Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member


Second Committee Member

Edward Peters, DMD, SM, ScD, FACE

Third Committee Member

Molly Cawley, DDS


Purpose: Antibiotic resistance is a major public health problem in the United States, resulting in significant morbidity and mortality (CDC, 2019). This study seeks to understand how antibiotic use for dental problems may contribute to antibiotic resistance and adverse drug reactions while only temporarily relieving the underlying oral health condition. Previous research suggests differences in prescribing patterns for pain management by provider type, but little is known about antibiotic prescribing patterns, especially for diverse groups of pediatric patients (Chua, et al., 2019). This study aims to characterize antibiotic prescribing patterns in a midwestern children's hospital emergency department for non-traumatic dental conditions.

Methods: A chart review (n=1,094) of emergency department visits between 2013 and 2021 at Children’s Hospital and Medical Center in Omaha, NE for patients 19 years and younger presenting with non-traumatic dental conditions was conducted. Out of the 1,094 charts reviewed, 731 met the inclusion criteria for the study. If the patients had multiple visits, only the first visit was included producing a final sample of 695. Statistical analysis was completed to examine the relationship between socioeconomic variables (insurance status, race, and ethnicity) and indication to write an antibiotic for a non-traumatic dental condition according to current American Academy of Pediatric Dentists (AAPD) guidelines in the emergency department. Descriptive statistics for continuous data are given as means ± standard deviations. Chi-square tests were utilized to produce associations between categorical variables. Independent samples t-tests were used to assess what differences there were in means of continuous variables between individuals prescribed an antibiotic inside and outside of the guidelines. A model was run to focus on demographic factors. Adjusted odds ratios (AORs) are presented with 95% confidence intervals (CIs) which have been Bonferroni adjusted for all pairwise comparisons. All analyses were performed using SAS software version 9.4 ((SAS Institute Inc., Cary, NC).

Results: There was a significant association between insurance status and following guidelines (p = 0.04). Patients with private insurance had the lowest proportion of antibiotics prescribed outside of guidelines (6.0%) while patients with Medicaid insurance had the highest (14.3%). There was a significant association between race and following guidelines (p < 0.001). White patients had the lowest proportion of antibiotics prescribed outside of guidelines (6.0%) while African American patients had the highest (14.3%). Race continued to be significantly associated with being prescribed an antibiotic outside of guidelines after adjusting for insurance status (p = 0.01).

Available for download on Tuesday, December 03, 2024

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