for this study. Practice questions regarding drug prescriptions Provide examples of most prescribed drug classes in the dental office Antibiotics Attitude questions regarding prescribing practices role in oral health Procedures dentists consider necessary to stay updated about drugs Seminars Bivariate analyses of factors associated with the dentist's self-confidence in prescribing drugs and the confidence in pharmacists indexes Variable Dentist's self-confidence in prescribing drugs Dentist's confidence in pharmacists Mean SD p-value Mean SD p-value Gender 0. Specialty in periodontics yes vs. Variables entered in the model: specialty in periodontics, age, involvement in academia teaching. Collaboration with pharmacists and implications for practice Our study finally assessed the relationship between dentists and pharmacists. Limitations and strengths Our study has some limitations, particularly related to the small sample size. Received: November 28, ; Accepted: February 28, My patients get enough counselling from their pharmacist about oral health. Model 1: Dichotomous dentist's self-confidence in prescribing drugs score as the dependent variable. Model 2: Dichotomous dentist's confidence in pharmacists score as the dependent variable.

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