Pharmacotherapy and Drug Prescription: Do Dental Students Have Adequate Knowledge?ABSTRACT
Objective: To evaluate the level of pharmacology knowledge among dental students enrolled in different undergraduate terms at two dental schools in a city in the Brazilian Amazon.
Material and Methods: This cross-sectional, descriptive survey included 128 dental students enrolled in either the sixth term, having recently completed the pharmacotherapy or equivalent course, or in the tenth term. Participants anonymously completed a previously validated multiple-choice questionnaire consisting of four questions on drug-prescription regulations and ten questions based on clinical pharmacology cases. The students’ knowledge levels were categorized as poor, fair, good, or excellent, and the frequencies of correct answers were compared using chi-square tests.
Results: The percentages of correct answers from students in different undergraduate terms within the same dental school were not significantly different (p = 0.938). In both institutions, most students demonstrated poor or fair knowledge levels. Overall, students from the private dental school achieved a significantly higher percentage of correct answers than those from the public dental school (p = 0.025). Questions related to drug prescription for medical emergencies and appropriate fluoride concentrations showed the lowest mean percentages of correct responses (7.8% and 13.3%, respectively).
Conclusion: The students assessed demonstrated insufficient levels of knowledge in pharmacotherapy and drug prescription, with marked deficiencies in prescribing fluorides and managing medical emergencies.
Keywords:
Drug Prescriptions; Pharmacology; Students, Dental; Education, Dental; Clinical Competence.
Introduction
Medication prescription is an essential competency in dental practice and requires mastery of therapeutic indications, mechanisms of action, dosage, drug interactions, and potential adverse effects [1-4]. Inadequate preparation in this field may lead to therapeutic failures, adverse events, increased healthcare costs, and negative impacts on clinical management [4-5]. Thus, the ability to select and prescribe medications appropriately depends directly on structured training in applied pharmacology.
Several studies indicate that pharmacology teaching in dental programs presents limitations related to course load, pedagogical approach, and integration with clinical practice [5-7]. Recent reviews discuss the need to strengthen core content and improve instructional methods to support the application of pharmacotherapeutic knowledge in real clinical settings [8,9]. These limitations may influence students’ performance, especially in situations that require evidence-based therapeutic decision-making [10].
Available evidence shows that dental students may display variable performance and relevant gaps in the knowledge required for safe medication prescription and use, including legal, technical, and clinical aspects of pharmacotherapy [11]. However, investigations comparing students at different stages of their training and from distinct institutions remain scarce, limiting the understanding of how pharmacological knowledge progresses during dental education.
Considering the limited number of studies on routine drug prescribing in dental practice, this study aimed to evaluate dental students' pharmacology knowledge across different undergraduate terms at two dental schools,
Material and Methods
Study Design, Ethical Clearance, and Participants
This cross-sectional, descriptive survey was approved by the Research Ethics Committee of the Health Sciences Institute at the Federal University of Pará (Approval Statement No. 3.180.251). Dental students from two institutions - one public and one private - located in a city in the Brazilian Amazon voluntarily participated in the study after signing an informed consent form. The dental schools were selected based on the criterion of having graduated more than ten cohorts of dental students.
Participants included students from the sixth undergraduate term, who had recently completed the pharmacotherapy or equivalent course, and students from the tenth term, who were nearing completion of their dental degrees.
Data Collection Instrument and Knowledge Level Classification
Data collection was conducted in person, in the classroom setting, using a self-administered questionnaire. Upon completion, participants placed their response forms into an unmarked envelope to ensure confidentiality and anonymity. Students who were absent on the day of data collection were excluded from the study. The entire process was carried out and supervised by the principal investigator.
Participants anonymously completed a multiple-choice questionnaire previously validated in an earlier study [11]. In addition to collecting general demographic information (gender, age, academic term, and date of response), the instrument included four questions related to drug-prescription regulations and ten questions on pharmacological clinical scenarios. The students’ level of pharmacological knowledge was classified according to their total number of correct responses as follows: Poor, 0 - 50%; Fair, 51 - 70%; Good, 71 - 89%; and Excellent, 90 - 100%.
Statistical Analysis
The frequencies of correct answers were compared by using the chi-square tests with a significance level of 5% (SPSS, IBM Corp., Chicago, IL, USA; Bioestat 5.0, Mamirauá Institute for Sustainable, Tefé, AM, Brazil).
Results
Eighty-two men (64.1%), aged 19 to 32 years, and 46 women (35.9%), aged 19 to 37 years, completed the questionnaire (76 and 52 students from the public and private dental schools, respectively) (Table 1).
The percentages of correct answers from students in different undergraduate terms within the same dental school were not significantly different (p = 0.938) (Table 2). Most students from the public dental school demonstrated poor knowledge (67%), followed by fair knowledge (28.9%) and good knowledge (3.9%). Students from the private dental school showed the same percentages of poor (44.2%) and fair (44.2%) knowledge, with a smaller percentage demonstrating good knowledge (11.5%). Overall, students from the private dental school achieved a significantly higher percentage of correct answers than those from the public dental school (p = 0.025) (Table 2).
Percentage of correct answers of students attending different undergraduate terms at two dental schools.
A significant difference in the percentage of correct answers was observed between students from the two dental schools for questions 3, 7, 8, 10, and 11 (Table 3). Questions 2 and 9 had the lowest mean percentages of correct responses (7.8% and 13.3%, respectively), whereas the highest mean percentages of correct answers were observed for questions 14 (92.2%), 10 (87.5%), and 3 (84.4%) (Table 3).
Discussion
Drugs are essential for the palliative, symptomatic, and curative treatment of a wide range of diseases. In addition to legal policies, dentists’ prescribing competence is associated with the expertise required to rationally select appropriate drugs for each clinical circumstance [12]. The poor level of knowledge regarding pharmacotherapy and drug prescription observed among dental students in this survey, unfortunately, corroborates findings from other studies reporting a lack of confidence in prescribing during dental school clinical training [11,13,14]. Learning deficits in drug-related knowledge during undergraduate education may further compromise the clinical performance of future dentists [15,16].
Although a significant difference was observed between the two dental schools, the majority of students demonstrated poor knowledge; thus, limitations in pharmacotherapy and drug prescription do not appear to be directly associated with a specific institution. Except for a few questions, the lower percentage of correct answers among students from the public dental school may be attributed to the absence of a dedicated pharmacotherapy course. The fact that these important concepts were reportedly delivered through workshops (20 hours in total) and integrated into a preclinical course appears insufficient. An undergraduate curriculum with deficient or redundant courses may impair skills development and the learning experiences necessary for future professional practice [17-19].
The absence of a significant difference in the percentages of correct answers between students who had recently completed the sixth term and those who had completed the tenth term indicates that pharmacotherapy knowledge remains insufficient even after three terms of supervised clinical internship. This finding may be associated with the traditional lecture-based teaching method, which does not optimize the assimilation of pharmacotherapy concepts [20]. Several studies have reported that dental students significantly improve their prescribing skills after receiving interactive pharmacology instruction [21,22]. Classroom debate appears to be an effective learning strategy, as it enhances cognitive skill development and promotes the use of scientific databases on various topics, including water fluoridation for drinking purposes and the use of antibiotics in dentistry [23].
Moreover, dentists’ misconceptions regarding cariostatic mechanisms impair the proper adjustment of fluoride prescriptions across optimal age ranges [24,25], which is consistent with the findings of this study. Furthermore, the poor level of knowledge observed among dental students suggests that learning deficits may compromise even simple guidance on the use of dentifrices and mouthwashes. A review of undergraduate dental curricula to better integrate pharmacotherapy theory with drug-prescription practices appears essential to prevent negative consequences for both dentists and patients [26,27].
Several studies have reported that a substantial number of dentists do not receive adequate training or develop sufficient confidence to manage medical emergencies in dental offices, which may lead to serious consequences and medico-legal issues [28,29]. In addition, dentists generally have limited knowledge and ability to perform basic life support procedures [30]. As expected, dental students in their final undergraduate term also lack self-confidence in managing certain medical emergencies due to insufficient training [31].
The treatment of oral diseases relies fundamentally on professionals’ knowledge and skills to prescribe effective and safe drugs [32]. A recent review highlighted the insufficient number of pharmacology teaching hours and recommended curricular improvements to adequately prepare future dentists in India [6]. Another study showed that drug-prescription patterns at an Indian dental teaching hospital did not adhere to World Health Organization criteria, such as the use of irrational drug combinations and the absence of generic names, and emphasized the need for prescribing guidelines and continuing education to ensure safe and effective practices among dentists [32].
The level of knowledge of dental students regarding pharmacotherapy and drug prescription appears to be insufficient and seems to result from deficient curricula and exclusively theoretical teaching methods. Therefore, interactive classes and hands-on activities are essential to improve undergraduate learning and future professional practice. This study also has limitations inherent to its cross-sectional design, which captures only a single point in time and does not allow for assessing knowledge progression or decline. In addition, although the questionnaire used had previously been validated and data collection ensured anonymity and confidentiality, the information obtained was self-reported, which may introduce biases related to students’ motivation to respond accurately and honestly. Despite these limitations, the findings underscore the urgent need for curricular revision and the adoption of active teaching methodologies to prepare professionals for safer, evidence-based clinical practice. Longitudinal and multicenter studies are needed to support the development of effective educational policies that promote safe dental practice.
Conclusion
The dental students evaluated demonstrated insufficient levels of knowledge in pharmacotherapy and drug prescription, predominantly classified as poor or fair, with notable deficiencies in prescribing appropriate fluoride concentrations and in managing medical emergencies.
-
Financial SupportNone.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
References
-
[1] Jain A, Gupta D, Singh D, Garg Y, Saxena A, Chaudhary H, et al. Knowledge regarding prescription of drugs among dental students: A descriptive study. J Basic Clin Pharm 2015; 7(1):12-16. https://doi.org/10.4103/0976-0105.170584
» https://doi.org/10.4103/0976-0105.170584 -
[2] Haranath PSRK. Medical curriculum and pharmacology: An appraisal. Indian J Pharmacol 2016; 48(Suppl 1):S10-13. https://doi.org/10.4103/0253-7613.193328
» https://doi.org/10.4103/0253-7613.193328 - [3] Gautam M, Shaw DH, Pate TD, Lambert HW. Pharmacology education in North American dental schools: The basic science survey series. J Dent Educ 2013; 77(8):1013-1021.
-
[4] Lutsenko O. Professionalization of the teaching of pharmacology to students under the educational and professional program "medicine". Sourc Pedag Skills 2022; 30:112-119. https://doi.org/10.33989/2075-146x.2022.30.270659 [In Ukrainian].
» https://doi.org/10.33989/2075-146x.2022.30.270659 -
[5] Park JS, Daniel BK, Wong PY, Abbott PV, Ngo HC. Dental students' knowledge of and attitudes towards prescribing medication in Western Australia. Eur J Dent Educ 2023; 27(2):287-295. https://doi.org/10.1111/eje.12802
» https://doi.org/10.1111/eje.12802 -
[6] Akram F, Manak S, Inder D, Khan A, Salman MT. Pharmacology teaching in dental education in India: Time for a reappraisal. J Popul Ther Clin Pharmacol 2021; 29(3):e1-10. https://doi.org/10.47750/jptcp.2022.843
» https://doi.org/10.47750/jptcp.2022.843 -
[7] Guzmán-Álvarez R, Medeiros M, Reyes Lagunes LI, Campos-Sepúlveda AE. Knowledge of drug prescription in dentistry students. Drug Healthc Patient Saf 2012; 4:55-59. https://doi.org/10.2147/DHPS.S30984
» https://doi.org/10.2147/DHPS.S30984 -
[8] Shenoy S, Pasha Z, Rajendiran S, Ahmed SO, Kant K, Shetti AN. The intersection of pharmacology and dentistry: A comprehensive overview of pharmacotherapeutics. Int J Pharm Chem Anal 2023; 10(2):66-69. https://doi.org/10.18231/j.ijpca.2023.013
» https://doi.org/10.18231/j.ijpca.2023.013 -
[9] Xiao CL, Ren H, Chen HQ, Liu WH, Luo ZY, Li WR, et al. Multidimensional evaluation of teaching strategies for pharmacology based on a comprehensive analysis involving 21,269 students. Front Pharmacol 2023; 14:1145456. https://doi.org/10.3389/fphar.2023.1145456
» https://doi.org/10.3389/fphar.2023.1145456 -
[10] Thanissorn C, Park JS, Wang KN, Tennant M, Page AT, Kruger E. Australian dental students’ knowledge on antibiotics prophylaxis for dental procedures. BMC Oral Health 2022; 22(1):633. https://doi.org/10.1186/s12903-022-02660-x
» https://doi.org/10.1186/s12903-022-02660-x -
[11] Kula J, Melo NSF de O, Lima AAS de. Knowledge of dentistry students about prescription and use of medications. Rev ABENO 2024; 24(1):1856. https://doi.org/10.30979/revabeno.v24i1.1856
» https://doi.org/10.30979/revabeno.v24i1.1856 -
[12] Gupta R, Satpathy S, Kumar H, Kamath V, Pandey L, Dubey R. Curr concepts of drug therapy in dentistry: A review. Res J Pharm Tech 2022; 15(11):5349-552. https://doi.org/10.52711/0974-360X.2022.00901
» https://doi.org/10.52711/0974-360X.2022.00901 -
[13] Park JS, Li J, Turner E, Page A, Kruger E, Tennant M. Medication knowledge among dental students in Australia-A cross-sectional study. J Dent Educ 2020; 84(7):799-804. https://doi.org/10.1002/jdd.12167
» https://doi.org/10.1002/jdd.12167 -
[14] Barry OP, O'Sullivan E. Comparison of dental students' performances and perceptions in preclinical and clinical pharmacology in an Irish Dental School. Eur J Dent Educ 2017; 21(4):e19-28. https://doi.org/10.1111/eje.12210
» https://doi.org/10.1111/eje.12210 -
[15] Mallhi TH, Alanazi AS, Khan YH, Alotaibi NH, Salman M, Alzarea AI, et al. Assessment of knowledge regarding safety profile, use, and boxed warnings of fluoroquinolones among healthcare professionals in Saudi Arabia: A potential implication for drug regulatory authorities. Front Med 2022; 9:1-12. https://doi.org/10.3389/fmed.2022.816320
» https://doi.org/10.3389/fmed.2022.816320 -
[16] Johannsen W, Frings B, Herzig S, Matthes J. Development of perceived pharmacological deficits of medical students and alumni supports claim for continuous and more application-oriented education. Naunyn Schmiedebergs Arch Pharmacol 2019; 392(1):29-36. https://doi.org/10.1007/s00210-018-1563-8
» https://doi.org/10.1007/s00210-018-1563-8 -
[17] Jarvis-Selinger S, Hubinette M. The matrix: Moving from principles to pragmatics in medical school curriculum renewal. Acad Med 2018; 93(10):1464-1471. https://doi.org/10.1097/ACM.0000000000002306
» https://doi.org/10.1097/ACM.0000000000002306 -
[18] Zanko M, Turbill J, Sykes C, Gibbons B, Moerman L, Spedding T. Building a matrix in the students' mind through embedding cross-disciplinarity in innovative capstone courses. In: 4th International Conference on Education and New Learning Technologies - Conference Proceedings, 2012. Available from: https://ro.uow.edu.au/buspapers/33/ [Accessed on June 13, 2024].
» https://ro.uow.edu.au/buspapers/33/ -
[19] Partner A, Vernitski A. Maths lecturers in denial about their own maths practice? A case of teaching matrix operations to undergraduate students. MSOR Connections 2023; 21(3):18-28. https://doi.org/10.21100/msor.v21i3.1353
» https://doi.org/10.21100/msor.v21i3.1353 -
[20] Kaskova L, Novikova S, Khmil O, Yanko N, Morgun N, Vashchenko I. Modern aspects of the practical training of future dentists. Ukr Dent Alman 2022; 4:73-77. https://doi.org/10.31718/2409-0255.4.2022.13
» https://doi.org/10.31718/2409-0255.4.2022.13 -
[21] Yanagita T. Practical pharmacotherapy education "pharmacology role-play": expansion and ingenuity in Medical, Dental, Pharmaceutical and Nursing education. Nihon Yakurigaku Zasshi 2023; 158(2):119-127. https://doi.org/10.1254/fpj.22111 [In Japanese].
» https://doi.org/10.1254/fpj.22111 -
[22] Patel AP, Katlam S. Dental students’ perceptions and feedback on teaching and learning pharmacology. Int J Basic Clin Pharm 2017; 6(9):2250-2253. https://doi.org/10.18203/2319-2003.ijbcp20173754
» https://doi.org/10.18203/2319-2003.ijbcp20173754 -
[23] Meschi M, Shirahmadi S, Amiri M, Ebrahimi-Siaghi N. Debating: Efective and satisfactory learning method in dentistry. BMC Med Educ 2024; 24(1):307. https://doi.org/10.1186/s12909-024-05286-5
» https://doi.org/10.1186/s12909-024-05286-5 -
[24] Kaczmarek U, Kowalczyk W, Gozdowski D, Olczak-Kowalczyk D. Dentists' knowledge of fluoride cariostatic mechanisms. Nowa Stomatol 2018; 23(3):102-109. https://doi.org/10.25121/NS.2018.23.3.102
» https://doi.org/10.25121/NS.2018.23.3.102 -
[25] Akbar AA, Al-Sumait N, Al-Yahya H, Sabti MY, Qudeimat MA. Knowledge, attitude, and barriers to fluoride application as a preventive measure among oral health care providers. Int J Dent 2018; 2018:8908924. https://doi.org/10.1155/2018/8908924
» https://doi.org/10.1155/2018/8908924 - [26] Araújo PC, Garbín CAS, Moimaz SAS, Saliba NA, Arcieri RM. Dental students' familiarity with the medical management of dental patients at Brazilian dental schools. J Dent Educ 2013; 77(5):621-625.
-
[27] Oliveira LML, Barbosa LM, Rebelo HL, Coelho T, Godoy GP. Evaluation of curriculum norms according to the national curriculum guidelines for graduate studies in dentistry. Rev ABENO 2019; 19(1):97-105. https://doi.org/10.30979/rev.abeno.v19i1.844
» https://doi.org/10.30979/rev.abeno.v19i1.844 - [28] Lúcio PSC, Barreto RC. Medical emergencies in the dental office and professional’s (in)security. Rev Bras Ciên Saúde 2012; 16(2):267-272.
- [29] Vaughan M, Mahoney G, Sholapurkar A, Esterman A. Public perception of dentists' ability to manage a medical emergency. J Milit Veter Health 2019; 27(3):29-24.
-
[30] Sohail Raja Z, Fazal M, Mehmood F, Farooq M, Hussaim SAA, Nadeem I. Assessment of basic life support knowledge among dental surgeons: A descriptive cross-sectional study. Pakistan J Health Sci 2023; 4(5):32-36. https://doi.org/10.54393/pjhs.v4i05.712
» https://doi.org/10.54393/pjhs.v4i05.712 -
[31] Arya L, Arya V, Prajapat J, Kumari P, Sikka N. Evaluation of prescription writing skill of dental students and professionals working in dental teaching institute in Haryana. Ind J Foren Med Toxicol 2022; 16(4):201-208. https://doi.org/10.37506/ijfmt.v16i4.18582
» https://doi.org/10.37506/ijfmt.v16i4.18582 - [32] Salman MT, Khan FA, Rahman SZ, Makhdoom M. Drug prescribing pattern in dental teaching hospital. JK Sci 2008; 11(2):107.
Edited by
-
Academic Editor: Alessandro Leite Cavalcanti
